Accuracy of Statin Assignment Using the 2013 AHA/ACC Cholesterol Guideline Versus the 2001 NCEP ATP III Guideline

Johnson, Kevin; Dowe, David A.

doi:10.1016/j.jacc.2014.05.056

Cited by 64 publications

(41 citation statements)

References 16 publications

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“…In studies evaluating statin prescribing in which the presence of atherosclerotic coronary artery disease was determined by coronary imaging, a greater proportion of patients were eligible for a statin based on the ACC/AHA guideline compared with the National Cholesterol Education Program Adult Treatment Panel III guideline 2, 3. Chia et al compared the Pooled Cohort Risk Score with actual practice data from 1998 to 2007 and found that statin use would need to increase under the new guideline 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan

Olufade

Zhou

Anzalone

et al. 2017

JAHA

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BackgroundThe purpose of this study was to characterize changes in statin utilization patterns in patients newly initiated on therapy in the 2 years following the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline in a large US health plan population.Methods and ResultsThis retrospective, observational study used administrative medical and pharmacy claims data to identify patients newly initiated on statin therapy over 4 quarters prior to and 8 quarters following the release of the guideline (average N/quarter=3596). Patients were divided into the 4 statin benefit groups (SBGs) based on risk factors and laboratory lipid levels as defined in the guideline: SBG1 (with atherosclerotic cardiovascular disease [ASCVD]; N=1046/quarter), SBG2 (without ASCVD, with low‐density lipoprotein cholesterol ≥190 mg/dL; N=454/quarter), SBG3 (without ASCVD, aged 40–75 years, with diabetes mellitus, low‐density lipoprotein cholesterol 70–189 mg/dL; N=1391/quarter), SBG4 (no ASCVD or diabetes mellitus, age 40–75 years, low‐density lipoprotein cholesterol 70–189 mg/dL, estimated 10‐year ASCVD risk of ≥7.5%; N=705/quarter). Demographic variables, statin utilization patterns, lipid levels, and comorbidities were analyzed for pre‐ and postguideline periods. Postguideline, gradually increased high‐intensity statin initiation occurred in SBG1, SBG2, and in SBG3 patients with 10‐year ASCVD risk ≥7.5%. Moderate‐ to high‐intensity statin initiation gradually increased among SBG4 patients. Recommended‐intensity statin choice changed to a greater degree among patients treated by specialty care physicians. Regarding sex, target‐intensity statin initiation was lower in women in all groups before and after guideline release.ConclusionsPrescriber implementation of the guideline recommendations has gradually increased, with the most marked change in the increased initiation of high‐intensity statins in patients with ASCVD and in those treated by a specialist.

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Section: Introductionmentioning

confidence: 99%

Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan

Olufade

Zhou

Anzalone

et al. 2017

JAHA

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“…showed the superiority of the ACC/AHA guidelines in predicting CHD detected by CCTA in patients who presented to the emergency department with acute chest pain but who were not diagnosed with acute coronary syndrome. Johnson et al 6. also reported that the ACC/AHA guidelines better matched total plaque burden than the ATP III guidelines with only a modest increase in the number of patients who were assigned statins.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding coronary imaging studies comparing the ACC/AHA and ATP III guidelines, the new guidelines showed better discrimination of coronary atherosclerosis than the ATP III guidelines, which suggests that the new guidelines will better predict future coronary events 5, 6, 7, 8. Pursnani et al 5.…”

Section: Discussionmentioning

confidence: 99%

2013 ACC/AHA Cholesterol Guideline Versus 2004 NCEP ATP III Guideline in the Prediction of Coronary Artery Calcification Progression in a Korean Population

Cho

Jung

Kang

et al. 2016

JAHA

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BackgroundSince the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, significant controversy has surrounded the applicability of the new cholesterol guidelines and the Pooled Cohort Equations. In this present study, we investigated whether eligibility for statin therapy determined by the 2013 ACC/AHA guidelines on the management of blood cholesterol is better aligned with the progression of coronary artery calcification (CAC) detected by coronary computed tomography angiography (CCTA) than the previously recommended 2004 National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines.Methods and ResultsWe enrolled 1246 asymptomatic participants who underwent repeated CAC score measurement during routine health examinations. The CAC score progression was defined as either incident CAC in a population free of CAC at baseline or increase ≥2.5 units between the baseline and final square root of CAC scores participants who had detectable CAC at baseline examination. Application of the ACC/AHA guidelines to the study population increased the proportion of statin‐eligible subjects from 20.5% (according to ATP III) to 54.7%. Statin‐eligible subjects, as defined by ACC/AHA guidelines, showed a higher odds ratio for CAC score progression than those considered statin eligible according to ATP III guidelines (2.73 [95% CI, 2.07–3.61] vs 2.00 [95% CI, 1.49–2.68]).ConclusionsCompared with the ATP III guidelines, the new ACC/AHA guidelines result in better discrimination of subjects with cardiovascular risk detected by CAC score progression in an Asian population.

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“…215 Earlier cholesterol guidelines that relied on LDL-C treatment thresholds perform less well than the 2013 ACC/AHA cholesterol guideline in identifying high-risk patients expected to benefit from statin therapy. [216][217][218] The 2013 ACC/AHA guideline recommends treating all individuals 40 to 75 years of age with LDL-C ≥190 mg/dL or calculated risk >7.5% over 10 years, patients with clinical ASCVD, and those with diabetes mellitus with statin therapy. Additional LDL-C-lowering nonstatin therapy is also recommended, if needed, to reduce both short-term and lifetime risk of ASCVD.…”

Section: Total Cholesterol (Not Prioritized Although Implied Within mentioning

confidence: 99%

Evidence-Based Policy Making: Assessment of the American Heart Association’s Strategic Policy Portfolio

Goldstein¹,

Antman²,

Arnett³

et al. 2016

Circulation

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Background-American Heart Association (AHA) public policy advocacy strategies are based on its Strategic Impact Goals.The writing group appraised the evidence behind AHA's policies to determine how well they address the association's 2020 cardiovascular health (CVH) metrics and cardiovascular disease (CVD) management indicators and identified research needed to fill gaps in policy and support further policy development. Methods and Results-The AHA policy research department first identified current AHA policies specific to each CVH metric and CVD management indicator and the evidence underlying each policy. Writing group members then reviewed each policy and the related metrics and indicators. The results of each review were summarized, and topic-specific priorities and overarching themes for future policy research were proposed. There was generally close alignment between current AHA policies and the 2020 CVH metrics and CVD management indicators; however, certain specific policies still lack a robust evidence base. For CVH metrics, the distinction between policies for adults (age ≥20 years) and children (<20 years) was often not considered, although policy approaches may differ importantly by age. Inclusion of all those <20 years of age as a single group also ignores important differences in policy needs for infants, children, adolescents, and young adults. For CVD management indicators, specific quantitative targets analogous to criteria for ideal, intermediate, and poor CVH are lacking but needed to assess progress toward the 2020 goal to reduce deaths from CVDs and stroke. New research in support of current policies needs to focus on the evaluation of their translation and implementation through expanded application of implementation science. Focused basic, clinical, and population research is required to expand and strengthen the evidence base for the development of new policies. Evaluation of the impact of targeted © 2016 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000410The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This policy statement was approved by the Advocacy Coordinating Committee February 23, 2016, and the American Heart Association Executive Committee on February 23, 2016. A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The American Heart Association requests that this document be cited as follows: Labarthe DR, Goldstein LB,...

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Accuracy of Statin Assignment Using the 2013 AHA/ACC Cholesterol Guideline Versus the 2001 NCEP ATP III Guideline

Abstract: The new American Heart Association/American College of Cardiology guideline matches statin assignment to total plaque burden better than the older guidelines, with only a modest increase in the number of patients who were assigned statins.

Cited by 64 publications

References 16 publications

Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan

Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan

2013 ACC/AHA Cholesterol Guideline Versus 2004 NCEP ATP III Guideline in the Prediction of Coronary Artery Calcification Progression in a Korean Population

Evidence-Based Policy Making: Assessment of the American Heart Association’s Strategic Policy Portfolio

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