Cholesterol, not just cardiovascular risk, is important in deciding who should receive statin treatment

Area of Science:

• Cardiovascular Medicine
• Pharmacoeconomics
• Clinical Guidelines

Background:

• Current primary prevention guidelines for cardiovascular disease (CVD) with statins primarily focus on absolute CVD risk.
• This approach may not fully utilize clinical trial evidence, as the magnitude of low-density lipoprotein (LDL) cholesterol reduction significantly impacts therapeutic benefit.

Purpose of the Study:

• To calculate the number needed to treat (NNT) to prevent one CVD event.
• To critically assess current guideline performance across varying CVD risks and LDL cholesterol concentrations.
• To propose an improved method for statin indication based on NNT and cholesterol reduction.

Main Methods:

• Calculated NNT considering both absolute CVD risk and pretreatment LDL (or non-HDL) cholesterol levels.
• Evaluated how current guidelines align with NNT calculations across different risk strata.
• Assessed the impact of guideline recommendations on patient selection for statin therapy.

Main Results:

• Current guidelines may lead to the exclusion of some individuals with higher cholesterol levels who stand to gain significant benefit.
• Conversely, some patients may be exposed to statins without a realistic prospect of benefit.
• Abandoning cholesterol treatment goals disadvantages patients with higher baseline cholesterol levels.

Conclusions:

• Basing statin treatment decisions on NNT, calculated from both absolute CVD risk and achievable LDL cholesterol reduction, can overcome current guideline limitations.
• This approach allows for more effective deployment of statins in the population.
• Existing computer programs for CVD risk estimation can be easily amended to incorporate NNT calculations, simplifying clinical application.