Guideline based eligibility for primary prevention statin therapy - Insights from the North India ST-elevation
Sameer Arora1, Arman Qamar2, Puneet Gupta3
1Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC (Dr Arora).
Insights
Current atherosclerotic cardiovascular disease (ASCVD) risk scores may not accurately identify Indian patients needing statin therapy for primary prevention. A significant portion of ST-elevation myocardial infarction (STEMI) patients did not meet guideline thresholds, highlighting the need for new risk tools.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Existing atherosclerotic cardiovascular disease (ASCVD) risk scores are primarily derived from Western populations, raising concerns about their applicability to diverse ethnic groups, including those in India.
- The effectiveness of current risk assessment tools in identifying individuals who would benefit from primary prevention statin therapy in the Indian subcontinent remains uncertain.
Purpose of the Study:
- To evaluate the eligibility of patients presenting with ST-elevation myocardial infarction (STEMI) for primary prevention statin therapy based on major U.S. cholesterol guidelines.
- To assess the applicability of the 2018 U.S. Multisociety Guideline, United States Preventive Services Task Force (USPSTF), and National Cholesterol Education Program (NCEP) III guidelines in a North Indian STEMI cohort.
Main Methods:
- The North India STEMI (NORIN-STEMI) registry prospectively collected data from 3,635 patients at two tertiary care centers in Delhi, India (January 2019 - February 2020).
- Pooled cohort risk equations were utilized to estimate ASCVD risk at the time of presentation.
- Statin eligibility was determined using the 2018 U.S. Multisociety Guideline, USPSTF, and NCEP III guidelines for primary prevention.
Main Results:
- Of 2,551 eligible patients, the median age was 54 years, with 17% women. The median ASCVD risk was 7.0%.
- Based on the guidelines, 54% were eligible by the Multisociety Guideline, 46% by USPSTF, and 30% by NCEP III.
- Patients under 50 years old were less likely to be recommended for statin therapy compared to those aged 50 and above, across all evaluated guidelines.
Conclusions:
- A substantial percentage of ST-elevation myocardial infarction (STEMI) patients in India do not meet current guideline criteria for primary prevention statin therapy.
- There is a critical need for the development of novel risk stratification tools tailored to the Indian population to optimize the identification of individuals for primary prevention statin therapy.
Background:
Current risk scores to estimate atherosclerotic cardiovascular disease (ASCVD) risk and allocate statins in at-risk persons have largely been developed in Western populations; their applicability in India is uncertain.
Objective:
To assess eligibility for primary prevention statin therapy using the 2018 U.S Multisociety Guideline and other contemporary cholesterol guidelines in patients presenting with ST-elevation myocardial infarction (STEMI) in the North India STEMI (NORIN-STEMI) registry.
Methods:
NORIN-STEMI registry prospectively enrolled 3,635 patients at 2 tertiary care centers in Delhi, India from January 2019 to February 2020. Pooled cohort risk equations were used to estimate ASCVD risk at presentation. Patients were evaluated for statin eligibility using the 2018 U.S Multisociety Guideline, United States Preventive Services Task Force (USPSTF), and National Cholesterol Education Program (NCEP) III cholesterol guidelines.
Results:
A total of 2,551 met the inclusion criteria. The median age was 54 years; 17% were women. The median ASCVD risk was 7.0%. At the time of MI, 54% of patients were eligible for primary prevention statin therapy by Multisociety Guideline, 46% by USPSTF, and 30% by NCEP III guidelines. These findings were applicable in both women and men. Compared with patients aged ≥50 years, those <50 years were less likely to be recommended statin therapy by all the three guidelines.
Conclusion:
A significant proportion of patients with STEMI in India did not meet the current guideline-based threshold for statin therapy for primary prevention. Novel risk stratification tools are needed to identify patients for primary prevention statin therapy in this population.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:26Atherosclerosis III: Management
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:26Angina IV: Management
01:22Myocarditis IV: Nursing Management
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents