Impact of PREVENT Cardiovascular Risk Equations on Statin Eligibility by Subgroup and Risk Thresholds: A...

Area of Science:

• Cardiovascular Medicine
• Public Health
• Health Services Research

Background:

• The Pooled Cohort Equations (PCEs) for atherosclerotic cardiovascular disease (ASCVD) risk assessment may be replaced by the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations.
• This transition is projected to decrease statin eligibility, leading to discussions about adjusting risk thresholds for PREVENT.
• The impact of these changes on statin eligibility across diverse patient subgroups remains unclear.

Purpose of the Study:

• To evaluate how replacing PCEs with PREVENT equations affects statin eligibility in a primary care setting.
• To analyze the influence of incorporating the social deprivation index (SDI) and modifying ASCVD risk thresholds on statin eligibility.
• To examine subgroup variations in statin eligibility based on age, sex, race, and social deprivation.

Main Methods:

• A cross-sectional analysis compared 10-year ASCVD risk scores and statin eligibility using PCEs and PREVENT equations.
• Data were sourced from adult patients visiting Vanderbilt primary care clinics in 2023.
• Subgroup analyses explored variations by age, sex, race, and social deprivation, with risk thresholds for statin eligibility systematically altered.

Main Results:

• The PREVENT equations yielded significantly lower mean 10-year ASCVD risk (3.6%) compared to PCEs (7.5%) across 50,123 patients.
• For patients not on statins (n=36,430), PREVENT reduced statin eligibility by 78.2%, with greater reductions observed in women (82.6%), 40-49-year-olds (97.8%), and Black patients (81.2%).
• Lowering the threshold to 3% increased overall eligibility but widened subgroup disparities, with Black patients experiencing a relative decrease while White patients saw an increase.

Conclusions:

• Replacing PCEs with PREVENT equations substantially decreases statin eligibility at the standard 7.5% threshold in primary care.
• Adjusting the risk threshold increases overall eligibility but creates or exacerbates disparities among different demographic groups.
• The findings highlight the need for careful consideration of risk thresholds and subgroup impacts when implementing new ASCVD risk prediction tools.