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Prevalence of Atherosclerotic Cardiovascular Disease Risk-Enhancing Factors and Their Association with Primary
Linnea M Wilson1,2, Jeremy B Sussman3,4, Roger S Blumenthal5
1Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Insights
Risk enhancing factors (REFs) are common in US adults and influence statin use decisions. Clearer guidelines are needed to effectively incorporate REFs for personalized cardiovascular disease prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Current guidelines recommend considering risk enhancing factors (REFs) for primary prevention of atherosclerotic cardiovascular disease (ASCVD).
- This is particularly relevant for the 44 million Americans with borderline or intermediate ASCVD risk.
- REFs help inform decisions regarding lipid-lowering therapies.
Purpose of the Study:
- To determine the prevalence of REFs in the US adult population.
- To assess the association between REFs and the likelihood of statin use.
Main Methods:
- Cross-sectional study utilizing pooled data from the National Health and Nutrition Examination Survey (NHANES) from 2015 to March 2020.
- Included adults aged 40-75 without established ASCVD.
- Analyzed nine measurable REFs, including family history, medical conditions (rheumatoid arthritis, metabolic syndrome, chronic kidney disease, premature menopause), and biomarkers (hypercholesterolemia, hypertriglyceridemia, elevated LDL-C, elevated CRP).
Main Results:
- The study analyzed data representing 115.7 million US adults; 77% had at least one REF, and 28% had at least three.
- Elevated high-sensitivity C-reactive protein (49.6%), metabolic syndrome (48.3%), and hypertriglyceridemia (18.9%) were the most common REFs.
- Any REF was associated with increased odds of statin use (aOR 2.17).
- Specific REFs like metabolic syndrome, family history of premature ASCVD, hypertriglyceridemia, and hypercholesterolemia showed significant associations with statin use.
- REFs were associated with higher statin use likelihood across low, intermediate, and high ASCVD risk categories, but not in borderline risk or diabetes categories.
Conclusions:
- Risk enhancing factors are highly prevalent among US adults.
- The association between REFs and statin use is inconsistent, highlighting a gap in current clinical practice.
- Clearer guidance is necessary for effectively integrating REFs into primary prevention prescribing decisions to personalize ASCVD risk assessment.
Background:
Guidelines on primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend considering risk enhancing factors (REFs) to inform decisions on use of lipid-lowering therapies for the 44 million Americans with borderline or intermediate estimated ASCVD risk.
Objective:
To quantify REF burden and estimate whether REFs are associated with higher likelihood of statin use.
Design:
Cross-sectional using National Health and Nutrition Examination Survey pooled 2015 to March 2020.
Participants:
Adults aged 40-75 without known ASCVD.
Main Measures:
Nine REFs were measurable in NHANES including family history of premature ASCVD, rheumatoid arthritis, metabolic syndrome, premature menopause, chronic kidney disease and biomarkers of hypercholesteremia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol and elevated C-reactive protein. Prevalence of REFs and association with statin use were calculated overall and across ASCVD treatment categories based on diabetes and 10-year ASCVD risk. KEY RESULTS: In the sample of 3,111 participants (mean age 56 years; 52.6% female) weighted to represent 115.7 million US adults, 77% had at least one REF and 28% had at least three. The most common REFs were elevated high sensitivity C-reactive protein (49.6%) metabolic syndrome (48.3%), and hypertriglyceridemia (18.9%). The presence of any REF was associated with a 2.17 (95% CI, 1.42-3.33) greater odds of statin use. Metabolic syndrome, family history of premature ASCVD, hypertriglyceridemia and hypercholesteremia were associated with greater odds of statin use (aORs ranging from 1.5 to 2.3). The presence of any REF was associated with higher likelihood of statin use in participants with low (< 5%), intermediate (7.5-19%), and high ASCVD risk (≥ 20%), but not borderline ASCVD risk (5-7.4%) or diabetes categories.
Conclusions:
REFs are highly prevalent and inconsistently associated with statin use. Achieving the potential benefit of individualizing ASCVD risk estimates will require clearer guidance on when and how to incorporate REFs into primary prevention prescribing decisions.
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