A cardiovascular disease (CVD) risk prediction tool developed by Northwestern Medicine scientists may also be effective for identifying which patients would most benefit from statin therapy, according to a recent study published in JAMA Cardiology.
The CVD risk calculator, called the PREVENT (Predicting Risk of cardiovascular disease EVENTs) risk equations, could ultimately help improve clinical decision-making conversations between patients and their physicians, according to Sadiya Khan, ‘09 MD, ‘14 MSc, ’10, ’12 GME, the Magerstadt Professor of Cardiovascular Epidemiology and lead author of the study.
“We hope these data will help support shared decision-making for starting a statin medicine. We want to help improve the conversation between healthcare clinicians and their patients about their risk and the potential benefit of starting a medication,” said Khan, who is also an associate professor of Medical Social Sciences in the Division of Determinants of Health and of Preventive Medicine in the Division of Epidemiology.
In 2023, Khan and colleagues developed the American Heart Association’s PREVENT risk equations to more accurately estimate CVD risk. In doing so, they recognized a need for new risk thresholds for when to consider prescribing medications such as statins to lower a patient’s risk of CVD.
“This was truly the next step on the PREVENT journey. Since the current guidelines recommend the Pooled Cohort Equations (PCEs), we also wanted to show how different thresholds for PREVENT compared with the thresholds used in the prior PCE model,” Khan said.
In the current study, the investigators studied population-level implications for statin eligibility according to different 10-year atheroclerotic CVD risk estimates based on PREVENT and compared them with guideline-defined thresholds based on the PCE model.
The investigators performed a cross-sectional analysis of data from the National Health and Nutrition Examination Surveys (conducted between January 2011 to March 2020), which included more than 5,200 U.S. adults ages 40 to 75 years.
Among the participants, representing more than 133 million adults, 28.1 million were already taking statins and an additional 15.2 million were eligible for statins for secondary prevention or high-risk primary prevention due to diabetes or LDL cholesterol levels of 190 milligrams per deciliter or greater.
Of the remaining 70.2 million adults, the scientists found that 11.8 million would be eligible for statin therapy with a 10-year CVD risk of 5 percent or greater with PREVENT. This translated into a 10-year absolute risk reduction of more than 2 percent.
“A risk estimate higher than 3 to 5 percent hits the ‘sweet spot’ to identify those patients who will have the greatest benefit from starting a lipid-lowering medication. While patients at even lower risk may have some benefit, it is likely to be smaller and warrants a more personalized discussion,” Khan said.
Khan said the findings can help support decision-making conversations between patients and healthcare providers when deciding whether to use statins to help reduce a patient’s CVD risk.
“If a clinician can have a conversation with their patient explaining that there is a certain threshold after which intervention is recommended because the benefit of starting the intervention is greater than any potential harm, this is often a concept patients understand and can help make them more confident in the decision to adhere to their providers’ recommendations,” Khan said.
While risk prediction can often be the first step in a shared decision-making process, Khan said that it’s not always a “one-size-fits-all” situation.
“While absolute risk is a helpful way to decide who should be treated, it can sometimes be challenging, so next steps in our work include how best to communicate risk with individual patients,” Khan said.
Co-authors of the study include Xiaoning Huang, PhD, research assistant professor of Medicine in the Division of Cardiology; Nilay Shah, ‘14 MD, ‘14 MPH, assistant professor of Medicine in the Division of Cardiology and of Preventive Medicine in the Division of Epidemiology; and John Wilkins, MD,
associate professor of Medicine in the Division of Cardiology and of Preventive Medicine in the Division of Epidemiology.
