Disease-guided approach ups specificity of statin treatment

(HealthDay)—A disease-guided approach to statin eligibility can improve treatment specificity, according to a study published in the Aug. 30 issue of the Journal of the American College of Cardiology.

Martin Bødtker Mortensen, M.D., Ph.D., from Aarhus University Hospital in Denmark, and colleagues personalized American College of Cardiology (ACA)/American Heart Association (AHA) risk-based statin eligibility criteria. Among 5,805 BioImage participants, down-classification from statin eligible to ineligible occurred for those with ≥7.5 percent 10-year atherosclerotic cardiovascular disease risk if imaging revealed no coronary artery calcium (CAC) or carotid plaque burden (cPB).

The researchers found that 86 percent of participants qualified for ACC/AHA risk-based statin therapy, with 96 percent sensitivity and 15 percent specificity. CAC and cPB scores of 0 were seen in 32 and 23 percent, respectively, and correlated with low event rates. Specificity for coronary heart disease events improved 22 percent with CAC-guided reclassification (P < 0.0001), with no significant loss in sensitivity, for a binary net reclassification index (NRI) of 0.20 (P < 0.0001). Specificity improved 16 percent with cPB-guided reclassification (P < 0.0001), with minor loss of sensitivity (7 percent), for a NRI of 0.09 (P = 0.001). For cardiovascular disease events the NRI was 0.14 and 0.06 for CAC-guided and cPB-guided, respectively.

"Withholding statins in individuals without CAC or carotid plaque could spare a significant proportion of elderly people from taking a pill that would benefit only a few," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry; the BioImage Study was designed by the High-Risk Plaque Initiative, which was funded by pharmaceutical companies.

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