Comparing eligibility for statin therapy for primary prevention under 2022 USPSTF recommendations and the 2018 AHA/ACC/ multi-society guideline recommendations: From National Health and Nutrition Examination Survey.
Level 4 - case-series / case-control
Cross-sectional analysis of national survey data applying clinical guideline criteria
PubMed 36038004 · doi:10.1016/j.pcad.2022.08.007
What was done
Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 were analyzed for 1,799 adults aged 40-75 years without self-reported atherosclerotic cardiovascular disease (ASCVD) and with LDL-C <190 mg/dL. Statin eligibility was calculated and compared between the 2022 USPSTF recommendations (10-year ASCVD risk >=10% plus >=1 CVD risk factor) and the 2018 AHA/ACC/Multisociety guidelines (diabetes, 10-year ASCVD risk >=20%, or risk 7.5% to <20% after accounting for risk enhancers and shared decision making), using survey weights to project national estimates.
What was found
Among 1,799 participants (weighted mean age 56.0 ± 0.5 years, 53.0% women, 10.6% non-Hispanic Black, weighted mean 10-year ASCVD risk 9.6 ± 0.3%), the 2022 USPSTF recommendations indicated statin eligibility for 31.8% (95% CI 28.6, 35.1) or 33.7 million adults. The 2018 AHA/ACC/MS guidelines indicated eligibility for 46.8% (95% CI 43.0, 50.5) or 49.7 million adults. Approximately 15% (~16.0 million) fewer adults were eligible under the 2022 USPSTF criteria. For adults with diabetes, 63.0% (95% CI 52.1, 72.7) were eligible under USPSTF compared with 100% under AHA/ACC/MS guidelines.
Why it matters
This analysis shows that the 2022 USPSTF primary prevention guidelines substantially restrict statin eligibility compared with cardiology society guidelines, leaving an estimated 16 million fewer US adults—and more than one-third of adults with diabetes—eligible for therapy.
Limits
The study is a cross-sectional analysis relying on self-reported ASCVD history. The abstract does not detail how AHA/ACC risk enhancers were operationalized in NHANES data. Longitudinal cardiovascular outcomes and actual prescription or adherence patterns were not evaluated.
Cited by
- supports Under current US guidelines, 40% or more of older adults qualify for a statin for primary prevention.