Guideline-Based Statin Eligibility, XXXX , and Cardiovascular Events.

@entity1 @entity301 @entity855 @entity453 @entity729 @entity583 @entity204 @entity65 @entity165 @entity385
IMPORTANCE: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for @entity165 management defined new eligibility criteria for statin therapy. However, it is unclear whether this approach improves identification of adults at higher risk of cardiovascular events. OBJECTIVE: To determine whether the ACC/AHA guidelines improve identification of individuals who develop incident @entity65 ( @entity65 ) and/or have @entity729 ( @entity729 ) compared with the National @entity165 Education Program's 2004 Updated Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) guidelines. DESIGN, SETTING, AND @entity1 : Longitudinal community-based cohort study, with @entity1 for this investigation drawn from the offspring and third-generation cohorts of the Framingham Heart Study. @entity1 underwent multidetector computed tomography for @entity729 between 2002 and 2005 and were followed up for a median of 9.4 years for incident @entity65 . EXPOSURES: Statin eligibility was determined based on Framingham risk factors and low-density lipoprotein thresholds for ATP III, whereas the pooled cohort calculator was used for ACC/AHA. MAIN OUTCOMES AND MEASURES: The primary outcome was incident @entity65 ( @entity583 , @entity204 due to @entity301 [ @entity301 ], or @entity385 ). Secondary outcomes were @entity301 and @entity729 (as measured by the Agatston score). RESULTS: Among 2435 statin-naive @entity1 (mean age, 51.3 [SD, 8.6] years; 56% female), 39% (941/2435) were statin eligible by ACC/AHA compared with 14% (348/2435) by ATP III (P   <   .001). There were 74 incident @entity65 events (40 nonfatal @entity583 , 31 nonfatal @entity385 , and 3 fatal @entity301 events). @entity1 who were statin eligible by ACC/AHA had increased hazard ratios for incident @entity65 compared with those eligible by @entity855 III: 6.8 (95% CI, 3.8-11.9) vs 3.1 (95% CI, 1.9-5.0), respectively (P<.001). Similar results were seen for @entity65 in @entity1 with intermediate Framingham Risk Scores and for @entity301 . @entity1 who were newly statin eligible (n   =   593 [24%]) had an incident @entity65 rate of 5.7%, yielding a number needed to treat of 39 to 58. @entity1 with @entity729 were more likely to be statin eligible by ACC/AHA than by ATP III: @entity729 score >0 (n   =   1015): 63% vs 23%; @entity729 score >100 (n   =   376): 80% vs 32%; and @entity729 score >300 (n   =   186): 85% vs 34% (all P   <   .001). A @entity729 score of 0 identified a low-risk group among ACC/AHA statin-eligible @entity1 (306/941 [33%]) with a @entity65 rate of 1.6%. CONCLUSIONS AND RELEVANCE: In this community-based primary prevention cohort, the ACC/AHA guidelines for determining statin eligibility, compared with the ATP III, were associated with greater accuracy and efficiency in identifying increased risk of incident @entity65 and subclinical @entity453 , particularly in intermediate-risk @entity1 .
