Guidelines Inconsistent on Statin Recommendations for African-Americans

HealthDay News — Guidelines differ on recommendations for statin treatment in African-Americans, according to a study published online in JAMA Cardiology to coincide with the annual meeting of the American College of Cardiology, held from March 17 to 19 in Washington, D.C.

Ravi V. Shah, MD, from Massachusetts General Hospital in Boston, and colleagues compared the relative accuracy of the US Preventive Services Task Force (USPSTF) and the American College of Cardiology/American Heart Association (ACC/AHA) recommendations in identifying atherosclerotic cardiovascular disease (ASCVD). A total of 2812 African-American individuals with prevalent ASCVD underwent risk assessment.

The researchers found that the USPSTF and ACC/AHA guidelines identified, respectively, 55.2% and 69.3% of African-American individuals with a coronary artery calcium (CAC) score greater than 0 (risk difference, 14.1%). There was an association for statin recommendation under both guidelines with a CAC score >0 (odds ratio, 5.1).

Individuals indicated for statins under both guidelines experienced 9.6 cardiovascular events per 1,000 patient-years, while those indicated only under ACC/AHA guidelines were at low-to-intermediate risk (4.1 events per 1,000 patient-years). African-Americans not eligible for statins by USPSTF guidelines had a higher ASCVD event rate in the presence of CAC vs without CAC (2.8 vs .8 per 1,000 person-years).

“These results support a guideline-based approach to statin recommendation, leveraging targeted imaging (or other surrogate atherosclerotic measures) in African-American individuals to further personalize statin-based prevention programs,” the researchers wrote.

One researcher disclosed financial ties to General Electric.

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Shah RV, Spahillari A, Mwasongwe S, et al. Subclinical atherosclerosis, statin eligibility, and outcomes in African American individuals [published online March 18, 2017]. JAMA Cardiol. doi:10.1001/jamacardio.2017.0944