Statin Guidance Varies for Black Patients

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The USPSTF guidelines focus statin recommendations on 38% of high-risk African American individuals at the expense of not recommending treatment in nearly 25% of African Americans.
The USPSTF guidelines focus statin recommendations on 38% of high-risk African American individuals at the expense of not recommending treatment in nearly 25% of 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, DC.

Ravi V. Shah, MD, from the Massachusetts General Hospital in Boston, and colleagues compared the relative accuracy of the U.S. 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 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 1000 patient-years, while those indicated only under ACC/AHA guidelines were at low-to-intermediate risk (4.1 events per 1000 patient-years). African-Americans not eligible for statins by USPSTF guidelines had a higher ASCVD event rate in the presence of CAC versus without CAC (2.8 vs 0.8 per 1000 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 authors write.

One author disclosed financial ties to General Electric.

Reference

  1. Shah RV, Spahillari A, Mwasongwe S, et al. Subclinical Atherosclerosis, Statin Eligibility, and Outcomes in African American Individuals: The Jackson Heart Study. JAMA Cardiol. 18 March 2017. doi: 10.1001/jamacardio.2017.0944

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