ACC/AHA Cholesterol Guidelines Found Efficient and Cost-Effective

By Cara Adler

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

The 2013 American College of Cardiology/American Heart Association cholesterol guidelines improve detection of individuals at increased risk for cardiovascular disease, a JAMA study finds. Moreover, the guideline's 10-year CVD risk threshold for primary statin treatment is cost-effective — and could even be lower — another JAMA study suggests.

Among more than 2400 adults not on statins at the start of a community-based cohort study, 39% were eligible for statins using the ACC/AHA criteria, compared with 14% using criteria from the 2004 ATP III guidelines. During roughly 9 years' follow-up, the risk for incident CVD in patients eligible for statins versus noneligible patients was significantly higher when applying the ACC/AHA criteria (hazard ratio, 6.8) than with the ATP III criteria (HR, 3.1).

In a separate simulation study, researchers found the ACC/AHA guideline's 7.5% 10-year CVD risk threshold for initiating statins had an "acceptable" incremental cost-effectiveness ratio of $37,000 per quality adjusted life-year (QALY) compared with a cutpoint of 10%. (Commonly used cost-effectiveness values are $50,000–$150,000 per QALY.) However, if the cost-effectiveness ratio were $100,000 per QALY, a 4% cutpoint would be optimal.

Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "These studies further support the wisdom of transitioning the guidelines from a focus on cholesterol levels to the level of the patient's risk. It is also important to remember that the guidelines are broad recommendations and each decision depends on the preferences of each individual patient."