title: 2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals.
abstract: Healthy People 2020 aim to reduce fatal atherosclerotic cardiovascular disease (ASCVD) by 20%, which translates into 310 000 fewer events annually assuming proportional reduction in fatal and nonfatal ASCVD. We estimated preventable ASCVD events by implementing the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Cholesterol Guideline in all statin-eligible adults. Absolute risk reduction (ARR) and number needed-to-treat (NNT) were calculated.
  
  
  
  National Health and Nutrition Examination Survey data for 2007-2012 were analyzed for adults aged 21 to 79 years and extrapolated to the US population. Literature-guided assumptions were used including (1) low-density lipoprotein cholesterol falls 33% with moderate-intensity statins and 51% with high-intensity statins; (2) for each 39 mg/dL decline in low-density lipoprotein cholesterol, 10-year ASCVD10 risk would fall 21% when ASCVD10 risk was ≥20% and 33% when ASCVD10 risk was <20%; and (3) either all statin-eligible untreated adults or all with ASCVD10 risk ≥7.5% would receive statins. Of 175.9 million adults aged 21 to 79 years not taking statins, 44.8 million (25.5%) were statin eligible. Treating all statin-eligible adults would prevent an estimated 243 589 ASCVD events annually (ARR 5.4%, 10-year NNT 18). Treating all statin-eligible adults with ASCVD10 risk ≥7.5% reduces the number treated to 32.2 million (28.2% fewer), whereas ASCVD events prevented annually fall only 10.5% to 217 974 (6.8% ARR, NNT 15).
  
  
  
  Implementing the ACC/AHA 2013 Cholesterol Guideline in all untreated, statin-eligible adults could achieve ≈78% of the Healthy People 2020 ASCVD prevention goal. Most of the benefit is attained by individuals with 10-year ASCVD risk ≥7.5%.
authors.affiliation: Department of Medicine, University of South Carolina School of Medicine-Greenville, SC Care Coordination Institute, Greenville, SC began@ccihealth.org.
authors.forename: Brent M
authors.initials: BM
authors.lastname: Egan
authors.affiliation: Department of Mathematics, College of Charleston, SC.
authors.forename: Jiexiang
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.
authors.forename: Kellee
authors.initials: K
authors.lastname: White
authors.affiliation: Care Coordination Institute, Greenville, SC.
authors.forename: Douglas O
authors.initials: DO
authors.lastname: Fleming
authors.affiliation: Faculty of Medical Sciences, The University of the West Indies, Barbados.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Connell
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX.
authors.forename: German T
authors.initials: GT
authors.lastname: Hernandez
authors.affiliation: Center for Obesity Research, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Jones
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Ferdinand
authors.affiliation: Department of Medicine, University of South Carolina School of Medicine-Greenville, SC Care Coordination Institute, Greenville, SC.
authors.forename: Angelo
authors.initials: A
authors.lastname: Sinopoli
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000187:drug effects* / Q000378:metabolism; D005260:Female; D006040:Goals; D040361:Healthy People Programs; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D061366:Numbers Needed To Treat; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D055502:Secondary Prevention; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: cardiovascular disease; cholesterol; epidemiology; guideline; primary prevention; secondary prevention; statin