2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Background: 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. methods and results: 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). conclusions: 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%. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.