Statin therapy has been shown to be cost-effective in lowering cholesterol in young adults, according to a study published in Journal of the American College of Cardiology.
These results justify the extension of preventive statin therapy to young adults, who are currently only eligible if they are at very high risk of atherosclerotic cardiovascular disease (ASCVD), according to the study authors.
“Targeting high risk factors early on in adulthood is a new approach that has the potential to once again improve cardiovascular health in the United States and abroad,” the authors wrote. .
Ciaran Kohli-Lynch, PhD, postdoctoral researcher in health services and outcomes at the Center for Education in Health Sciences (CEHS), was the lead author of the study. Norrina Allen, PhD, Director of the Center for Epidemiology and Population Health (CEPH) at the Institute of Public Health and Medicine (IPHAM) and Associate Professor of Preventive Medicine in the Division of Epidemiology, and Bonnie Spring, PhD , chief of behavioral medicine in the Department of Preventive Medicine and director of the Center for Behavior and Health at IPHAM, were the co-authors of the study.
Atherosclerosis, the buildup of fibro-fatty plaque in the arteries, is the leading cause of cardiovascular disease, including heart attacks and strokes. LDL cholesterol plays an important role in the development of atherosclerosis and a recent study of observational data found that cumulative exposure to LDL cholesterol in young adults significantly increases the risk of cardiovascular events later in life. .
The US Task Force on Prevention Services guidelines recommend statin therapy for adults aged 40 to 75 years with a greater than 10% risk of ASCVD. For adults under 40, statins are only recommended when they have a very high risk of ASCVD, determined by LDL cholesterol levels above 190 mg / dl.
In the current study, researchers evaluated the lifetime cost-effectiveness of initiating cholesterol-lowering therapy at lower LDL cholesterol thresholds than recommended in a cohort of young American adults. A computer simulation model synthesized evidence on LDL cholesterol lowering effects, side effects, treatment costs, and health costs associated with statin therapy and intensive group lifestyle interventions. The risk of cardiovascular events later in life in the model was determined by multiple cardiovascular risk factors, including cumulative LDL cholesterol levels throughout adulthood.
About 26.3 million young American adults – 27% – have LDL cholesterol levels above 130 mg / DL. Statin therapy for young men with high LDL cholesterol would cost $ 31,000 per quality-adjusted life year (QALY) gained, while statin therapy for young adult women with LDL cholesterol â¥ 130 mg / dL would cost $ 106,000 per QALY gained. These fall under the definition of “very cost effective” and “intermediate cost-effective”, respectively, as defined by the American Heart Association.
Cardiovascular disease rates fell in the second half of the 20e century thanks to the recognition of risk factors and the development of cholesterol-lowering and hypotensive drugs, but this decline has since stabilized. According to Kohli-Lynch, these findings represent a new way forward.
Expanding statin use to more young adults could once again lower rates of atherosclerotic cardiovascular disease, allowing people to live longer and healthier lives. “
Ciaran Kohli-Lynch, PhD, Postdoctoral Fellow, Health Services and Outcomes Research, Center for Education in Health Sciences (CEHS)
Kohli-Lynch, CN, et al. (2021) Cost-effectiveness of lipid-lowering treatments in young adults. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2021.08.065.