Statin therapy eligibility in a large primary prevention cohort according to European Society of Cardiology Guidelines

Abstract Background 2016 European Society of Cardiology (ESC) guidelines on statin therapy eligibility in primary prevention were updated in 2021, with significant differences and particularly the use of a new estimation of 10-year fatal and nonfatal CVD risk with Systematic Coronary Risk Estimation 2 (SCORE2). Purpose The aim of the study was to compare the proportion of subjects aged 40 to 69 years eligible to statin therapy according to the 2016 and 2021 ESC recommendations in a large primary prevention cohort. Methods We conducted a screening campaign between January 2007 and December 2022 for cardiovascular risk factors in large urban cohort of subjects aged 40-69 (the CARVAR 92 study). We systematically calculated the individual cardiovascular risk for all our subjects. We thus estimated the proportion of subjects eligible for statin therapy based on 2021 ESC guidelines versus 2016 ESC guidelines. Costs relating to statin therapy were also estimated. Results 27,807 subjects were included in the CARVAR 92 study: 13.7% were eligible to statin therapy according to the 2016 ESC guidelines versus 32.2% according to the 2021 guidelines (p 0.0001). The proportion of subjects eligible to statin therapy increased by a factor 2.3 between the 2016 and 2021 ESC guidelines for the whole cohort, and increased by a factor 12 in men aged 40 to 50 (from 3.8% of individuals eligible to statin therapy for 2016 recommendation to 45.7% p 0.0001 for 2021 recommendation). Costs associated with statin therapy for the whole cohort increased by a 2.7 factor between 2016 and 2021 recommendations. Conclusion In a large primary prevention cohort, we observed a strong increase in the number of subjects eligible to statin therapy with the new 2021 ESC recommendations (versus 2016) and therefore in statin costs, particularly in men between 40 and 50 years old. The clinical and economic impact on the occurrence of cardiovascular events of these new recommendations in a real life remains to be evaluated. Eligibilty to statin therapy.