Key result
Primary prevention risk models show wide discordance, varying statin eligibility from ~3% to ~67%.
Why the study?
Does the choice of cardiovascular risk prediction model affect statin eligibility in adults with metabolic syndrome?
Cross-Sectional (n=11,174)
No
Does the choice of cardiovascular risk prediction model affect statin eligibility in adults with metabolic syndrome?
Effect estimate: median κ 0.38
In adults with metabolic syndrome, statin eligibility varies widely depending on the cardiovascular risk prediction model used, highlighting the substantial influence of model selection on primary prevention decisions.
Background and Objectives: Cardiovascular risk prediction models (RPMs) are widely used to guide statin initiation in primary prevention, yet the extent to which different models produce concordant treatment decisions in the same population remains insufficiently characterized. We compared statin eligibility across nine commonly used RPMs: SCORE2, PREVENT, PCE, ASSIGN, FRS-hCHD, AusCVDRisk, MESA, QRISK3, and RRS. Materials and Methods: We performed a cross-sectional analysis of 11,174 adults aged 40–65 years with metabolic syndrome enrolled in the Lithuanian High Cardiovascular Risk primary prevention program (LitHiR) and evaluated them at a single tertiary center during 2006–2023. Statin eligibility was determined for each RPM using guideline-mapped treatment thresholds. Pairwise agreement was assessed using Cohen’s κ, Gwet’s AC1, Positive and Negative Percent Agreement (PPA/NPA), the Jaccard index, and McNemar testing. Analyses were repeated by sex. Consensus eligibility was defined as treatment recommended by at least k of nine models. Results: Eligibility varied more than twenty-fold, from 67.39% (7530/11,174) with SCORE2 to 3.03% (339/11,174) with AusCVDRisk; intermediate estimates included PREVENT at 44.83%, QRISK3 at 39.00%, and PCE at 37.97%. Overall pairwise agreement was modest: κ ranged from 0.03 (SCORE2 vs. AusCVDRisk) to 0.67 (QRISK3 vs. ASSIGN), with a median κ of 0.38 (IQR: 0.19–0.51). Median AC1 was 0.58 (IQR 0.37–0.68). Agreement was stronger for non-eligibility than for eligibility (median NPA: 0.82 vs. median PPA: 0.53). Consensus eligibility declined from 73.5% at k = 1 to 45.1% at k = 3, 30.0% at k = 5, and 1.87% at k = 9, with the greatest sex divergence at intermediate stringency. Conclusions: In this real-world cohort with elevated cardiometabolic risk, statin eligibility was highly dependent on RPM choice and showed only modest inter-model concordance. Increasing consensus stringency rapidly reduced eligibility, indicating that RPM selection and embedded thresholds substantially influence statin treatment decisions in primary prevention.
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Navickas et al. (2026) conducted a cross-sectional in Metabolic syndrome (n=11,174). Cardiovascular risk prediction models vs. Between-model comparison was evaluated on Statin eligibility and pairwise agreement (median κ 0.38). Statin eligibility across nine cardiovascular risk prediction models varied widely from 3.03% to 67.39%, demonstrating only modest inter-model concordance (median κ 0.38) in primary prevention.
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