Key result
An active approach to statin selection increased statin use (25.3% vs 9.8%, P<0.0001) but did not significantly reduce major adverse cardiovascular events (0.6% vs 1.0%, P=0.47) compared to usual care.
Why the study?
Statins improve outcomes in high-risk primary prevention, but application in clinical practice has lagged.
Does an active strategy for statin selection improve statin utilization and lipid levels compared to passive usual care in primary prevention patients ≥50 years of age?
RCT (n=3,770)
1:1
Does an active strategy for statin selection improve statin utilization and lipid levels compared to passive usual care in primary prevention patients ≥50 years of age?
An active approach to statin selection for primary ASCVD prevention significantly increases statin utilization and lowers LDL-C compared to passive usual care.
Statins can improve outcomes in high-risk primary prevention populations. However, application in clinical practice has lagged. The objective of this study was to compare an active vs a passive strategy (ie, usual care) to statin prescription for primary prevention of atherosclerotic cardiovascular disease (ASCVD). A total of 3,770 patients ≥50 years of age without a history of ASCVD or statin use were invited to enroll in CorCal, with 601 consenting to participate. These patients were randomized 1:1 to statin initiation guided by the pooled cohort equation or by coronary artery calcium scoring (CACS). Outcomes (2.8-year follow-up) compared patients managed actively vs passively (randomly invited but declined or did not respond). Patient demographics were well matched. Statin recommendation was common among enrolled patients (41.7%). During follow-up, 25.3% of active patients were taking a statin vs 9.8% managed passively (P < 0.0001). Active patients had more lipid panels (median 2.0 vs 1.0), lower low-density lipoprotein cholesterol (109 vs 117 mg/dL) (both P < 0.0001), and a low rate of major adverse cardiovascular events during follow-up (0.6% vs 1.0%, P = 0.47). Statistical comparisons included t-tests, chi-squared tests, nonparametric tests, and time-to-event tests as appropriate. An active approach to statin selection for primary ASCVD prevention identified a large treatment opportunity and led to over twice as many patients on statins compared to passive (usual care) management. A large CorCal Outcomes Trial is underway to more definitively assess the impact on outcomes of active management of statins for primary prevention.
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Anderson et al. (2023) conducted an RCT in Primary prevention of atherosclerotic cardiovascular disease (ASCVD) (n=3,770). Active strategy for statin selection vs. Passive strategy (usual care) was evaluated on major adverse cardiovascular events (p=0.47). An active approach to statin selection increased statin use (25.3% vs 9.8%, P<0.0001) but did not significantly reduce major adverse cardiovascular events (0.6% vs 1.0%, P=0.47) compared to usual care.
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