Key result
Early statins for LDL-C ≥130 mg/dL are cost-effective in young adults, particularly in men.
Why the study?
Most young adults with elevated LDL-C do not currently receive lipid-lowering treatment despite the association with later ASCVD, and the cost-effectiveness of such treatments in this population is unclear.
Is statin therapy or intensive lifestyle intervention cost-effective for ASCVD-free young adults with LDL-C ≥130 mg/dL or ≥160 mg/dL compared to standard care?
Is statin therapy or intensive lifestyle intervention cost-effective for ASCVD-free young adults with LDL-C ≥130 mg/dL or ≥160 mg/dL compared to standard care?
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Expanding statin use to more young adults could once again drive down rates of atherosclerotic cardiovascular disease, allowing individuals to live longer and healthier lives.”
“Targeting elevated risk factors early, in young adulthood, is a new approach that has the potential to once more improve cardiovascular health in the United States and abroad.”
Initiating moderate-intensity statin treatment in young adults with LDL-C ≥130 mg/dL is cost-effective and projected to prevent long-term ASCVD events.
Background: Raised low-density lipoprotein cholesterol (LDL-C) in young adulthood (ages 18–39 years) is associated with atherosclerotic cardiovascular disease (ASCVD) later in life. Most young adults with elevated LDL-C do not currently receive lipid-lowering treatment. Objectives: We aimed to estimate the prevalence of elevated LDL-C in ASCVD-free U.S. young adults and the cost-effectiveness of lipid-lowering strategies for raised LDL-C in young adulthood compared with standard care. Methods: Prevalence of raised LDL-C was examined in the U.S. National Health and Nutrition Examination Survey. The CVD Policy Model projected lifetime quality-adjusted life years (QALYs), healthcare costs, and incremental cost-effectiveness ratios (ICERs) for lipid-lowering strategies. Standard care was statin treatment for adults aged ≥40 years based on LDL-C, ASCVD risk, or diabetes plus young adults with LDL-C ≥190 mg/dL. Lipid-lowering incremental to standard care with moderate-intensity statins or intensive lifestyle interventions was simulated starting when young adult LDL-C was either ≥160 mg/dL or ≥130 mg/dL. Results: Around 27% of ASCVD-free young adults have LDL-C ≥130 mg/dL, and 9% have LDL-C ≥160 mg/dL. The model projected that young adult lipid-lowering with statins or lifestyle interventions would prevent lifetime ASCVD events and increase QALYs compared with standard care. ICERs were $31,000/QALY for statins in young adult men with LDL-C ≥130 mg/dL, and $106,000/QALY for statins in young adult women with LDL-C ≥130 mg/dL. Intensive lifestyle intervention was more costly and less effective than statin therapy. Conclusion: Statin treatment for LDL-C ≥130 mg/dL is highly cost-effective in young adult men and intermediately cost-effective in young adult women.
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Kohli-Lynch et al. (2021) studied Elevated LDL-C in young adulthood. Statin treatment vs. Standard care (statin treatment for adults ≥40 years based on 2018 ACC/AHA guidelines plus young adults with LDL-C ≥190 mg/dL) was evaluated on Incremental cost-effectiveness ratio (ICER) and lifetime quality-adjusted life years (QALYs). Statin treatment for LDL-C ≥130 mg/dL in young adults is highly cost-effective in men ($31,000/QALY) and intermediately cost-effective in women ($106,000/QALY) compared with standard care.
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