Estimating Benefits in Risk Reduction from Cardiovascular Preventive Therapies in Medicare Patients

Cardiovascular disease, and its chief underlying cause, atherosclerosis, remains the leading cause of mortality and morbidity in the US, particularly among older Americans. Effective preventive approaches exist, but are currently underutilized or not applied to the appropriate spectrum of patients. The current paradigm for prevention of atherosclerotic cardiovascular disease (ASCVD) is that the intensity of prevention efforts should match the absolute risk of the patient for developing ASCVD. This paradigm was promulgated in 1996, operationalized in the Third Adult Treatment Panel cholesterol guidelines (ATP-III) in 2001 and 2004, and fully endorsed by the 2013 American College of Cardiology/ American Heart Association prevention guidelines on Risk Assessment5,6 and Treatment of Blood Cholesterol to Reduce Atherosclerotic Risk in Adults. Under this paradigm, individuals at low absolute predicted risk for ASCVD in the near term (10 years) are recommended for all appropriate lifestyle modification (e.g., smoking cessation, dietary and physical activity changes), whereas those at higher predicted risk receive lifestyle counseling as well as consideration for immediate drug therapy (such as statin medications and aspirin) to reduce risk. This paradigm has been adopted widely by US and international guidelines and professional societies.