Evaluation of Atherosclerotic Cardiovascular Disease Categories and Statin Use Based on 4 Groups of ACC-AHA Guidelines
Abstract
Background: Cardiovascular disease (CVD) is the predominant cause of mortality and morbidity globally. Statin therapy is an important part of managing cholesterol since it can help stop and treat atherosclerotic cardiovascular diseases (ASCVD). The aim of this study was to evaluate the effectiveness of statin therapy and the extent to which clinical practices comply with the 2018 ACC-AHA guidelines for the risk management of ASCVD. Methods: This retrospective descriptive analysis assessed the effectiveness of statin therapy and adherence to the latest ACC-AHA guidelines for managing ASCVD risk. After putting the participants into four risk groups, we looked at how well they followed the instructions for using statins. Results: According to the study's rules, 88.4% of patients were taking their medicine correctly, and 73.5% of patients were on statin therapy. The high adherence rate (81.0%) shows that taking statin medicine is necessary for better cardiovascular outcomes. However, it was found that 11.6% of patients were not taking statins correctly. This was either because they were not prescribed enough in the high-risk group or too much in the low-risk group. There was a strong link between taking statins and being older, being male, having been in the hospital before, and having other health problems such high blood pressure and diabetes (p < 0.05). Conclusion: The study's findings stress even more the need to keep improving statin medications and making sure that clinical processes follow the ACC-AHA guidelines for prescribing statins and assessing ASCVD risk. Future study should concentrate on the enduring impacts and strategies to reconcile the disparity between professional standards and clinical practice.
Full Text:
PDFReferences
Salvo SG. Cardiovascular pathologies and disorders. In: Mosby's Pathology for Massage Professionals. St. Louis, Missouri; Elsevier; 2021.
Şahin B, İlgün G. Risk factors of deaths related to cardiovascular diseases in World Health Organization (WHO) member countries. Health & Social Care in the Community. 2022;30(1):73-80. https://doi.org/10.1111/hsc.13156
Gaziano TA. Cardiovascular diseases worldwide. Public Health Approach to Cardiovascular Disease Prevention & Management. Boca Raton, Florida, USA: CRC Press; 2023.
Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, et al. Ten-year differences in women’s awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey: a special report from the American Heart Association. Circulation. 2021;143(7):e239-e248. https://doi.org/10.1161/CIR.0000000000000907
Lechner K, von Schacky C, McKenzie AL, Worm N, Nixdorff U, Lechner B, Kränkel N, Halle M, Krauss RM, Scherr J. Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors. European Journal of Preventive Cardiology. 2020;27(4):394-406. https://doi.org/10.1177/2047487319869400
Chou R, Cantor A, Dana T, Wagner J, Ahmed AY, Fu R, Ferencik M. Statin use for the primary prevention of cardiovascular disease in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2022;328(8):754-771. https://doi.org/10.1001/jama.2022.12138
Teo KK, Rafiq T. Cardiovascular risk factors and prevention: a perspective from developing countries. Canadian Journal of Cardiology. 2021;37(5):733-43. https://doi.org/10.1016/j.cjca.2021.02.009
Maxfield FR, Steinfeld N, Ma C-IJ. The formation and consequences of cholesterol-rich deposits in atherosclerotic lesions. Frontiers in Cardiovascular Medicine. 2023;10:1148304. https://doi.org/10.3389/fcvm.2023.1148304
Baumer Y, McCurdy S, Jin X, Weatherby TM, Dey AK, Mehta NN, Yap JK, Kruth HS, Boisvert WA. Ultramorphological analysis of plaque advancement and cholesterol crystal formation in Ldlr knockout mouse atherosclerosis. Atherosclerosis. 2019;287:100-11. https://doi.org/10.1016/j.atherosclerosis.2019.05.029
Dutta A, Das M, Ghosh A, Rana S. Molecular and cellular pathophysiology of circulating cardiomyocyte-specific cell free DNA (cfDNA): Biomarkers of heart failure and potential therapeutic targets. Genes & Diseases. 2023;10(3):948-59. https://doi.org/10.1016/j.gendis.2022.08.008
Malekmohammad K, Bezsonov EE, Rafieian-Kopaei M. Role of lipid accumulation and inflammation in atherosclerosis: focus on molecular and cellular mechanisms. Frontiers in Cardiovascular Medicine. 2021;8:707529. https://doi.org/10.3389/fcvm.2021.707529
Linton MF, Yancey PG, Davies SS, Jerome WG, Linton EF, Song WL, Doran AC, Vickers KC. The Role of Lipids and Lipoproteins in Atherosclerosis. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK343489/ (Accessed on 5 Mar 2026)
Mohebbati R, Momeni-Moghaddam MA. The role of red blood cells in cholesterol accumulation and atherosclerotic plaque instability: a perspective on atherosclerosis. Current Cardiology Reviews. 2025;21(5):e1573403X358572. https://doi.org/10.2174/011573403X358572250128104335
Flora GD, Nayak MK. A brief review of cardiovascular diseases, associated risk factors and current treatment regimes. Current Pharmaceutical Design. 2019;25(38):4063-84. https://doi.org/10.2174/1381612825666190925163827
Angell SY, McConnell MV, Anderson CA, Bibbins-Domingo K, Boyle DS, Capewell S, et al. The American Heart Association 2030 impact goal: a presidential advisory from the American Heart Association. Circulation. 2020;141(9):e120-e38. https://doi.org/10.1161/CIR.0000000000000758
Global Cardiovascular Risk Consortium, Magnussen C, Ojeda FM, Leong DP, Alegre-Diaz J, Amouyel P, et al. Global effect of modifiable risk factors on cardiovascular disease and mortality. New England Journal of Medicine. 2023;389(14):1273-1285. https://doi.org/10.1056/NEJMoa2206916
Münzel T, Hahad O, Sørensen M, Lelieveld J, Duerr GD, Nieuwenhuijsen M, Daiber A. Environmental risk factors and cardiovascular diseases: a comprehensive expert review. Cardiovascular Research. 2022;118(14):2880-902. https://doi.org/10.1093/cvr/cvab316
Vijayaraghavan K, Baum S, Desai N, Voyce S. Intermediate and long-term residual cardiovascular risk in patients with established cardiovascular disease treated with statins. Frontiers in Cardiovascular Medicine. 2024;10:1308173. https://doi.org/10.3389/fcvm.2023.1308173
Kontush A. Cholesterol, Lipoproteins, and Cardiovascular Health: Separating the Good (HDL), the Bad (LDL), and the Remnant. Hoboken, New Jersey: John Wiley & Sons; 2024. https://doi.org/10.1002/9781394158393
Hadi MK, Abdulkadir MQ, Sahib HA, Dakhel Z. Hydroxy Methylglutaryl-CoA Reductase Inhibitors (Statins), Mechanism of Action, Chemistry, Pharmacokinetics and their Relative Efficacy for Improving the Lipid Profile. ACE Journal of Advance Research in Chemical Sciences. 2021;1(4):52-62.
Balasubramanian R, Maideen NMP. HMG-CoA reductase inhibitors (statins) and their drug interactions involving CYP enzymes, P-glycoprotein and OATP transporters-an overview. Current Drug Metabolism. 2021;22(5):328-341. https://doi.org/10.2174/1389200222666210114122729
Liu T, Zuo R, Wang J, Huangtao Z, Wang B, Sun L, Wang S, Li B, Zhu Z, Pan Y. Cardiovascular disease preventive effects of aspirin combined with different statins in the United States general population. Scientific Reports. 2023;13(1):4585. https://doi.org/10.1038/s41598-023-31739-w
Rosenblit PD. Extreme atherosclerotic cardiovascular disease (ASCVD) risk recognition. Current Diabetes Reports. 2019;19(8):61. https://doi.org/10.1007/s11892-019-1178-6
Rossini E, Biscetti F, Rando MM, Nardella E, Cecchini AL, Nicolazzi MA, Covino M, Gasbarrini A, Massetti M, Flex A. Statins in high cardiovascular risk patients: do comorbidities and characteristics matter? International Journal of Molecular Sciences. 2022;23(16):9326. https://doi.org/10.3390/ijms23169326
Paparodis RD, Bantouna D, Livadas S, Angelopoulos N. Statin therapy in primary and secondary cardiovascular disease prevention. Current Atherosclerosis Reports. 2025;27(1):21. https://doi.org/10.1007/s11883-024-01265-9
Writing Committee, Birtcher KK, Allen LA, Anderson JL, Bonaca MP, Gluckman TJ, Hussain A, Kosiborod M, Mehta LS, Virani SS. 2022 ACC expert consensus decision pathway for integrating atherosclerotic cardiovascular disease and multimorbidity treatment: a framework for pragmatic, patient-centered care: a report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2023;81(3):292-317. Available from: https://www.jacc.org/doi/abs/10.1016/j.jacc.2022.08.754 (Accessed on 5 Mar 2026)
Writing Committee W, Lloyd-Jones DM, Morris PB, Ballantyne CM, Birtcher KK, Covington AM, et al. 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2022;80(14):1366-418. Available from: https://www.jacc.org/doi/abs/10.1016/j.jacc.2022.07.006 (Accessed on 5 Mar 2026)
Chi C-L, Wang J, Yew PY, Lenskaia T, Loth M, Pradhan PM, Liang Y, Kurella P, Mehta R, Robinson JG, Tonellato PJ, Adam TJ. Producing personalized statin treatment plans to optimize clinical outcomes using big data and machine learning. Journal of biomedical informatics. 2022;128:104029. https://doi.org/10.1016/j.jbi.2022.104029
Black AD. Increasing Early Detection of Cardiovascular Disease Risk in Primary Care. Lafayette, Louisiana: University of Louisiana Lafayette; 2024.
Moore A. ASCVD Screening for Adults at Risk for Stroke: Primary Care Integration. Hickory, North Carolina: Lenoir Rhyne University; 2023. Available from: https://lair.lr.edu/server/api/core/bitstreams/152d12bc-6144-42cc-8ca6-79be1cbb5b50/content (Accessed on 5 Mar 2026)
Rehan M, Farooq MI. The Role of Personalized Medicine in Cardiovascular Disease Management. Spectrum of Research and Reviews. 2024;2(1):1-18. Available from: https://thesrr.net/index.php/Journal/article/view/16 (Accessed on 5 Mar 2026)
Behdani B, Kazemi T, Zardast M, Khosravi Bizhaem S, Jafari S. Adherence to the 2018 AHA cholesterol management guideline in hyperlipidemia treatment among adults in an outpatient setting. Frontiers in Cardiovascular Medicine. 2024;11:1340311. https://doi.org/10.3389/fcvm.2024.1340311
Naveed A, Atique R, Saeed HA, Sharif J, Haidar A, Samad A. Cardiovascular Diseases: Understanding the Leading Cause of Death Worldwide. Global Journal of Multidisciplinary Sciences and Arts. 2024;1(1):100-110. https://doi.org/10.70445/gjmdsa.1.1.2024.100-110
Hermel M, Chiou A, Minhas AMK, Inam M, Waldman CE, Youngblood E, Mehta S, Slipczuk L, Sheikh S, Meloche C, Khoja A, Virani SS. Highlights of cardiovascular disease prevention studies presented at the 2023 American Heart Association Scientific Sessions. Current Atherosclerosis Reports. 2024;26(4):119-131. https://doi.org/10.1007/s11883-024-01193-8
Alabi OA. Implementing Statin Therapy in Primary Care for Management of Cardiovascular Risk. Baltimore, Maryland: University of Maryland, Baltimore; 2024. Available from: https://archive.hshsl.umaryland.edu/entities/publication/a30f5296-d7ab-4ad1-a33f-c30c7b05ef49 (Accessed on 5 Mar 2026)
Singh M, McEvoy JW, Khan SU, Wood DA, Graham IM, Blumenthal RS, Mishra AK, Michos E. Comparison of transatlantic approaches to lipid management: the AHA/ACC/Multisociety Guidelines vs the ESC/EAS Guidelines. Mayo Clinic Proceedings; 2020;95(5):998-1014. https://doi.org/10.1016/j.mayocp.2020.01.011
Stone NJ, Greenland P, Grundy SM. Statin usage in primary prevention—comparing the USPSTF recommendations with the AHA/ACC/multisociety guidelines. JAMA Cardiology. 2022;7(10):997-999. https://doi.org/10.1001/jamacardio.2022.2851
Yang Y, Yan T, Wang Y, Zhang Z, Li L, Zhang C, Cao N, Xia Y, Shen Y, Liu K, Fang X, Zhang X, Zhang N. Association of sdLDL-C/LDL-C ratio with atherosclerotic cardiovascular disease: a case-control study. BMC Cardiovascular Disorders. 2025;25(1):430. https://doi.org/10.1186/s12872-025-04871-w
Rosenblit PD. Lowering targeted atherogenic lipoprotein cholesterol goals for patients at “extreme” ASCVD risk. Current Diabetes Reports. 2019;19(12):146. https://doi.org/10.1007/s11892-019-1246-y
Bhatia HS, Rikhi R, Allen TS, Yeang C, Guan W, Garg PK, Tsai MY, Criqui MH, Shapiro MD, Tsimikas S. Lipoprotein (a) and the pooled cohort equations for ASCVD risk prediction: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2023;381:117217. https://doi.org/10.1016/j.atherosclerosis.2023.117217
Gupta K, Kakar TS, Jain V, Gupta M, Al Rifai M, Slipczuk L, Nambi V, Bittner V, Blumenthal RS, Stone NJ, Lavie CJ, Virani SS. Comparing eligibility for statin therapy for primary prevention under 2022 USPSTF recommendations and the 2018 AHA/ACC/multi-society guideline recommendations: from National Health and Nutrition Examination Survey. Progress in Cardiovascular Diseases. 2022;75:78-82. https://doi.org/10.1016/j.pcad.2022.08.007
Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreich PA. Association of statin adherence with mortality in patients with atherosclerotic cardiovascular disease. JAMA Cardiology. 2019;4(3):206-213. 2019;4;(3):206-213. https://doi.org/10.1001/jamacardio.2018.4936
Mulchandani R, Lyngdoh T, Kakkar AK. Statin use and safety concerns: an overview of the past, present, and the future. Expert Opinion on Drug Safety. 2020;19(8):1011-1024. https://doi.org/10.1080/14740338.2020.1796966
Hope HF, Binkley GM, Fenton S, Kitas GD, Verstappen SM, Symmons DP. Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease. PLoS One. 2019;14(1):e0201196. https://doi.org/10.1371/journal.pone.0201196
Tsioufis K, Castellano Vázquez JM, Sykara G, Mondello Malvestiti F, van Vugt J. Real-world evidence for adherence and persistence with atorvastatin therapy. Cardiology and Therapy. 2021;10(2):445-464. https://doi.org/10.1007/s40119-021-00240-8
Rosenberg J, Lampridou S, Moores A, Garfield S, Wingfield D, Judah G. A systematic review uncovering modifiable influences on statin adherence. Patient Preference and Adherence. 2025;19:29-48. https://doi.org/10.2147/PPA.S502645
DOI: https://doi.org/10.33846/hd30505
Refbacks
- There are currently no refbacks.
____________________________________________________________________________________________________________________________________________
Health Dynamics || Open Access Journal || Online version only || Publisher: Knowledge Dynamics || ISSN: 3006-5518 (online) || Contact: healthdynamics.journal@gmail.com; +8801814901991; +6282136364408