TOPLINE: 

More than three quarters of US adults aged 40-75 years without known atherosclerotic cardiovascular disease (ASCVD) have one or more risk-enhancing factors. The presence of risk-enhancing factors was associated with increased odds of statin use, although this association varied across categories of ASCVD risk and was strongest in high-risk individuals.

METHODOLOGY:

• Researchers conducted a cross-sectional analysis using pooled data (2015-2020) from the National Health and Nutrition Examination Survey (NHANES) to examine the prevalence of risk-enhancing factors and their association with statin use.
• A total of 3111 adults (weighted mean age, 56 years; 52.6% women) without known ASCVD who completed fasting visits at a mobile examination center were included in the analysis.
• Nine risk-enhancing factors were assessed: a family history of premature ASCVD, rheumatoid arthritis, metabolic syndrome, premature menopause, chronic kidney disease, hypercholesterolemia, hypertriglyceridemia, elevated levels of low-density lipoprotein cholesterol, and elevated levels of high-sensitivity C-reactive protein.
• The prevalence of risk-enhancing factors was calculated across age groups and hierarchical categories of ASCVD risk: diabetes (any risk) and low (< 5.0%), borderline (5.0%-7.4%), intermediate (7.5%-19.9%), and high (≥ 20.0%) risk based on pooled cohort equations.

TAKEAWAY:

• Overall, 25.5% of participants had one risk-enhancing factor, 23.1% had two, and 28.2% had three or more; 22.4% of participants were on statins.
• The presence of one or more risk-enhancing factors was associated with greater odds of statin use (adjusted odds ratio [aOR], 2.17; 95% CI, 1.42-3.33).
• Among individual risk-enhancing factors, metabolic syndrome (aOR, 1.87; 95% CI, 1.43-2.45), hypercholesterolemia (aOR, 2.32; 95% CI, 1.56-3.45), hypertriglyceridemia (aOR, 1.58; 95% CI, 1.07-2.32), and a family history of premature ASCVD (aOR, 1.50; 95% CI, 1.03-2.18) were associated with increased odds of statin use, whereas rheumatoid arthritis was associated with lower odds (aOR, 0.45; 95% CI, 0.24-0.84).
• The presence of one or more risk-enhancing factors was associated with a higher predicted probability of statin use in low (7.9 percentage-point difference; 95% CI, 1.9-13.9), intermediate (11.1 percentage-point difference; 95% CI, 1.5-20.7), and high (27.5 percentage-point difference; 95% CI, 14.1-40.9) ASCVD risk categories, but no significant association was noted in the borderline-risk or diabetes categories.

IN PRACTICE:

"The potential benefit of individualizing risk and enhancing patient engagement in cardiovascular risk management by incorporating REFs [risk-enhancing factors] into risk assessment warrants greater clarity on how REFs should be used alongside other advances in cardiovascular risk prediction," the authors wrote.

SOURCE: 

The research was led by Linnea M. Wilson, MPH, of the Division of General Internal Medicine at Beth Israel Deaconess Medical Center in Boston, Massachusetts. The study was published online April 20 in the Journal of General Internal Medicine.

LIMITATIONS: 

The study relied on self-reported NHANES data for some risk-enhancing factors. The cross-sectional design prevented confirmation of risk-enhancing factors across multiple measurements over time. Not all risk-enhancing factors mentioned in guidelines were collected by NHANES, such as pregnancy-related risk markers, which may have led to an underestimation of the overall burden of the factors.

DISCLOSURES:

The study did not receive any specific funding. Some authors reported receiving grants, personal fees, consulting fees, and/or in-kind donations from various sources outside the submitted work. One author reported receiving personal fees from the American Medical Association for serving as an associate editor at JAMA Internal Medicine.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.