J Gen Intern Med. 2026 Apr 20. doi: 10.1007/s11606-026-10423-5. Online ahead of print.
ABSTRACT
BACKGROUND: Guidelines on primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend considering risk enhancing factors (REFs) to inform decisions on use of lipid-lowering therapies for the 44 million Americans with borderline or intermediate estimated ASCVD risk.
OBJECTIVE: To quantify REF burden and estimate whether REFs are associated with higher likelihood of statin use.
DESIGN: Cross-sectional using National Health and Nutrition Examination Survey pooled 2015 to March 2020.
PARTICIPANTS: Adults aged 40-75 without known ASCVD.
MAIN MEASURES: Nine REFs were measurable in NHANES including family history of premature ASCVD, rheumatoid arthritis, metabolic syndrome, premature menopause, chronic kidney disease and biomarkers of hypercholesteremia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol and elevated C-reactive protein. Prevalence of REFs and association with statin use were calculated overall and across ASCVD treatment categories based on diabetes and 10-year ASCVD risk. KEY RESULTS: In the sample of 3,111 participants (mean age 56 years; 52.6% female) weighted to represent 115.7 million US adults, 77% had at least one REF and 28% had at least three. The most common REFs were elevated high sensitivity C-reactive protein (49.6%) metabolic syndrome (48.3%), and hypertriglyceridemia (18.9%). The presence of any REF was associated with a 2.17 (95% CI, 1.42-3.33) greater odds of statin use. Metabolic syndrome, family history of premature ASCVD, hypertriglyceridemia and hypercholesteremia were associated with greater odds of statin use (aORs ranging from 1.5 to 2.3). The presence of any REF was associated with higher likelihood of statin use in participants with low (< 5%), intermediate (7.5-19%), and high ASCVD risk (≥ 20%), but not borderline ASCVD risk (5-7.4%) or diabetes categories.
CONCLUSIONS: REFs are highly prevalent and inconsistently associated with statin use. Achieving the potential benefit of individualizing ASCVD risk estimates will require clearer guidance on when and how to incorporate REFs into primary prevention prescribing decisions.
PMID:42010102 | DOI:10.1007/s11606-026-10423-5