In 2019, primary prevention recommendations expanded statin eligibility consideration to individuals at borderline to intermediate risk for atherosclerotic cardiovascular disease (ASCVD) in the presence of a risk-enhancing factor (REF). However, it was unknown how many US adults were affected by these guidelines, particularly those considered to be at borderline to intermediate risk for ASCVD. To ascertain the current prevalence of statin usage and eligibility among US people with a low, borderline, moderate, or high ten-year risk of ASCVD in the context of ASCVD risk factors.

From 2015 to 2018, researchers included participants aged 20 years old from the National Health and Nutrition Examination Survey. The Pooled Cohort Equations defined ten-year ASCVD risk as follows: low 5%, borderline 5-7.5%, intermediate 7.5-20%, and high 20%. In each risk group, the weighted prevalence of statin usage was estimated. Weighted logistic regression was used to examine the relationship between the presence of risk-enhancing characteristics and statin usage across ASCVD risk strata.

The average (SE) age of the 1,350 participants (representing 37,705,137 US people) was 58 (0.6) years. These 39%, 15%, 31%, and 15% were in the low, borderline, intermediate, and high ASCVD risk categories, respectively. Adults with borderline and moderate ASCVD risk had at least one risk-enhancing factor in 89% and 90% of cases, respectively. About 88% and 91% of these people were not taking a statin, respectively. Despite a significant prevalence of risk-enhancing variables, a considerable number of persons with borderline/intermediate ASCVD risk were not taking a statin.