Comparison of Five Major Guidelines for Statin Use in Primary Prevention in a Contemporary General Population

TY - JOUR

T1 - Comparison of Five Major Guidelines for Statin Use in Primary Prevention in a Contemporary General Population

AU - Mortensen, Martin Bødtker

AU - Nordestgaard, Børge Grønne

PY - 2018/1/16

Y1 - 2018/1/16

N2 - Background: Five major organizations recently published guidelines for using statins to prevent atherosclerotic cardiovascular disease (ASCVD): in 2013, the American College of Cardiology/American Heart Association (ACC/AHA); in 2014, the United Kingdom's National Institute for Health and Care Excellence (NICE); and in 2016, the Canadian Cardiovascular Society (CCS), the U.S. Preventive Services Task Force (USPSTF), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). Objective: To compare the utility of these guidelines for primary prevention of ASCVD. Design: Observational study of actual ASCVD events during 10 years, followed by a modeling study to estimate the effectiveness of different guidelines. Setting: The Copenhagen General Population Study. Participants: 45 750 Danish persons aged 40 to 75 years who did not use statins and did not have ASCVD at baseline. Measurements: The number of participants eligible to use statins according to each guideline and the estimated number of ASCVD events that statins could have prevented. Results: The percentage of participants eligible for statins was 44% by the CCS guideline, 42% by ACC/AHA, 40% by NICE, 31% by USPSTF, and 15% by ESC/EAS. The estimated percentage of ASCVD events that could have been prevented by using statins for 10 years was 34% for CCS, 34% for ACC/AHA, 32% for NICE, 27% for USPSTF, and 13% for ESC/EAS. Limitation: This study was limited to primary prevention in white Europeans. Conclusion: Guidelines recommending that more persons use statins for primary prevention of ASCVD should prevent more events than guidelines recommending use by fewer persons.

AB - Background: Five major organizations recently published guidelines for using statins to prevent atherosclerotic cardiovascular disease (ASCVD): in 2013, the American College of Cardiology/American Heart Association (ACC/AHA); in 2014, the United Kingdom's National Institute for Health and Care Excellence (NICE); and in 2016, the Canadian Cardiovascular Society (CCS), the U.S. Preventive Services Task Force (USPSTF), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). Objective: To compare the utility of these guidelines for primary prevention of ASCVD. Design: Observational study of actual ASCVD events during 10 years, followed by a modeling study to estimate the effectiveness of different guidelines. Setting: The Copenhagen General Population Study. Participants: 45 750 Danish persons aged 40 to 75 years who did not use statins and did not have ASCVD at baseline. Measurements: The number of participants eligible to use statins according to each guideline and the estimated number of ASCVD events that statins could have prevented. Results: The percentage of participants eligible for statins was 44% by the CCS guideline, 42% by ACC/AHA, 40% by NICE, 31% by USPSTF, and 15% by ESC/EAS. The estimated percentage of ASCVD events that could have been prevented by using statins for 10 years was 34% for CCS, 34% for ACC/AHA, 32% for NICE, 27% for USPSTF, and 13% for ESC/EAS. Limitation: This study was limited to primary prevention in white Europeans. Conclusion: Guidelines recommending that more persons use statins for primary prevention of ASCVD should prevent more events than guidelines recommending use by fewer persons.

KW - Adult

KW - Aged

KW - Atherosclerosis/epidemiology

KW - Denmark/epidemiology

KW - Female

KW - Guideline Adherence

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use

KW - Male

KW - Middle Aged

KW - Practice Guidelines as Topic

KW - Primary Prevention

KW - Prospective Studies

KW - Societies, Medical

U2 - 10.7326/M17-0681

DO - 10.7326/M17-0681

M3 - Journal article

C2 - 29297004

SN - 0003-4819

VL - 168

SP - 85

EP - 92

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

IS - 2

ER -