Davood Khalili1, Samaneh Asgari2, Farzad Hadaegh3, Ewout W Steyerberg4, Kazem Rahimi5, Noushin Fahimfar6, Fereidoun Azizi7. 1. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: fzhadaegh@endocrine.ac.ir. 4. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. 5. The George Institute for Global Health, University of Oxford, Oxford, United Kingdom. 6. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 7. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
BACKGROUND: The ACC/AHA released a new guideline on the assessment of cardiovascular risk and management of hypercholesterolemia that some controversy exists concerning its usefulness. We examined the clinical usefulness of this guideline in a high incidence population using novel measures. METHODS: First, we validated the new risk equation in a cohort of 2372 men and 2781 women aged 40-75 years. Then, high risk individuals for cardiovascular diseases (CVDs) were identified according to the ACC/AHA guideline at baseline (as a predictor) and CVD outcomes were detected during a 10-year follow-up. Discrimination of the guideline was quantified and the quality of decisions was evaluated by Net Benefit Fraction index considering the harm, for false-positive, and benefit, for true-positive predictions. Finally, net number needed to treat (NNT) for statin was estimated, using test tradeoff index, in diabetic and non-diabetic subjects. RESULTS: During follow-up, 726 CVD events including 298 hard CVDs occurred. The equation overestimated the risk by 57% in men and 48% in women. Based on the guideline, 73% of men and 44% of women were eligible for statin therapy. The lowest sensitivity was detected for intensive treatment in non-diabetic subgroups (82% in men and 41% in women; corresponding specificity, 52% and 90% respectively). The guideline had a significant net benefit for both moderate and intensive treatment, which resulted in estimated NNTs ranged 5-55; however, net benefit of intensive therapy was uncertain in non-diabetic women. CONCLUSIONS: We objectively showed that the ACC/AHA recommendations could be useful in our population but with some overtreatment in women.
BACKGROUND: The ACC/AHA released a new guideline on the assessment of cardiovascular risk and management of hypercholesterolemia that some controversy exists concerning its usefulness. We examined the clinical usefulness of this guideline in a high incidence population using novel measures. METHODS: First, we validated the new risk equation in a cohort of 2372 men and 2781 women aged 40-75 years. Then, high risk individuals for cardiovascular diseases (CVDs) were identified according to the ACC/AHA guideline at baseline (as a predictor) and CVD outcomes were detected during a 10-year follow-up. Discrimination of the guideline was quantified and the quality of decisions was evaluated by Net Benefit Fraction index considering the harm, for false-positive, and benefit, for true-positive predictions. Finally, net number needed to treat (NNT) for statin was estimated, using test tradeoff index, in diabetic and non-diabetic subjects. RESULTS: During follow-up, 726 CVD events including 298 hard CVDs occurred. The equation overestimated the risk by 57% in men and 48% in women. Based on the guideline, 73% of men and 44% of women were eligible for statin therapy. The lowest sensitivity was detected for intensive treatment in non-diabetic subgroups (82% in men and 41% in women; corresponding specificity, 52% and 90% respectively). The guideline had a significant net benefit for both moderate and intensive treatment, which resulted in estimated NNTs ranged 5-55; however, net benefit of intensive therapy was uncertain in non-diabetic women. CONCLUSIONS: We objectively showed that the ACC/AHA recommendations could be useful in our population but with some overtreatment in women.
Authors: Noushin Fahimfar; Akbar Fotouhi; Mohammad Ali Mansournia; Reza Malekzadeh; Nizal Sarrafzadegan; Fereidoun Azizi; Marjan Mansourian; Sadaf G Sepanlou; Mohammad Hassan Emamian; Farzad Hadaegh; Hamidreza Roohafza; Hassan Hashemi; Hossein Poustchi; Akram Pourshams; Tahereh Samavat; Maryam Sharafkhah; Mohammad Talaei; David Van Klaveren; Ewout W Steyerberg; Davood Khalili Journal: Int J Health Policy Manag Date: 2022-02-01
Authors: Johanna A Damen; Romin Pajouheshnia; Pauline Heus; Karel G M Moons; Johannes B Reitsma; Rob J P M Scholten; Lotty Hooft; Thomas P A Debray Journal: BMC Med Date: 2019-06-13 Impact factor: 8.775