Martin Bødtker Mortensen1, Børge Grønne Nordestgaard1. 1. From Aarhus University Hospital, Aarhus, and Herlev and Gentofte Hospital and Copenhagen University Hospital, Herlev, and University of Copenhagen, Copenhagen, Denmark.
Abstract
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. Primary Funding Source: Copenhagen University Hospital.
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. Primary Funding Source: Copenhagen University Hospital.
Authors: Lisa Pennells; Stephen Kaptoge; Angela Wood; Mike Sweeting; Xiaohui Zhao; Ian White; Stephen Burgess; Peter Willeit; Thomas Bolton; Karel G M Moons; Yvonne T van der Schouw; Randi Selmer; Kay-Tee Khaw; Vilmundur Gudnason; Gerd Assmann; Philippe Amouyel; Veikko Salomaa; Mika Kivimaki; Børge G Nordestgaard; Michael J Blaha; Lewis H Kuller; Hermann Brenner; Richard F Gillum; Christa Meisinger; Ian Ford; Matthew W Knuiman; Annika Rosengren; Debbie A Lawlor; Henry Völzke; Cyrus Cooper; Alejandro Marín Ibañez; Edoardo Casiglia; Jussi Kauhanen; Jackie A Cooper; Beatriz Rodriguez; Johan Sundström; Elizabeth Barrett-Connor; Rachel Dankner; Paul J Nietert; Karina W Davidson; Robert B Wallace; Dan G Blazer; Cecilia Björkelund; Chiara Donfrancesco; Harlan M Krumholz; Aulikki Nissinen; Barry R Davis; Sean Coady; Peter H Whincup; Torben Jørgensen; Pierre Ducimetiere; Maurizio Trevisan; Gunnar Engström; Carlos J Crespo; Tom W Meade; Marjolein Visser; Daan Kromhout; Stefan Kiechl; Makoto Daimon; Jackie F Price; Agustin Gómez de la Cámara; J Wouter Jukema; Benoît Lamarche; Altan Onat; Leon A Simons; Maryam Kavousi; Yoav Ben-Shlomo; John Gallacher; Jacqueline M Dekker; Hisatomi Arima; Nawar Shara; Robert W Tipping; Ronan Roussel; Eric J Brunner; Wolfgang Koenig; Masaru Sakurai; Jelena Pavlovic; Ron T Gansevoort; Dorothea Nagel; Uri Goldbourt; Elizabeth L M Barr; Luigi Palmieri; Inger Njølstad; Shinichi Sato; W M Monique Verschuren; Cherian V Varghese; Ian Graham; Oyere Onuma; Philip Greenland; Mark Woodward; Majid Ezzati; Bruce M Psaty; Naveed Sattar; Rod Jackson; Paul M Ridker; Nancy R Cook; Ralph B D'Agostino; Simon G Thompson; John Danesh; Emanuele Di Angelantonio Journal: Eur Heart J Date: 2019-02-14 Impact factor: 29.983