Key result
2021 ESC guidelines expand primary prevention statin eligibility to ~62% in first-STEMI patients vs prior guidelines.
Why the study?
The impact of the 2021 ESC guidelines on eligibility for primary prevention statins and intensive lipid-lowering treatments after first STEMI was unclear.
Do the 2021 ESC guidelines increase the proportion of patients eligible for primary prevention statins prior to a first STEMI compared to 2019 and 2016 guidelines?
Observational (n=2,757)
Do the 2021 ESC guidelines increase the proportion of patients eligible for primary prevention statins prior to a first STEMI compared to 2019 and 2016 guidelines?
Absolute Event Rate: 61.8% vs 23.6%
p-value: p=< 0.01
The 2021 ESC guidelines significantly improve the theoretical detection and eligibility for statin treatment in individuals at risk for a first STEMI compared to older guidelines.
2021 ESC guidelines expand pre-STEMI statin eligibility; leaves open whether this reduces events in real-world cohorts.
AIMS: The European Society of Cardiology (ESC) has released three consecutive guidelines within 5 years addressing cardiovascular prevention, risk scores, and cholesterol treatment. This study aims to evaluate whether the 2021 ESC guidelines improved the eligibility of individuals for primary prevention statin therapy before their first ST-segment elevation myocardial infarction (STEMI), and for intensive lipid-lowering treatments in secondary prevention. METHODS AND RESULTS: The cardiovascular risk category of 2757 consecutive individuals admitted for a first STEMI was evaluated to assess whether they would have been eligible for primary prevention statins according to 2021 vs. 2019 and 2016 ESC guidelines. Eligibility for intensive lipid-lowering therapy in secondary prevention was assessed according to the real-life follow-up low-density lipoprotein cholesterol (LDL-C) and the expected follow-up LDL-C. More individuals would have been eligible for primary prevention statins according to 2021 and 2019 vs. 2016 guidelines (61.8% vs. 38.7% vs. 23.6%, P < 0.01), a finding observed in both men (62.3% vs. 35.0% vs. 24.9%, P < 0.01) and women (60.2% vs. 50.7% vs. 19.3%, P = 0.18). Only 27% of individuals reached the LDL-C objective of 55 mg/L in secondary prevention: using the ESC stepwise approach, 61.7% were eligible for higher doses of statins, 26.2% for ezetimibe, and 12.1% for a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor (PCSK9i). Based on expected LDL-C reductions, eligibility for a PCSK9i in secondary prevention was greater with 2021 vs. 2016 guidelines (44.5% vs. 22.5%, P < 0.01). CONCLUSION: The 2021 ESC guidelines improved the detection and treatment of individuals at risk for a first myocardial infarction. In secondary prevention, 70% of patients kept LDL-C levels above 55 mg/dL: increasing the statin dose and adding ezetimibe were the most frequently recommended therapeutic actions.
No takes yet. Share an insight, caveat, or question.
Sulman et al. (2022) conducted an observational in First STEMI (n=2,757). 2021 ESC guidelines vs. 2019 and 2016 ESC guidelines was evaluated on Eligibility for primary prevention statins (p=< 0.01). The 2021 ESC guidelines increased eligibility for primary prevention statins compared to 2019 and 2016 guidelines (61.8% vs. 38.7% vs. 23.6%, P<0.01) in patients with a first STEMI.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: