Applying the CCS and ACC/AHA guidelines for primary prevention of ASCVD was estimated to prevent 34% of events over 10 years, compared with 32% for NICE, 27% for USPSTF, and 13% for ESC/EAS.
Observational (n=45,750)
How do five major guidelines for statin use in primary prevention compare in terms of eligibility and estimated ASCVD events prevented in a contemporary general population?
Guidelines recommending broader statin eligibility for primary prevention (like CCS and ACC/AHA) are estimated to prevent more ASCVD events than more restrictive guidelines (like ESC/EAS).
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.
Mortensen et al. (2018) conducted an observational in Atherosclerotic cardiovascular disease (ASCVD) (n=45,750). Statin eligibility guidelines (CCS, ACC/AHA, NICE, USPSTF, ESC/EAS) was evaluated on Estimated percentage of ASCVD events that could have been prevented by using statins for 10 years. Applying the CCS and ACC/AHA guidelines for primary prevention of ASCVD was estimated to prevent 34% of events over 10 years, compared with 32% for NICE, 27% for USPSTF, and 13% for ESC/EAS.