Comparison of Application of the ACC/AHA Guidelines, Adult Treatment Panel III Guidelines, and European Society of Cardiology Guidelines for Cardiovascular Disease Prevention in a European Cohort

Abstract

In this European population aged 55 years or older, proportions of individuals eligible for statins differed substantially among the guidelines. The ACC/AHA guideline would recommend statins for nearly all men and two-thirds of women, proportions exceeding those with the ATP-III or ESC guidelines. All 3 risk models provided poor calibration and moderate to good discrimination. Improving risk predictions and setting appropriate population-wide thresholds are necessary to facilitate better clinical decision making.

2013 ACC/AHA Cholesterol Guideline Versus 2004 NCEP ATP III Guideline in the Prediction of Coronary Artery Calcification Progression in a Korean Population

“…There have been general concerns that the new guidelines overestimate risk and cause too many patients to be eligible for statins 3, 4, 28. However, although the ACC/AHA guidelines recommend statin to considerable population, it is less likely to miss patients who could be beneficiary of statins.…”

“…Compared with the 2004 ATP III guidelines, which involved risk‐based low‐density lipoprotein cholesterol (LDL‐C) thresholds for treatment of coronary heart disease (CHD) alone, the ACC/AHA guidelines focus more on the treatment of absolute cardiovascular risk and was broadened to estimate the 10‐year risk of all atherosclerotic cardiovascular diseases (ASCVDs), including CHD and stroke, using Pooled Cohort Equations 1, 2. The application of the ACC/AHA guidelines largely expanded the number of adults endorsed for statin treatment attributed to a lower cut‐off point of 7.5%, and there have been debates about whether the ACC/AHA guidelines have set too low an ASCVD risk threshold for statin therapy eligibility 3, 4…”

Use and Customization of Risk Scores for Predicting Cardiovascular Events Using Electronic Health Record Data

“…Our finding that the recently proposed PCE had worse calibration than the FRS is consistent with some recent literature that has shown mixed results in validating the PCE in diverse populations. [13][14][15][16]32 The PCE may suffer somewhat from being overfitted to the longitudinal cohort study data from which it was derived, which negatively affects its calibration in new settings. Suboptimal calibration may also be due to improved strategies for managing and treating risk factors, particularly hypertension and hypercholesterolemia.…”

“…11,12 Most efforts to validate cardiovascular risk prediction models use data from longitudinal cohort studies. [13][14][15][16][17][18][19][20] However, in practice, these risk scores are typically used to counsel the set of patients seen routinely in a clinic setting, a population that may be quite different from those enrolled in longitudinal cohort studies. Further, in clinical settings the risk factor values used to predict risk will often be obtained from the electronic health record, in contrast to longitudinal cohort studies, where risk factors are measured using wellestablished protocols.…”

Implementing Cardiovascular Risk Prediction in Clinical Practice: The Future Is Now

“…Some analyses have identified overprediction of risk with the PCE,7, 8, 9, 10, 11 while others have found acceptable calibration, particularly at clinically relevant risk levels near decision thesholds 12, 13, 14, 15. The prevailing uncertainties have led to calls for transformative changes in the way risk prediction algorithms are developed and validated 6, 16.…”