Comparison of current guidelines for primary prevention of coronary heart disease

Broedl, Uli C.; Geiss, H.C.; Parhofer, Klaus G.

doi:10.1046/j.1525-1497.2003.20207.x

Cited by 28 publications

(20 citation statements)

References 30 publications

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“…11,12 A Swiss study using the PCE and European SCORE risk estimates found that more adults qualified for statin therapy based on the U.S. PCE 10-year predicted risk than under the European guidelines. 6 This finding is not surprising, given the ACC/AHA and ESC/EAS guidelines use different risk thresholds for statin recommendations.…”

Section: Discussionmentioning

confidence: 99%

Population Effect of Differences in Cholesterol Guidelines in Eastern Europe and the United States

et al. 2016

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IMPORTANCE The American College of Cardiology/American Heart Association (ACC/AHA) guidelines for management of blood cholesterol and current European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines differ in how they identify adults in need of statin therapy; furthermore, it is unclear how this difference translates into numbers and characteristics of patients recommended for treatment. OBJECTIVE To determine the impact of the ACC/AHA and ESC/EAS cholesterol guidelines when applied to a population-based sample. DESIGN, SETTING, AND PARTICIPANTS We utilized nationally representative data for all adults ages 40–65 from the 2007–2012 National Health and Nutrition Examination Surveys for the U.S. (n=3,055) and from the 2001 Nadciśnięnie Tętnicze w Polsce (NATPOL) survey for Poland (n=1,060). MAIN OUTCOME MEASURES The number and characteristics of adults recommended for statin therapy under ACC/AHA and ESC/EAS guidelines were evaluated, and characteristics compared between adults with discordant recommendations. RESULTS In the U.S., 43.8% (95% confidence interval [CI] 40.9–46.7%) of adults under ACC/AHA and 39.1% (95% CI 36.4–41.8%) under ESC/EAS would be recommended for statin therapy. In Poland, 49.9% (95% CI 46.9–52.9%) of adults would be recommended under ACC/AHA compared with 47.6% (95% CI 44.6–50.7%) under ESC/EAS. Among individuals free of cardiovascular disease (CVD) and not currently on statins, 11.0% of U.S. and 10.5% of Polish adults had discordant guideline recommendations. Compared to those recommended by ESC/EAS and not ACC/AHA, those recommended by ACC/AHA only had less chronic kidney disease (CKD); however, these individuals were also more likely to smoke, have lower high-density lipoprotein cholesterol levels, and higher predicted 10-year CVD risks. CONCLUSIONS AND RELEVANCE Despite differences in the ACC/AHA and EAS/ESC guidelines, the numbers of adults aged 40–65 recommended for cholesterol-lowering therapy under each guideline were similar when applied to nationwide representative samples from both the U.S. and Poland. Discordant recommendations were driven by differences in the risk equations used in the two guidelines and different recommendations for adults with CKD.

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Section: Discussionmentioning

confidence: 99%

Population Effect of Differences in Cholesterol Guidelines in Eastern Europe and the United States

et al. 2016

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“…The basis of the diagnostic pyramid described was a clinical examination, the patient's history, and the use of established risk scores, such as those used in the Framingham 27 and PROCAM (prospective cardiovascular Munster) studies. 28 Since these allow for calculation of relative risk only, implying that only a certain percentage of a patient population obviously is at risk, additional diagnostic efforts are required to characterise the vulnerable patient further.…”

Section: Non-invasive Determination Of Plaque Morphology By Msctmentioning

confidence: 99%

Non-invasive evaluation of atherosclerosis with contrast enhanced 16 slice spiral computed tomography: results of ex vivo investigations

Schroeder

Kuettner²,

Wojak³

et al. 2004

Heart

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Objective: To evaluate the diagnostic accuracy of 16 slice computed tomography (CT) in determining plaque morphology and composition in an experimental setting. The results were compared with histopathological analysis as the reference standard. Methods: Nine human popliteal arteries derived from amputations because of atherosclerotic disease were investigated with multislice spiral CT (MSCT). Atherosclerotic lesions were morphologically classified (completely or partially occlusive, concentric, eccentric), and tissue densities were determined within these plaques. In addition, vessel dimensions were quantitatively measured. Conclusions: 16 slice CT was found to be a reliable non-invasive imaging technique for assessing atherosclerotic plaque morphology and composition. Although calcified lesions can be differentiated from non-calcified lesions, the diagnostic accuracy in further subclassifying non-calcified plaques as lipid rich and fibrotic is low, even under experimental conditions.

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“…Current guidelines in the world recommend lipid-lowering therapy by specific drugs, if the absolute risk exceeds a certain threshold (18). The threshold is 20% over 10 years according to the joint European Societies guidelines (4, 5) and 15% over 10 years according to the joint British guidelines (6).…”

Section: Discussionmentioning

confidence: 99%

Risk Evaluation of Coronary Heart Disease and Cerebrovascular Disease by the Japan Atherosclerosis Society Guidelines 2002 Using the Cohort of the Holicos-PAT Study

Koizumi

Shimizu

Miyamoto³

et al. 2005

JAT

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Our purpose in this study was to evaluate the new JAS guidelines as a risk assessment tool in Japanese patients with hypercholesterolemia, using the cohort of the Holicos-PAT study. The Holicos-PAT study was designed as a prospective observational study. 2039 patients were followed with or without pravastatin for 5 years. We assessed coronary heart disease (CHD) and cerebrovascular disease (CVD) risks by the patient categories described in the JAS guidelines. In the Holicos-PAT study, the primary endpoints were CHD, and the secondary endpoints were CVD and total mortality. CHD event includes onset and worsening of angina pectoris, performing CABG or PTCA, non-fatal and fatal myocardial infarction, and death from CHD including heart death and sudden death. CVD events are onset or recurrence of cerebral infarction, onset of cerebral hemorrhage, and death from cerebral infarction or hemorrhage. The event rates were calculated by the person-years method, and the differences in event rates between category groups were analyzed by chi-square test. The event rates of CHD in Category A, B1, B2, B3, B4 and C, were 1.1, 4.0, 2.8, 5.7, 18.2 and 38.8 per 1,000 person-years. The rates of CHD events in the higher risk category groups, Category B4 group (p = 0.004 in whole patients) and C group (p < 0.001 in whole patients), were significantly higher than that in the combined category groups A + B1 + B2. The event rates of CVD in Category A, B1, B2, B3, B4 and C, were 2.1, 1.8, 1.8, 0.6, 10.8 and 6.4 per 1,000 person-years. The event rates of CHD in men were significantly higher than those in women, in categories B4 (p < 0.001) and C (p < 0.001). From these results, each category classified by accumulation of risk factors, showed increasing event rates of CHD and CVD. The categories in the JAS guidelines are useful to assess CHD and CVD risk in Japanese patients with hypercholesterolemia. However, the risk evaluation by the JAS guideline categories may underestimate the risk in men and overestimate it in women. J Atheroscler Thromb, 2005; 12: 48-52.

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Comparison of current guidelines for primary prevention of coronary heart disease

Cited by 28 publications

References 30 publications

Population Effect of Differences in Cholesterol Guidelines in Eastern Europe and the United States

Population Effect of Differences in Cholesterol Guidelines in Eastern Europe and the United States

Non-invasive evaluation of atherosclerosis with contrast enhanced 16 slice spiral computed tomography: results of ex vivo investigations

Risk Evaluation of Coronary Heart Disease and Cerebrovascular Disease by the Japan Atherosclerosis Society Guidelines 2002 Using the Cohort of the Holicos-PAT Study

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