Comparison of Swiss and European risk algorithms for cardiovascular prevention in Switzerland

Beuret, Hadrien; Häusler, Nadine; Nanchen, David; Méan, Marie; Marques‐Vidal, Pedro; Vaucher, Julien

doi:10.1177/2047487320906305

Cited by 24 publications

(21 citation statements)

References 23 publications

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“…However, it is also possible that some of the GPs generally used other thresholds than those recommended by the current European guideline, irrespective of individual patients. Some GPs might follow the national [21] rather than the European guidelines, which have been shown, however, to closely overlap [22]. Interestingly, patients treated by older GPs were more often subject to undertreatment, which suggested that older GPs might have followed older guidelines using higher LDL-C treatment thresholds [23].…”

Section: Discussionmentioning

confidence: 99%

Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Rachamin

Markun

Grischott

et al. 2020

JCM

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Guidelines recommend initiation of statins depending on cardiovascular risk and low-density lipoprotein cholesterol (LDL-C) levels. In this retrospective cohort study, we aimed to assess guideline concordance of statin treatment decisions and to find determinants of undertreatment in Swiss primary care in the period 2016–2019. We drew on electronic medical records of 8060 statin-naive patients (50.0% female, median age 59 years) with available LDL-C levels and cardiovascular risk. Guideline concordance was assessed based on the recommendations of the European Society of Cardiology, and multilevel logistic regression was performed to find determinants of undertreatment. We found that statin treatment was initiated in 10.2% of patients during one year of follow up. Treatment decisions were classified as guideline-concordant in 63.0%, as undertreatment in 35.8% and as overtreatment in 1.2%. Among determinants of undertreatment were small deviation from LDL-C treatment thresholds (odds ratio per decrease by 1 mmol/L: 2.09 [95% confidence interval 1.87–2.35]), high compared with very high cardiovascular risk (1.64 [1.30–2.05]), female sex (1.31 [1.05–1.64]), and being treated by older general practitioners (per 10 year decrease: 0.74 [0.61–0.90]). In conclusion, undertreatment of patients at high or very high cardiovascular risk was common, but general practitioners considered cardiovascular risk and LDL-C in their treatment decisions.

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Section: Discussionmentioning

confidence: 99%

Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Rachamin

Markun

Grischott

et al. 2020

JCM

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“…The complete procedure has been described previously. 18 The SHCS was approved by ethical committees of each participating institutions and all participants provided written informed consent. The Institutional Ethics Committee of the University of Lausanne approved the CoLausjPsyCoLaus study and all participants provided written informed consent.…”

Section: Study Participantsmentioning

confidence: 99%

Cardiovascular risk assessment in people living with HIV compared to the general population

Delabays

Cavassini

Damas

et al. 2021

European Journal of Preventive Cardiology

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Aims We prospectively assessed and compared the accuracy of cardiovascular risk scores in people living with HIV (PLWH) and individuals from the general population. Methods and results The Systematic Coronary Risk Evaluation Score 2 (SCORE2), the Pooled Cohort Equations (PCE), and the HIV-specific Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) score were calculated in participants free from atherosclerotic cardiovascular disease (ASCVD) between 2003 and 2009. In total, 6373 [mean age, 40.6 years (SD, 9.9)] PLWH from the Swiss HIV Cohort Study (SHCS) and 5403 [52.8 years (SD, 10.7)] individuals from the CoLaus|PsyCoLaus study were eligible for analysis. We tested discrimination and calibration, and the value of adding HIV-specific factors to scores using the net reclassification improvement (NRI). During mean follow-ups of 13.5 (SD, 4.1) in SHCS and 9.9 (SD, 2.3) years in CoLaus|PsyCoLaus study, 533 (8.4%) and 374 (6.9%) people developed an incident ASCVD, respectively. This translated into age-adjusted incidence rates of 12.9 and 7.5 per 1000 person-year, respectively. In SHCS, SCORE2, PCE, and D:A:D presented comparable discriminative capacities [area under the receiver operating characteristic curve of 0.745 (95% confidence interval, CI, 0.723–0.767), 0.757 (95% CI, 0.736–0.777), and 0.763 (95% CI, 0.743–0.783)]. Adding HIV-specific variables (CD4 nadir and abacavir exposure) to SCORE2 and PCE resulted in an NRI of −0.1% (95% CI, −1.24 to 1, P = 0.83) and of 2.7% (95% CI, 0.3–5.1, P = 0.03), respectively. Conclusions PLWH present a two-fold higher rate of incident ASCVD compared to individuals from the general population. SCORE2 and PCE, which are clinically easier to use (reduced set of variables without adding HIV-specific factors), are valid to predict ASCVD in PLWH.

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“…Both algorithms performed equally well or equally poorly with sensitivities of respectively 52% and 59%. 2 Discrimination and calibration were also similar between the two algorithms. The results also demonstrate the risk related to diabetes mellitus and to chronic kidney disease, illustrating that patients with these conditions should be considered as being at high or very-high risk even if they are asymptomatic.…”

Section: At the Level Of The Individual The Most Appropriatementioning

confidence: 70%

“…In this issue of the European Journal of Preventive Cardiology results are presented comparing Swiss and European risk algorithms for ASCVD prevention that have been recalibrated for Switzerland. 2 Based on results from the CoLaus cohort study the authors determined which model predicted best the incidence of ASCVD during a 10.2-year period. They also assessed statin eligibility.…”

Section: At the Level Of The Individual The Most Appropriatementioning

confidence: 99%

“…In the CoLaus cohort only 9.2 % of the participants were on statins at the study initiation in 2003-2006. 2 In many countries nowadays that proportion is much higher. In Belgium, where statins came on the market in 1990, 1.4 million adults were taking statins in 2012, representing 25% of the population aged 40 years and more; that number has stabilized since then.…”

Section: At the Level Of The Individual The Most Appropriatementioning

confidence: 99%

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On the use of models to estimate the total risk of developing atherosclerotic cardiovascular disease

Backer

2020

European Journal of Preventive Cardiology

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The estimation of the total risk of developing atherosclerotic cardiovascular disease (ASCVD) was introduced in the first recommendations on the prevention of coronary heart disease in clinical practice in 1994 published by a joint task force of the European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS) and the European Society of Hypertension. 1 Nowadays in all guidelines on the prevention of ASCVD the use of standardized risk estimation systems to stratify the asymptomatic, apparently healthy adult population in categories of risk is recommended. The purposes of doing so are multiple:

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Comparison of Swiss and European risk algorithms for cardiovascular prevention in Switzerland

Cited by 24 publications

References 23 publications

Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Cardiovascular risk assessment in people living with HIV compared to the general population

On the use of models to estimate the total risk of developing atherosclerotic cardiovascular disease

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