New cholesterol guidelines: Worth the wait?

Raymond, Chad; Cho, Leslie; Rocco, Michael; Hazen, Stanley L.

doi:10.3949/ccjm.81a.13161

Cited by 27 publications

(21 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1–3 Concerns have been raised about the validity of the Pooled Cohort Equations cardiovascular risk estimator, which forms the basis of further patient–physician discussions about statin treatment, because some recent observations have noted much higher predicted ASCVD risk (relative to observed ASCVD risk) when used in contemporary cohorts. 4–6 …”

Section: Introductionmentioning

confidence: 99%

Implications of the US Cholesterol Guidelines on Eligibility for Statin Therapy in the Community: Comparison of Observed and Predicted Risks in the Framingham Heart Study Offspring Cohort

Andersson

Enserro

Larson

et al. 2015

JAHA

View full text Add to dashboard Cite

BackgroundConcerns have been raised that the 2013 atherosclerotic cardiovascular disease (ASCVD) risk estimator overpredicts risk in contemporary cohorts. Whether suboptimal calibration will lead to overtreatment with statins is unknown. We investigated the numbers of people eligible for statin treatment in the Framingham Heart Study Offspring Cohort, based on the 2013 cholesterol guidelines, and estimated the proportion that may be overtreated as a result of potential miscalibration of the ASCVD estimator.Methods and ResultsDuring a median follow‐up of 10 years, we observed 285 ASCVD events (8.4%; comprising ischemic stroke, myocardial infarction, and coronary artery disease death) among 3396 men and 112 events (2.9%) among 3838 women. Hosmer–Lemeshow chi‐square statistics were 16.3 in men (340 predicted versus 285 observed events) and 29.1 in women (166 predicted versus 112 observed events). Overprediction predominantly occurred among women in the highest risk decile and among men in the ≥7th risk deciles, for which observed ASCVD event rates were ≥7.5%. In total, 2615 participants (36%; 867 women) were eligible for statins based on the new guidelines. Of these, 171 women (20%) and 154 men (9%) were reclassified downward (as not eligible for statin therapy) using a recalibrated ASCVD estimator. In the latter group, 18 women (10.5%; 95% CI 5.9% to 15.2%) and 11 men (7.1%; 95% CI 3.0% to 11.3%) experienced ASCVD.ConclusionsThe risk estimator overpredicted ASCVD risk but did so mainly among high‐risk participants who would be considered eligible for statin use anyway. Our findings may mitigate concerns regarding the potential impact of miscalibration of the ASCVD estimator in contemporary cohorts.

show abstract

Section: Introductionmentioning

confidence: 99%

Implications of the US Cholesterol Guidelines on Eligibility for Statin Therapy in the Community: Comparison of Observed and Predicted Risks in the Framingham Heart Study Offspring Cohort

Andersson

Enserro

Larson

et al. 2015

JAHA

View full text Add to dashboard Cite

show abstract

“…However, statin discontinuation was also accompanied by a marked worsening in the lipid profile, with clinicallyrelevant increases in LDL cholesterol, which are expected to cause a 25-30% raise in the relative risk of MACE [26]. How the balance of these opposing effects influences CV risk after a brief statin discontinuation is unclear, but if these changes are to be projected long-term, any potential benefit arising from the increased EPC levels would be largely outweighed by the detrimental effects of cholesterol rebound.…”

Section: Discussionmentioning

confidence: 99%

Short-term statin discontinuation increases endothelial progenitor cells without inflammatory rebound in type 2 diabetic patients

Fadini

Rigato

Boscari

et al. 2015

Vascular Pharmacology

View full text Add to dashboard Cite

“…Una reciente revisión crítica 6 de la Guía de ACC/AHA, aunque aplaude el enfoque de utilizar únicamente los datos de ensayos clínicos controlados aleatorizados, aconseja cautela en el estricto seguimiento de las nuevas directrices, y en su lugar insta a los médicos a considerar un «híbrido» de las guías anteriores (con objetivos específicos de c-LDL) y de las nuevas (con énfasis en la evaluación global del RCV y el tratamiento con estatinas de alta intensidad), sin olvidar en la elección del tratamiento «la importancia del juicio clínico, sopesando los beneficios potenciales, los efectos adversos, las interacciones farmacológicas y las preferencias del paciente».…”

Section: Pacientes Con Antecedentes De Enfermedad Vascular Arteriosclunclassified

Dislipidemia y riesgo vascular. Una revisión basada en nuevas evidencias

Pallarés-Carratalá

Pascual-Fuster

Godoy-Rocati

2015

SEMERGEN - Medicina de Familia

View full text Add to dashboard Cite

ARTICLE IN PRESS PALABRAS CLAVE Dislipidemia; Guías clínicas; Riesgo cardiovascularResumen La dislipidemia es uno de los principales factores de riesgo de cardiopatía isquémica, primera causa de mortalidad en el mundo. Realizar una detección temprana y una intervención terapéutica precoz son elementos clave a la hora de establecer una adecuada prevención de una enfermedad cardiovascular. Debemos conocer el arsenal terapéutico de que disponemos para su adecuada utilización en cada una de las situaciones clínicas que puedan presentar nuestros pacientes. En los últimos 3 años, la proliferación de múltiples guías para el manejo clínico del paciente dislipidémico con aparentes mensajes contradictorios en relación con la consecución de los objetivos de control llegan a confundir a los médicos. En esta revisión se pretende ofrecer una visión actualizada de la situación de la dislipidemia, partiendo del posicionamiento de las guías tanto europeas como americanas, pasando por diferentes situaciones de riesgo y finalizando con el concepto de dislipidemia aterogénica, reconocido factor de riesgo cardiovascular. © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. Todos los derechos reservados. KEYWORDS Dyslipidaemia; Clinical guidelines; Cardiovascular risk Dyslipidaemia and vascular risk. A new evidence based reviewAbstract Dyslipidaemia is one of the major risk factors for ischaemic heart disease, the leading cause of death worldwide. Early detection and therapeutic intervention are key elements in the adequate prevention of cardiovascular disease. It is essential to have knowledge of the therapeutic arsenal available for their appropriate use in each of the clinical situations that * Autor para correspondencia.

show abstract

New cholesterol guidelines: Worth the wait?

Cited by 27 publications

References 31 publications

Implications of the US Cholesterol Guidelines on Eligibility for Statin Therapy in the Community: Comparison of Observed and Predicted Risks in the Framingham Heart Study Offspring Cohort

Implications of the US Cholesterol Guidelines on Eligibility for Statin Therapy in the Community: Comparison of Observed and Predicted Risks in the Framingham Heart Study Offspring Cohort

Short-term statin discontinuation increases endothelial progenitor cells without inflammatory rebound in type 2 diabetic patients

Dislipidemia y riesgo vascular. Una revisión basada en nuevas evidencias

Contact Info

Product

Resources

About