Comparison of the European and US guidelines for lipid-lowering therapy in primary prevention of cardiovascular disease.

Autor:	Delabays B; Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne 1011, Switzerland., de La Harpe R; Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne 1011, Switzerland., Vollenweider P; Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne 1011, Switzerland., Fournier S; Heart and Vessel Department, Division of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne 1011, Switzerland., Müller O; Heart and Vessel Department, Division of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne 1011, Switzerland., Strambo D; Department of Clinical Neurosciences, Division of Neurology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne 1011, Switzerland., Graham I; School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2 D02 PN40, Ireland., Visseren FLJ; Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, Netherlands., Nanchen D; Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, Lausanne 1011, Switzerland., Marques-Vidal P; Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne 1011, Switzerland., Vaucher J; Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne 1011, Switzerland.
Jazyk:	angličtina
Zdroj:	European journal of preventive cardiology [Eur J Prev Cardiol] 2023 Nov 30; Vol. 30 (17), pp. 1856-1864.
DOI:	10.1093/eurjpc/zwad193
Abstrakt:	Aims: Population-wide impacts of new guidelines in the primary prevention of atherosclerotic cardiovascular disease (ASCVD) should be explored in independent cohorts. Assess and compare the lipid-lowering therapy eligibility and predictive classification performance of 2016 and 2021 European Society of Cardiology (ESC), 2019 American Heart Association/American College of Cardiology (AHA/ACC), and 2022 US Preventive Services Task Force (USPSTF) guidelines. Methods and Results: Participants from the CoLaus|PsyCoLaus study, without ASCVD and not taking lipid-lowering therapy at baseline. Derivation of 10-year risk for ASCVD using Systematic COronary Risk Evaluation (SCORE1), SCORE2 [including SCORE2-Older Persons (SCORE2-OP)], and pooled cohort equation. Computation of the number of people eligible for lipid-lowering therapy based on each guideline and assessment of discrimination and calibration metrics of the risk models using first incident ASCVD as an outcome. Among 4,092 individuals, 158 (3.9%) experienced an incident ASCVD during a median follow-up of 9 years (interquartile range, 1.1). Lipid-lowering therapy was recommended or considered in 40.2% (95% confidence interval, 38.2-42.2), 26.4% (24.6-28.2), 28.6% (26.7-30.5), and 22.6% (20.9-24.4) of women and in 62.1% (59.8-64.3), 58.7% (56.4-61.0), 52.6% (50.3-54.9), and 48.4% (46.1-50.7) of men according to the 2016 ESC, 2021 ESC, 2019 AHA/ACC, and 2022 USPSTF guidelines, respectively. 43.3 and 46.7% of women facing an incident ASCVD were not eligible for lipid-lowering therapy at baseline according to the 2021 ESC and 2022 USPSTF, compared with 21.7 and 38.3% using the 2016 ESC and 2019 AHA/ACC, respectively. Conclusion: Both the 2022 USPSTF and 2021 ESC guidelines particularly reduced lipid-lowering therapy eligibility in women. Nearly half of women who faced an incident ASCVD were not eligible for lipid-lowering therapy. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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