Comparison of Five Major Guidelines for Statin Use in Primary Prevention in a Contemporary General Population

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Background:Five major organizations recently published guidelines for using statins to prevent atherosclerotic cardiovascular disease (ASCVD): in 2013, the American College of Cardiology/American Heart Association (ACC/AHA); in 2014, the United Kingdom's National Institute for Health and Care Excellence (NICE); and in 2016, the Canadian Cardiovascular Society (CCS), the U.S. Preventive Services Task Force (USPSTF), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS).Objective:To compare the utility of these guidelines for primary prevention of ASCVD.Design:Observational study of actual ASCVD events during 10 years, followed by a modeling study to estimate the effectiveness of different guidelines.Setting:The Copenhagen General Population Study.Participants:45 750 Danish persons aged 40 to 75 years who did not use statins and did not have ASCVD at baseline.Measurements:The number of participants eligible to use statins according to each guideline and the estimated number of ASCVD events that statins could have prevented.Results:The percentage of participants eligible for statins was 44% by the CCS guideline, 42% by ACC/AHA, 40% by NICE, 31% by USPSTF, and 15% by ESC/EAS. The estimated percentage of ASCVD events that could have been prevented by using statins for 10 years was 34% for CCS, 34% for ACC/AHA, 32% for NICE, 27% for USPSTF, and 13% for ESC/EAS.Limitation:This study was limited to primary prevention in white Europeans.Conclusion:Guidelines recommending that more persons use statins for primary prevention of ASCVD should prevent more events than guidelines recommending use by fewer persons.Primary Funding Source:Copenhagen University Hospital.

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