Bittencourt Marcio Sommer, Staniak Henrique Lane, Pereira Alexandre Costa, Santos Itamar S, Duncan Bruce B, Santos Raul D, Blaha Michael J, Jones Steve R, Toth Peter P, Bensenor Isabela M, Lotufo Paulo A
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil.
Clin Cardiol. 2016 Apr;39(4):215-22. doi: 10.1002/clc.22511. Epub 2016 Feb 5.
The new US guidelines for the primary prevention of cardiovascular disease have substantially changed the approach to hyperlipidemia treatment. However, the impact of those recommendations in other populations is limited. In the present study, we evaluated the potential implications of those recommendations in the Brazilian population.
The new U.S. recommendations may increase the proportion of individuals who are candidates for statin therapy.
We included all participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) without known cardiovascular disease. We calculated the indication for statin therapy according to the current Brazilian recommendations and the new US guidelines, using both the 5.0% and the 7.5% risk cutoffs to recommend treatment, and compared their impact in the Brazilian population stratified by age, sex, and race.
Although the current guidelines would recommend treatment for 5499 (39.1%) individuals, the number of individuals eligible for statin therapy increased to 6014 (42.7%) and to 7130 (50.7%) using the 7.5% and 5% cutoffs, respectively (P < 0.001). This difference is more pronounced for older individuals, and virtually all individuals age >70 years would be eligible for statins, whereas the new guidelines would reduce the number of candidates for statin therapy in individuals age <45 years.
The application of the new US guidelines for the use of lipid-lowering medications in a large middle-aged Brazilian cohort would result in a significant increase in the population eligible for statins. This is largely driven by males and older individuals. Additional cost-effectiveness analyses are needed to define the appropriateness of this strategy in the Brazilian population.
美国心血管疾病一级预防新指南已大幅改变高脂血症的治疗方法。然而，这些建议在其他人群中的影响有限。在本研究中，我们评估了这些建议对巴西人群的潜在影响。
美国新建议可能会增加符合他汀类药物治疗条件的个体比例。
我们纳入了巴西成人健康纵向研究（ELSA-Brasil）中所有无已知心血管疾病的参与者。我们根据巴西现行建议和美国新指南计算他汀类药物治疗的适应症，分别使用5.0%和7.5%的风险阈值来推荐治疗，并比较了它们在按年龄、性别和种族分层的巴西人群中的影响。
尽管现行指南会推荐5499名（39.1%）个体接受治疗，但使用7.5%和5%的阈值时，符合他汀类药物治疗条件的个体数量分别增至6014名（42.7%）和7130名（50.7%）（P < 0.001）。这种差异在老年个体中更为明显，几乎所有70岁以上的个体都符合使用他汀类药物的条件，而新指南会减少45岁以下个体中符合他汀类药物治疗条件的人数。
在美国新指南应用于巴西一个大型中年队列中使用降脂药物时，符合他汀类药物治疗条件的人群将显著增加。这在很大程度上由男性和老年个体推动。需要进行额外的成本效益分析来确定该策略在巴西人群中的适用性。
