From Aarhus University Hospital, Aarhus, and Herlev and Gentofte Hospital and Copenhagen University Hospital, Herlev, and University of Copenhagen, Copenhagen, Denmark.
Ann Intern Med. 2018 Jan 16;168(2):85-92. doi: 10.7326/M17-0681. Epub 2018 Jan 2.
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).
To compare the utility of these guidelines for primary prevention of ASCVD.
Observational study of actual ASCVD events during 10 years, followed by a modeling study to estimate the effectiveness of different guidelines.
The Copenhagen General Population Study.
45 750 Danish persons aged 40 to 75 years who did not use statins and did not have ASCVD at baseline.
The number of participants eligible to use statins according to each guideline and the estimated number of ASCVD events that statins could have prevented.
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.
This study was limited to primary prevention in white Europeans.
Guidelines recommending that more persons use statins for primary prevention of ASCVD should prevent more events than guidelines recommending use by fewer persons.
Copenhagen University Hospital.
五个主要组织最近发布了使用他汀类药物预防动脉粥样硬化性心血管疾病（ASCVD）的指南：2013 年，美国心脏病学会/美国心脏协会（ACC/AHA）；2014 年，英国国家卫生与保健优化研究所（NICE）；2016 年，加拿大心血管学会（CCS）、美国预防服务工作组（USPSTF）和欧洲心脏病学会/欧洲动脉粥样硬化学会（ESC/EAS）。
比较这些指南在 ASCVD 一级预防中的应用。
对 10 年内实际 ASCVD 事件进行观察性研究，然后进行建模研究以估计不同指南的有效性。
哥本哈根一般人群研究。
45750 名年龄在 40 至 75 岁之间、未服用他汀类药物且基线时无 ASCVD 的丹麦人。
根据每个指南，符合他汀类药物使用条件的参与者人数以及他汀类药物可能预防的 ASCVD 事件数。
CCS 指南下，44%的参与者有资格使用他汀类药物；ACC/AHA 指南下，42%的参与者有资格使用他汀类药物；NICE 指南下，40%的参与者有资格使用他汀类药物；USPSTF 指南下，31%的参与者有资格使用他汀类药物；ESC/EAS 指南下，15%的参与者有资格使用他汀类药物。使用他汀类药物治疗 10 年，估计可预防的 ASCVD 事件百分比为 CCS 为 34%，ACC/AHA 为 34%，NICE 为 32%，USPSTF 为 27%，ESC/EAS 为 13%。
本研究仅限于白人欧洲人的一级预防。
建议更多人使用他汀类药物进行 ASCVD 一级预防的指南应比建议较少人使用他汀类药物的指南预防更多事件。
哥本哈根大学医院。
