Statin therapy: what guideline is best?

  • Mortensen MB & al.
  • JAMA Cardiol
  • 2 Oct 2019

  • International Clinical Digest
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Takeaway

  • Among 5 options, 3 sets of guidelines capture the most patients for statin treatment who later develop atherosclerotic cardiovascular disease (ASCVD).
  • Numbers needed to treat (NNTs) to prevent 1 event are similar among the guidelines.

Why this matters

  • For primary prevention, these authors give preference to the National Institute for Health and Care Excellence (NICE), Canadian Cardiovascular Society (CCS), and American College of Cardiology/American Heart Association (ACC/AHA) guidelines more than those from US Preventive Services Task Force (USPSTF) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). 

Key results

  • By guidelines, sensitivity values for ASCVD events:
    • CCS: 68%;
    • ACC/AHA: 70%;
    • NICE: 68%;
    • USPSTF: 57%; and
    • ESC/EAS: 24%.
  • Specificity values by guidelines:
    • CCS: 59%;
    • ACC/AHA: 60%;
    • NICE: 63%;
    • USPSTF: 72%; and
    • ESC/EAS: 86%.
  • NNT to prevent 1 event under moderate- or high-intensity therapy by guidelines: 
    • CCS: 32 and 21;
    • ACC/AHA: 30 and 20;
    • NICE: 30 and 20;
    • USPSTF: 27 and 18; and
    • ESC/EAS: 29 and 20.
  • Highest capture for statin eligibility was with CCS (44%); lowest was with ESC/EAS (15%).

Study design

  • Population-based cohort study, Denmark, with 45,750 people ages 40-75 years, 2003-2009, with no baseline ASCVD; mean follow-up, 10.9 years.
  • Funding: Aarhus University; others.

Limitations

  • Included only people of European ancestry in a single country.

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