European guidelines not doing enough to encourage statin therapy
A review of guidelines on the use of statins for primary prevention suggest that US, Canadian and UK guidelines, which recommend lower thresholds for people to receive statins, are more effective than European recommendations.
Danish researchers used the Copenhagen General Population Study cohort to estimate the percentage of Danes who would be eligible for statin therapy under each guideline. The population included 45,750 Danish adults aged between 40-75 who did not use statins and did not have atherosclerotic CVD (nonfatal MI, fatal coronary heart disease, and stroke) at baseline.
The researchers modelled the number of participants eligible to use statins according to each guideline (Table) and the estimated number of ASCVD events that statins could have prevented. Statin therapy as directed by the ACC/AHA guideline and the CCS could have prevented the 34% of the atherosclerotic cardiovascular disease events if taken for 10 years, with 32% prevented by the NICE recommendations and 27% by the USPSTF guideline. The EAS guideline would only have prevented 13%.
The study authors said that, given the well-documented safety and low cost of statins, the results show that the CCS, ACC/AHA, and NICE guidelines are preferable because of their prevention of more events. These three guidelines reduce atherosclerotic cardiovascular disease events by roughly a third during a 10-year period. However, it is still unclear whether these guidelines are followed in the real world.
Guidelines for using statins to prevent atherosclerotic cardiovascular disease
|Guideline assessed||% of patients eligible for statin therapy|
2013 American College of Cardiology/American Heart Association (ACC/AHA)
2014 UK NICE
2016 Canadian Cardiovascular Society (CCS)
2016 US Preventive Services Task Force (USPSTF),
|2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS).||15%|
The study suggests that some guidelines may need to be updated in order to assign statin therapy to more patients to prevent more cardiovascular events.
Dr Chris Arden, Editor-in-Chief of the PCCJ commented, "The statin primary prevention analysis is reassuring as there is correlation between the populations identified as being at risk using the various CVD risk scoring tools and outcomes. However the authors do highlight the heterogeneity of the different populations and application of different CVD risk calculators. The main challenge the study presents is in achieving physician and, more importantly, patient buy-in to the evidence base, which is something we have not achieved successfully to date. It is likely that more education and awareness of the benefits of lipid modification, together with other lifestyle interventions (such as reducing sugar/salt intake, weight etc.) will also have a positive impact in improving longer term CVD outcomes."