Cardiovascular Risk Estimation and Eligibility for Statins in Primary Prevention Comparing Different Strategies

Recommendations for statin use for primary prevention of coronary heart disease (CHD) are based on estimation of the 10-year CHD risk. It is unclear which risk algorithm and guidelines should be used in European populations. Using data from a population-based study in Switzerland, we first assessed...

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Bibliographic Details
Published in:	The American journal of cardiology 2009-04, Vol.103 (8), p.1089-1095
Main Authors:	Nanchen, David, MD, Chiolero, Arnaud, MD, MSc, Cornuz, Jacques, MD, MPH, Marques-Vidal, Pedro-Manuel, MD, PhD, Firmann, Mathieu, MD, Mooser, Vincent, MD, Paccaud, Fred, MD, MSc, Waeber, Gérard, MD, Vollenweider, Peter, MD, Rodondi, Nicolas, MD, MAS
Format:	Article
Language:	eng
Subjects:	Adult Aged Atherosclerosis (general aspects, experimental research) Biological and medical sciences Blood and lymphatic vessels Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Coronary Disease - prevention & control Female Heart Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Male Medical sciences Middle Aged Preventive medicine Risk Assessment Risk factors Statins Switzerland
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Summary:	Recommendations for statin use for primary prevention of coronary heart disease (CHD) are based on estimation of the 10-year CHD risk. It is unclear which risk algorithm and guidelines should be used in European populations. Using data from a population-based study in Switzerland, we first assessed 10-year CHD risk and eligibility for statins in 5,683 women and men 35 to 75 years of age without cardiovascular disease by comparing recommendations by the European Society of Cardiology without and with extrapolation of risk to age 60 years, the International Atherosclerosis Society, and the US Adult Treatment Panel III. The proportions of participants classified as high-risk for CHD were 12.5% (15.4% with extrapolation), 3.0%, and 5.8%, respectively. Proportions of participants eligible for statins were 9.2% (11.6% with extrapolation), 13.7%, and 16.7%, respectively. Assuming full compliance to each guideline, expected relative decreases in CHD deaths in Switzerland over a 10-year period would be 16.4% (17.5% with extrapolation), 18.7%, and 19.3%, respectively; the corresponding numbers needed to treat to prevent 1 CHD death would be 285 (340 with extrapolation), 380, and 440, respectively. In conclusion, the proportion of subjects classified as high risk for CHD varied over a fivefold range across recommendations. Following the International Atherosclerosis Society and the Adult Treatment Panel III recommendations might prevent more CHD deaths at the cost of higher numbers needed to treat compared with European Society of Cardiology guidelines.
ISSN:	0002-9149 1879-1913