Martin Bødtker Mortensen, MD, PhD; Børge Grønne Nordestgaard, MD, DMSc
Acknowledgment: The authors thank the staff and participants of the CGPS for their contributions.
Financial Support: By Herlev and Gentofte Hospital, Copenhagen University Hospital, Aarhus University, and the Copenhagen County Foundation.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0681.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Mortensen (e-mail, Martin.email@example.com). Data set: Not available, because this is not allowed by the Danish Data Protection Agency.
Requests for Single Reprints: Børge G. Nordestgaard, MD, DMSc, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Mortensen: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Dr. Nordestgaard: Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
Author Contributions: Conception and design: M.B. Mortensen, B.G. Nordestgaard.
Analysis and interpretation of the data: M.B. Mortensen, B.G. Nordestgaard.
Drafting of the article: M.B. Mortensen.
Critical revision of the article for important intellectual content: M.B. Mortensen, B.G. Nordestgaard.
Final approval of the article: M.B. Mortensen, B.G. Nordestgaard.
Provision of study materials or patients: B.G. Nordestgaard.
Statistical expertise: M.B. Mortensen, B.G. Nordestgaard.
Obtaining of funding: B.G. Nordestgaard.
Administrative, technical, or logistic support: B.G. Nordestgaard.
Collection and assembly of data: M.B. Mortensen, B.G. Nordestgaard.
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.
Mortensen MB, Nordestgaard BG. Comparison of Five Major Guidelines for Statin Use in Primary Prevention in a Contemporary General Population. Ann Intern Med. 2018;168:85–92. [Epub ahead of print 2 January 2018]. doi: https://doi.org/10.7326/M17-0681
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Published: Ann Intern Med. 2018;168(2):85-92.
Published at www.annals.org on 2 January 2018
Cardiology, Coronary Risk Factors, Dyslipidemia.
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