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Editorials |16 January 2018

Comparison Shopping: Guidelines for Statins for Primary Prevention of Cardiovascular Disease

G.B. John Mancini, MD

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This article was published at Annals.org on 2 January 2018.
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Developing clinical guidelines is complex. They must be well-focused for intended users and adhere to accepted standards (1, 2). Participants in their development must be selected to balance methodological and clinical expertise while mitigating conflicts of interest. Professional organizations worldwide have access to skilled experts and scientific evidence yet often arrive at different recommendations. These differences reflect the priorities, preferences, local needs, and practical realities of intended users. Thus, guidelines are well-reasoned, sociopolitical statements based on science. I have witnessed the care, professionalism, and passion required to generate a dyslipidemia guideline (3), but consensus can be elusive and, once achieved, difficult to shake. Herein lies the value of Mortensen and Nordestgaard's study (4).
Mortensen and Nordestgaard applied major recommendations from respected groups to 45 750 persons to determine statin eligibility for primary prevention of cardiovascular disease. They then assessed the actual versus modeled occurrence of atherosclerotic cardiovascular disease (ASCVD) over 10 years. Participants were enrolled in the Copenhagen General Population Study, were aged 40 to 75 years, and had no prior statin use or ASCVD. Reduction of ASCVD risk was calculated assuming a 25% relative risk reduction per 1-mmol/L (38.7-mg/dL) reduction in low-density lipoprotein cholesterol (LDL-C) level. The authors did analyses for 50% and 30% reductions of baseline LDL-C level. They also explored the potential effect of adding weaker recommendations warranting statin therapy as well as a narrower age range (40 to 65 years) to accommodate the age limits of the European Society...
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Mancini GJ. Comparison Shopping: Guidelines for Statins for Primary Prevention of Cardiovascular Disease. Ann Intern Med. 2018;168:145–146. [Epub ahead of print 2 January 2018]. doi: https://doi.org/10.7326/M17-2917

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Published: Ann Intern Med. 2018;168(2):145-146.

DOI: 10.7326/M17-2917

Published at www.annals.org on 2 January 2018

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2018 American College of Physicians
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Related Topics
Cardiology
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Dyslipidemia
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Cardiology, Coronary Risk Factors, Dyslipidemia, Prevention/Screening.

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