[Comparison of international recommendations for the recognition of asymptomatic high risk patients for a heart attack in Germany].
The recommendations of the International Task Force for the Prevention of Coronary Heart Disease/International Atherosclerosis Society (ITF/IAS), the US-American Adult Treatment Panel III of the National Cholesterol Education Programs (ATP III) and the 3rd Joint European Guidelines (3JE) for the prevention coronary heart disease (CHD) show good agreement in tertiary prevention. All three guidelines recommend that patients with manifest CHD should have a blood pressure below 140/90 mm Hg and LDL-cholesterol below 2.6 mmol/l (100 mg/dl). By contrast, the three recommendations differ with respect to the prevention of cardiovascular events in asymptomatic high risk patients (secondary prevention), notably in the strategy to be used for risk assessment. Both the ITF/IAS guidelines and the 3JE guidelines can be adapted and realized in the various European countries. We therefore compared the prognostic values of the three recommendations by applying them to the data of male participants of the Prospective Cardiovascular Munster (PROCAM) Study. The ITF/IAS recommendations show the highest specificity (94.5%), positive predictive value (32.0%) and diagnostic efficacy (90.5%); the 3JE guidelines have the highest sensitivity (64.6%) but lowest specificity (77.9%), positive predictive value (17.5%) and diagnostic efficacy (77.0%). The application of the 3JE recommendations would target 25% of German men aged 35-65 years as cardiovascular high risk patients, by contrast to 7.5% through application of the ITF/IAS guidelines. In view of the limited resources in the public health systemthe application of the ITF/IAS guidelines in Germany appears more appropriate.
von Eckardstein
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Institut für Klinische Chemie, Universitätsspital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. Arnold.voneckardstein@usz.ch
Schulte
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H
Assmann
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D000328:Adult; D000368:Aged; D000465:Algorithms; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis*; D001794:Blood Pressure / Q000502:physiology; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
D008078:Cholesterol, LDL