title: A comparative analysis of three widely used lipid management guidelines in the EPIC-Norfolk cohort.
abstract: OBJECTIVE
  To compare the impact of three major guidelines for the prevention of cardiovascular disease (CVD).
  
  
  RESULTS
  21,263 men and women aged 39-79 years from the EPIC (European Prospective Investigation of Cancer) Norfolk cohort were retrospectively classified at baseline by statin therapy recommendations according to the NICE, ESC and ATPIII CVD prevention guidelines. Recommendations based on baseline data were related to 10-year follow-up to calculate number of new CVD events that could be prevented by statins, number-needed-to-treat (NNT) and CVD incidence decrease. Statin therapy was recommended to 34% by the NICE guideline, 29% by ESC and 32% by ATPIII. A total of 263 events could potentially have been prevented by application of the NICE guideline, 219 by ESC and 199 by ATPIII. The NNT with statins over 10 years was 27 with the NICE guideline, 28 with ESC and 34 with ATPIII. Application of the NICE guideline could have decreased CVD incidence by 13%; using ESC guidelines the figure is 11% and with ATPIII it is 10%.
  
  
  CONCLUSIONS
  The NICE guideline selected greater percentages of elderly and subjects with prevalent CVD risk factors. It performed best in recommending statins and could have prevented the greatest number of CVD events. With all guidelines, nearly half the subjects who developed a CVD event were not considered eligible for statins at baseline. Less selective prevention strategies need to be explored.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. b.e.colkesen@amc.uva.nl
authors.forename: Ersen B
authors.initials: EB
authors.lastname: Colkesen
authors.forename: Harald T
authors.initials: HT
authors.lastname: Jørstad
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Bart S
authors.initials: BS
authors.lastname: Ferket
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061366:Numbers Needed To Treat; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors