title: Discrepancies between two lipid-lowering guidelines for CVD prevention in seemingly healthy individuals-case study Lebanon.
abstract: BACKGROUND
  In deciding on optimal interventions for cardiovascular disease (CVD) prevention, more than one set of guidelines are available.
  
  
  OBJECTIVE
  The aim of the study was to assess the agreement between the European Society of Cardiology (ESC) 2011 Guidelines for CVD Prevention and the Canadian Cardiovascular Society (CCS) 2009 Guidelines in recommending lipid lowering interventions in a seemingly healthy cohort of Lebanese persons.
  
  
  METHODS
  A nationally representative cohort of Lebanon was identified according to the World Health Organization (WHO) Steps Criteria. From this cohort, a group of 283 adult individuals not known to have chronic illnesses was selected. Using the algorithms present in each guideline, lipid lowering recommendations for each individual were determined. Agreement between the two guideline recommendations was determined using the Kappa test.
  
  
  RESULTS
  As per ESC, 3.9% of the participants required immediate drug therapy, 15.5% should be considered for drug therapy, and 80.1% required lifestyle intervention. As per the CCS, however, 19.4% required drug therapy. The overall level of agreement between the ESC and CCS for recommending lipid lowering was moderate (Kappa 0.77), and better in males (Kappa 0.82). In contrast, 37.5% of females recommended drug therapy as per the CCS guidelines would not be per the ESC guidelines (Kappa 0.63).
  
  
  CONCLUSIONS
  Significant discrepancies exist in recommendations for lipid-lowering therapy between CCS and ESC guidelines when applied to Lebanese individuals, particularly for women. Local healthcare authorities and the WHO should attend to this issue in order to unify treatment approaches and limit disparities in care.
authors.affiliation: Department of Internal Medicine, American University of Beirut, Lebanon ; Vascular Medicine Program, American University of Beirut, Lebanon.
authors.forename: Hussain Ali
authors.initials: HA
authors.lastname: Isma'eel
authors.forename: Bernard
authors.initials: B
authors.lastname: Harbieh
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.forename: Lara
authors.initials: L
authors.lastname: Nasreddine
authors.forename: Farah
authors.initials: F
authors.lastname: Naja
authors.forename: Abla
authors.initials: A
authors.lastname: Sibai
authors.forename: Nada
authors.initials: N
authors.lastname: Adra
authors.forename: Kamal
authors.initials: K
authors.lastname: Badr
authors.forename: Nahla
authors.initials: N
authors.lastname: Hwalla
keywords: Applicability; cardiovascular disease; guidelines; prevention; statins