title: Real-life evaluation of European and American high-risk strategies for primary prevention of cardiovascular disease in patients with first myocardial infarction.
abstract: OBJECTIVE
  To determine the detection rate (sensitivity) of the high-risk strategy recommended in the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE/UK) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines on cardiovascular disease (CVD) prevention. In particular, to evaluate the ability to ensure statin therapy to contemporary Europeans destined for a first myocardial infarction (MI).
  
  
  METHODS
  393 consecutive statin-naïve, CVD-free patients without diabetes hospitalised for a first MI, 247 of whom were 40-75 years of age. We assumed they had undergone a health check the day before their MI and estimated the predicted risk.
  
  
  METHODS
  Sensitivity of the risk-based eligibility for primary prevention with statins recommended by the guidelines.
  
  
  RESULTS
  All recommended risk scores rank-ordered patients similarly, but the sensitivity of the cut point above which statin therapy should be considered differed substantially. In younger patients (age 40-60), 62% of men and 13% of women qualified for statin therapy by ACC/AHA criteria, compared with only 2% of men and no women using the ESC criteria recommended for most non-Eastern European countries. In those 60-75 years of age, the ACC/AHA guidelines captured all men and 85% of women, compared with 12% and 2%, respectively, using the new ESC guideline. This guideline restricted the eligibility for primary prevention with statins substantially by reclassifying many European countries from 'high-risk' to 'low-risk', whereas the eligibility was expanded in the ACC/AHA and the new NICE/UK guidelines by lowering the decision threshold.
  
  
  CONCLUSIONS
  The 2012 ESC guidelines differ substantially from the 2013 ACC/AHA and 2014 NICE/UK guidelines in ability to secure statin therapy to those destined for a first MI. A great opportunity for primary prevention with statins remains unexploited in Europe.
authors.affiliation: Atherosclerosis Research Unit, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Mortensen
authors.affiliation: Atherosclerosis Research Unit, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Erling
authors.initials: E
authors.lastname: Falk
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005060:Europe; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: PREVENTIVE MEDICINE; VASCULAR MEDICINE