title: Comparing Guidelines for Statin Treatment in Canada and the United States.
abstract: BACKGROUND
  New guidelines for cardiovascular disease risk assessment and statin eligibility have recently been published in the United States by the American College of Cardiology and the American Heart Association (ACC-AHA). It is unknown how these guidelines compare with the Canadian Cardiovascular Society (CCS) recommendations.
  
  
  RESULTS
  Using data from the Canadian Health Measures Survey 2007-2011, we estimated the cardiovascular disease risk and proportion of the Canadian population, aged 40 to 75 years without cardiovascular disease, who would theoretically be eligible for statin treatment under both the CCS and ACC-AHA guidelines. The survey sample used (n=1975) represented 13.1 million community dwelling Canadians between the ages of 40 and 75 years. In comparing the CVD risk assessment methods, we found that calculated CVD risk was higher based on the CCS guidelines compared with the ACC-AHA guidelines. Despite this, a similar proportion and number of Canadians would be eligible for statin treatment under the 2 sets of recommendations. Some discordance in recommendations was found within subgroups of the population, with the CCS guidelines recommending more treatment for individuals who are younger, with a family history of CVD, or with chronic kidney disease. The ACC-AHA recommend more treatment for people who are older (age 60+ years). These results likely overestimate the treatment rate under both guidelines because, in primary prevention, a clinician-patient discussion must occur before treatment and determines uptake.
  
  
  CONCLUSIONS
  Implementing the ACC-AHA lipid treatment guidelines in Canada would not result in an increase in individuals eligible for statin treatment. In fact, the proportion of the population recommended for statin treatment would decrease slightly and be targeted at different subgroups of the population.
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada (D.A.H., T.B., D.G.M.).
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hennessy
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada (D.A.H., T.B., D.G.M.).
authors.forename: Tracey
authors.initials: T
authors.lastname: Bushnik
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada (D.A.H., T.B., D.G.M.) Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.G.M.) C.T. Lamont Primary Health Care Research Centre and Bruyere Research Institute, Ottawa, Ontario, Canada (D.G.M.) Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.G.M.) Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa, Ontario, Canada (D.G.M.).
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.affiliation: Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.).
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004608:Eligibility Determination; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000592:standards; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D011314:Preventive Health Services; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: cardiovascular disease; risk assessment; statin eligibility; treatment guidelines