title: Change in calculated cardiovascular risk due to guideline revision: A cross-sectional study in the Netherlands.
abstract: BACKGROUND
  Guidelines and accompanying risk charts concerning cardiovascular risk management (CVRM) are regularly revised worldwide.
  
  
  OBJECTIVE
  To evaluate whether revision of the Dutch CVRM guideline has led to the reclassification of patients and, accordingly, to changes in drug recommendations.
  
  
  METHODS
  All medical records (year 2011) of patients aged 40-65 years with no history of cardiovascular disease (CVD) but using antihypertensive and/or lipid-lowering drugs, were selected from the Registration Network of General Practices associated with Leiden University Medical Center. Multiple imputation techniques for missing determinants were used. The individual cardiovascular risk was calculated and the resulting drug recommendation was assessed according to both the 2006 and 2012 versions of the guideline.
  
  
  RESULTS
  In total, 2075 patients were selected, of whom 1248 fulfilled the guideline criteria (systolic blood pressure 115-180 mmHg and total cholesterol/high-density-lipoprotein-cholesterol ratio 3.5-8). According to the 2012 guideline, 58.2% of the patients had low risk and 249 patients (20.0%) shifted to a different risk category. For 150 of these patients (12.0%), this category shift implied a shift in drug recommendation. The probability of shifting in drug recommendation increased with increasing age, cholesterol level, and blood pressure, and by being male.
  
  
  CONCLUSIONS
  Guideline revision may have important implications: based on identical values for risk factors, according to the latest revision of the Dutch CVRM guideline 20% of patients shifted in risk category and 12% of the patients shifted in drug recommendation.
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , the Netherlands.
authors.forename: Clare H
authors.initials: CH
authors.lastname: Luymes
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , the Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: de Ruijter
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , the Netherlands.
authors.forename: Rosalinde Ke
authors.initials: RK
authors.lastname: Poortvliet
authors.affiliation: b Department of Medical Statistics and Bioinformatics , Leiden University Medical Center , the Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.affiliation: c Health Cooperative Katwijk langs de Rijn , Katwijk , the Netherlands.
authors.forename: Huug J
authors.initials: HJ
authors.lastname: van Duijn
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , the Netherlands.
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , the Netherlands.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Drewes
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , the Netherlands.
authors.forename: Jeanet W
authors.initials: JW
authors.lastname: Blom
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , the Netherlands.|d Department of Primary and Community care , Radboud University Medical Center , the Netherlands.
authors.forename: Willem Jj
authors.initials: WJ
authors.lastname: Assendelft
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000145:classification / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D002784:Cholesterol
keywords: Cardiovascular diseases; guidelines as topic; preventive medicine; primary prevention; risk assessment