title: Implications of the New US Cholesterol Guidelines in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: BACKGROUND
  The new US guidelines for the primary prevention of cardiovascular disease have substantially changed the approach to hyperlipidemia treatment. However, the impact of those recommendations in other populations is limited. In the present study, we evaluated the potential implications of those recommendations in the Brazilian population.
  
  
  OBJECTIVE
  The new U.S. recommendations may increase the proportion of individuals who are candidates for statin therapy.
  
  
  METHODS
  We included all participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) without known cardiovascular disease. We calculated the indication for statin therapy according to the current Brazilian recommendations and the new US guidelines, using both the 5.0% and the 7.5% risk cutoffs to recommend treatment, and compared their impact in the Brazilian population stratified by age, sex, and race.
  
  
  RESULTS
  Although the current guidelines would recommend treatment for 5499 (39.1%) individuals, the number of individuals eligible for statin therapy increased to 6014 (42.7%) and to 7130 (50.7%) using the 7.5% and 5% cutoffs, respectively (P < 0.001). This difference is more pronounced for older individuals, and virtually all individuals age >70 years would be eligible for statins, whereas the new guidelines would reduce the number of candidates for statin therapy in individuals age <45 years.
  
  
  CONCLUSIONS
  The application of the new US guidelines for the use of lipid-lowering medications in a large middle-aged Brazilian cohort would result in a significant increase in the population eligible for statins. This is largely driven by males and older individuals. Additional cost-effectiveness analyses are needed to define the appropriateness of this strategy in the Brazilian population.
authors: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Marcio Sommer
authors: MS
authors: Bittencourt
authors: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Henrique Lane
authors: HL
authors: Staniak
authors: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.|Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Alexandre Costa
authors: AC
authors: Pereira
authors: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.|University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Itamar S
authors: IS
authors: Santos
authors: Postgraduate Program in Epidemiology, School of Medicine, and Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors: Bruce B
authors: BB
authors: Duncan
authors: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Raul D
authors: RD
authors: Santos
authors: Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Michael J
authors: MJ
authors: Blaha
authors: Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Steve R
authors: SR
authors: Jones
authors: Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.|CGH Medical Center, Sterling, Illinois.|University of Illinois School of Medicine, Peoria, Illinois.
authors: Peter P
authors: PP
authors: Toth
authors: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.|University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Isabela M
authors: IM
authors: Bensenor
authors: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.|University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Paulo A
authors: PA
authors: Lotufo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D015415:Biomarkers; D002784:Cholesterol