title: Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: results from a multiethnic case-control study.
abstract: BACKGROUND
  The 2013 ACC/AHA cholesterol treatment guidelines have introduced a new cardiovascular risk assessment approach (PCE) and have revisited the threshold for prescribing statins. This study aims to compare the ex ante application of the ACC/AHA and the ATP-III guideline models by using a multiethnic case-control study.
  
  
  METHODS
  ATP-III-FRS and PCE were assessed in 739 patients with first STEMI and 739 age- and gender-matched controls; the proportion of cases and controls that would have been eligible for statin as primary prevention therapy and the discriminatory ability of both models were evaluated.
  
  
  RESULTS
  The application of the ACC/AHA compared to the ATP-III model, resulted in an increase in sensitivity [94% (95%CI: 91%-95%) vs. 65% (61%-68%), p< 0.0001], a reduction in specificity [19% (15%-22%) vs. 55% (51%-59%), p< 0.0001] with similar global accuracy [0.56 (0.53-0.59) vs.0.59 (0.57-0.63), p ns]. When stratifying for ethnicity, the accuracy of the ACC/AHA model was higher in Europeans than in Chinese (p = 0.003) and to identified premature STEMI patients within Europeans much better compared to the ATP-III model (p = 0.0289).
  
  
  CONCLUSIONS
  The application of the ACC/AHA model resulted in a significant reduction of first STEMI patients who would have escaped from preventive treatment. Age and ethnicity affected the accuracy of the ACC/AHA model improving the identification of premature STEMI among Europeans only. Key messages According to the ATP-III guideline model, about one-third of patients with STEMI would not be eligible for primary preventive treatment before STEMI. The application of the new ACC/AHA cholesterol treatment guideline model leads to a significant reduction of the percentage of patients with STEMI who would have been considered at lower risk before the STEMI. The global accuracy of the new ACC/AHA model is higher in the Europeans than in the Chinese and, moreover, among the Europeans, the application of the new ACC/AHA guideline model also improved identification of premature STEMI patients.
authors.affiliation: a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy ;|b Heart Care Foundation Onlus , Florence , Italy ;
authors.forename: Marco
authors.initials: M
authors.lastname: Magnoni
authors.affiliation: a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy ;
authors.forename: Martina
authors.initials: M
authors.lastname: Berteotti
authors.affiliation: c Department of Pharmacological and Biomolecular Sciences , Università degli Studi di Milano , Milan , Italy.
authors.forename: Giuseppe Danilo
authors.initials: GD
authors.lastname: Norata
authors.affiliation: a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy ;
authors.forename: Luca Rosario
authors.initials: LR
authors.lastname: Limite
authors.affiliation: a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy ;
authors.forename: Giovanni
authors.initials: G
authors.lastname: Peretto
authors.affiliation: a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy ;
authors.forename: Nicole
authors.initials: N
authors.lastname: Cristell
authors.affiliation: b Heart Care Foundation Onlus , Florence , Italy ;
authors.forename: Attilio
authors.initials: A
authors.lastname: Maseri
authors.affiliation: a IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele , Milan , Italy ;
authors.forename: Domenico
authors.initials: D
authors.lastname: Cianflone
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000517:prevention & control*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D000072657:ST Elevation Myocardial Infarction / Q000208:ethnology / Q000517:prevention & control; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: Risk assessment; myocardial infarction; primary prevention; statin