title: Population Effect of Differences in Cholesterol Guidelines in Eastern Europe and the United States.
abstract: The American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of blood cholesterol and the current European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines differ in how they identify adults in need of statin therapy; furthermore, it is unclear how this difference translates into numbers and characteristics of patients recommended for treatment.
  
  
  
  To determine the effect of the ACC/AHA and ESC/EAS cholesterol guidelines when applied to a population-based sample.
  
  
  
  We used nationally representative data for 3055 adults aged 40 to 65 years from the 2007-2012 National Health and Nutrition Examination Surveys (NHANES) for the United States and for 1060 adults aged 40 to 65 years from the 2011 Nadciśnięnie Tętnicze w Polsce survey for Poland. Data analysis was conducted from May 1, 2014, to December 31, 2015.
  
  
  
  The number and characteristics of adults recommended for statin therapy according to the ACC/AHA and ESC/EAS guidelines were evaluated, and characteristics were compared between adults with discordant recommendations.
  
  
  
  The 3136 US adults in NHANES (2007-2012) aged 40 to 65 years represented 100.1 million adults; after excluding the 81 patients with missing data, these population estimates translate to 97.9 million adults. Similarly, the 1060 Polish adults in NATPOL (2011) aged 40 to 65 years represent 13.5 million adults. Using weighted data, in the United States, 43.8% (95% CI, 40.9%-46.7%) of adults would be recommended for statin therapy according to ACC/AHA guidelines and 39.1% (95% CI, 36.4%-41.8%) according to ESC/EAS guidelines. In Poland, 49.9% (95% CI, 46.9%-52.9%) of adults would be recommended for statin therapy under ACC/AHA guidelines compared with 47.6% (95% CI, 44.6%-50.7%) under ESC/EAS guidelines. Among individuals without cardiovascular disease and not currently taking statins, 11.0% of US and 10.5% of Polish adults had discordant guideline recommendations. Compared with individuals recommended for statin therapy by the ESC/EAS guidelines but not the ACC/AHA guidelines, those recommended for statin therapy under the ACC/AHA guidelines only had less chronic kidney disease; however, these individuals were also more likely to smoke, have lower high-density lipoprotein cholesterol levels, and have higher predicted 10-year risk of cardiovascular disease.
  
  
  
  Despite differences in the ACC/AHA and EAS/ESC guidelines, the numbers of adults aged 40 to 65 years recommended for cholesterol-lowering therapy under each guideline were similar when applied to nationwide representative samples from both the United States and Poland. Discordant recommendations were driven by differences in the risk equations used in the 2 guidelines and different recommendations for adults with chronic kidney disease.
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Jerry C
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Neurology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zdrojewski
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina4Deputy Editor for Statistics, JAMA Cardiology.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Gdansk University of Technology, Gdansk, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Wyszomirski
authors.affiliation: Gdansk University of Technology, Gdansk, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Lachacz
authors.affiliation: Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
authors.affiliation: Department of Neurology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Bandosz
authors.affiliation: Department of Neurology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Rutkowski
authors.affiliation: Department of Internal Medicine, Hypertension and Vascular Disease, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gaciong
authors.affiliation: Department of Neurology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Wyrzykowski
authors.affiliation: Duke University Medical Center, Durham, North Carolina3Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Navar
mesh_terms: D000328:Adult; D000368:Aged; D000572:American Heart Association; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002784:Cholesterol; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011044:Poland; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014481:United States
chemical_list: D000924:Anticholesteremic Agents; D002784:Cholesterol