title: Comparison of ACC/AHA and ESC Guideline Recommendations Following Trial Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: Results From the Population-Based Rotterdam Study.
abstract: The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) guidelines both recommend lipid-lowering treatment for primary prevention based on global risk for cardiovascular disease (CVD). However, randomized clinical trials (RCTs) for statin use have included participants with specific risk-factor profiles.
  
  
  
  To evaluate the overlap between the ACC/AHA and ESC guideline recommendations and available evidence from RCTs for statin use in primary prevention of CVD.
  
  
  
  We calculated the 10-year risk for hard atherosclerotic CVD (ASCVD) following the ACC/AHA guideline, 10-year risk of CVD mortality following the ESC guideline, and we determined eligibility for each of 10 major RCTs for primary prevention of CVD. Conducted from July 2014 to August 2015, this study included 7279 individuals free of CVD, aged 45 to 75 years, examined between 1997 and 2008 for the Rotterdam Study, a prospective population-based cohort.
  
  
  
  Proportions of individuals qualifying for lipid-lowering treatment per guidelines, proportions of individuals eligible for any of the 10 RCTs, overlap between these groups, and corresponding ASCVD incidence rates.
  
  
  
  Of the 7279 individuals included in the study, 58.2% were women (n = 4238) and had a mean (SD) age of 61.1 (6.9) years. The ACC/AHA guidelines would recommend statin initiation in 4284 participants (58.9%), while the ESC guidelines would in 2399 participants (33.0%) (overlapping by 95.8% with ACC/AHA). A total of 3857 participants (53.0%) met eligibility criteria for at least 1 RCT. Recommendations from both guidelines and trial evidence overlapped for 1546 participants (21.2%), who were at high risk for ASCVD (21.5 per 1000 person-years). A further 1703 participants (23.4%) would be recommended for statins by the guidelines in the absence of direct trial evidence, while 1176 (16.2%) would have been eligible for at least 1 trial without being recommended statin treatment by any guideline. Finally, 1719 participants (23.6%) would not be recommended a statin, nor would qualify for any of the trials. These individuals had low incidence of ASCVD (3.3 per 1000 person-years).
  
  
  
  Based on this European population study, ACC/AHA and ESC prevention guidelines often did not align at the individual level. However, for one-fifth of the general population, guidelines on both sides of the Atlantic recommend statin initiation, with trial data supporting the efficacy. There should be no controversy about providing optimal preventive medication to these individuals.
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Jelena
authors.initials: J
authors.lastname: Pavlovic
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.affiliation: Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.affiliation: Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Jasper J
authors.initials: JJ
authors.lastname: Brugts
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Maryam
authors.initials: M
authors.lastname: Kavousi
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Klodian
authors.initials: K
authors.lastname: Dhana
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands4Department of Neurology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands5Department of Radiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands6Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands7Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands8Inspectorate for Health Care, Utrecht, the Netherlands.
authors.forename: Bruno H
authors.initials: BH
authors.lastname: Stricker
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands3Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands6Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Maarten J G
authors.initials: MJ
authors.lastname: Leening
mesh_terms: D000368:Aged; D002309:Cardiology; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012306:Risk
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors