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Call for cholesterol drug guideline rethink

Monday March 31st, 2014

Guidelines for prescribing cholesterol-lowering statins vary massively between Europe and North America, according to a new study.

And no set of guidelines is accurate at identifying those most at risk of heart attacks and cardiovascular disease, Dutch researchers say.

The researchers reported their findings to a conference of the American College of Cardiology at the weekend.

They are based on a study of nearly 5,000 people in the Netherlands starting in 1990.

The researchers set out to compare the impact of European Society of Cardiology guidelines and those from the American College of Cardiology and the American Heart Association together with a further set from the National Cholesterol Education Program in the USA.

They report that the US guidelines tend to advise greater use of statins than in Europe. And all the three sets of guidelines tended to exaggerate the risk of heart disease by up to two times, they found.

For the study they sought to identify the proportion of patients identified as being at risk by the guidelines and compare it with the number of illnesses that actually occurred.

The American Heart Association guidelines suggested that 21% of men in the study would suffer from cardiovascular events while in fact just 12.7% did, they report. And for women, the guidelines suggested 11.6% would fall ill while just 7.9% actually did, they say.

The guidelines also "recommended" treatment for 96.4% of the men and 65.8% of the women, they report.

In contrast the European guidelines recommended treatment for 66.1% of men and 39.1% of women.

The guidelines are based on predicting the risk of dying from heart disease. They suggested that 6.8% of men would die while just 3.7% did while just 2% of women died against a prediction of 3.8%.

Researcher Dr Maryam Kavousi, of Erasmus MC-University Medical Centre, Rotterdam, said: "Improving risk predictions and setting appropriate population-wide thresholds are necessary to facilitate better clinical decision making."

Journal of the American Medical Association 28 March 2014; doi:10.1001/jama.2014.2632 [abstract]

Tags: Europe | Heart Health | North America | Pharmaceuticals

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