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01-10-2017 | Editorial

What’s in a Number? Risk Thresholds in Different Statin Guidelines

Authors: Christopher J. Wong, MD, Lisa Inouye, MD

Published in: Journal of General Internal Medicine | Issue 10/2017

Excerpt

When exactly should we recommend statin therapy to our patients for primary prevention? Clinical practice guidelines published since the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend quite a range of different treatment thresholds. Imagine the veteran who starts in a private practice, is recommended a 7.5% 10-year risk threshold to start statin therapy, then transfers to the VA system, where the threshold changes to 12%, and then moves to Canada, where the threshold goes back to 10%. …

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Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25B):2889–934.

Downs JR, O’Malley PG. Management of dyslipidemia for cardiovascular disease risk reduction: synopsis of the 2014 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Ann Intern Med. 2015;163(4):291–7.

NICE guidelines [CG181]. Cardiovascular disease: risk assessment and reduction, including lipid modification. Publication date July 2014. Accessed online at http://www.nice.org.uk/guidance/cg181 February 23, 2016.

Allan GM, Lindblad AJ, Comeau A, et al. Simplified lipid guidelines: Prevention and management of cardiovascular disease in primary care. Can Fam Physician. 2015;61(10):857–67.

Anderson TJ, Gregoire J, Pearson GJ, et al. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Can J Cardiol. 2016:1–20.

Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.

US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(19):1997–2007.

Pandya A, Sy S, Cho S, et al. Cost-effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease. JAMA. 2015;314(2):142–50.CrossRefPubMedPubMedCentral

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Cook NR, Ridker PM. Calibration of the pooled cohort equations for atherosclerotic cardiovascular disease: an update. Ann Intern Med. 2016;165(11):786–94.CrossRefPubMed

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Mayo Clinic Statin Choice Decision Aid. Available at: https://statindecisionaid.mayoclinic.org/. Accessed May 8, 2017.

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Berry JD, Dyer A, Cai X, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366(4):321–9.CrossRefPubMedPubMedCentral

Title: What’s in a Number? Risk Thresholds in Different Statin Guidelines
Authors: Christopher J. Wong, MD
Lisa Inouye, MD
Publication date: 01-10-2017
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 10/2017
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-017-4114-y

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