Cardiovascular Risk Stratification and Statin Eligibility Based on the Brazilian vs. North American Guidelines on Blood Cholesterol Management

Abstract

Background:The best way to select individuals for lipid-lowering treatment in the population is controversial.Objective:In healthy individuals in primary prevention:to assess the relationship between cardiovascular risk categorized according to the V Brazilian Guideline on Dyslipidemia and the risk calculated by the pooled cohort equations (PCE);to compare the proportion of individuals eligible for statins, according to different criteria.Methods:In individuals aged 40-75 years consecutively submitted to routine health assessment at one single center, four criteria of eligibility for statin were defined: BR-1, BR-2 (LDL-c above or at least 30 mg/dL above the goal recommended by the Brazilian Guideline, respectively), USA-1 and USA-2 (10-year risk estimated by the PCE ≥ 5.0% or ≥ 7.5%, respectively).Results:The final sample consisted of 13,947 individuals (48 ± 6 years, 71% men). Most individuals at intermediate or high risk based on the V Brazilian Guideline had a low risk calculated by the PCE, and more than 70% of those who were considered at high risk had this categorization because of the presence of aggravating factors. Among women, 24%, 17%, 4% and 2% were eligible for statin use according to the BR-1, BR-2, USA-1 and USA-2 criteria, respectively (p < 0.01). The respective figures for men were 75%, 58%, 31% and 17% (p < 0.01). Eighty-five percent of women and 60% of men who were eligible for statin based on the BR-1 criterion would not be candidates for statin based on the USA-1 criterion.Conclusions:As compared to the North American Guideline, the V Brazilian Guideline considers a substantially higher proportion of the population as eligible for statin use in primary prevention. This results from discrepancies between the risk stratified by the Brazilian Guideline and that calculated by the PCE, particularly because of the risk reclassification based on aggravating factors.

Resistant hypertension: Prevalence and profile of patients followed in a university ambulatory

“… 35 , 36 Furthermore, the use of statins was more common among patients with RH, which may also be related to the elevated CVR and renal dysfunction risk in this group. 37 Although greater in the RH group, the difference between the prevalence of dyslipidemia in the two groups was lower than the difference found between the percentage of statin use. We must consider that the prescription of this medication is not exclusively dependent on serum cholesterol levels, being mainly associated with the assessment of the patient’s CVR and considering the existence of a contraindication to its use.…”

“…We must consider that the prescription of this medication is not exclusively dependent on serum cholesterol levels, being mainly associated with the assessment of the patient’s CVR and considering the existence of a contraindication to its use. 37 …”

Risco Cardiovascular e Elegibilidade Para Estatina na Prevenção Primária: Comparação Entre a Diretriz Brasileira e a Diretriz da AHA/ACC

“…síndrome metabólica, níveis elevados de proteína C-reativa ultrassensível, história familiar de doença arterial coronariana prematura) na Atualização da Diretriz Brasileira, bem como uma "valorização" dos fatores agravantes do risco para decisões de tratamento na diretriz O presente estudo atualiza e expande nosso estudo prévio comparando a V Diretriz Brasileira de Dislipidemias e a Diretriz de Colesterol do ACC/AHA de 2013. 6 Setenta e cinco porcento da amostra da presente análise correspondem aos indivíduos incluídos no estudo anterior; os demais referem-se aos indivíduos atendidos no mesmo serviço mais recentemente. Portanto, nossos resultados permitem uma avaliação do impacto das mudanças na versão atualizada da diretriz brasileira sobre a estratificação de risco e elegibilidade ao tratamento com estatina.…”

“…[1][2][3][4][5] Em um estudo prévio, observamos que uma proporção consideravelmente maior da população em prevenção primária foi considerada elegível a receber estatina com base nas recomendações da V Diretriz Brasileira de Dislipidemias, em relação à diretriz do American College of Cardiology (ACC)/American Heart Association (AHA) para o manejo do colesterol de 2013. 6 Este achado ocorreu como consequência de uma clara discrepância entre a estratificação do risco cardiovascular segundo a diretriz brasileira 1 e o risco calculado pelas pooled cohort equations (PCE), conforme recomendado pela diretriz do ACC/AHA. 3,7 A Diretriz Brasileira de Dislipidemias foi atualizada em 2017.…”

Cardiovascular Risk Stratification: From Phenotype to Genotype?

“…Cardiovascular risk scores, such as the Framingham score, have been strongly recommended by clinical guidelines on the assessment of cardiovascular risk. 1 However, several studies have shown limitations for their use, 2 , 3 particularly in patients at intermediate risk, young patients with a definite family history, and women. Among different tools aimed at improving risk stratification by complementary methods, the use of genetic information has been proposed to enhance risk prediction.…”