Assessing gaps in cholesterol treatment guidelines for primary prevention of cardiovascular disease based on available randomised clinical trial evidence: The Rotterdam Study

Abstract

BackgroundThe purpose of this study was to determine how American College of Cardiology/American Heart Association (ACC/AHA) 2013 and European Society of Cardiology 2016 guidelines for the primary prevention of atherosclerotic cardiovascular disease (CVD) compare in reflecting the totality of accrued randomised clinical trial evidence for statin treatment at population level.MethodsFrom 1997–2008, 7279 participants aged 45–75 years, free of atherosclerotic cardiovascular disease, from the population-based Rotterdam Study were included. For each participant, we compared eligibility for each one of 11 randomised clinical trials on statin use in primary prevention of CVD, with recommendations on lipid-lowering therapy from the ACC/AHA and European Society of Cardiology (ESC) guidelines. Atherosclerotic cardiovascular disease incidence and cardiovascular disease mortality rates were calculated.ResultsThe proportion of participants eligible for each trial ranged from 0.4% for ALLHAT-LLT to 30.8% for MEGA. The likelihood of being recommended for lipid-lowering treatment was lowest for those eligible for low-to-intermediate risk RCTs (HOPE-3, MEGA, and JUPITER), and highest for high-risk individuals with diabetes (MRC/BHF HPS, CARDS, and ASPEN) or elderly PROSPER. Eligibility for an increasing number of randomised clinical trials correlated with a greater likelihood of being recommended lipid-lowering treatment by either guideline (p < 0.001 for both guidelines).ConclusionCompared to RCTs done in high risk populations, randomised clinical trials targeting low-to-intermediate risk populations are less well-reflected in the ACC/AHA, and even less so in the ESC guideline recommendations. Importantly, the low-to-intermediate risk population targeted by HOPE-3, the most recent randomised clinical trial in this field, is not well-captured by the current European prevention guidelines and should be specifically considered in future iterations of the guidelines.

Grapeseed Meal Used as Natural Antioxidant in High Fatty Acid Diets for Hubbard Broilers

“…The positive effects of cholesterol-lowering in meat from broiler (breast and thigh) are important for human nutrition and health, reducing in particular the cardiovascular disease problems. Studies have shown that lowering cholesterol may reduce the risk of heart attack, so whether or not they suffer from heart disease, the adult population must necessarily keep their cholesterol levels under constant surveillance (Pavlovic et al, 2018). Within this context, we can consider that the inclusion of grapeseed meal in broiler diets acted as a feed additive with qualities of natural antioxidant due to the rich content of bioactive compounds with antioxidant properties.…”

Evidence, Guidelines and Treatment Algorithms for Patients with Arterial Hypertension and Dyslipidemia: the Need for Compromise and Optimization of Tactics in Practical Healthcare

“…В таких условиях для распространения полученных результатов на более широкую популяцию неизбежны некоторые допущения, в частности, по данным анализа, недавно выполненного J. Pavlović и соавт. [3], доля лиц 45-75 лет в общей популяции, характеристики которых соответствовали участникам РКИ по оценке эффективности применения статинов с целью первичной профилактики, составляла от 0,4 до 30,8%.…”

“…Результаты обсервационного исследова-ния Rotterdam Study, включавшего 14926 участников 45 лет и старше, свидетельствовали о том, что бóльшая часть умерших от осложнений ССЗОА имели низкий риск развития таких осложнений в соответствии с оценкой по шкале SCORE (т.е. имели риск развития смертельного осложнения ССЗ в течение 10 лет менее 5%) [3]. Более того, из 26 умерших участников в возрасте моложе 65 лет у 88,5% участников до развития неблагоприятного исхода отсутствовали формальные показания к приему статинов в соответствии с рекомендациями европейского общества кардиологов.…”

Primary prevention of cardiovascular disease: The past, present, and future of blood pressure- and cholesterol-lowering treatments

“…Treatment recommendations from current risk-based prevention guidelines [ 6 – 8 , 15 – 17 ] do not directly reflect the evidence derived from clinical trials [ 12 , 18 ] but rather reflect generalizations of findings derived from clinical trials showing greater absolute risk reduction in those at higher observed cardiovascular risk. Very low-risk individuals may not be recommended preventive treatment although trial evidence of statin efficacy is available for such people [ 18 ]. Conversely, findings from trials of antihypertensives and statins are extrapolated to high-risk individuals in whom the efficacy of preventive treatment has not been studied [ 12 , 18 ].…”

“…Very low-risk individuals may not be recommended preventive treatment although trial evidence of statin efficacy is available for such people [ 18 ]. Conversely, findings from trials of antihypertensives and statins are extrapolated to high-risk individuals in whom the efficacy of preventive treatment has not been studied [ 12 , 18 ]. For many of these high-risk individuals, it is highly unlikely that direct trial evidence will ever be accrued, because not every specific patient group can be studied; therefore, extrapolation will always be necessary to some extent.…”