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Comparing Guidelines for Statin Treatment in Canada and the United States
Deirdre A Hennessy1, Tracey Bushnik1, Douglas G Manuel2
1Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada (D.A.H., T.B., D.G.M.).
Insights
New US guidelines for cardiovascular disease risk assessment and statin eligibility do not increase the number of Canadians eligible for treatment compared to Canadian guidelines. Some subgroups receive different recommendations.
Area of Science:
- Cardiology
- Public Health
- Health Policy
Background:
- New cardiovascular disease (CVD) risk assessment and statin eligibility guidelines were published by the American College of Cardiology and American Heart Association (ACC-AHA).
- Comparison with existing Canadian Cardiovascular Society (CCS) recommendations is currently unknown.
Purpose of the Study:
- To compare the ACC-AHA guidelines with CCS recommendations for cardiovascular disease risk assessment and statin eligibility in Canada.
- To estimate the proportion of the Canadian population eligible for statin treatment under both guideline sets.
Main Methods:
- Utilized data from the Canadian Health Measures Survey (2007-2011) for 1975 participants aged 40-75 without pre-existing CVD.
- Calculated CVD risk and statin eligibility based on both CCS and ACC-AHA guidelines.
- The sample represented 13.1 million community-dwelling Canadians.
Main Results:
- Calculated CVD risk was higher using CCS guidelines versus ACC-AHA guidelines.
- A similar overall proportion of Canadians were eligible for statin treatment under both guideline sets.
- Discordance observed in subgroups: CCS recommended more treatment for younger individuals, those with family history of CVD, or chronic kidney disease; ACC-AHA recommended more for older individuals (60+).
Conclusions:
- Adoption of ACC-AHA lipid treatment guidelines in Canada would not increase the number of individuals eligible for statin therapy.
- A slight decrease in the proportion of the population recommended for statin treatment is anticipated.
- Targeting of statin recommendations would shift to different population subgroups under ACC-AHA guidelines compared to CCS.
Background:
New guidelines for cardiovascular disease risk assessment and statin eligibility have recently been published in the United States by the American College of Cardiology and the American Heart Association (ACC-AHA). It is unknown how these guidelines compare with the Canadian Cardiovascular Society (CCS) recommendations.
Methods And Results:
Using data from the Canadian Health Measures Survey 2007-2011, we estimated the cardiovascular disease risk and proportion of the Canadian population, aged 40 to 75 years without cardiovascular disease, who would theoretically be eligible for statin treatment under both the CCS and ACC-AHA guidelines. The survey sample used (n=1975) represented 13.1 million community dwelling Canadians between the ages of 40 and 75 years. In comparing the CVD risk assessment methods, we found that calculated CVD risk was higher based on the CCS guidelines compared with the ACC-AHA guidelines. Despite this, a similar proportion and number of Canadians would be eligible for statin treatment under the 2 sets of recommendations. Some discordance in recommendations was found within subgroups of the population, with the CCS guidelines recommending more treatment for individuals who are younger, with a family history of CVD, or with chronic kidney disease. The ACC-AHA recommend more treatment for people who are older (age 60+ years). These results likely overestimate the treatment rate under both guidelines because, in primary prevention, a clinician-patient discussion must occur before treatment and determines uptake.
Conclusions:
Implementing the ACC-AHA lipid treatment guidelines in Canada would not result in an increase in individuals eligible for statin treatment. In fact, the proportion of the population recommended for statin treatment would decrease slightly and be targeted at different subgroups of the population.
