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[Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology
José María Lobos Bejarano1, Enrique Galve2, Miguel Ángel Royo-Bordonada3
1Comité Español Interdisciplinario de Prevención Cardiovascular, España; Sociedad Española de Medicina de Familia y Comunitaria, Madrid, España.
Insights
The 2013 American guidelines for high cholesterol treatment shift from treat-to-target to risk reduction, potentially increasing statin use in primary prevention. European guidelines are recommended for the Spanish population to avoid overtreatment.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Practice Guidelines
Background:
- The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines introduced a paradigm shift.
- These guidelines moved from a low-density lipoprotein cholesterol (LDL-C) treat-to-target strategy to a risk reduction approach for statin therapy.
- This review compares the 2013 ACC/AHA guidelines with current European guidelines on cardiovascular prevention and dyslipidemia management.
Purpose of the Study:
- To review and compare the 2013 ACC/AHA cholesterol guidelines with European guidelines.
- To assess the impact of the ACC/AHA guidelines on clinical practice, particularly in Spain.
- To evaluate the appropriateness of the ACC/AHA guidelines for primary prevention in the Spanish population.
Main Methods:
- Comparative analysis of the 2013 ACC/AHA cholesterol guidelines and current European guidelines.
- Review of the shift from LDL-C treat-to-target to risk reduction strategies.
- Assessment of the implications for statin therapy in primary and secondary cardiovascular prevention.
Main Results:
- Both guidelines recommend similar strategies (high-dose potent statins) for patients with established cardiovascular disease.
- The ACC/AHA guidelines, if applied in primary prevention, would significantly increase the number of individuals, especially older adults, receiving statin therapy.
- The elimination of the LDL-C treat-to-target strategy may lead to confusion, decreased adherence, and potential overtreatment in primary prevention.
Conclusions:
- The European guidelines are considered more appropriate for the Spanish setting, utilizing native population risk charts.
- The European guidelines help avoid potential overtreatment with statins in primary prevention.
- This article reaffirms the recommendations of the European guidelines due to concerns regarding the ACC/AHA guidelines' impact on clinical practice and patient adherence.
Abstract:
The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.