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2019 vs. 2016 ESC/EAS statin guidelines for primary prevention of atherosclerotic cardiovascular disease

Martin Bødtker Mortensen1,2,3, Børge Grønne Nordestgaard2,3

  • 1Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.

European Heart Journal
|April 1, 2020
PubMed

Insights

The 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines significantly increase statin eligibility for primary prevention of atherosclerotic cardiovascular disease (ASCVD). This expansion offers greater potential for ASCVD event prevention in the general population.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Public Health

Background:

  • Dyslipidemia guidelines impact cardiovascular disease (CVD) prevention strategies.
  • Previous European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines (2016) provided a framework for statin use in primary prevention.
  • The 2019 ESC/EAS guidelines introduced updated recommendations, necessitating an evaluation of their impact on statin eligibility and CVD prevention.

Purpose of the Study:

  • To compare statin eligibility for primary prevention of atherosclerotic cardiovascular disease (ASCVD) between the 2019 and 2016 ESC/EAS dyslipidemia guidelines.
  • To assess the potential impact of these guideline changes on ASCVD event prevention in the general population.

Main Methods:

  • Analysis of 45,750 individuals from the Copenhagen General Population Study, free of ASCVD and statin use.
  • Follow-up for 9.2 years to record ASCVD events (myocardial infarction, stroke, cardiovascular death).
  • Comparison of statin eligibility and estimated prevention impact based on 2019 vs. 2016 ESC/EAS guidelines.

Main Results:

  • The 2019 guidelines identified 32.3% of individuals as statin-eligible versus 15.4% under the 2016 guidelines.
  • Increased eligibility in 2019 was attributed to lower low-density lipoprotein cholesterol (LDL-C) thresholds and an older age range.
  • Estimated 10-year high-intensity statin use could prevent 25% of ASCVD events with 2019 guidelines versus 11% with 2016 guidelines.
  • The number needed to treat (NNT) to prevent one ASCVD event was similar (19 for 2019 vs. 20 for 2016).

Conclusions:

  • The 2019 ESC/EAS guidelines substantially increase statin eligibility for primary ASCVD prevention.
  • These updated guidelines offer enhanced potential for preventing ASCVD events in the general population.
  • The NNT to prevent a single ASCVD event remains comparable, indicating efficient risk management with the newer recommendations.
Abstract

Keywords:
LDL cholesterolLipid-lowering therapyLipidsLipoproteinsNon-HDL cholesterolTriglycerides

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