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Cardiovascular Risk and Statin Eligibility in Primary Prevention: A Comparison between the Brazilian and the AHA/ACC

Fernando H Y Cesena1, Viviane A Valente1, Raul D Santos1,2

  • 1Hospital Israelita Albert Einstein, São Paulo, SP - Brasil.

Arquivos Brasileiros De Cardiologia
|October 7, 2020
PubMed

Insights

The Brazilian dyslipidemia guideline identifies more patients as high-risk and eligible for statin therapy compared to the AHA/ACC guideline. This highlights significant differences in cardiovascular risk stratification and treatment recommendations between the two guidelines.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Clinical Guidelines

Background:

  • Current cardiovascular disease prevention strategies rely on guidelines for risk stratification and treatment.
  • The Brazilian Guideline on Dyslipidemias and the American Heart Association (AHA)/American College of Cardiology (ACC) Cholesterol Guideline offer different approaches to managing dyslipidemia.
  • Direct comparisons of these guidelines' impact on risk assessment and statin eligibility in primary prevention are limited.

Purpose of the Study:

  • To compare cardiovascular risk categorization between the Brazilian and AHA/ACC guidelines.
  • To evaluate differences in statin eligibility for primary prevention patients based on these two guidelines.
  • To identify potential discrepancies in clinical decision-making for lipid management.

Main Methods:

  • Retrospective analysis of 18,525 individuals aged 40-74 years without high-risk conditions.
  • Cardiovascular risk stratification performed using both Brazilian and AHA/ACC guideline criteria.
  • Statin eligibility determined by comparing LDL-c levels and 10-year atherosclerotic cardiovascular disease risk scores.

Main Results:

  • The Brazilian guideline categorized over 80% of intermediate/high-risk individuals into lower-risk categories under the AHA/ACC guideline.
  • Statin eligibility was significantly higher under the Brazilian guideline: 45% for men and 16% for women, versus 16% and 1% respectively for AHA/ACC.
  • A substantial proportion (82% of women, 57% of men) eligible by Brazilian criteria were not eligible by AHA/ACC criteria.

Conclusions:

  • The Brazilian guideline designates a greater proportion of primary prevention patients as higher risk compared to the AHA/ACC guideline.
  • The Brazilian guideline leads to substantially increased statin eligibility in primary prevention populations.
  • These findings underscore significant differences in risk assessment and statin initiation recommendations between the two major guidelines.
Abstract

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