An evaluation of the different clinical practice guidelines for dyslipidemia treatment in outpatient primary prevention patients

Abstract

Introduction

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. There are several assessment scales to estimate cardiovascular risk that help make decisions aimed at primary prevention. The objective of the study was to evaluate the concordance between the AHA/ACC, ESC/EAS, USPSTF and CPG guidelines in determining cardiovascular risk and the decision to prescribe statins as primary prevention.

Methods

Analytical observational concordance study. Patients between 40 and 75 years of age with no history of cardiovascular disease, who attended the internal medicine outpatient clinic of Hospital San José in the period between January 2019 and January 2021, were included. The Framingham risk score, adjusted Framingham risk score and SCORE were applied to eligible patients to determine the correlation in the evaluation of cardiovascular risk; and the AHA/ACC, ESC/EAS, USPSTF, and CPG guidelines to assess concordance in the decision to start statins as primary prevention.

Results

288 patients were included, mean age 60.5 years, 63.2% female, 46.2% had a diagnosis of arterial hypertension and 25% of diabetes mellitus. Concordance in risk assessment by Lin's coefficient between AHA and SCORE was 0.59, AHA and Framingham 0.67, AHA and modified Framingham 0.53, Framingham and SCORE 0.63, modified Framingham and SCORE 0.72, modified Framingham and Framingham 0.91. Regarding the decision to give statins between the AHA/ACC and ESC/EAS guidelines, a low agreement was found with a kappa index of 0.48.

Conclusions

In patients who attended the internal medicine outpatient clinic at Hospital San José without documented cardiovascular disease, there was moderate agreement in the evaluation of cardiovascular risk and low agreement in the decision to give or not a statins as primary prevention.