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    Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study

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    Authors
    Magnoni, M.
    Berteotti, M.
    Norata, Giuseppe
    Limite, L.
    Peretto, G.
    Cristell, N.
    Maseri, A.
    Cianflone, D.
    Date
    2016
    Collection
    • Curtin Research Publications
    Type
    Journal Article
    Metadata
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    Abstract

    © 2016 Informa UK Limited, trading as Taylor & Francis Group. Background: The 2013 ACC/AHA cholesterol treatment guidelines have introduced a new cardiovascular risk assessment approach (PCE) and have revisited the threshold for prescribing statins. This study aims to compare the ex ante application of the ACC/AHA and the ATP-III guideline models by using a multiethnic case-control study. Methods: ATP-III-FRS and PCE were assessed in 739 patients with first STEMI and 739 age- and gender-matched controls; the proportion of cases and controls that would have been eligible for statin as primary prevention therapy and the discriminatory ability of both models were evaluated. Results: The application of the ACC/AHA compared to the ATP-III model, resulted in an increase in sensitivity [94% (95%CI: 91%-95%) vs. 65% (61%-68%), p < 0.0001], a reduction in specificity [19% (15%-22%) vs. 55% (51%-59%), p < 0.0001] with similar global accuracy [0.56 (0.53-0.59) vs.0.59 (0.57-0.63), p ns] . When stratifying for ethnicity, the accuracy of the ACC/AHA model was higher in Europeans than in Chinese (p = 0.003) and to identified premature STEMI patients within Europeans much better compared to the ATP-III model (p = 0.0289). Conclusion: The application of the ACC/AHA model resulted in a significant reduction of first STEMI patients who would have escaped from preventive treatment. Age and ethnicity affected the accuracy of the ACC/AHA model improving the identification of premature STEMI among Europeans only. Key messagesAccording to the ATP-III guideline model, about one-third of patients with STEMI would not be eligible for primary preventive treatment before STEMI.The application of the new ACC/AHA cholesterol treatment guideline model leads to a significant reduction of the percentage of patients with STEMI who would have been considered at lower risk before the STEMI.The global accuracy of the new ACC/AHA model is higher in the Europeans than in the Chinese and, moreover, among the Europeans, the application of the new ACC/AHA guideline model also improved identification of premature STEMI patients.

    Citation
    Magnoni, M. and Berteotti, M. and Norata, G. and Limite, L. and Peretto, G. and Cristell, N. and Maseri, A. et al. 2016. Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study. Annals of Medicine. 48 (4): pp. 282-292.
    Source Title
    Annals of Medicine
    URI
    http://hdl.handle.net/20.500.11937/55914
    DOI
    10.3109/07853890.2016.1168934
    Department
    School of Biomedical Sciences

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