Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study
© 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 appli...
| Main Authors: | , , , , , , , |
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| Format: | Journal Article |
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2016
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| Online Access: | http://hdl.handle.net/20.500.11937/55914 |
| _version_ | 1848759738588725248 |
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| author | Magnoni, M. Berteotti, M. Norata, Giuseppe Limite, L. Peretto, G. Cristell, N. Maseri, A. Cianflone, D. |
| author_facet | Magnoni, M. Berteotti, M. Norata, Giuseppe Limite, L. Peretto, G. Cristell, N. Maseri, A. Cianflone, D. |
| author_sort | Magnoni, M. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 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. |
| first_indexed | 2025-11-14T10:04:39Z |
| format | Journal Article |
| id | curtin-20.500.11937-55914 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:04:39Z |
| publishDate | 2016 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-559142017-09-13T16:10:39Z Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study Magnoni, M. Berteotti, M. Norata, Giuseppe Limite, L. Peretto, G. Cristell, N. Maseri, A. Cianflone, D. © 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. 2016 Journal Article http://hdl.handle.net/20.500.11937/55914 10.3109/07853890.2016.1168934 restricted |
| spellingShingle | Magnoni, M. Berteotti, M. Norata, Giuseppe Limite, L. Peretto, G. Cristell, N. Maseri, A. Cianflone, D. Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study |
| title | Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study |
| title_full | Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study |
| title_fullStr | Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study |
| title_full_unstemmed | Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study |
| title_short | Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: Results from a multiethnic case-control study |
| title_sort | applicability of the 2013 acc/aha risk assessment and cholesterol treatment guidelines in the real world: results from a multiethnic case-control study |
| url | http://hdl.handle.net/20.500.11937/55914 |