Article

The challenge of the primary prevention of cardiovascular disease
(CVD) is to identify patients who would benefit from treatment with statins.
Statins are currently prescribed to many patients, even those at a low 10-year
risk of CVD. These latter patients may not be eligible for statins according to
current guidelines. Design This study investigated the prescription of
guideline-consistent (according to guidelines) and guideline-inconsistent (not
according to guidelines) lipid-lowering treatment in primary prevention in a
large contemporary Dutch cohort study (Lifelines). Methods Lifelines is a large
cohort study from the Netherlands. Participants were recruited between 2006 and
2013. They completed questionnaires and underwent a physical examination.
Participants with previous CVD were excluded. Statins and ezetimibe were grouped
as statin treatment. The Dutch guideline on cardiovascular management was used to
assess eligibility for statins. Results Of 147,785 participants, 7092 (4.8%)
reported statin treatment. In 4667 (66%) participants, statin treatment was
inconsistent with the Dutch guideline. A total of 78% of these participants had a
low 10-year predicted CVD risk. Multivariable logistic regression analysis showed
that female sex and smoking were strongly associated with guideline-inconsistent
treatment. Interestingly, 65% of the these participants had low-density
lipoprotein cholesterol levels above the 95th percentile, adjusted for age and
sex, two or more major risk factors of CVD or a positive family history of
premature CVD. Therefore treatment might be reasonable. Conclusions There is a
large inconsistency between guideline recommendations and the prescription of
statins in clinical practice in the Netherlands. This is especially true for
patients with low CVD risk. Many of these patients probably had risk-increasing
circumstances justifying treatment.

Langue : ANGLAIS