Background: The ACC/AHA released a new guideline onthe assessment of cardiovascular risk and management of hypercholesterolemia that some controversy exists concerning its usefulness. We examined the clinical usefulness of this guideline in a high incidence population using novel measures. Methods: First, we validated the new risk equation in a cohort of 2372 men and 2781 women aged 40-75 years. Then, high risk individuals for cardiovascular diseases (CVDs) were identified according to the ACC/AHA guideline at baseline (as a predictor) and CVD outcomes were detected during a 10-year follow-up. Discrimination of the guideline was quantified and the quality of decisions was evaluated by Net Benefit Fraction index considering the harm, for false-positive, and benefit, for true-positive predictions. Finally, net number needed to treat (NNT) for statin was estimated, using test tradeoff index, in diabetic and non-diabetic subjects. Results: During follow-up, 726 CVD events including 298 hard CVDs occurred. The equation overestimated the risk by 57% in men and 48% in women. Based on the guideline, 73% of men and 44% of women were eligible for statin therapy. The lowest sensitivity was detected for intensive treatment in non-diabetic subgroups (82% in men and 41% in women; corresponding specificity, 52% and 90% respectively). The guideline had a significant net benefit for both moderate and intensive treatment, which resulted in estimated NNTs ranged 5-55; however, net benefit of intensive therapy was uncertain in non-diabetic women. Conclusions: We objectively showed that the ACC/AHA recommendations could be useful in our population but with some overtreatment in women.

Cardiovascular diseases, Net benefit, Number needed to treat, Prevention, Statins,
International Journal of Cardiology
Department of Public Health

Khalili, D, Asgari, S, Hadaegh, F, Steyerberg, E.W, Rahimi, K, Fahimfar, N, & Azizi, J. (2015). A new approach to test validity and clinical usefulness of the 2013 ACC/AHA guideline on statin therapy: A population-based study. International Journal of Cardiology, 184(1), 587–594. doi:10.1016/j.ijcard.2015.03.067