TY - JOUR

T1 - Extent of undertreatment and overtreatment with cholesterol-lowering therapy according to European guidelines in 92,348 Danes without ischemic cardiovascular disease and diabetes in 2004-2014

AU - Langsted, Anne

AU - Freiberg, Jacob J

AU - Nordestgaard, Børge G

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2017/2

Y1 - 2017/2

N2 - BACKGROUND AND AIMS: We estimated the extent of undertreatment and overtreatment with cholesterol-lowering therapy according to European guidelines in individuals in the Danish general population without ischemic cardiovascular disease and diabetes.METHODS: We examined 92,348 such individuals aged 35-100 years recruited from 2004 through 2014 in the Copenhagen General Population Study. Each individual was assigned their 10-year risk of fatal cardiovascular disease according to the European SCORE chart based on age, sex, smoking, total cholesterol, and systolic blood pressure. European guidelines recommend cholesterol-lowering therapy definitely at ≥10% risk and LDL cholesterol ≥1.8 mmol/L, definitely at 5-9% risk and LDL cholesterol ≥2.5 mmol/L, possibly at 1-4% risk and LDL cholesterol ≥3 mmol/L, but not at <1% risk.RESULTS: 3858 individuals had ≥10% risk, 16,255 had 5-9% risk, 49,131 had 1-4% risk, and 23,104 had <1% 10-year risk of fatal cardiovascular disease. In these groups, 81%, 86%, 93%, and 99% did not receive cholesterol-lowering therapy. Definite undertreatment and overtreatment according to guidelines were found in 19% and 0.2% or in 187,660 and 1570 per million 35-100 year olds without ischemic cardiovascular disease and diabetes. If definite and possible undertreatment and overtreatment were combined, the corresponding numbers were 52% and 3% or 519,416 and 29,194 per million.CONCLUSIONS: In the Danish general population, ∼190,000 per million 35-100 year olds without ischemic cardiovascular disease and diabetes are not treated to LDL cholesterol goals according to European guidelines. Conversely, ∼1600 per million received cholesterol-lowering therapy without endorsement in European guidelines.

AB - BACKGROUND AND AIMS: We estimated the extent of undertreatment and overtreatment with cholesterol-lowering therapy according to European guidelines in individuals in the Danish general population without ischemic cardiovascular disease and diabetes.METHODS: We examined 92,348 such individuals aged 35-100 years recruited from 2004 through 2014 in the Copenhagen General Population Study. Each individual was assigned their 10-year risk of fatal cardiovascular disease according to the European SCORE chart based on age, sex, smoking, total cholesterol, and systolic blood pressure. European guidelines recommend cholesterol-lowering therapy definitely at ≥10% risk and LDL cholesterol ≥1.8 mmol/L, definitely at 5-9% risk and LDL cholesterol ≥2.5 mmol/L, possibly at 1-4% risk and LDL cholesterol ≥3 mmol/L, but not at <1% risk.RESULTS: 3858 individuals had ≥10% risk, 16,255 had 5-9% risk, 49,131 had 1-4% risk, and 23,104 had <1% 10-year risk of fatal cardiovascular disease. In these groups, 81%, 86%, 93%, and 99% did not receive cholesterol-lowering therapy. Definite undertreatment and overtreatment according to guidelines were found in 19% and 0.2% or in 187,660 and 1570 per million 35-100 year olds without ischemic cardiovascular disease and diabetes. If definite and possible undertreatment and overtreatment were combined, the corresponding numbers were 52% and 3% or 519,416 and 29,194 per million.CONCLUSIONS: In the Danish general population, ∼190,000 per million 35-100 year olds without ischemic cardiovascular disease and diabetes are not treated to LDL cholesterol goals according to European guidelines. Conversely, ∼1600 per million received cholesterol-lowering therapy without endorsement in European guidelines.

U2 - 10.1016/j.atherosclerosis.2016.11.025

DO - 10.1016/j.atherosclerosis.2016.11.025

M3 - Journal article

C2 - 28038381

VL - 257

SP - 9

EP - 15

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -