Abstract
BackgroundWith development of cholesterol management guidelines by the American College of Cardiology/American Heart Association (ACC/AHA), more individuals at risk of cardiovascular disease may be eligible for statin therapy. It is not known how this affects statin eligibility in the Africa and Middle East Region.MethodsData were used from the Africa Middle East Cardiovascular Epidemiological (ACE) study. The percentage of subjects eligible for statins per the ACC/AHA 2013 cholesterol guidelines and the 2002 National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III) recommendations were compared. Analyses were carried out according to age, gender, community (urban/rural), and country income categories based on World Bank definitions.ResultsAccording to the ACC/AHA recommendations, 1695 out of 4378 subjects (39%; 95% confidence interval [CI], 37–40%) satisfied statin eligibility criteria vs. 1043/4378 (24%; 95% CI, 23–25%) per NCEP-ATP recommendations, representing a 63% increase in statin eligibility. Consistent increases in eligibility for statin therapy were seen according to the ACC/AHA vs. NCEP-ATP guidelines across sub-groups of age, gender, community, and country income. Notable increases for statin eligibility according to ACC/AHA vs. NCEP-ATP were seen, respectively, in subjects aged ≥65 years (86% vs. 39%), in males (46% vs. 25%), in low-income countries (28% vs. 14%), and rural communities (37% vs. 19%).ConclusionAn increase in statin eligibility was seen applying ACC/AHA cholesterol guidelines compared with previous NCEP-ATP recommendations in the Africa Middle East region. The economic consequences of these guideline recommendations will need further research.Trial registrationThe ACE trial is registered under NCT01243138.
Highlights
With development of cholesterol management guidelines by the American College of Cardiology/ American Heart Association (ACC/American Hypertension Society (AHA)), more individuals at risk of cardiovascular disease may be eligible for statin therapy
It is expected that increased use of lipid-lowering therapy in high-risk patients will result in wider benefits with short- and long-term use, leading to prevention of cardiovascular disease and the associated morbidity and mortality [9], sustaining a trend observed over the past few decades [10]
Utilizing data from a study of cardiovascular risk factors across the Africa and Middle East region [15], the present study investigates the impact that 2013 American College of Cardiology/ American Heart Association (ACC/AHA) blood cholesterol guidelines [19] have on patient eligibility for statin use in this cohort of outpatients from the Africa Middle East region in comparison with the established National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) blood cholesterol guidelines [20]
Summary
With development of cholesterol management guidelines by the American College of Cardiology/ American Heart Association (ACC/AHA), more individuals at risk of cardiovascular disease may be eligible for statin therapy. It is expected that increased use of lipid-lowering therapy in high-risk patients will result in wider benefits with short- and long-term use, leading to prevention of cardiovascular disease and the associated morbidity and mortality [9], sustaining a trend observed over the past few decades [10]. Countries with adequate financial resources are better prepared to afford the short-term costs of prescription medications in order to recover the long-term benefits of reducing the morbidity and mortality associated with cardiovascular disease. Developing countries, on the other hand, with more limited financial resources, may be challenged to provide the medications and healthcare needed to meet recommendations for management of cardiovascular disease [11]
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