The 2006 Canadian dyslipidemia guidelines will prevent more deaths while treating fewer people – but should they be further modified?

Abstract

When clinical guidelines affect large numbers of individuals or substantial resources, it is important to understand their benefits, harms and costs from a population perspective. Many countries' dyslipidemia guidelines include these perspectives. To compare the effectiveness and efficiency of the 2003 and 2006 Canadian dyslipidemia guidelines for statin treatment in reducing deaths from coronary artery disease (CAD) in the Canadian population. The 2003 and 2006 Canadian dyslipidemia guidelines were applied to data from the Canadian Heart Health Survey (weighted sample of 12,300,000 people), which includes information on family history and physical measurements, including fasting lipid profiles. The number of people recommended for statin treatment, the potential number of CAD deaths avoided and the number needed to treat to avoid one CAD death with five years of statin therapy were determined for each guideline. Compared with the 2003 guidelines, 1.4% fewer people (20 to 74 years of age) are recommended statin treatment, potentially preventing 7% more CAD deaths. The number needed to treat to prevent one CAD death over five years decreased from 172 (2003 guideline) to 147 (2006 guideline). From a population perspective, the 2006 Canadian dyslipidemia recommendations are an improvement of earlier versions, preventing more CAD events and deaths with fewer statin prescriptions. Despite these improvements, the Canadian dyslipidemia recommendations should explicitly address issues of absolute benefit and cost-effectiveness in future revisions.