Guidelines assessed were from the American College of Cardiology/American Heart Association (ACC/AHA; 2013), NICE (2014), Canadian Cardiovascular Society (CCS), U.S. Preventive Services Task Force (USPSTF), and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) [all 2016].
An editorial notes limitations of analysis include use of atherosclerotic CVD end points that are different from those in the 5 guidelines, the ethnically homogeneous study population (Danish), modeling only relative LDL-C reductions (not absolute reductions or specific levels of on-treatment LDL-C), no consideration of costs or harms of therapy, a focus on statin monotherapy, inability to take into account use of preventive therapies during follow-up, and lack of examination of alternative methods (such as imaging) not embodied in existing guidelines. However, it acknowledges that important lessons do emerge and this research does show “how approaches liberalizing statin use for primary prevention and emphasizing large LDL-C reductions are expected to achieve greater reduction in atherosclerotic CVD. They motivate us to examine whether the risk algorithms should be replaced by more sophisticated risk calculators or by the simpler approaches of randomized trials.”