Impacto de las nuevas guías estadounidense y británica en el manejo y el tratamiento de las dislipemias en una población laboral española / Impact of the New American and British Guidelines on the Management and Treatment of Dyslipidemia in a Spanish Working Population

Introducción y objetivos: La guía para el manejo y el tratamiento de las dislipemias del American College of Cardiology/American Heart Association estadounidense y la del National Institute for Health and Clinical Excellence británico recomiendan cambios importantes, como la supresión de los objetivos terapéuticos o la utilización de unas tablas de riesgo nuevas. Este estudio pretende evaluar el impacto de utilizar estas nuevas guías en comparación con lo que supone la aplicación de la guía europea. Métodos Estudio de tipo observacional realizado en trabajadores españoles. Se incluyó a todos los trabajadores reconocidos por la Sociedad de Prevención de Ibermutuamur durante el año 2011 y cuyo riesgo cardiovascular era evaluable. De cada sujeto, se calculó el riesgo cardiovascular utilizando las tablas Systematic Coronary Risk Evaluation para países de bajo riesgo y las tablas recomendadas por las guías estadounidense y británica. Resultados: Se incluyó a 258.676 trabajadores (el 68,2% varones; media de edad, 39,3 años). Según las tablas Systematic Coronary Risk Evaluation, el 3,74% de la población resultó ser de alto riesgo, mientras que según las tablas británicas eran el 6,85% y según las tablas estadounidenses, el 20,83%. Se debería tratar a más de 20.558 trabajadores si se sigue la guía estadounidense, 13.322 con la británica y 2.612 siguiendo las recomendaciones de las sociedades europeas. Con la guía estadounidense, el coste diario de estatinas se multiplicaría casi por 8. Conclusiones: La nuevas recomendaciones supondrían identificar a más pacientes de alto riesgo y tratar con hipolipemiantes a más población que con las recomendaciones europeas, lo que aumentaría los costes (AU)

Introduction and Objectives The guidelines of the American College of Cardiology/American Heart Association and the British National Institute for Health and Clinical Excellence on the management and treatment of dyslipidemia recommend significant changes, such as the abolition of therapeutic targets and the use of new risk tables. This study aimed to evaluate the impact of the use of these new guidelines compared with the application of European guidelines. Methods Observational study conducted among Spanish workers. We included all workers registered with the Sociedad de Prevención de Ibermutuamur in 2011 whose cardiovascular risk could be evaluated. Cardiovascular risk was calculated for each worker using the Systematic Coronary Risk Evaluation cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines. Results A total of 258 676 workers were included (68.2% men; mean age, 39.3 years). High risk was found in 3.74% of the population according to the Systematic Coronary Risk Evaluation tables and in 6.85% and 20.83% according to the British and American tables, respectively. Treatment would be needed in 20.558 workers according to the American guidelines and in 13.222 according to the British guidelines, but in only 2612 according to the European guidelines. By following the American guidelines, the cost of statins would increase by a factor of 8. Conclusions: The new recommendations would result in identifying more high-risk patients and in treating a larger fraction of the population with lipid-lowering drugs than with the European recommendations, which would result in increased costs (AU)

Impact of the new American and British guidelines on the management and treatment of dyslipidemia in a Spanish working population.

INTRODUCTION AND OBJECTIVES: The guidelines of the American College of Cardiology/American Heart Association and the British National Institute for Health and Clinical Excellence on the management and treatment of dyslipidemia recommend significant changes, such as the abolition of therapeutic targets and the use of new risk tables. This study aimed to evaluate the impact of the use of these new guidelines compared with the application of European guidelines. METHODS: Observational study conducted among Spanish workers. We included all workers registered with the Sociedad de Prevención de Ibermutuamur in 2011 whose cardiovascular risk could be evaluated. Cardiovascular risk was calculated for each worker using the Systematic Coronary Risk Evaluation cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines. RESULTS: A total of 258,676 workers were included (68.2% men; mean age, 39.3 years). High risk was found in 3.74% of the population according to the Systematic Coronary Risk Evaluation tables and in 6.85% and 20.83% according to the British and American tables, respectively. Treatment would be needed in 20 558 workers according to the American guidelines and in 13,222 according to the British guidelines, but in only 2612 according to the European guidelines. By following the American guidelines, the cost of statins would increase by a factor of 8. CONCLUSIONS: The new recommendations would result in identifying more high-risk patients and in treating a larger fraction of the population with lipid-lowering drugs than with the European recommendations, which would result in increased costs.