Increases in statin eligibility to reduce cardiovascular risk according to the 2013 ACC/AHA cholesterol guidelines in the Africa Middle East region: a sub-analysis of the Africa Middle East Cardiovascular Epidemiological (ACE) study

• Published in: BMC cardiovascular disorders Vol. 19; no. 1; p. 61
• Main Authors: Hamoui, Omar, Omar, Mohamed I, Raal, Frederick J, Rashed, Wafa, Kane, Abdoul, Alami, Mohamed, Abreu, Paula, Mashhoud, Walid, Alsheikh-Ali, Alawi A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.03.2019; BioMed Central; BMC
• Subjects: Adolescent; Adult; Africa - epidemiology; Africa Middle East region; Age Factors; Aged; Anticholesteremic agents; Antilipemic agents; Banks (Finance); Biomarkers - blood; Cardiovascular agents; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Cholesterol; Cholesterol - blood; Cholesterol guidelines; Cross-Sectional Studies; Diagnosis; Disease prevention; Dyslipidemias - blood; Dyslipidemias - diagnosis; Dyslipidemias - drug therapy; Dyslipidemias - epidemiology; Education; Eligibility Determination - standards; Epidemiology; Female; Guideline Adherence - standards; Health risk assessment; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Income; Lipid-lowering therapy; Male; Middle Aged; Middle East - epidemiology; Mortality; Practice Guidelines as Topic - standards; Practice Patterns, Physicians' - standards; Risk Assessment; Risk Factors; Rural Health - standards; Sex Factors; Statin therapy; Statins; The Africa and Middle East Cardiovascular Epidemiological (ACE) study; Treatment Outcome; Urban Health - standards; Young Adult; Middle East; Africa; South Africa; Cholesterol guidelines; The Africa and Middle East Cardiovascular Epidemiological (ACE) study; Africa Middle East region; Lipid-lowering therapy; Statin therapy; Income
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-019-1034-2

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 not known how this affects statin eligibility in the Africa and Middle East Region. Data 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. According 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%). An 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. The ACE trial is registered under NCT01243138 .