COMPARISON OF PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE GUIDELINES BETWEEN AUSTRALIA, ENGLAND AND THE UNITED STATES. (April 2021)

• Record Type: Journal Article
• Authors: Chapman, Niamh; Breslin, Monique; Lay-Flurrie, Sarah; Zhou, Zhen; Sharman, James; Nelson, Mark; Mcmanus, Richard
• Is Part Of: Journal of hypertension. Volume 39(2021)e-Supplement 1
• Publication Date: 2021-04
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000747604.30980.3b
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Background: Cardiovascular disease (CVD) primary prevention guidelines recommend absolute CVD risk estimation to guide lipid and blood pressure lowering therapy recommendations but these are inconsistent despite relying on similar evidence. This study aimed to understand the effect of such inconsistencies on the populations recommended for treatment according to CVD primary prevention guidelines in Australia, England and the United States. Design and method: Methods: Data were drawn from Australian(n = 3, 942), English(n = 1, 899) and United States(n = 2, 949) national health surveys in adults aged 40 years or older. Participants were classified as recommended for therapy based on absolute CVD risk stratification and clinical characteristics denoting high risk according to each country's guidelines. Agreement was assessed by Kappa statistic. Results: Results: Agreement in therapy recommendation according to CVD primary prevention guidelines was minimal to weak (Kappa = 0.30–0.51). This reflected different populations being targeted due to different risk thresholds (risk calculation agreement Kappa = 0.07–0.45) and different clinical risk criteria (high risk characteristic agreement Kappa = 0.22–0.73). Conclusions: Conclusion: Despite a similar evidence base apparently underpinning guidance, there is very little agreement between populations targeted for CVD primary prevention in Australia, England and the United States. This disparity is driven by differences in both absolute CVD risk stratification thresholds and the clinical characteristics considered to denote high risk. Whilst different countries may adopt different policies on the appropriate level of risk to target, given a largely common evidence base, international consensus on how to define population CVD risk would allow optimum targeting of primary prevention.