Tehran University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
A New Approach to Test Validity and Clinical Usefulness of the 2013 Acc/Aha Guideline on Statin Therapy: A Population-Based Study Publisher Pubmed



Khalili D1, 2 ; Asgari S1 ; Hadaegh F1 ; Steyerberg EW3 ; Rahimi K4 ; Fahimfar N5 ; Azizi F6
Authors
Show Affiliations
Authors Affiliations
  1. 1. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, PO Box 19395, Tehran, 4763, Iran
  2. 2. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Department of Public Health, Erasmus MC, Rotterdam, Netherlands
  4. 4. George Institute for Global Health, University of Oxford, Oxford, United Kingdom
  5. 5. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: International Journal of Cardiology Published:2015


Abstract

Background: The ACC/AHA released a new guideline onthe assessment of cardiovascular risk and management of hypercholesterolemia that some controversy exists concerning its usefulness. We examined the clinical usefulness of this guideline in a high incidence population using novel measures. Methods: First, we validated the new risk equation in a cohort of 2372 men and 2781 women aged 40-75 years. Then, high risk individuals for cardiovascular diseases (CVDs) were identified according to the ACC/AHA guideline at baseline (as a predictor) and CVD outcomes were detected during a 10-year follow-up. Discrimination of the guideline was quantified and the quality of decisions was evaluated by Net Benefit Fraction index considering the harm, for false-positive, and benefit, for true-positive predictions. Finally, net number needed to treat (NNT) for statin was estimated, using test tradeoff index, in diabetic and non-diabetic subjects. Results: During follow-up, 726 CVD events including 298 hard CVDs occurred. The equation overestimated the risk by 57% in men and 48% in women. Based on the guideline, 73% of men and 44% of women were eligible for statin therapy. The lowest sensitivity was detected for intensive treatment in non-diabetic subgroups (82% in men and 41% in women; corresponding specificity, 52% and 90% respectively). The guideline had a significant net benefit for both moderate and intensive treatment, which resulted in estimated NNTs ranged 5-55; however, net benefit of intensive therapy was uncertain in non-diabetic women. Conclusions: We objectively showed that the ACC/AHA recommendations could be useful in our population but with some overtreatment in women. © 2015 Elsevier Ireland Ltd. All rights reserved.
Related Docs
View other Related Docs
1. Serum Alkaline Phosphatase and the Risk of Coronary Heart Disease, Stroke and All-Cause Mortality: Tehran Lipid and Glucose Study, BMJ Open (2018)
2. Prediction of Cardiovascular Disease Mortality in a Middle Eastern Country: Performance of the Globorisk and Score Functions in Four Population-Based Cohort Studies of Iran, International Journal of Health Policy and Management (2022)
3. Risk of Coronary Heart Events Based on Rose Angina Questionnaire and Ecg Besides Diabetes and Other Metabolic Risk Factors: Results of a 10-Year Follow-Up in Tehran Lipid and Glucose Study, International Journal of Endocrinology and Metabolism (2017)
4. An Office-Based Cardiovascular Prediction Model Developed and Validated in Cohort Studies of a Middle-Income Country, Journal of Clinical Epidemiology (2022)
5. Menstrual Cycle Irregularity and Metabolic Disorders: A Population-Based Prospective Study, PLoS ONE (2016)
6. Sex-Specific Impact of Metabolic Dysfunction-Associated Fatty Liver Disease on Incident Cardiovascular Diseases and Mortality, Endocrinology, Diabetes and Metabolism (2025)
7. Pars Risk Charts: A 10-Year Study of Risk Assessment for Cardiovascular Diseases in Eastern Mediterranean Region, PLoS ONE (2017)
8. The Risk and Added Values of the Atherosclerotic Cardiovascular Risk Enhancers on Prediction of Cardiovascular Events: Tehran Lipid and Glucose Study, Journal of Translational Medicine (2021)
Experts (# of related papers)
View all Related Experts
Mohammad Ali Mansournia (10)
Noushin Fahimfar (5)
Other Related Docs
9. Performance of the Revised World Health Organization Cardiovascular Disease Risk Prediction Models for the Middle East and North Africa: A Validation Study in the Tehran Lipid and Glucose Study, Journal of Clinical Epidemiology (2025)
10. Dyslipidemia Incidence and the Trend of Lipid Parameters Changes in Women With History of Gestational Diabetes: A 15-Year Follow-Up Study, Endocrine (2017)
11. The Synergistic Effect of Obesity and Dyslipidemia on Hypertension: Results From the Steps Survey, Diabetology and Metabolic Syndrome (2024)
12. Do Trends of Adiposity and Metabolic Parameters Vary in Women With Different Ovarian Reserve Status? a Population-Based Cohort Study, Menopause (2020)
13. External Validation of the European Risk Assessment Tool for Chronic Cardio-Metabolic Disorders in a Middle Eastern Population, Journal of Translational Medicine (2020)
14. Diabetes in Women and Health-Related Quality of Life in the Whole Family: A Structural Equation Modeling, Health and Quality of Life Outcomes (2019)
15. Optimizing Cardiovascular Disease Mortality Prediction: A Super Learner Approach in the Tehran Lipid and Glucose Study, BMC Medical Informatics and Decision Making (2024)
16. Distribution of Body Mass Index in Children With Different Parental Risk: Findings of a Family-Based Cohort Study in a West-Asian Population, Scientific Reports (2019)
17. Blood Pressure and Cardiovascular Morbidity Risk in Type 2 Diabetes With Hypertension Over a Decade of Follow-Up: Evidence for J-Shaped Phenomenon, Journal of Human Hypertension (2017)
18. The Relationship Between Visfatin and Serum Concentrations of C-Reactive Protein, Interleukin 6 in Patients With Metabolic Syndrome, Journal of Endocrinological Investigation (2016)
19. Non-Invasive Risk Prediction Models in Identifying Undiagnosed Type 2 Diabetes or Predicting Future Incident Cases in the Iranian Population, Archives of Iranian Medicine (2019)
20. The Association Between Index-Year, Average, and Variability of the Triglyceride-Glucose Index With Health Outcomes: More Than a Decade of Follow-Up in Tehran Lipid and Glucose Study, Cardiovascular Diabetology (2024)
21. Performance of Stepwise Screening Methods in Identifying Individuals at High Risk of Type 2 Diabetes in an Iranian Population, International Journal of Health Policy and Management (2022)
22. Socio-Behavioral Factors Associated With Overweight and Central Obesity in Tehranian Adults: A Structural Equation Model, International Journal of Behavioral Medicine (2017)
23. Effects of a Healthy Lifestyle Education on the Incidence of Metabolic Syndrome in Children During a 13-Year Follow-Up, International Journal of Behavioral Medicine (2018)
24. Subnational Exposure to Secondhand Smoke in Iran From 1990 to 2013: A Systematic Review, Environmental Science and Pollution Research (2021)
25. Bibliometric Overview of the Tehran Lipid and Glucose Study (Tlgs) Publications From 2000 to 2022, Journal of Diabetes and Metabolic Disorders (2024)
26. Impact of 3-Year Changes in Lipid Parameters and Their Ratios on Incident Type 2 Diabetes: Tehran Lipid and Glucose Study, Nutrition and Metabolism (2018)
27. Cardiometabolic Risks in Polycystic Ovary Syndrome: Long-Term Population-Based Follow-Up Study, Fertility and Sterility (2018)
28. Assessing the Association Between Dairy Consumption and the 10-Year Framingham Risk Score in Women, BMC Nutrition (2025)
29. Evaluation of the Hypercholesterolemia Care Cascade and Compliance With Ncep-Atp Iii Guidelines in Iran Based on the Who Steps Survey, Lipids in Health and Disease (2025)
30. Mean Versus Variability of Lipid Measurements Over 6 Years and Incident Cardiovascular Events: More Than a Decade Follow-Up, Frontiers in Cardiovascular Medicine (2022)
31. Trend of Cardiovascular Risk Factors in the Older Iranian Population: 2002–2014, Geriatrics and Gerontology International (2018)
32. Changes Over-Time in Blood Pressure of Women With Preeclampsia Compared to Those With Normotensive Pregnancies: A 15 Year Population-Based Cohort Study, Pregnancy Hypertension (2019)
33. Trend of Various Adiposity Indices in Women With and Without History of Gestational Diabetes: A Population-Based Cohort Study, BMC Endocrine Disorders (2019)
34. Associations Between Dairy Products Consumption and Risk of Type 2 Diabetes: Tehran Lipid and Glucose Study, International Journal of Food Sciences and Nutrition (2015)
35. Validation of the Framingham Hypertension Risk Score in a Middle Eastern Population: Tehran Lipid and Glucose Study (Tlgs), BMC Public Health (2021)
36. Ldl-Cholesterol Measurement in Diabetic Type 2 Patients: A Comparison Between Direct Assay and Popular Equations, Journal of Diabetes and Metabolic Disorders (2017)
37. Factors Associated With Pre-Diabetes in Tehranian Men and Women: A Structural Equations Modeling, PLoS ONE (2017)
38. Population Attributable Fraction Estimates of Cardiovascular Diseases in Different Levels of Plasma Total Cholesterol in a Large-Scale Cross-Sectional Study: A Focus on Prevention Strategies and Treatment Coverage, Journal of Diabetes and Metabolic Disorders (2020)
39. Maternal Characteristics and Incidence of Overweight/Obesity in Children: A 13-Year Follow-Up Study in an Eastern Mediterranean Population, Maternal and Child Health Journal (2017)
40. Direct and Indirect Effects of Central and General Adiposity on Cardiovascular Diseases: The Tehran Lipid and Glucose Study, European Journal of Preventive Cardiology (2018)
41. Predictors of Early Adulthood Hypertension During Adolescence: A Population-Based Cohort Study, BMC Public Health (2017)
42. Diabetes Mellitus Risk Prediction in the Presence of Class Imbalance Using Flexible Machine Learning Methods, BMC Medical Informatics and Decision Making (2022)