Agreement of Swiss-Adapted International and European Guidelines for the Assessment of Global Vascular Risk and for Lipid Lowering Interventions

Abstract

Background

The Swiss national guidelines for the prevention of cardiovascular events have been published in 2005 by the Swiss Society of Cardiology (SGK) and the working group on lipids and atherosclerosis (AGLA). An agreement for global cardiovascular risk assessment and indications for cholesterol lowering among the international (IAS-AGLA) and the European (ESC score) guidelines is unknown.

Material and methods

Subjects aged ≥45 years were recruited using newspaper announcements for the participation in our free of charge cardiovascular prevention program of the Vascular Risk Foundation (Varifo). The data served to calculate cardiovascular 10 year risk and to compare IAS-AGLA und ESC score with respect to risk and lipid lowering indications.

Results

The primary prevention group included 713 subjects aged 55 ± 6 years of which 47% were women. The mean 10-year risk ± standard deviation was low (IAS-AGLA: 3.9% ± 4.4% for myocardial infarction; ESC score: 1.7% ± 1.8% for cardiovascular death). In those subjects qualifying for a lipid lowering intervention, according to the IAS-AGLA score or the ESC score, the percentage of agreement between both scores was only 18% (kappa value 0.31 [95%CI: 0.22–0.39], p < 0.0001).

Conclusions

Our study shows, that the agreement for the available Swiss guidelines (IAS-AGLA, ESC score) for initiation of a lipid lowering therapy is low in our primary prevention group of subjects aged 45–65 years. According to the PROCAM study, about 30% of myocardial infarctions occur in persons with an intermediate risk. Therefore an improved risk stratification strategy is necessary.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Riesen W, Darioli R, Noseda G, Bertel O, Buser P. Empfehlungen zur Prävention der Atherosklerose. SAeZ 2005;22:1355–61.

    Google Scholar 

  2. 2.

    Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002;105:310–5.

    PubMed  Article  Google Scholar 

  3. 3.

    Conroy R, Pyörälä K, Fitzgerald A, Score Project Group, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987–1003.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Tunstall H, Kuulasmaa K, Mähönen M, et al. Contribution of trends in survival and coronary event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations. Lancet 1999;353:1547–57.

    Article  Google Scholar 

  5. 5.

    Silber S, Jarre F, Pittrow D, et al. Cardiovascular risk assessment by primary-care physicians in germany and its lack of agreement with the established risk scores (DETECT). Med Klin (Munch) 2008;103:638–45.

    Article  Google Scholar 

  6. 6.

    Battegay E, Bertel O, Darioli R, et al. Empfehlungen 1999 zur Behandlungsindikation des Risikofaktors Cholesterin. Schweiz Arztezeitung 1999;80:549–52.

    Google Scholar 

  7. 7.

    Bayes ET. An assay toward solving a problem in the doctrin of chance. Philos Trans R Soc Lond B 1763;53:370–418.

    Article  Google Scholar 

  8. 8.

    Fagan TJ. Nomogram for Bayes theorem. N Engl J Med 1975;293:257.

    PubMed  CAS  Google Scholar 

  9. 9.

    Newcombe RG. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med 1998;17:873–90.

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgment

The Cordicare I study could be undertaken due to donations of the Unigamma Foundation, Aarau, the Vascular Risk Foundation (Varifo), Olten, and the Thalmann Foundation, Olten. We also thank our Head Study Nurse, Franziska M. Kaiser, for her excellent contribution in handling and acquiring of the subjects data.

Conflicts of interest

None

Author information

Affiliations

Authors

Corresponding author

Correspondence to Michel Romanens.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Romanens, M., Ackermann, F., Abay, M. et al. Agreement of Swiss-Adapted International and European Guidelines for the Assessment of Global Vascular Risk and for Lipid Lowering Interventions. Cardiovasc Drugs Ther 23, 249 (2009). https://doi.org/10.1007/s10557-009-6162-y

Download citation

Key words

  • Primary prevention
  • Myocardial infarction
  • Guidelines