Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: results from a multiethnic case-control study

Background: The 2013 ACC/AHA cholesterol treatment guidelines have introduced a new cardio-vascular risk assessment approach (PCE) and have revisited the threshold for prescribing statins.This study aims to compare the ex ante application of the ACC/AHA and the ATP-III guidelinemodels by using a multiethnic case-control study. Methods: ATP-III-FRS and PCE were assessed in739 patients with first STEMI and 739 age- and gender-matched controls; the proportion of casesand controls that would have been eligible for statin as primary prevention therapy and the dis-criminatory ability of both models were evaluated. Results: The application of the ACC/AHA com-pared to the ATP-III model, resulted in an increase in sensitivity [94% (95%CI: 91%–95%) vs. 65%(61%–68%), p< 0.0001], a reduction in specificity [19% (15%–22%) vs. 55% (51%–59%),p< 0.0001] with similar global accuracy [0.56 (0.53–0.59) vs.0.59 (0.57–0.63), p ns]. When stratify-ing for ethnicity, the accuracy of the ACC/AHA model was higher in Europeans than in Chinese(p ¼ 0.003) and to identified premature STEMI patients within Europeans much better comparedto the ATP-III model (p ¼ 0.0289). Conclusion: The application of the ACC/AHA model resulted ina significant reduction of first STEMI patients who would have escaped from preventive treat-ment. Age and ethnicity affected the accuracy of the ACC/AHA model improving the identifica-tion of premature STEMI among Europeans only.