ESC/EAS guidelines for the detection, prevention, and treatment of individuals at risk of a first myocardial infarction: effect of 5 years of updates and the new SCORE2

• Published in: European heart journal. Cardiovascular pharmacotherapy 2022-10, Vol.8 (6), p.633-643
• Main Authors: Sulman, David, Zeitouni, Michel, Silvain, Johanne, Kerneis, Mathieu, Guedeney, Paul, Barthélémy, Olivier, Brugier, Delphine, Sabouret, Pierre, Lattuca, Benoit, Mertens, Emilie, Posson, Julianne, Procopi, Niki, Salloum, Tomy, Collet, Jean-Philippe, Montalescot, Gilles
• Format: Article
• Language: English
• Subjects: Anticholesteremic Agents / therapeutic use; Cardiology; Cardiology and cardiovascular system; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Cholesterol; Cholesterol, LDL; Disease prevention; Ezetimibe / therapeutic use; Female; Guidelines; Health risks; Heart attack; Heart attacks; Human health and pathology; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use; Life Sciences; Low density lipoproteins; Male; Medical diagnosis; Metabolic disorders; Myocardial Infarction / diagnosis; Myocardial Infarction / drug therapy; Myocardial Infarction / epidemiology; Practice guidelines (Medicine); Practice Guidelines as Topic; Prevention; Proprotein Convertase 9; ST Elevation Myocardial Infarction / diagnosis; ST Elevation Myocardial Infarction / drug therapy; ST Elevation Myocardial Infarction / epidemiology; Statins
• ISSN: 2055-6837; 2055-6845
• DOI: 10.1093/ehjcvp/pvac021

Abstract Aims The European Society of Cardiology (ESC) has released three consecutive guidelines within 5 years addressing cardiovascular prevention, risk scores, and cholesterol treatment. This study aims to evaluate whether the 2021 ESC guidelines improved the eligibility of individuals for primary prevention statin therapy before their first ST-segment elevation myocardial infarction (STEMI), and for intensive lipid-lowering treatments in secondary prevention. Methods and results The cardiovascular risk category of 2757 consecutive individuals admitted for a first STEMI was evaluated to assess whether they would have been eligible for primary prevention statins according to 2021 vs. 2019 and 2016 ESC guidelines. Eligibility for intensive lipid-lowering therapy in secondary prevention was assessed according to the real-life follow-up low-density lipoprotein cholesterol (LDL-C) and the expected follow-up LDL-C. More individuals would have been eligible for primary prevention statins according to 2021 and 2019 vs. 2016 guidelines (61.8% vs. 38.7% vs. 23.6%, P