Little consensus among CVD screening guidelines
medwireNews: Cardiovascular disease (CVD) screening guidelines developed by Western medical organisations have few areas of agreement, say researchers who reviewed 21 recent examples.
In the face of such disagreement, they suggest that doctors should “assess the strength of the recommendations and the level of evidence to decide which of the recommendations they should implement.”
The guidelines, all published since 2010, variously cover total CVD risk, dyslipidaemia, dysglycaemia and hypertension. Most guidelines recommend opportunistic rather than systematic screening, but have varying opinions as to who should be screened; the baseline age for screening varies widely, with some guidelines modifying this according to gender and ethnicity and others not.
The researchers found agreement on many of the risk factors that should be assessed, with age, gender, lipid levels, blood pressure and smoking most commonly advocated, but no consensus on which risk model should be used, with recommendations including the Pooled Cohort Equation, QRISK2 and the Framingham Risk Score (FRS).
MG Myriam Hunink (Erasmus Medical Center, Rotterdam, the Netherlands) and study co-authors say this differs markedly from when they reviewed the guidelines 6 years ago, at which time the FRS was predominant.
“This variability can lead to the same groups receiving different treatment, makes comparison among several health care systems challenging, and could also lead to health care inequality”, they write in the Annals of Internal Medicine.
Since the previous review, the thresholds for initiating intensive lifestyle changes and statin treatment have tended to fall overall, they say, with falling statin costs due to expiring patents being one reason given for the latter.
However, the team found that the thresholds are still highly variable between guidelines, except that all the dyslipidaemia guidelines advocate intensive lifestyle modification for patients at high risk of diabetes. Most guidelines also agree on the need for blood pressure control in diabetes patients, but the threshold for intervention varies.
One current area of agreement is that most guidelines are no longer advocating aspirin for primary prevention, with only two guidelines recommending it based on old age alone. And none of the current guidelines are strongly advocating emerging biomarkers; the European Society of Cardiology guidelines cover these the most extensively, but advise use of them only in limited, specific situations.
The researchers note that the lack of consensus among the CVD screening guidelines “may partly reflect the uncertainty of the benefits of screening.”
They conclude: “The optimal strategy for systematic screening of the apparently healthy population remains to be found.”
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016
Ann Intern Med 2016; Advance online publication