Statins: Large Disparity Between US/Canadian/UK and European Guidelines Interview with:

Borge G. Nordestgaard,

Borge G. Nordestgaard

Børge G. Nordestgaard, MD, DMSc
Department of Clinical Biochemistry
Herlev and Gentofte Hospital, Copenhagen University Hospital
Herlev, Denmark What is the background for this study?

Response: Five major organizations recently published guidelines for using statins to prevent atherosclerotic cardiovascular disease  — the American College of Cardiology/American Heart Association (ACC/AHA) in 2013, the United Kingdom’s National Institute for Health and Care Excellence (NICE) in 2014, and in 2016 the Canadian Cardiovascular Society (CCS), the US Preventive Services Task Force (USPSTF), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). We applied these five guidelines to a contemporary study cohort of 45,750 40-75 year olds from the Copenhagen General Population Study. What are the main findings?

Response: Our study clearly shows that the main American ACC/AHA, the Canadian and the British guidelines recommending statin therapy to 40-44% of individuals aged 40-75 have the potential for reducing the burden of atherosclerotic cardiovascular disease by a third, that is, if they are fully implemented and if high-dose statins are prescribed.

In contrast, European guidelines only recommend statins to 15% and only have the potential to prevent 1 in 8 of cardiovascular disease events. The USPSTF statement was in between. What should readers take away from your report?

Response: The most important take-home messages are:

1) To use high-dose statins rather than lower doses.

2) That the American College of Cardiology/American Heart Association, Canadian or British guidelines should be followed rather than those issued in Europe or by the US Preventive Services Task Force, as the former three will prevent more atherosclerotic cardiovascular disease events.

3) Despite being founded on the same evidence originating from randomized statin trials, it was surprising to see the large heterogeneity between guidelines in the number of individuals qualifying for primary prevention with statins. What recommendations do you have for future research as a result of this work?

Response: Cost-effective analyses of using more versus using less statins for primary prevention. Is there anything else you would like to add?

 Response: I wonder why many people, some doctors, and mainly European societies are not interested in the full implementation of this efficient method of prevention cardiovascular disease, the disease that kills the most people world-wide. Statins are safe, inexpensive and very effective in reducing atherosclerotic cardiovascular disease risk. Double-blind studies document that “real” side effects for statins are extremely rare, although perceived side effects are frequently reported by patients – partly because of negative news on statins in the lay media.

No conflict of interest.


Mortensen MB, Nordestgaard BG. Comparison of Five Major Guidelines for Statin Use in Primary Prevention in a Contemporary General Population. Ann Intern Med. [Epub ahead of print 2 January 2018] doi: 10.7326/M17-0681 is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional.

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Last Updated on January 14, 2018 by Marie Benz MD FAAD