ESC and AHA/ACC Guidelines Differ on Statin Recommendations

HealthDay News – European and American guidelines lead to different recommendations for statin therapy, according to a study published online in JACC: Cardiovascular Imaging.

Amir A. Mahabadi, MD, from the University of Duisburg-Essen in Germany, and colleagues assessed the coronary artery calcification (CAC) score of 3745 participants from the population-based longitudinal Heinz Nixdorf Recall cohort study without cardiovascular disease or lipid lowering therapy at baseline. Based on individual baseline characteristics, statin indication was determined according to 2012 European Society of Cardiology (ESC) and 2013 American Heart Association/American College of Cardiology (AHA/ACC) guidelines.

The researchers observed a lower frequency of statin recommendation with ESC vs AHA/ACC guidelines (34% vs 56%; P <.0001); in individuals with statin indication by both guidelines, low CAC score (<100) was common (59% and 62%, respectively). 

One hundred thirty-one myocardial infarctions occurred during 10.4 ± 2.0 years of follow-up. For ESC recommendations, risk was differentiated by a CAC score of 100 among individuals without statin indication (1.0; 95% confidence interval [CI]: 0.4-1.5 vs 6.5; 95% CI: 4.1-8.9 coronary events per 1000 person-years for CAC 0 vs ≥100) and those with statin indications (2.6; 95% CI: 0.6-4.7 vs 9.9; 95% CI: 7.3-12.5 per 1000 person-years for CAC 0 vs ≥100). 

According to AHA/ACC guidelines, a CAC score of 100 stratified proportions of events among those individuals with statin indication (2.7; 95% CI: 1.1-4.2 vs 9.1; 95% CI: 7.0-11.0 per 1000 person-years for CAC 0 vs ≥100). However, the event rate was low for individuals without statin indication (1.1; 95% CI: 0.65-1.68 per 1000 person-years).

“Current ESC and AHA/ACC guidelines lead to markedly different recommendations regarding statin therapy in a German primary prevention cohort,” the authors wrote. “Quantification of CAC score in addition to the guidelines improves stratification.”


  1. Blaha MJ, Matsushita K. Coronary artery calcium. Need for more clarity in guidelines. JACC Cardiovasc Imag. 2016. doi:10.1016/j.jcmg.2016.05.017.
  2. Mahabadi A, Mohlenkamp S, Lehmann N, et al. CAC score improves coronary and CV risk assessment above statin indication by ESC and AHA/ACC primary prevention guidelines. JACC Cardiovasc Imag. 2016. doi:10.1016/j.jcmg.2016.03.022.