Background:Despite using identical evidence to support practice guidelines for lipid-lowering treatment in primary prevention of cardiovascular disease (CVD), it is unclear to what extent the 2018 American Heart Association/American College of Cardiology/Multisociety, 2016 US Preventive Services Task Force (USPSTF), 2020 Department of Veterans Affairs/Department of Defense, 2021 Canadian Cardiovascular Society, and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines differ in grading and assigning levels of evidence and classes of recommendations (LOE/class) at a population level.Methods:We included 7262 participants, aged 45 to 75 years, without history of CVD from the prospective population-based Rotterdam Study. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity for CVD events, and numbers needed to treat at 10 years were calculated.Results:Mean age was 61.1 (SD 6.9) years; 58.2% were women. American Heart Association/American College of Cardiology/Multisociety, USPSTF, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society strongly recommended statin initiation in respective 59.4%, 40.2%, 45.2%, 73.7%, and 42.1% of the eligible population based on high-quality evidence. Sensitivity for CVD events for treatment recommendations supported with strong LOE/class was 86.3% for American Heart Association/American College of Cardiology/Multisociety (IA or IB), 69.4% for USPSTF (USPSTF-B), 74.5% for Department of Veterans Affairs/Department of Defense (strong for), 93.3% for Canadian Cardiovascular Society (strong), and 66.6% for European Society of Cardiology/European Atherosclerosis Society (IA). Specificity was highest for the USPSTF at 45.3% and lowest for European Society of Cardiology/European Atherosclerosis Society at 10.0%. Estimated numbers needed to treat at 10 years for those with the strongest LOE/class were ranging from 20 to 26 for moderate-intensity and 12 to 16 for high-intensity statins.Conclusions:Sensitivity, specificity, and numbers needed to treat at 10 years for assigned LOE/class varied greatly among 5 CVD prevention guidelines. The level of variability seems to be driven by differences in how the evidence is graded and translated into LOE/class underlying the treatment recommendations by different professional societies. Efforts towards harmonizing evidence grading systems for clinical guidelines in primary prevention of CVD may reduce ambiguity and reinforce updated evidence-based recommendations.

中文翻译：

---

在心血管疾病一级预防中使用他汀类药物的建议和相关证据水平：美国心脏协会/美国心脏病学会/多社会、美国预防服务工作组、加拿大退伍军人事务部/国防部的人群水平比较心血管学会和欧洲心脏病学会/欧洲动脉粥样硬化学会临床实践指南

背景：尽管使用相同的证据来支持心血管疾病 (CVD) 一级预防降脂治疗的实践指南，但尚不清楚 2018 年美国心脏协会/美国心脏病学会/多协会、2016 年美国预防服务工作组在多大程度上(USPSTF)、2020 年退伍军人事务部/国防部、2021 年加拿大心血管学会和 2019 年欧洲心脏病学会/欧洲动脉粥样硬化学会指南在对人群的证据等级和建议等级 (LOE/等级) 的分级和分配方面有所不同水平。方法：我们纳入了 7262 名参与者，年龄在 45 至 75 岁之间，没有 CVD 病史，这些参与者来自基于人群的前瞻性鹿特丹研究。根据指南，按 LOE/类别推荐他汀类药物治疗的人群比例，计算 CVD 事件的敏感性和特异性，以及 10 年需要治疗的人数。结果：平均年龄为 61.1 (SD 6.9) 岁；58.2% 是女性。美国心脏协会/美国心脏病学会/多社会学会、USPSTF、退伍军人事务部/国防部、加拿大心血管学会和欧洲心脏病学会/欧洲动脉粥样硬化学会强烈推荐他汀类药物起始治疗的比例分别为 59.4%、40.2%、45.2%、基于高质量证据的合格人群的 73.7% 和 42.1%。美国心脏协会/美国心脏病学会/多社会学会（IA 或 IB）对 CVD 事件的强烈 LOE/类别支持的治疗建议的敏感性为 86.3%，USPSTF (USPSTF-B) 为 69.4%，退伍军人事务部为 74.5% /国防部（强），93。加拿大心血管学会（强）为 3%，欧洲心脏病学会/欧洲动脉粥样硬化学会 (IA) 为 66.6%。USPSTF 的特异性最高，为 45.3%，欧洲心脏病学会/欧洲动脉粥样硬化学会的特异性最低，为 10.0%。对于具有最强 LOE/等级的患者，估计在 10 年需要治疗的人数为中等强度的 20 至 26 和高强度他汀类药物的 12 至 16。结论：敏感性、特异性和 10 年所需治疗的数量指定的 LOE/类别在 5 个 CVD 预防指南中差异很大。变异水平似乎是由不同专业协会对证据进行分级和转化为 LOE/等级的差异所驱动的。