P6213Differences in recommendations and associated level of evidence for statins in primary prevention of CVD according to the ACC/AHA 2013, CCS 2016, ESC 2016, and USPSTF 2016 clinical practice guidelines
Bibliographic record
Abstract
Introduction: Considerable agreement and disagreement exists among recommendations from several prevailing North-American and European cardiovascular society guidelines, despite having the same underlying evidence. However, it is unknown to what extent these recommendations and associated attributed level of evidence vary at population level. Methods: We compared the USPSTF recommendations with the 2013 American College of Cardiology/American Heart Association (ACC/AHA), the 2016 Canadian Cardiovascular Society (CCS), and the 2016 European Society of Cardiology (ESC) guidelines in 7279 participants free of CVD, aged 45 to 75 years, from the unselected Dutch prospective population-based Study cohort (baseline 1997 to 2006). Results: Mean (SD) age was 61.1 (6.9) years and 58.2% were women. Diabetes was present in 8.4% of participants, 24.7% were smokers, mean (SD) LDL level was 142 (35) mg/dL, mean (SD) body mass index was 27.3 (4.3) kg/m2, and mean (SD) blood pressure was 137/80 (20/11) mmHg. USPSTF recommends offering 40.2% of the population statin treatment, and in another 8.5% statins are selectively recommended based on at least moderate certainty that net benefit is small (Figure). ACC/AHA, CCS, and ESC strongly recommended statin use for a respective 58.9%, 71.9%, and 20.2% based on high-quality evidence. In another respective 12.6%, 10.4%, and 57.6% of participants statin use can be considered based on varying levels of evidence. The USPSTF was the only entity not making any treatment recommendations in 8.6% of the population with LDL levels >190 mg/dL, who were all strongly recommended statin therapy in the cardiovascular society guidelines. USPSTF recommends low- to moderate-dose statin therapy for primary prevention, whereas ACC/AHA guidelines recommend initiating moderate- to high-intensity statin therapy depending on the individual's cardiovascular risk profile. CCS and ESC guidelines do not explicitly make recommendations on the intensity or dosage of statin therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.102 | 0.327 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.006 |
| Bibliometrics | 0.012 | 0.010 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".