A Comparison of Statin Treatment Algorithms Based on the ACC/AHA and Philippine Guidelines for Primary Prevention of Dyslipidemia in Statin-Naive Filipino Patients

Abstract

Objectives

This cross-sectional study evaluates the degree of agreement between the 2018 American College of Cardiology/American Heart Association (ACC/AHA2018) and 2020 Philippine Guideline (PG2020) treatment algorithms for the primary prevention of dyslipidemia among Filipinos.

Methodology

This review included 159 charts of statin-naive Filipinos who are 45-79 years old. Using risk profile and lipid measurements, statin treatment recommendation was determined through the PG2020 algorithm and ACC/AHA-ASCVD Risk Estimator Plus web application. The degree of agreement was measured by Cohen’s kappa statistic with the two algorithms as independent raters.

Results

A total of 159 patients were included in the final analysis. There was a slight agreement with a kappa coefficient of 0.209 or 4.4% (95% CI 0.078-0.340, p=0.003). Statin treatment was recommended in 69 out of 159 patients (43.4%) by the PG2020 overlapping with ACC/AHA2018 in 56 cases (81.2%). On the other hand, 109 cases (68.6%) were recommended for statin treatment by ACC/AHA2018 overlapping with PG2020 in only 51.4%.

Conclusions

The low degree of agreement between the two treatment algorithms highlights the key demographic and ethnic variations in dyslipidemia management necessitating outcome-based studies to translate these differences. Overestimation of ASCVD risk calculation in the ACC/AHA2018 and consideration of important, unique risk factors among Filipinos favors the applicability of the Philippine guideline.