The new European guidelines for prevention of cardiovascular disease are misleading

Expert Rev Clin Pharmacol. 2020 Dec;13(12):1289-1294. doi: 10.1080/17512433.2020.1841635. Epub 2021 Jan 8.

Abstract

Introduction: The European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) have recently published three major revisions of their guidelines for the management of chronic heart disease, blood lipids, and diabetes. Areas covered: We have scrutinized these guidelines in detail and found that the authors have ignored many studies that are in conflict with their conclusions and recommendations. Expert commentary: The authors of the guidelines have ignored that LDL-cholesterol (LDL-C) of patients with acute myocardial infarction is lower than normal; that high cholesterol is not a risk factor for diabetics; that the degree of coronary artery calcification is not associated with LDL-C; and that 27 follow-up studies have shown that people with high total cholesterol or LDL-C live just as long or longer than people with low cholesterol. They have also ignored the lack of exposure-response in the statin trials; that several of these trials have been unable to lower CVD or total mortality; that no statin trial has succeeded with lowering mortality in women, elderly people, or diabetics; and that cholesterol-lowering with statins has been associated with many serious side effects.

Keywords: Cholesterol; cardiovascular; diabetes; guidelines; statin.

Publication types

  • Review

MeSH terms

  • Anticholesteremic Agents / administration & dosage
  • Anticholesteremic Agents / adverse effects
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Cholesterol / blood*
  • Cholesterol, LDL / blood
  • Europe
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hypercholesterolemia / complications
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / etiology
  • Practice Guidelines as Topic / standards*
  • Risk Factors

Substances

  • Anticholesteremic Agents
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Cholesterol