gms | German Medical Science

Background: Cardiovascular diseases (CVD) are the leading cause of mortality in Germany, accounting for over 300,000 deaths each year [1]. Primary prevention of CVD comprises non-pharmacological and pharmacological components. The pharmacological component involves the treatment of hypertension, diabetes, or dyslipidemia. The goal of our project was to synthesize the evidence to update German guidelines on primary prevention of CVD in general practice, encompassing both non-pharmacological and pharmacological aspects, and to ensure the consistency of recommendations to be included in the updated guidelines.

Materials and methods: We conducted a systematic review of guidelines following the methodology of Muth et al. [2]. We systematically searched MEDLINE via PubMed and “Turning Research Into Practice” (TRIP), as well as guideline databases and the websites of guideline-producing medical societies. Recommendations on the primary prevention of CVD in adults without a history of CVD were extracted by two independent reviewers and assessed for relevance, methodological quality, and consistency of recommendations across the guidelines. The results were tabulated and narratively synthesized.

Results: We identified 26 guidelines providing 581 recommendations for the primary prevention of CVD. Among these, 274 were related to the pharmacological treatment of predisposing conditions. For 79 recommendations (28.8%), consistency could not be evaluated. The remaining recommendations were grouped into 46 clusters of comparable recommendations addressing the same clinical questions. Out of the 15 consistent pharmacologic clusters (32.6%), only 4 demonstrated strong consistency in content, such as recommendations not to prescribe nicotinic acid, aspirin, and fibrates alone for primary prevention of CVD, or to offer treatment with 20 mg/day of atorvastatin to adults at high risk of CVD. In 31 clusters (67.4%), the recommendations were inconsistent. For instance, the recommendation against maximizing the statin dose in patients on moderate-dose statins [3] was inconsistent with the recommendation to use a high-intensity statin when the decision to prescribe statin is made [4].

Conclusion: The majority of pharmacological recommendations for the primary prevention of CVD exhibit inconsistencies among the guidelines. This may be indicative of the impact of the national healthcare context on the development of clinical guidelines and emphasizes the need for further research regarding the pharmacological treatment of predisposing conditions for primary CVD prevention.