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Comment & Response
January 11, 2017

Statin Eligibility Under American and European Cholesterol Guidelines—Reply

Author Affiliations
  • 1Duke University Medical Center, Durham, North Carolina
  • 2Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
  • 3Duke Clinical Research Institute, Durham, North Carolina
JAMA Cardiol. Published online January 11, 2017. doi:10.1001/jamacardio.2016.5081

In Reply We thank Falk and Mortensen for their thoughtful comments regarding our article in JAMA Cardiology.1 We agree that the classification of the United States as a high-risk or low-risk country alters the proportion of Americans recommended for cholesterol-lowering therapy, as shown in our sensitivity analysis. However, how to classify a country remains somewhat vague. As the authors of the 2012 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines point out, “any cut-off point is arbitrary and open to debate.”2 As specified in the Methods section, we used country-specific cardiovascular disease mortality data to classify the United States as a high-risk country and included the United States as a low-risk country in our sensitivity analysis.3

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