Discrepancies in low-value practices across cardiovascular disease prevention guidelines. A narrative review.

IF 2.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

European Journal of General Practice Pub Date : 2026-12-01 Epub Date: 2026-09-21 DOI:10.1080/13814788.2026.2729221

Carlos Brotons, Irene Moral, Tom Axelrod, John Brandt Brodersen, Carlos Martins, Serdar Öztora, Iva Petričušić, Veerle Piessens, Carlen Reyes, Laura Rodriguez-Benito, Andras Terebessi

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引用次数: 0

Abstract

Background: Low-value practices are interventions that do not provide health benefits due to lack of effectiveness or associated risks that outweigh the potential benefits.

Objectives: The purpose of this study is to demonstrate discrepancies across various cardiovascular prevention guidelines published by numerous institutions and organisations, and establish an objective overview of the current state of the art and formulate recommendations for general practitioners.

Methods: A narrative review of clinical practice guidelines for CVD prevention published in English between January 2017 and December 2025 was conducted. Searches focused on major European, British, North American, and Australian scientific societies; only guidelines containing explicit recommendations on low-value or unnecessary practices were included. We identified the scientific evidence supporting these recommendations and searched for ongoing clinical trials - specifically in cases where recommendations were based on a single randomised trial, large non-randomised studies, retrospective data, or expert opinion.

Results: Guidelines show significant discrepancies regarding recommendations for low-value practices. These primarily relate to the evaluation of the coronary artery calcium (CAC) score, determination of lipoprotein(a) (Lp(a)), screening for abdominal aortic aneurysm (AAA), and the initiation of lipid-lowering treatment in older adults. Controversy and uncertainty were most evident when recommendations were based on non-randomised clinical trials or expert opinion.

Conclusions: While some guidelines align, others exhibit clear discrepancies, illustrating the uncertainty of the scientific evidence and differing interpretations. Until robust evidence from high-quality clinical trials becomes available, clinicians should exercise caution regarding certain screening procedures and therapeutic interventions in CVD prevention within general practice.

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低价值做法在心血管疾病预防指南中的差异。叙述性评论

背景：低价值做法是指由于缺乏有效性或相关风险超过潜在益处而不能提供健康益处的干预措施。目的：本研究的目的是证明由众多机构和组织发布的各种心血管预防指南之间的差异，并建立当前技术状况的客观概述，并为全科医生制定建议。方法：对2017年1月至2025年12月发表的英文CVD预防临床实践指南进行叙述性回顾。搜索集中在欧洲、英国、北美和澳大利亚的主要科学协会；只包括关于低价值或不必要做法的明确建议的指导方针。我们确定了支持这些建议的科学证据，并检索了正在进行的临床试验——特别是在建议基于单个随机试验、大型非随机研究、回顾性数据或专家意见的情况下。结果：指南显示关于低价值实践的建议存在显著差异。这些主要与冠状动脉钙（CAC）评分的评估、脂蛋白(a) （Lp(a)）的测定、腹主动脉瘤（AAA）的筛查以及老年人降脂治疗的开始有关。当建议基于非随机临床试验或专家意见时，争议和不确定性最为明显。结论：虽然一些指南是一致的，但其他指南表现出明显的差异，说明了科学证据的不确定性和不同的解释。在获得高质量临床试验的有力证据之前，临床医生应谨慎对待一般实践中心血管疾病预防的某些筛查程序和治疗干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of General Practice PRIMARY HEALTH CARE-MEDICINE, GENERAL & INTERNAL

CiteScore

5.10

自引率

5.90%

发文量

审稿时长

>12 weeks

期刊介绍： The EJGP aims to: foster scientific research in primary care medicine (family medicine, general practice) in Europe stimulate education and debate, relevant for the development of primary care medicine in Europe. Scope The EJGP publishes original research papers, review articles and clinical case reports on all aspects of primary care medicine (family medicine, general practice), providing new knowledge on medical decision-making, healthcare delivery, medical education, and research methodology. Areas covered include primary care epidemiology, prevention, diagnosis, pharmacotherapy, non-drug interventions, multi- and comorbidity, palliative care, shared decision making, inter-professional collaboration, quality and safety, training and teaching, and quantitative and qualitative research methods.