PhD defence J. (Jelena) Pavlović

Below is a brief summary of the dissertation: 

Atherosclerotic cardiovascular disease (ASCVD) is largely preventable, with most risk factors being modifiable through lifestyle changes, pharmacological treatments, and public health measures. Statins are the primary treatment recommended for lowering cholesterol in the prevention of ASCVD. This thesis evaluated and compared how different clinical practice guidelines for the primary prevention of ASCVD, particularly those from Europe and the United States, recommend statin use and how well these recommendations align with available randomized controlled trial evidence. The main findings from this thesis revealed that guideline recommendations and trial evidence were fully aligned for about one in five adults, highlighting important discrepancies. Notably, the evidence from trials involving low- to intermediate-risk populations was less well incorporated into the evaluated guidelines. Changes in the updated iterations of the guidelines affected statin eligibility over time. Differences in how guidelines grade and apply evidence also contribute to the observed differences in recommendations across cardiovascular societies and corresponding guidelines. The thesis further explored how non-traditional risk markers, such as N-terminal pro-B-type natriuretic peptide levels and coronary artery calcium scores, can help better identify individuals at low- to intermediate risk who would benefit most from statin treatment. These cardiovascular risk (bio)markers were shown to improve risk stratification and treatment decisions at acceptable numbers needed to treat. Overall, although public health policies reflected in the clinical guidelines vary across international settings, the findings from this thesis underscore the need for more consistent, evidence-aligned guideline recommendations and approaches in ASCVD prevention.