{"id":"b8086dfdae02","type":"article","url":"https://hartvaat.nl/2026/12/01/discrepantie-in-richtlijnen-over-laagwaardige-zorg-bij-hart-en-vaatziekten-narra/","title":"Discrepantie in richtlijnen over laagwaardige zorg bij hart- en vaatziekten — narratieve review","title_en":"Discrepancies in low-value practices across cardiovascular disease prevention guidelines. A narrative review.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":[],"journal":"The European journal of general practice","doi":"10.1080/13814788.2026.2729221","source_url":"https://doi.org/10.1080/13814788.2026.2729221","authors":["Carlos Brotons","Irene Moral","Tom Axelrod","John Brandt Brodersen","Carlos Martins","Serdar Öztora","Iva Petričušić","Veerle Piessens","Carlen Reyes","Laura Rodriguez-Benito","Andras Terebessi"],"significance":5,"published":"2026-09-28","source_date":"2026-12-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/lipiden/inclisiran-sirna/"],"congress":"","summary_en":"This narrative review examines discrepancies across international cardiovascular prevention guidelines regarding low-value practices. The authors highlight significant uncertainty around recommendations for coronary artery calcium scoring, lipoprotein(a) testing, abdominal aortic aneurysm screening, and lipid-lowering therapy in older adults. Given that many recommendations rely on non-randomised data or expert consensus, clinicians are advised to exercise caution when implementing these screening and therapeutic interventions in routine practice.","created":"2026-09-22T00:46:06Z","updated":"2026-09-22T00:46:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze narratieve review analyseert de verschillen tussen internationale richtlijnen voor cardiovasculaire preventie op het gebied van laagwaardige zorg. De auteurs tonen aan dat er grote onduidelijkheid bestaat over aanbevelingen rondom coronair calciumscans, lipoproteïne(a)-bepaling, buikaorta-aneurysmascreening en lipidendaling bij ouderen. Omdat veel aanbevelingen gebaseerd zijn op niet-randomisatie data of expertconsensus, pleiten ze voor voorzichtigheid bij deze screeningen en interventies in de dagelijkse praktijk.","abstract_original":"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."}