Author + information
- Received June 6, 2019
- Revision received August 21, 2019
- Accepted September 4, 2019
- Published online November 11, 2019.
- Lisandro D. Colantonio, MD, PhDa,∗ (, )@lcolantonio,
- Erin D. Shannon, MPHb,
- Kate K. Orroth, PhD, MPHc,
- Rebecca Zaha, MPHc,
- Elizabeth A. Jackson, MD, MPHd,
- Robert S. Rosenson, MDe,
- Jason Exter, PharmDf,
- Katherine E. Mues, PhD, MPHc and
- Paul Muntner, PhDa
- aDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- bSimulStat Inc., Solana Beach, California
- cCenter for Observational Research, Amgen Inc., Thousand Oaks, California
- dDepartment of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- eMount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
- fAmgen Inc., Thousand Oaks, California
- ↵∗Address for correspondence:
Dr. Lisandro D. Colantonio, Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Avenue South, RPHB 527C, Birmingham, Alabama 35294-0013.
Background The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline includes recommendations for intensive lipid-lowering therapy in patients at very high risk for atherosclerotic cardiovascular disease (ASCVD) events.
Objectives This study sought to estimate event rates among adults with a history of ASCVD who met and did not meet the definition of very high risk in the 2018 AHA/ACC cholesterol guideline.
Methods Data from U.S. adults with health insurance in the MarketScan database who had a history of ASCVD on January 1, 2016 (n = 27,775) were analyzed. Very high risk for ASCVD events was defined as a history of ≥2 major ASCVD events or 1 event and ≥2 high-risk conditions. Patients were followed through December 31, 2017, for ASCVD events, including myocardial infarction, ischemic stroke, and major adverse limb events.
Results Overall, 15,366 patients (55.3%) with ASCVD met the definition of very high risk. Among patients with and without very high risk, the ASCVD event rate per 1,000 person-years was 53.1 (95% confidence interval [CI]: 50.1 to 56.1) and 17.0 (95% CI: 15.2 to 18.9), respectively. Among patients with ≥2 major ASCVD events and with 1 event and ≥2 high-risk conditions, the ASCVD event rate per 1,000 person-years was 89.8 (95% CI: 82.2 to 98.0) and 41.3 (95% CI: 38.3 to 44.4), respectively. The age- and sex-adjusted hazard ratios for ASCVD events among patients with very high risk, overall, with ≥2 major ASCVD events and with 1 event and ≥2 high-risk conditions versus those without very high risk were 2.98 (95% CI: 2.63 to 3.37), 4.89 (95% CI: 4.22 to 5.66), and 2.33 (95% CI: 2.04 to 2.66), respectively.
Conclusions The 2018 AHA/ACC cholesterol guideline directs intensive lipid-lowering therapy to adults with a very high ASCVD event rate.
- anticholesteremic agents
- cardiovascular disease
- guideline as topic
Supported by a research grant from Amgen, Inc. Drs. Orroth, Zaha, Exter, and Mues are employees of Amgen, Inc. Drs. Exter and Mues own stock in Amgen, Inc. Drs. Jackson, Rosenson, and Muntner have received research support from Amgen, Inc. Dr. Rosenson has received research support from Akcea, AstraZeneca, The Medicines Company, and Regeneron; is a consultant for Akcea, C5, and CVS Caremark; has received honoraria from Amgen, Kowa, and Pfizer; has received royalties from UpToDate, Inc.; and owns stock in MediMergent. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Nathan D. Wong, MD, served as Guest Associate Editor for this paper.
- Received June 6, 2019.
- Revision received August 21, 2019.
- Accepted September 4, 2019.
- 2019 American College of Cardiology Foundation
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