Ischemic Event Rates in Very-High-Risk Adults

被引:41
作者
Colantonio, Lisandro D. [1 ]
Shannon, Erin D. [2 ]
Orroth, Kate K. [3 ]
Zaha, Rebecca [3 ]
Jackson, Elizabeth A. [4 ]
Rosenson, Robert S. [5 ]
Exter, Jason [6 ]
Mues, Katherine E. [3 ]
Muntner, Paul [1 ]
机构
[1] Univ Alabama Birmingham, Dept Epidemiol, 1720 2nd Ave South,RPHB 527C, Birmingham, AL 35294 USA
[2] SimulStat Inc, Solana Beach, CA USA
[3] Amgen Inc, Ctr Observat Res, Thousand Oaks, CA 91320 USA
[4] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA
[5] Icahn Sch Med Mt Sinai, Mt Sinai Heart, New York, NY 10029 USA
[6] Amgen Inc, Thousand Oaks, CA 91320 USA
关键词
anticholesteremic agents; atherosclerosis; cardiovascular disease; guideline as topic; hypercholesterolemia; risk; LIPID-LOWERING THERAPY; STATIN THERAPY; MEDICARE DATA; CHOLESTEROL; EZETIMIBE; POPULATION; ALIROCUMAB; EFFICACY; SAFETY; TRENDS;
D O I
10.1016/j.jacc.2019.09.025
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. (J Am Coll Cardiol 2019;74:2496-507) (c) 2019 by the American College of Cardiology Foundation.
引用
收藏
页码:2496 / 2507
页数:12
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