Five-Year Residual Atherosclerotic Cardiovascular Disease Risk Prediction Model for Statin Treated Patients With Known Cardiovascular Disease
Section snippets
Methods
We studied statin-treated patients with previous ASCVD from the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes (AIM-HIGH) clinical trial cohort.9 In brief, 3,414 participants aged ≥45 years from 92 centers in the United States and Canada with documented ASCVD (coronary artery disease, cerebrovascular or carotid disease, and/or symptomatic peripheral arterial disease) in addition to having atherogenic dyslipidemia defined as:
Results
Our cohort included 85.4% men, with a mean age of 63.6 years (ranged 45 to 85 years) and with 65% on moderate-intensity and 24% on high-intensity statin at baseline. Compared with those without any ASCVD during follow-up, those who had recurrent ASCVD events were more likely men, with less alcohol consumption and more family history of CVD (Table 1). During mean follow-up of 4.18 years, 621(16%) of patients had a first recurrent ASCVD event with 189 having symptomatic driven revascularization,
Discussion
Our risk prediction model derived from patients with known ASCVD on statin therapy estimated a mean 5-year ASCVD recurrent event risk of 21.1%, with 16% of patients actually experiencing a recurrent event over the 4.2-year follow-up. Male sex, HbA1c, alcohol use (inversely), family history of CVD, homocysteine, history of carotid artery disease, and lipoprotein(a) were significant predictors of this residual risk. Body mass index, serum creatinine, and history of heart failure were also
Disclosures
Dr. Wong receives research support through his institution from Amgen, Amarin, Boehringer Ingelheim, Novo Nordisk, and Novartis and is on the speaker's bureau for Amarin, Esperion, and Sanofi. Drs. Pin, Coll and López are employees and stockholders of Amgen Inc.
Author Contribution
Dr. Nathan Wong designed the study and wrote the manuscript. Dr. Yanglu Zhao conducted the analysis and provided critical review and revision. Drs. Coll, Xiang, and Lopez provided critical review and revision.
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Funding: This project was supported by a contract from Amgen, Inc. to the University of California, Irvine. AIM-HIGH was supported by the National Heart, Lung, and Blood Institute (U01-HL-081616 and U01-HL-081649) and by an unrestricted grant from Abbott Laboratories (now AbbVie), Chicago, IL. Abbott Laboratories donated the extended-release niacin, the matching placebo, and the ezetimibe; Merck donated the simvastatin. Neither of these companies had any role in the oversight or design of the study, or in the analysis or interpretation of the data.