Elsevier

The American Journal of Cardiology

Volume 137, 15 December 2020, Pages 7-11
The American Journal of Cardiology

Five-Year Residual Atherosclerotic Cardiovascular Disease Risk Prediction Model for Statin Treated Patients With Known Cardiovascular Disease

https://doi.org/10.1016/j.amjcard.2020.09.043Get rights and content

Despite statin therapy, many patients with atherosclerotic cardiovascular disease (ASCVD) still suffer from ASCVD events. Predictors of residual ASCVD risk are not well-delineated. We aimed to develop an ASCVD risk prediction model for patients with previous ASCVD on statin use. We utilized statin-treated patients with ASCVD from the AIM-HIGH trial cohort. A 5-year risk score for subsequent ASCVD events with known ASCVD was developed using Cox regression, including potential risk factors with age, sex, and race forced in the model. Internal discrimination and calibration were evaluated. We included 3,271 patients with ASCVD (85.4% male, mean age 63.6 years, 65% on moderate- and 24% on high-intensity statin) with complete risk factor data and mean follow-up of 4.18 years. Overall, the estimated 5-year ASCVD risk was 21.1%: 10.2% of patients had a 5-year risk of >30%, and 38.8% had risk of between 20% and 30%. In the model, male sex, hemoglobin A1c, alcohol use (inversely), family history of cardiovascular disease, homocysteine, history of carotid artery disease, and lipoprotein(a) best predicted residual ASCVD risk. Niacin treatment status did not enter the model. A C-statistic of 0.59 was obtained, with the Greenwood-Nam-D'Agostino test showing excellent calibration. We developed a risk prediction risk model for predicting 5-year residual ASCVD risk in statin-treated patients with known ASCVD that may help in identifying such persons at the highest risk of recurrent events. Validation in larger samples with patients on high-intensity statin is needed.

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.

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