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AHA/ACC guideline directs intensive lipid-lowering therapy to adults with very high risk of ASCVD events

Stephen Padilla
27 Nov 2019

Intensive lipid-lowering therapy is recommended to adults with a very high risk for atherosclerotic cardiovascular disease (ASCVD) events based on the 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline, reports a study.

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, the investigators analysed data from US adults with health insurance in the MarketScan database who had an ASCVD history on 1 January 2016 (n=27,775). They followed patients through 31 December 2017 for ASCVD events, including myocardial infarction, ischaemic stroke and major adverse limb events.

Very high risk for ASCVD events was defined as a history of at least two major ASCVD events or one event and two or more high-risk conditions.

Of the patients with ASCVD, more than half (n=15,366; 55.3 percent) met the definition of very high risk. The ASCVD event rate among those with and without very high risk was 53.1 (95 percent confidence interval [CI], 50.1–56.1) and 17.0 (95 percent CI, 15.2–18.9) per 1,000 person-years, respectively.

Moreover, the ASCVD event rate per 1,000 person-years was 89.9 (95 percent CI, 82.2–98.0) among patients with ≥2 major ASCVD events and 41.3 (95 percent CI, 38.3–44.4) among those with one event and ≥2 high-risk conditions.

The age- and sex-adjusted hazard ratios (HRs) for ASCVD events were higher among patients with very high risk with ≥2 major ASCVD events (HR, 2.98, 95 percent CI, 2.63–3.37) and with one event and ≥2 high-risk conditions (HR, 4.89, 95 percent CI, 4.22–5.66) than among those without very high risk (HR, 2.33, 95 percent CI, 2.04–2.66).

“The 2018 AHA/ACC cholesterol guideline includes recommendations for intensive lipid-lowering therapy in patients at very high risk for ASCVD events,” the investigators said.

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Most Read Articles
Pearl Toh, 20 Nov 2019
The trade-off between the risk of ischaemic vs bleeding events may be different between Asian and non-Asian patients, which warrants careful consideration when deciding on the duration of antiplatelet therapy following a percutaneous coronary intervention (PCI), according to a presentation at ESC Asia Congress 2019.
4 days ago
Participating in a long-distance skiing event may help lower the risk of hypertension, with the number of completed races showing a weak association with the risk, a study has found.
06 Sep 2019
Hypertensive adults with lower plasma zinc concentration are at increased risk of haemorrhagic stroke, especially those with higher body mass index or lower plasma copper levels, a study has found.
06 Jan 2020
Target organ damage appears to be more noticeable in patients affected by primary aldosteronism than those affected by arterial hypertension without primary aldosteronism, suggests a study, adding that specific treatment can ease such condition.