Evaluating a Simple Approach to Identify Adults Meeting the 2018 AHA/ACC Cholesterol Guideline Definition of Very High Risk for Atherosclerotic Cardiovascular Disease

Paul Muntner, Kate K. Orroth, Katherine E. Mues, Jason Exter, Erin D. Shannon, Rebecca Zaha, Robert S. Rosenson, Elizabeth A. Jackson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline defines very high atherosclerotic cardiovascular disease (ASCVD) risk as a history of ≥ 2 major ASCVD events or 1 major ASCVD event and multiple high-risk conditions. We tested if a simplified approach, having a history of a major ASCVD event, would identify a high proportion of patients that meet the 2018 AHA/ACC cholesterol guideline criteria for very high risk. Methods: We analyzed data from US adults with health insurance in the MarketScan database who had experienced an acute coronary syndrome in the past year (recent ACS, n = 3626), a myocardial infarction (MI) other than a recent ACS (n = 7572), an ischemic stroke (n = 3551), or symptomatic peripheral artery disease (PAD, n = 5919). Patients were followed from January 1, 2016, through December 31, 2017, for recurrent ASCVD events. Results: Among 16,344 patients with a history of a major ASCVD event, 94.0% met the 2018 AHA/ACC cholesterol guideline definition for very high risk including 92.9%, 96.5%, 93.1%, and 96.2% with a recent ACS, history of MI, history of stroke, and symptomatic PAD, respectively. The incidence of ASCVD events per 1000 person-years was 50.4 (95% CI: 47.6–53.3) among all patients with a history of a major ASCVD event versus 53.1 (95% CI: 50.1–56.1) among patients who met the 2018 AHA/ACC cholesterol guideline definition of very high risk. Conclusion: The vast majority of patients with a recent ACS, history of MI, ischemic stroke, or symptomatic PAD meet the 2018 AHA/ACC cholesterol guideline definition of very high risk.

Original languageEnglish
Pages (from-to)475-481
Number of pages7
JournalCardiovascular Drugs and Therapy
Volume36
Issue number3
DOIs
StatePublished - Jun 2022

Keywords

  • Cholesterol
  • Guidelines
  • Risk prediction

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