The Projected Impact of Population-Wide Achievement of LDL Cholesterol <70 mg/dL on the Number of Recurrent Events Among US Adults with ASCVD

Emily C. McKinley, Vera A. Bittner, Todd M. Brown, Ligong Chen, Jason Exter, Michael E. Farkouh, Lei Huang, Elizabeth A. Jackson, Emily B. Levitan, Kate K. Orroth, Stephanie R. Reading, Robert S. Rosenson, Monika M. Safford, Mark Woodward, Paul Muntner, Lisandro D. Colantonio

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Purpose: Adults with atherosclerotic cardiovascular disease (ASCVD) are recommended high-intensity statins, with those at very high risk for recurrent events recommended adding ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor if their low-density lipoprotein cholesterol (LDL-C) is ≥70 mg/dL. We estimated the number of recurrent ASCVD events potentially averted if all adults in the United States (US) ≥45 years of age with ASCVD achieved an LDL-C <70 mg/dL. Methods: The number of US adults with ASCVD and LDL-C ≥70 mg/dL was estimated from the National Health and Nutrition Examination Survey 2009–2016 (n = 596). The 10-year cumulative incidence of recurrent ASCVD events was estimated from the REasons for Geographic And Racial Differences in Stroke study (n = 5390), weighted to the US population by age, race, and sex. The ASCVD risk reduction by achieving an LDL-C <70 mg/dL was estimated from meta-analyses of lipid-lowering treatment trials. Results: Overall, 14.7 (95% CI, 13.7–15.8) million US adults had ASCVD, of whom 11.6 (95% CI, 10.6–12.5) million had LDL-C ≥70 mg/dL. The 10-year cumulative incidence of ASCVD events was 24.3% (95% CI, 23.2–25.6%). We projected that 2.823 (95% CI, 2.543–3.091) million ASCVD events would occur over 10 years among US adults with ASCVD and LDL-C ≥70 mg/dL. Overall, 0.634 (95% CI, 0.542–0.737) million ASCVD events could potentially be averted if all US adults with ASCVD achieved and maintained LDL-C <70 mg/dL. Conclusion: A substantial number of recurrent ASCVD events could be averted over 10 years if all US adults with ASCVD achieved, and maintained, an LDL-C <70 mg/dL.

Original languageEnglish
Pages (from-to)107-116
Number of pages10
JournalCardiovascular Drugs and Therapy
Volume37
Issue number1
DOIs
StatePublished - Feb 2023

Keywords

  • Atherosclerotic cardiovascular disease
  • Low-density lipoprotein cholesterol
  • Population attributable risk
  • Secondary prevention

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