Abstract
Background
The latest guidelines from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) introduced a new “ultra-high risk” category of patients, for whom a low-density lipoprotein cholesterol (LDL-C) level <55 mg/dL (1.4 mmol/L) is advised.
Purpose
Based on the above, we aimed to identify the proportion of patients, who are at ultra-high/extremely-high cardiovascular (CV) risk.
Method
Finally, we analyzed the data of 19,781 consecutive patients included in theHyperlipidaemia Therapy in the tERtiary Cardiological cEnTer (TERCET) Registry admitted to the Polish tertiary cardiovascular centre between 2006 and 2018. Among them, there were 7,319 patients admitted with ACS: 3,085 due to ST-segment elevation myocardial infarction (STEMI), 2,256 due to non-ST-segment elevation myocardial infarction (NSTEMI), and 1,978 due to unstable angina (UA), as well as 12,462 due to stable angina (SA). According to the European Society of Cardiology (ESC), all patients included in the Registry are at very high CV risk. All of the patients included in the registry underwent coronary angiography during the hospital stay. On the basis of the multivariate analysis, we aimed at determining the subgroup of the patients with the most unfavourable 12-month outcomes and therefore to indicate the risk factors responsible for extremely-high CV risk.
Results
According to the results of the multivariate analysis performed with stepwise backward regression, we identified the following risk factors: LVEF<40% (odds ratio [OR]=3.51, 95% CI: 2.87–4.29), prior stroke (OR=2.28, 95% CI: 1.65–3.01), diabetic nephropathy (OR=2.16, 95% CI: 1.68–2.77), age>75 years (OR=1.84, 95% CI: 1.33–2.55), atrial fibrillation (OR=1.81, 95% CI: 1.45–2.25), acute MI at admission (OR=1.56, 95% CI: 1.26–1.95), multivessel CAD (OR=1.40, 95% CI: 1.15–1.72), prior MI (OR=1.31, 95% CI: 1.07–1.60) and lower body-mass index (OR=1.02 per 1 kg/m2+ less, 95% CI: 1.00–1.04) that might help to define the group of very high risk patients, who should be considered as of extremely-high cardiovascular risk (all p<0.05). The aggregate summary of risk factors associated with “ultra-high” risk is presented in the attached Figure.
Multivariate analysis results
Conclusions
To our best knowledge, the presented study is the first such an analysis conducted on such a large population of very-high cardiovascular risk patients gathered in the registry of secondary cardiovascular prevention. In very-high cardiovascular risk patients, potential risk factors were identified that might help to establish the group of individuals at extremely high CV risk what contributes to higher 12-month mortality.
Acknowledgement/Funding
None
Statin utilization and lipid goal attainment in high or very-high cardiovascular risk patients: Insights from Italian general practice
