scholarly journals Cardiovascular Disease Risk–Based Statin Utilization and Associated Outcomes in a Primary Prevention Cohort: Insights From a Large Health Care Network

2021 ◽  
Author(s):  
Anum Saeed ◽  
Jianhui Zhu ◽  
Floyd Thoma ◽  
Oscar Marroquin ◽  
Aryan Aiyer ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health Care ◽  
Primary Prevention ◽  
High Risk ◽  
Risk Groups ◽  
Health Care Network ◽  
Ascvd Risk ◽  
Mean Time ◽  
Risk Categories ◽  
Statin Use

Background: Current American College of Cardiology/American Heart Association guidelines recommend using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk to guide statin therapy for primary prevention. Real-world data on adherence and consequences of nonadherence to the guidelines in primary are limited. We investigated the guideline-directed statin intensity (GDSI) and associated outcomes in a large health care system, stratified by ASCVD risk. Methods: Statin prescription in patients without coronary artery disease, peripheral vascular disease, or ischemic stroke were evaluated within a large health care network (2013–2017) using electronic medical health records. Patient categories constructed by the 10-year ASCVD risk were borderline (5%–7.4%), intermediate (7.5%–19.9%), or high (≥20%). The GDSI (before time of first event) was defined as none or any intensity for borderline, and at least moderate for intermediate and high-risk groups. Mean (±SD) time to start/change to GDSI from first interaction in health care and incident rates (per 1000 person-years) for each outcome were calculated. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization. Results: Among 282 298 patients (mean age ≈50 years), 29 134 (10.3%), 63 299 (22.4%), and 26 687 (9.5%) were categorized as borderline, intermediate, and high risk, respectively. Among intermediate and high-risk categories, 27 358 (43%) and 8300 (31%) patients did not receive any statin, respectively. Only 17 519 (65.6%) high-risk patients who were prescribed a statin received GDSI. The mean time to GDSI was ≈2 years among the intermediate and high-risk groups. At a median follow-up of 6 years, there was a graded increase in risk of ASCVD events in intermediate risk (hazard ratio=1.15 [1.07–1.24]) and high risk (hazard ratio=1.27 [1.17–1.37]) when comparing no statin use with GDSI therapy. Similarly, mortality risk among intermediate and high-risk groups was higher in no statin use versus GDSI. Conclusions: In a real-world primary prevention cohort, over one-third of statin-eligible patients were not prescribed statin therapy. Among those receiving a statin, mean time to GDSI was ≈2 years. The consequences of nonadherence to guidelines are illustrated by greater incident ASCVD and mortality events. Further research can develop and optimize health care system strategies for primary prevention.

Abstract 17321: Guideline Recommended Statin Therapy Implementation and Cardiovascular Outcomes: Insights From a Multi-Site Healthcare Primary Prevention Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anum Saeed ◽  
Jianhui Zhu ◽  
Floyd W Thoma ◽  
Oscar C MARROQUIN ◽  
Aryan Aiyer ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Healthcare System ◽  
Risk Groups ◽  
Prescription Practices ◽  
Ascvd Risk ◽  
Mean Time ◽  
Risk Categories ◽  
Statin Use

Background: The 2013 and 2018 ACC/AHA cholesterol guidelines recommend using the 10-year ASCVD risk to guide statin therapy for primary prevention. Evidence of real-world consequences of non-adherence to these guidelines in primary prevention cohorts is limited. We investigated outcomes based on statin use in a large healthcare system, stratified by 10y ASCVD risk. Methods: Statin prescription practices in patients without CAD or ischemic stroke were evaluated ( 2013-2019). Patient categories constructed per the ASCVD risk were; Borderline (5%-7.4%), Intermediate (7.5%-19.9%) or High (≥20%). Guideline-directed statin intensity (GDSI) , at time of first event, was defined as; “none or any intensity” for borderline , “at least moderate” for Intermediate and high -risk groups. Mean (±SD) time to start/change to GD therapy from first interaction in healthcare, ASCVD incident rates [IR] and mortality were calculated across risk categories stratified by statin utilization. Results: Among 282,298 patients (mean age ~50y), 29,134 (10.3%), 63,299 (22.4%) and 26,687 (9.5%) were borderline, intermediate and high risk, respectively. Within intermediate-risk, 27,358 (43%) and 8,300 (31%) of high-risk never received any statin. Only 17,519 (65.6%) high-risk subjects who were prescribed statin, received GDSI [mean time ~1.8y]. A graded increase in ASCVD and mortality IRs was seen in all risk categories comparing statin versus no statin use (Table). Conclusions: In a multi-site healthcare network, over one-third of statin-eligible patients were not prescribed statin therapy. In eligible patients, who ultimately received statins, mean time to GDSI was ~2yrs. The consequences of non-adherence to guidelines is illustrated with greater incident ASCVD events and mortality among those patients not treated with statin therapy. Further research can define identify barriers and develop healthcare system strategies to optimize preventive therapies.

Arterial calcification in the prediction of atherosclerotic cardiovascular disease among women and men

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.E Van Der Toorn ◽  
D Bos ◽  
B Arshi ◽  
M.K Ikram ◽  
M.W Vernooij ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
The Netherlands ◽  
Arterial Calcification ◽  
Funding Source ◽  
Atherosclerotic Cardiovascular Disease ◽  
Intermediate Risk ◽  
C Statistic ◽  
Ascvd Risk ◽  
Risk Categories

Abstract Background The Coronary Artery Calcium (CAC) Score has emerged as a valuable tool in atherosclerotic cardiovascular disease (ASCVD) risk stratification. However, data on the relevance of arterial calcification in different vascular territories for ASCVD risk prediction is lacking. Purpose First, to assess the sex-specific distribution of arterial calcification in different vessel beds across ASCVD risk categories. Second, to determine the added value of arterial calcification in different vascular territories for ASCVD risk prediction. Methods From a large population-based study, 2,139 participants (mean age 69 years, 55% women) underwent non-contrast computed tomography to quantify CAC, aortic arch calcification (AAC), extracranial- (ECAC) and intracranial carotid artery calcification (ICAC), and vertebrobasilar artery calcification (VBAC). The outcome measure, incident ASCVD, composed of fatal and nonfatal myocardial infarction (MI), other coronary heart disease (CHD) mortality, and stroke. We fitted sex-specific prediction models according to the Pooled Cohort Equations (PCE), and categorized participants into low- (<5%), borderline- (5% to 7.5%), intermediate- (7.5% to 20%), and high ASCVD risk (≥20%), based on the American College of Cardiology (ACC) and American Heart Association (AHA) guideline. Subsequently, we determined the distribution of calcifications in different vascular territories across the risk categories. Next, we extended the PCE prediction model with calcification volumes and calculated the c-statistic and the net reclassification improvement for events (NRIe) and non-events (NRIne). Results The median follow-up for ASCVD was 9.3 years. Among women, 38% was classified as low-risk, 19% as borderline risk, 31% as intermediate risk, and 12% as high risk. Among men, 2% was classified as low-risk, 10% as borderline risk, 60% as intermediate risk, and 28% as high risk. With increasing risk of ASCVD, a larger burden of calcification was observed. In women, simultaneously adding calcification volumes in all vessel beds led to the largest increase in c statistic (from 0.71 to 0.75) for the prediction of ASCVD and the most beneficial reclassification (NRIe: 11%, NRIne: 2%). Among men, the addition of CAC alone most substantially improved the prediction of ASCVD (c statistic improved from 0.65 to 0.68, NRIe and NRIne were 4% and 14%, respectively). Conclusions Our findings suggest a potential role for comprehensive assessment of calcification in different vessel beds for ASCVD risk stratification in particular among women. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The Rotterdam Study is supported by Erasmus MC and Erasmus University Rotterdam; the Netherlands Organization for Scientific Research; the Netherlands Organization for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly; the Netherlands Genomics Initiative; the Ministry of Education, Culture, and Science; the Ministry of Health, Welfare, and Sports; European Commission; and the Municipality of Rotterdam. Dr. Kavousi is supported by the VENI grant (91616079) from ZonMw. Dr. Bos was supported by a fellowship of the BrightFocus Foundation (A2017424F). Oscar L. Rueda-Ochoa receives a scholarship from COLCIENCIAS-Colombia and support from Universidad Industrial de Santander,UIS-Colombia. None of the funders had any role in study design; study conduct; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the article.

Abstract P051: Healthy Lifestyle Factors are Uncommon and Associated with Reduced Risk of Cardiovascular Disease and Mortality in Candidates for Primary Prevention with Statin Therapy

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
John N Booth ◽  
Lisandro D Colantonio ◽  
Mary Cushman ◽  
George Howard ◽  
Monika Safford ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
High Risk ◽  
Saturated Fat ◽  
Lifestyle Factors ◽  
Healthy Lifestyles ◽  
Fat Intake ◽  
Ascvd Risk ◽  
Saturated Fat Intake ◽  
Diet Score

Introduction: Adults with a 10 year predicted atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5% are candidates for statin therapy for primary prevention. Lifestyle interventions may benefit this high risk group. Hypothesis: We estimated the use of healthy lifestyles and their association with ASCVD and mortality risk in adults with a 10 year predicted ASCVD risk ≥7.5%. Methods: The REasons for Geographic and Racial Differences in Stroke cohort study enrolled adults ≥45 years old from the 48 continental US states and District of Columbia in January 2003 - October 2007 (n=30,239). The final sample was restricted to adults 45 - 79 years old, without ASCVD or diabetes history, low density lipoprotein cholesterol 70 - 189 mg/dL and a 10 year predicted ASCVD risk ≥7.5% (n=5,709). Ideal lifestyle factors, assessed during an in-home physical exam and through surveys, included non-obese waist circumference (<88/<102 cm for women/men), physical activity (PA) ≥4 times per week, nonsmoking, low saturated fat intake (<7.0% of daily calories) and highest Mediterranean diet score quartile. Participants were contacted every 6 months to detect incident ASCVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or coronary heart disease death) and all-cause mortality for adjudication. Results: The prevalence of ideal lifestyles was 56.9% for non-obesity, 33.5% for PA, 80.7% for nonsmoking, 7.1% for low saturated fat intake, and 27.6% for highest Mediterranean diet score quartile. Overall, 4.8%, 27.2%, 35.5%, 23.5% and 9.0% had 0, 1, 2, 3, and ≥4 of the 5 ideal lifestyles. There were 377 ASCVD events and 471 deaths (median follow up: 5.8 and 6.0 years, respectively). After multivariable adjustment, there was a graded association for lower ASCVD incidence and mortality with 1, 2, 3 and ≥4 versus 0 ideal lifestyles (Table 1). Conclusion: Healthy lifestyles were underused in adults with a 10 year predicted ASCVD risk ≥7.5%. Improving lifestyle factors may significantly reduce ASCVD and delay mortality in this high risk population.

Abstract 16657: Guideline Recommended Statin Therapy and Sex Based Cardiovascular Disease Outcomes: Data From a Multi-site Healthcare Network Primary Prevention Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anum Saeed ◽  
Jianhui Zhu ◽  
Floyd W Thoma ◽  
Oscar C MARROQUIN ◽  
Malamo E Countouris ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Healthcare System ◽  
Stroke Risk ◽  
Cox Regression ◽  
High Risk Women ◽  
Increased Risk ◽  
Ascvd Risk ◽  
Statin Use

Introduction: Statin therapy has been shown to reduce ASCVD morbidity and mortality. Evidence on statin utilization per the ACC/AHA cholesterol guidelines and outcomes are limited in primary prevention cohorts of women. We investigated statin use outcomes per 10-year ASCVD risk in a large healthcare system stratified by sex. Methods: Statin prescription in patients without CAD (MI or revascularization) or ischemic stroke were evaluated (2013-2019). Risk categories per the ASCVD risk were defined as: Borderline (5%-7.4%), Intermediate (7.5%-19.9%) or High (≥20%). Guideline-directed statin intensity (GDSI), at time of first event, was defined as: “at least moderate” for Intermediate and high -risk groups. Cox regression hazard ratios (HR) [95% CI] were calculated for statin use and outcomes (MI, stroke and composite ASCVD events) stratified by gender. Interaction terms (age ≥75y and sex) were applied. Results: Among 159,100 women (out of 282,298 patients; mean age ~51y), 15,153 (9.5%), 26,697 (16.8%) and 10,583 (6.7%) were categorized as borderline, intermediate and high risk, respectively. Only 9,277 (35%) intermediate and 4,893 (46%) of high-risk women received any intensity of statin. High risk women (vs men) on GDSI, had lower association with CAD events (HR 0.8 [0.7-0.9]) and increased stroke risk (HR 1.2 [1.1-1.4]) ( Table). Intermediate and high-risk women (on <GD statin or no statin) had higher stroke risk than those on GD statin (p for interaction <0.001 ). Older women (≥75y) on “no statin” (vs GD statin) had independently increased risk of CAD (HR 1.30[1.1-1.6]) (p interaction <0.001) . Conclusions: In a real-world primary prevention cohort, women on statin therapy had significantly improved ASCVD outcomes and lower mortality. However, approximately one-fourth of statin-eligible women were not prescribed any statin therapy. Further research can develop healthcare system strategies to optimize under-treatment of women for ASCVD prevention.

Abstract 14236: Cardiovascular Risk at Presentation for Gender-Affirming Care in the Transgender Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kara J Denby ◽  
Meghana Patil ◽  
Karlo Toljan ◽  
Leslie Cho ◽  
Cecile A Ferrando
Keyword(s):  
Medical Condition ◽  
Risk Scores ◽  
Chronic Medical Condition ◽  
Inclusion Criteria ◽  
Undiagnosed Hypertension ◽  
Laboratory Results ◽  
Ascvd Risk ◽  
Cv Disease ◽  
Risk Categories ◽  
Statin Use

Introduction: Due to stigma, the transgender (TG) population experiences socioeconomic and health disparities, including decreased access to care. Use of gender affirming hormone therapy (GAHT) may place TG individuals at increased cardiovascular (CV) risk. The objective of this study is to identify the baseline CV risk of TG individuals presenting for gender affirming care. Methods: This was a retrospective study of TG patients seeking GAHT from a multi-disciplinary transgender program. Patients were included if they had not yet initiated GAHT. Once patients were identified, the EMR was queried for the following data: demographics, medical history, vitals, medications, and laboratory results. The ACC/AHA ASCVD and QRISK3 risk scores were calculated for all patients who did not have documented CV disease. Results: 427 patients met inclusion criteria. Demographics are in Table 1. Of the patients, 237 (55.4%) had a chronic medical condition. The incidence of undiagnosed hypertension and hyperlipidemia was 6.8% and11.3% respectively, and of these cases, only 64.4% and 24.1% were on appropriate therapies. Mean ASCVD risk and QRISK3 for ages 40-65 was 8.3% and 12.2%, respectively. Mean QRISK for ages 25-39 years was 4.6%. Of those patients who fell into intermediate or high risk categories, there was limited statin use (Figure 1). Conclusions: TG individuals presenting for GAHT have elevated CV risk, including high rates of undiagnosed and untreated CV risk factors with inadequate CV prevention. They appear to be at higher risk than their age matched historical cohorts regardless of gender.

scholarly journals Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk

2021 ◽  
Author(s):  
Deepak Palakshappa ◽  
Edward H. Ip ◽  
Seth A. Berkowitz ◽  
Alain G. Bertoni ◽  
Kristie L. Foley ◽  
...  
Keyword(s):  
Mental Health ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Food Insecurity ◽  
Access To Care ◽  
Risk Score ◽  
Equation Modeling ◽  
Care Pathways ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk

Background Food insecurity (FI) has been associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk; however, the pathways by which FI leads to worse cardiovascular health are unknown. We tested the hypothesis that FI is associated with ASCVD risk through nutritional/anthropometric (eg, worse diet quality and increased weight), psychological/mental health (eg, increased depressive symptoms and risk of substance abuse), and access to care pathways. Methods and Results We conducted a cross‐sectional study of adults (aged 40–79 years) using the 2007 to 2016 National Health and Nutrition Examination Survey. Our primary exposure was household FI, and our outcome was 10‐year ASCVD risk categorized as low (<5%), borderline (≥5% –<7.5%), intermediate (≥7.5%–<20%), and high risk (≥20%). We used structural equation modeling to evaluate the pathways and multiple mediation analysis to determine direct and indirect effects. Of the 12 429 participants, 2231 (18.0%) reported living in a food‐insecure household; 5326 (42.9%) had a low ASCVD risk score, 1402 (11.3%) borderline, 3606 (29.0%) intermediate, and 2095 (16.9%) had a high‐risk score. In structural models, we found significant path coefficients between FI and the nutrition/anthropometric (β, 0.130; SE, 0.027; P <0.001), psychological/mental health (β, 0.612; SE, 0.043; P <0.001), and access to care (β, 0.110; SE, 0.036; P =0.002) pathways. We did not find a significant direct effect of FI on ASCVD risk, and the nutrition, psychological, and access to care pathways accounted for 31.6%, 43.9%, and 15.8% of the association, respectively. Conclusions We found that the association between FI and ASCVD risk category was mediated through the nutrition/anthropometric, psychological/mental health, and access to care pathways. Interventions that address all 3 pathways may be needed to mitigate the negative impact of FI on cardiovascular disease.

Abstract 18787: Hypertension Treatment and Control Rates in United States Adults by Risk Group

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kunal N Karmali ◽  
Hongyan Ning ◽  
Donald M Lloyd-Jones
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Kidney Disease ◽  
Risk Group ◽  
Intensive Therapy ◽  
Risk Groups ◽  
Middle Aged ◽  
Ascvd Risk ◽  
Middle Aged Adults ◽  
And Control

Introduction: Ten-year cardiovascular disease (CVD) risk and absolute benefit from antihypertensive therapy vary at any given BP based on associated risk factor levels. Thus, implications of treatment and control rates at a particular BP vary substantially in different risk groups. Objectives: We examined the prevalence, treatment, and control of hypertension (HTN) by risk group in US adults without prevalent CVD. Methods: We used data from the National Health and Nutrition Examination Survey 2005 to 2010 for adults age 40-79 years without prevalent CVD (n=4,066). We estimated 10-year risk for an atherosclerotic CVD (ASCVD) event using the ACC/AHA 2013 Pooled Cohort risk equations. We examined HTN treatment and control rates according to current guidelines in middle-aged (40-59 years) and older (60-79 years) adults with: 10-year ASCVD risk <7.5% (no diabetes/kidney disease); 10-year ASCVD risk ≥7.5% (no diabetes/kidney disease); and either diabetes or kidney disease. Results: The proportion of adults with treatment-eligible HTN was 39.3% for those with 10-year ASCVD risk <7.5%, 32.2% for those with 10-year ASCVD risk ≥7.5%, and 28.4% for those with either diabetes or kidney disease (see Table 1). Treatment rates across the risk groups varied from 51.5% to 79.0% for middle-aged adults and 81.8% to 90.2% for older adults. HTN control rates were highest (87.7%) in older adults with 10-year ASCVD risk <7.5% but were lowest (29.3%) in middle-aged individuals with 10-year ASCVD risk ≥7.5%. Conclusions: US HTN guidelines, based solely on BP thresholds, identify a higher proportion of low-risk adults and a lower proportion of high-risk adults as being eligible for treatment. Control rates remain suboptimal in high-risk individuals, particularly middle-aged adults. Future guidelines should consider pre-treatment risk stratification to identify those at increased pretreatment ASCVD risk who would benefit most from more intensive therapy.

Abstract P275: Demographic and Clinical Profile of Patients with Risk Factors for Coronary Heart Disease (CHD) Defined by National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Guidelines

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
David M Kern ◽  
Sanjeev Balu ◽  
Ozgur Tunceli ◽  
Swetha Raparla ◽  
Deborah Anzalone
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Groups ◽  
Lipid Lowering ◽  
High Risk Patients ◽  
Low Hdl ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High ◽  
Statin Use

Introduction: This study aimed to compare the demographic and clinical characteristics of patients with different risk factors for CHD as defined by NCEP ATP III guidelines. Methods: Dyslipidemia patients (≥1 medical claim for dyslipidemia, ≥1 pharmacy claim for a statin, or ≥1 LDL-C value ≥100 mg/dL [index date]) aged ≥18 y were identified from the HealthCore Integrated Research Environment from 1/1/2007-7/31/2012. Patients were classified as low risk (0 or 1 risk factor): hypertension, age ≥45 y [men] or ≥55 y [women], or low HDL-C), moderate/moderately high risk (≥2 risk factors), high risk (having CHD or CHD risk equivalent), or very high risk (having ACS or other established cardiovascular disease plus diabetes or metabolic syndrome). Demographics, comorbidities, medication use and lipid levels during the 12 months prior, and statin use during the 6 months post-index date were compared across risk groups (very high vs each other risk group). Results: There were 1,524,351 low-risk (mean age: 47 y; 45% men), 242,357 moderate-risk (mean age: 58 y; 59% men), 188,222 high-risk (mean age: 57 y; 52% men), and 57,469 very-high-risk (mean age: 63 y; 61% men) patients identified. Mean Deyo-Charlson comorbidity score differed greatly across risk strata: 0.20, 0.33, 1.26, and 2.22 from low to very high risk (p<.0001 for each). Compared with high-risk patients, very-high-risk patients had a higher rate of ischemic stroke: 5.4% vs 4.1%; peripheral artery disease: 17.1% vs 11.6%; coronary artery disease: 8.5% vs 8.2%; and abdominal aortic aneurysm: 2.3% vs 2.0% (p<.05 for each). Less than 1% of the total population had a prior prescription for each non-statin lipid-lowering medication (bile acid sequestrants, fibrates, ezetimibe, niacin, and omega-3). Very-high-risk patients had lower total cholesterol (very-high-risk mean: 194 mg/dL vs 207, 205, and 198 mg/dL for low-, moderate-/moderately-high-, and high-risk patients, respectively) and LDL-C (very-high-risk mean: 110 mg/dL vs 126, 126, and 116 mg/dL for the other risk groups; p<.0001 for each); higher triglycerides (TG) (very-high-risk mean: 206 mg/dL vs 123, 177, and 167 mg/dL for the other groups; p<.0001 for each); and lower HDL-C (very-high-risk mean: 45 mg/dL vs 57 [p<.0001], 45 [p=.006], and 51 mg/dL [p<.0001]). Statin use was low overall (15%), but higher in the very-high-risk group (45%) vs the high- (29%), moderate-/moderately-high- (18%), and low- (12%) risk groups (p<.0001 for each). Conclusions: Despite a large proportion of patients having high lipid levels, statin use after a dyslipidemia diagnosis was low: ≥80% of all patients (and more than half at very high risk) failed to receive a statin, indicating a potentially large population of patients who could benefit from statin treatment. Prior use of non-statin lipid-lowering medications was also low considering the high TG and low HDL-C levels among high-risk patients.

Cardiovascular Risk Based on ASCVD and KDIGO Categories in Chinese Adults: A Nationwide, Population-Based, Prospective Cohort Study

2021 ◽  
pp. ASN.2020060856
Author(s):  
Yu Xu ◽  
Mian Li ◽  
Guijun Qin ◽  
Jieli Lu ◽  
Li Yan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Risk Prediction ◽  
Cox Regression ◽  
Rank Test ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
Ascvd Risk ◽  
Risk Categories

BackgroundThe Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline used eGFR and urinary albumin-creatinine ratio (ACR) to categorize risks for CKD prognosis. The utility of KDIGO’s stratification of major CVD risks and predictive ability beyond traditional CVD risk prediction scores are unknown.MethodsTo evaluate CVD risks on the basis of ACR and eGFR (individually, together, and in combination using the KDIGO risk categories) and with the atherosclerotic cardiovascular disease (ASCVD) score, we studied 115,366 participants in the China Cardiometabolic Disease and Cancer Cohort study. Participants (aged ≥40 years and without a history of cardiovascular disease) were examined prospectively for major CVD events, including nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death.ResultsDuring 415,111 person-years of follow-up, 2866 major CVD events occurred. Incidence rates and multivariable-adjusted hazard ratios of CVD events increased significantly across the KDIGO risk categories in ASCVD risk strata (all P values for log-rank test and most P values for trend in Cox regression analysis <0.01). Increases in c statistic for CVD risk prediction were 0.01 (0.01 to 0.02) in the overall study population and 0.03 (0.01 to 0.04) in participants with diabetes, after adding eGFR and log(ACR) to a model including the ASCVD risk score. In addition, adding eGFR and log(ACR) to a model with the ASCVD score resulted in significantly improved reclassification of CVD risks (net reclassification improvements, 4.78%; 95% confidence interval, 3.03% to 6.41%).ConclusionsUrinary ACR and eGFR (individually, together, and in combination using KDIGO risk categories) may be important nontraditional risk factors in stratifying and predicting major CVD events in the Chinese population.

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