Comparison of achieving 2019 ESC/EAS versus 2018 ACC/AHA IDL-C goals for patients with atherosclerotic cardiovascular disease: a cardiovascular risk simulation from the da Vinci study
File(s)
Published version
Author(s)
Type
Conference Paper
Abstract
Background
European and American guidelines recommend different LDL-C goals for ASCVD patients. We simulated the residual CV risk for 2019 ESC/EAS versus 2018 ACC/AHA LDL-C goals (<55 versus <70 mg/dL).
Methods
From the Da Vinci study (Ray et al., 2020), we predicted 10-year CV risk using REACH equation among ASCVD patients receiving stabilized lipid-lowering therapy (no change in dose or frequency for ≥28 days). For patients with LDL-C ≥70 mg/dL, we: 1) calculated the absolute LDL-C reduction required to achieve LDL-C levels of 69 and 54 mg/dL; 2) simulated the relative risk reduction by randomly sampling from the inverse distribution of the rate ratio per 39 mg/dL in the CTTC meta-analysis; 3) calculated the absolute risk reduction and residual CV risk for LDL-C levels of 69 and 54 mg/dL.
Results
Of 2039 patients, 1238 (61%) did not achieve LDL-C <70 mg/dL. Median (interquartile range) baseline LDL-C and 10-year CV risk in these patients were 93 (81-115) mg/dL and 32% (25%-43%), respectively. LDL-C reductions of 24 (12-46) and 39 (27-61) mg/dL were needed to achieve LDL-C levels of 69 and 54 mg/dL, respectively. Attaining ACC/AHA and ESC/EAS LDL-C goals resulted in lower 10-year CV risks of 28% (20%-37%) and 25% (18%-34%), and in absolute risk reductions of 4% (2%-7%) and 6% (4%-9%), respectively (Figure).
Conclusion
In ASCVD patients, achieving ESC/EAS LDL-C goals results in a further 50% relative (2% absolute) reduction in residual CV risk compared with achieving ACC/AHA goals.
European and American guidelines recommend different LDL-C goals for ASCVD patients. We simulated the residual CV risk for 2019 ESC/EAS versus 2018 ACC/AHA LDL-C goals (<55 versus <70 mg/dL).
Methods
From the Da Vinci study (Ray et al., 2020), we predicted 10-year CV risk using REACH equation among ASCVD patients receiving stabilized lipid-lowering therapy (no change in dose or frequency for ≥28 days). For patients with LDL-C ≥70 mg/dL, we: 1) calculated the absolute LDL-C reduction required to achieve LDL-C levels of 69 and 54 mg/dL; 2) simulated the relative risk reduction by randomly sampling from the inverse distribution of the rate ratio per 39 mg/dL in the CTTC meta-analysis; 3) calculated the absolute risk reduction and residual CV risk for LDL-C levels of 69 and 54 mg/dL.
Results
Of 2039 patients, 1238 (61%) did not achieve LDL-C <70 mg/dL. Median (interquartile range) baseline LDL-C and 10-year CV risk in these patients were 93 (81-115) mg/dL and 32% (25%-43%), respectively. LDL-C reductions of 24 (12-46) and 39 (27-61) mg/dL were needed to achieve LDL-C levels of 69 and 54 mg/dL, respectively. Attaining ACC/AHA and ESC/EAS LDL-C goals resulted in lower 10-year CV risks of 28% (20%-37%) and 25% (18%-34%), and in absolute risk reductions of 4% (2%-7%) and 6% (4%-9%), respectively (Figure).
Conclusion
In ASCVD patients, achieving ESC/EAS LDL-C goals results in a further 50% relative (2% absolute) reduction in residual CV risk compared with achieving ACC/AHA goals.
Date Issued
2021-05-11
Date Acceptance
2021-05-01
Citation
Journal of the American College of Cardiology, 2021, 77 (18), pp.1579-1579
ISSN
0735-1097
Publisher
Elsevier
Start Page
1579
End Page
1579
Journal / Book Title
Journal of the American College of Cardiology
Volume
77
Issue
18
Copyright Statement
© 2021, The Author. Published by Elsevier on Behalf of The American College of Cardiology Foundation. This is an Open Access Article under the CC BY-NC-ND License (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000647487501586&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Source
70th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC)
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Publication Status
Published
Start Date
2021-05-15
Finish Date
2021-05-17
Coverage Spatial
ELECTR NETWORK
Date Publish Online
2021-05-01