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Model predicts 5-year ASCVD risk in patients on statin therapy
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SAN ANTONIO — Researchers developed an ASCVD risk score that was shown to estimate residual ASCVD risk among adults with prior CVD who are on statin therapy.
The risk model for predicting 5-year residual ASCVD risk in this population identifies older age, male sex, no alcohol use, positive family history, diabetes, increased lipoprotein(a), homocysteine and serum creatinine as significant contributors to risk prediction, Yanglu Zhao, MD, MS, PhD candidate of epidemiology at UCLA, said during a presentation at the American Society for Preventive Cardiology Congress on CVD Prevention.
The strongest predictor of recurrent ASCVD events was Lp(a), according to results presented here.
The study was selected as a winning Young Investigator poster at the 2019 meeting.
Zhao and colleagues analyzed data from 3,271 participants (mean age, 64 years; 85% men) in the AIM-HIGH trial. All patients had prior ASCVD and were treated with statins, and had low HDL and high triglycerides at baseline.
The risk score equation used in the development of this risk prediction model was similar to the American College of Cardiology/American Heart Association Pooled Cohort Equation, Zhao said.
The study endpoint was composite ASCVD, defined as CHD death, nonfatal MI, ACS hospitalization, ischemic stroke, or symptom-driven coronary or cerebral revascularization. Patients were followed for a mean of 3.33 years.
Overall, 531 patients had incident ASCVD. Those with and without ASCVD had significant differences in factors sex, alcohol consumption, family history of CVD, HDL, Lp(a), HbA1c and diabetes, Zhao said.
During follow-up, MI and symptom-driven revascularization were the primary events that occurred in patients with incident ASCVD.
The mean 5-year ASCVD risk was 21.7%. This score ranged from 9% to 60.6% in the study. Nearly 10% of patients had 5-year ASCVD risk greater than 30%, and 46% had a risk score of 20% to 30%, according to the data presented.
This new risk model showed “modest discrimination and excellent calibration,” according to Zhao.
“To our knowledge, this is the first ASCVD risk score to estimate residual ASCVD risk among those with prior CVD and on statin [therapy],” Zhao said. However, “due to relatively short follow-up time of the derivation cohort, long-term prediction of residual risk may not be reliably estimated by this current score.”
Future efforts will focus on validating this score in an external cohort. – by Darlene Dobkowski
Reference:
Zhao Y. Session 4: Young Investigator Presentations. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 19-21, 2019; San Antonio.
Disclosure: Zhao reports consulting for MUSE Microscopy.