• NEWS . 18 Sep 2020
  • Implications of risk stratification for cholesterol management in ACS secondary prevention

  • In the 2018 American College of Cardiology/American Heart Association cholesterol guidelines for secondary prevention, patients are classified as ‘very high risk’ (VHR), either because of a history of multiple major atherosclerotic cardiovascular disease (ASCVD) events or a single major ASCVD event with multiple high-risk features. A second group, ‘high risk’ (HR), was defined as patients without any of the risk features in the VHR group. The incidence and relative risk differences of these two groups in a non-trial population has not been well identified. 

    In a single-centre, large, academic, retrospective cohort study, researchers sought to compare the incidence of VHR and HR patients as well as their relative risk for cardiovascular morbidity and mortality through analysis of the Northwestern Medicine Enterprise Data Warehouse. 

    Altogether, 1,483 patients with acute coronary events from January 2014 to December 2016 were risk stratified into VHR and HR groups. Results showed that the VHR patients had 87±5.4 composite events per 1,000 patient-years compared with HR patients who had 33±5.1 events per 1,000 patient-years (p<0.001). Further, the VHR group had increased risk of future events compared with the HR group (multivariable adjusted hazard ratio, 1.66, 95% confidence interval, 1.01–2.74; p=0.047).

    The researchers concluded that these findings support the stratification of patients into VHR and HR groups for secondary prevention.

    Kong NW, et al. Risk differences in secondary prevention patients who present with acute coronary syndrome and implications of guideline-directed cholesterol management. Am J Cardiol 2020. doi: 10.1016/j.amjcard.2020.07.039. [Epub ahead of print]