Residual cardiovascular risk in individuals on lipid-lowering treatment: quantifying absolute and relative risk in the community.

TitelResidual cardiovascular risk in individuals on lipid-lowering treatment: quantifying absolute and relative risk in the community.
MedientypJournal Article
Jahr der Veröffentlichung2018
AutorenLieb W, Enserro DM, Larson MG, Vasan RS
JournalOpen Heart
Volume5
Ausgabe1
Paginatione000722
Datum der Veröffentlichung2018
ISSN2053-3624
Zusammenfassung

<p><b>Objective: </b>The residual cardiovascular disease (CVD) risk in individuals on long-term lipid-lowering treatment (LLT) in the general population is not well described.</p><p><b>Methods: </b>We estimated absolute CVD risks by age and sex for different categories of low-density lipoprotein cholesterol (LDL-C) levels, stratified by LLT status, and assessed subclinical carotid atherosclerosis in 3012 Framingham Study participants (mean age, 58.4 years; 55% women) free of CVD. Individuals were categorised into five groups: (1) LDL-C <100 mg/dL without LLT; (2) LDL-C ≥100 mg/dL to <130 mg/dL without LLT; (3) LDL-C <130 mg/dL on LLT; (4) LDL-C ≥130 mg/dL without LLT; and (5) LDL-C ≥130 mg/dL on LLT.</p><p><b>Results: </b>Individuals in groups 3-5 had significantly more carotid atherosclerosis compared with group 1. During follow-up (median, 13.7 years), 548 CVD events occurred. Individuals on LLT (groups 3 and 5) had substantial residual CVD risk (26.7 (95% CI 19.5 to 34.0) and 24.1 (95% CI 16.2 to 31.9) per 1000 person-years, respectively), representing approximately three times the risk for untreated individuals with LDL <100 mg/dL (group 1: 9.0 (95% CI 6.8 to 11.3) per 1000 person-years). Absolute CVD risks rose with age and were slightly greater in men than in women. After adjustment for traditional risk factors, groups 3-5 displayed increased hazards for CVD (HR=1.47, 1.42 and 1.54, respectively) compared with group 1. Further adjustment for carotid atherosclerosis modestly attenuated these results.</p><p><b>Conclusions: </b>There is substantial residual CVD risk in individuals on LLT, compared with participants with optimal LDL-C (<100 mg/dL), even when LDL-C levels <130 mg/dL are reached.</p>

DOI10.1136/openhrt-2017-000722
Alternate JournalOpen Heart
PubMed ID29387429
PubMed Central IDPMC5786911