Implications of ACC/AHA Versus ESC/EAS LDL-C Recommendations for Residual Risk Reduction in ASCVD: A Simulation Study From DA VINCI
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Purpose: Low-density lipoprotein cholesterol (LDL-C) recommendations differ between the 2018 American College of Cardiology/American Heart Association (ACC/AHA) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) (< 70 vs. < 55 mg/dl, respectively). In the DA VINCI study, residual cardiovascular risk was predicted in ASCVD patients. The extent to which relative and absolute risk might be lowered by achieving ACC/AHA versus ESC/EAS LDL-C recommended approaches was simulated. Methods: DA VINCI was a cross-sectional observational study of patients prescribed lipid-lowering therapy (LLT) across 18 European countries. Ten-year cardiovascular risk (CVR) was predicted among ASCVD patients receiving stabilized LLT. For patients with LDL-C ≥ 70 mg/dl, the absolute LDL-C reduction required to achieve an LDL-C of < 70 or < 55 mg/dl (LDL-C of 69 or 54 mg/dl, respectively) was calculated. Relative and absolute risk reductions (RRRs and ARRs) were simulated. Results: Of the 2039 patients, 61% did not achieve LDL-C < 70 mg/dl. For patients with LDL-C ≥ 70 mg/dl, median (interquartile range) baseline LDL-C and 10-year CVR were 93 (81–115) mg/dl and 32% (25–43%), respectively. Median LDL-C reductions of 24 (12–46) and 39 (27–91) mg/dl were needed to achieve an LDL-C of 69 and 54 mg/dl, respectively. Attaining ACC/AHA or ESC/EAS goals resulted in simulated RRRs of 14% (7–25%) and 22% (15–32%), respectively, and ARRs of 4% (2–7%) and 6% (4–9%), respectively. Conclusion: In ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach. Graphical abstract: [Figure not available: see fulltext.]
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Cardiovascular Drugs and Therapy |
| Vol/bind | 37 |
| Udgave nummer | 5 |
| Sider (fra-til) | 941-953 |
| ISSN | 0920-3206 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
CV has received research grant(s)/support and honoraria from Amgen, ELPEN, MSD, Sanofi, and VIANEX.
Funding Information:
NRP has received financial support from several pharmaceutical companies that manufacture lipid-lowering agents, for consultancy fees (Amgen and Pfizer), research projects and staff (Amgen and Pfizer), and for arranging and speaking at educational meetings (Amgen, MSD, and Pfizer). He holds no stocks and shares in any such companies. NRP is supported by the National Institute for Health Research Senior Investigator Awards, Biomedical Research Centre funding, and the British Heart Foundation Research Centre Excellence Award.
Funding Information:
KR has received research grants for clinical trials, and consulting fees and honoraria for presentations, from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Gilead, Merck, Mylan, Novo Nordisk, Pfizer, Sanofi, and Zentiva.
Funding Information:
JWJ or his institution department has received research grants from, and/or was a speaker (with or without lecture fees) at meetings sponsored by Amgen, AstraZeneca, Athera, Biotronik, Boston Scientific, Dalcor, Daiichi Sankyo, Lilly, Medtronic, Merck-Schering-Plough, Pfizer, Roche, Sanofi-Aventis, The Medicine Company, the Netherlands Heart Foundation, CardioVascular Research the Netherlands (CVON), the Netherlands Heart Institute and the European Community Framework KP7 Programme.
Funding Information:
MV has received grants, personal fees, or non-financial support from Abbott Laboratories, Amgen, AstraZeneca, Boehringer Ingelheim, KRKA, Mylan, Novartis, Novo Nordisk, Pfizer, Sanofi-Aventis, Servier, and Zentiva, outside of the submitted work.
Funding Information:
This study was funded by Amgen Europe (GmbH).
Funding Information:
APa has received research grants and personal fees from Amgen, AstraZeneca, Bayer, Pfizer, and Sanofi-Aventis.
Funding Information:
The authors would like to thank Sinéad Flannery PhD (PharmaGenesis London, London, UK) and Ryan Woodrow (Aspire Scientific, Bollington, UK) for medical writing and editorial support, which was funded by Amgen. KKR acknowledges support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre and from the NIHR ARC for North West London. AJVV acknowledges support from the “Programa Beatriz Galindo” from the Ministry of Universities, Spain, and University of Seville, Spain.
Funding Information:
SK has received grant/research support from Amgen, AstraZeneca, and Bayer; and consulting fees/honoraria from Amgen, Bayer, BMS, Boehringer Ingelheim, MSD, Mesi, Pfizer, Philips Healthcare, Sanofi, and Servier.
Publisher Copyright:
© 2022, The Author(s).
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