TY - JOUR
TI - Implications of ACC/AHA Versus ESC/EAS LDL-C Recommendations for Residual Risk Reduction in ASCVD: A Simulation Study From DA VINCI
AU - Vallejo-Vaz, A.J.
AU - Bray, S.
AU - Villa, G.
AU - Brandts, J.
AU - Kiru, G.
AU - Murphy, J.
AU - Banach, M.
AU - De Servi, S.
AU - Gaita, D.
AU - Gouni-Berthold, I.
AU - Kees Hovingh, G.
AU - Jozwiak, J.J.
AU - Jukema, J.W.
AU - Gabor Kiss, R.
AU - Kownator, S.
AU - Iversen, H.K.
AU - Maher, V.
AU - Masana, L.
AU - Parkhomenko, A.
AU - Peeters, A.
AU - Clifford, P.
AU - Raslova, K.
AU - Siostrzonek, P.
AU - Romeo, S.
AU - Tousoulis, D.
AU - Vlachopoulos, C.
AU - Vrablik, M.
AU - Catapano, A.L.
AU - Poulter, N.R.
AU - Ray, K.K.
AU - On behalf of the DA VINCI Study Investigators
JO - Cardiovascular Drugs and Therapy
PY - 2022
VL - null
TODO - null
SP - null
PB - Springer-Verlag
SN - 0920-3206, 1573-7241
TODO - 10.1007/s10557-022-07343-x
TODO - null
TODO - 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.] © 2022, The Author(s).
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