Journal Article

Implications of ACC/AHA Versus ESC/EAS LDL-C Recommendations for Residual Risk Reduction in ASCVD: A Simulation Study From DA VINCI

Masana, Luis, Banach, Maciej, Vallejo-Vaz, Antonio J, Kiru, Gaia, Jozwiak, Jacek J, Jukema, J. Wouter, Kees Hovingh, G, De Servi, Stefano, Gabor Kiss, Robert, Siostrzonek, Peter, Clifford, Piers, Vrablik, Michal, Gaita, Dan, Parkhomenko, Alexander, Peeters, André, Kownator, Serge, Tousoulis, Dimitrios, Villa, Guillermo, Vlachopoulos, Charalambos, Iversen, Helle K, Ray, Kausik K, Maher, Vincent, Poulter, Neil R, Catapano, Alberico L, Brandts, Julia, Raslova, Katarina, Gouni-Berthold, Ioanna, Bray, Sarah, Romeo, Stefano, Murphy, Jennifer

2023

Overview

PurposeLow-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.MethodsDA 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.ResultsOf 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.ConclusionIn ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach.

• Publisher: Springer Nature B.V
• Subject: Arteriosclerosis / Atherosclerosis / Cardiology / Cardiovascular diseases / Cholesterol / Lipids / Low density lipoprotein / Risk management / Simulation