Purpose

Adults with atherosclerotic cardiovascular disease (ASCVD) are recommended high-intensity statins, with those at very high risk for recurrent events recommended adding ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor if their low-density lipoprotein cholesterol (LDL-C) is ≥70 mg/dL. We estimated the number of recurrent ASCVD events potentially averted if all adults in the United States (US) ≥45 years of age with ASCVD achieved an LDL-C <70 mg/dL.

Methods

The number of US adults with ASCVD and LDL-C ≥70 mg/dL was estimated from the National Health and Nutrition Examination Survey 2009–2016 (n = 596). The 10-year cumulative incidence of recurrent ASCVD events was estimated from the REasons for Geographic And Racial Differences in Stroke study (n = 5390), weighted to the US population by age, race, and sex. The ASCVD risk reduction by achieving an LDL-C <70 mg/dL was estimated from meta-analyses of lipid-lowering treatment trials.

Results

Overall, 14.7 (95% CI, 13.7–15.8) million US adults had ASCVD, of whom 11.6 (95% CI, 10.6–12.5) million had LDL-C ≥70 mg/dL. The 10-year cumulative incidence of ASCVD events was 24.3% (95% CI, 23.2–25.6%). We projected that 2.823 (95% CI, 2.543–3.091) million ASCVD events would occur over 10 years among US adults with ASCVD and LDL-C ≥70 mg/dL. Overall, 0.634 (95% CI, 0.542–0.737) million ASCVD events could potentially be averted if all US adults with ASCVD achieved and maintained LDL-C <70 mg/dL.

Conclusion

A substantial number of recurrent ASCVD events could be averted over 10 years if all US adults with ASCVD achieved, and maintained, an LDL-C <70 mg/dL.

中文翻译：

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全人群 LDL 胆固醇 <70 mg/dL 对美国成人 ASCVD 复发事件数量的预计影响

目的

推荐患有动脉粥样硬化性心血管疾病 (ASCVD) 的成人使用高强度他汀类药物，对于复发事件风险极高的成人，如果他们的低密度脂蛋白胆固醇 (LDL-C) ) ≥ 70 毫克/分升。如果美国 (US) ≥ 45 岁的所有患有 ASCVD 的成年人达到 LDL-C <70 mg/dL，我们估计了可能避免的复发 ASCVD 事件的数量。

方法

根据 2009-2016 年国家健康和营养检查调查（ n = 596）估计患有 ASCVD 和 LDL-C ≥ 70 mg/dL 的美国成年人人数。ASCVD 事件复发的 10 年累积发生率是根据卒中地理和种族差异的原因研究 ( n = 5390) 估算的，按年龄、种族和性别对美国人口进行加权。通过降脂治疗试验的荟萃分析估计通过实现 LDL-C <70 mg/dL 来降低 ASCVD 风险。

结果

总体而言，14.7（95% CI，13.7-15.8）百万美国成年人患有 ASCVD，其中 11.6（95% CI，10.6-12.5）百万人的 LDL-C ≥ 70 mg/dL。ASCVD 事件的 10 年累积发生率为 24.3%（95% CI，23.2–25.6%）。我们预计在 ASCVD 和 LDL-C ≥70 mg/dL 的美国成年人中，10 年内将发生 2.823（95% CI，2.543–3.091）百万次 ASCVD 事件。总体而言，如果所有患有 ASCVD 的美国成年人达到并维持 LDL-C <70 mg/dL，则有可能避免 0.634（95% CI，0.542–0.737）万次 ASCVD 事件。

结论

如果所有患有 ASCVD 的美国成年人都达到并维持 LDL-C <70 mg/dL，则可以在 10 年内避免大量复发性 ASCVD 事件。