Residual atherosclerotic cardiovascular disease risk in statin-treated adults

The Multi-Ethnic Study of Atherosclerosis

Nathan D. Wong, Yanglu Zhao, Ruben G.W. Quek, Roger S Blumenthal, Matthew J. Budoff, Mary Cushman, Parveen Garg, Veit Sandfort, Michael Tsai, J. Antonio G. Lopez

Research output: Contribution to journalArticle

Abstract

Background: Residual atherosclerotic cardiovascular disease (ASCVD) risk in statin-treated US adults without known ASCVD is not well described. Objective: To quantitate residual ASCVD risk and its predictors in statin-treated adults. Methods: We studied 1014 statin-treated adults (53.3% female, mean 66.0 years) free of clinical ASCVD in the Multi-Ethnic Study of Atherosclerosis. We examined ASCVD event rates by National Lipid Association risk groups over 11-year follow-up and the relation of standard risk factors, biomarkers, and subclinical atherosclerosis measures with residual ASCVD event risk. Results: Overall, 5.3% of participants were at low, 12.2% at moderate, 60.3% at high, and 22.2% at very high baseline risk. Despite statin therapy, age- and race-standardized ASCVD rates per 1000 person-years for men and women were both 4.9 for low/moderate risk, 19.1 and 14.2 for high risk, and 35.6 and 26.7 for very high risk, respectively. Specific independent predictors of residual risk included current smoking, family history, diabetes, high-sensitivity C-reactive protein, low-density lipoprotein particle number, carotid intimal medial thickness, and especially coronary artery calcium score. Those on moderate- or high-intensity statins at baseline (compared with low intensity) had 39% lower risks and those who increased statin intensity 62% lower ASCVD event risks (P < .01). Conclusion: Residual risk of ASCVD remains high despite statin treatment and is predicted by specific risk factors and subclinical atherosclerosis. These findings may be helpful for identifying those at highest risk needing more aggressive treatment.

Original languageEnglish (US)
JournalJournal of Clinical Lipidology
DOIs
StateAccepted/In press - 2017

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Atherosclerosis
Cardiovascular Diseases
Tunica Intima
LDL Lipoproteins
C-Reactive Protein

Keywords

  • Atherosclerosis
  • Cardiovascular disease risk
  • Dyslipidemia
  • Risk factors
  • Statins

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

Cite this

Residual atherosclerotic cardiovascular disease risk in statin-treated adults : The Multi-Ethnic Study of Atherosclerosis. / Wong, Nathan D.; Zhao, Yanglu; Quek, Ruben G.W.; Blumenthal, Roger S; Budoff, Matthew J.; Cushman, Mary; Garg, Parveen; Sandfort, Veit; Tsai, Michael; Lopez, J. Antonio G.

In: Journal of Clinical Lipidology, 2017.

Research output: Contribution to journalArticle

Wong, Nathan D. ; Zhao, Yanglu ; Quek, Ruben G.W. ; Blumenthal, Roger S ; Budoff, Matthew J. ; Cushman, Mary ; Garg, Parveen ; Sandfort, Veit ; Tsai, Michael ; Lopez, J. Antonio G. / Residual atherosclerotic cardiovascular disease risk in statin-treated adults : The Multi-Ethnic Study of Atherosclerosis. In: Journal of Clinical Lipidology. 2017.
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abstract = "Background: Residual atherosclerotic cardiovascular disease (ASCVD) risk in statin-treated US adults without known ASCVD is not well described. Objective: To quantitate residual ASCVD risk and its predictors in statin-treated adults. Methods: We studied 1014 statin-treated adults (53.3{\%} female, mean 66.0 years) free of clinical ASCVD in the Multi-Ethnic Study of Atherosclerosis. We examined ASCVD event rates by National Lipid Association risk groups over 11-year follow-up and the relation of standard risk factors, biomarkers, and subclinical atherosclerosis measures with residual ASCVD event risk. Results: Overall, 5.3{\%} of participants were at low, 12.2{\%} at moderate, 60.3{\%} at high, and 22.2{\%} at very high baseline risk. Despite statin therapy, age- and race-standardized ASCVD rates per 1000 person-years for men and women were both 4.9 for low/moderate risk, 19.1 and 14.2 for high risk, and 35.6 and 26.7 for very high risk, respectively. Specific independent predictors of residual risk included current smoking, family history, diabetes, high-sensitivity C-reactive protein, low-density lipoprotein particle number, carotid intimal medial thickness, and especially coronary artery calcium score. Those on moderate- or high-intensity statins at baseline (compared with low intensity) had 39{\%} lower risks and those who increased statin intensity 62{\%} lower ASCVD event risks (P < .01). Conclusion: Residual risk of ASCVD remains high despite statin treatment and is predicted by specific risk factors and subclinical atherosclerosis. These findings may be helpful for identifying those at highest risk needing more aggressive treatment.",
keywords = "Atherosclerosis, Cardiovascular disease risk, Dyslipidemia, Risk factors, Statins",
author = "Wong, {Nathan D.} and Yanglu Zhao and Quek, {Ruben G.W.} and Blumenthal, {Roger S} and Budoff, {Matthew J.} and Mary Cushman and Parveen Garg and Veit Sandfort and Michael Tsai and Lopez, {J. Antonio G.}",
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T1 - Residual atherosclerotic cardiovascular disease risk in statin-treated adults

T2 - The Multi-Ethnic Study of Atherosclerosis

AU - Wong, Nathan D.

AU - Zhao, Yanglu

AU - Quek, Ruben G.W.

AU - Blumenthal, Roger S

AU - Budoff, Matthew J.

AU - Cushman, Mary

AU - Garg, Parveen

AU - Sandfort, Veit

AU - Tsai, Michael

AU - Lopez, J. Antonio G.

PY - 2017

Y1 - 2017

N2 - Background: Residual atherosclerotic cardiovascular disease (ASCVD) risk in statin-treated US adults without known ASCVD is not well described. Objective: To quantitate residual ASCVD risk and its predictors in statin-treated adults. Methods: We studied 1014 statin-treated adults (53.3% female, mean 66.0 years) free of clinical ASCVD in the Multi-Ethnic Study of Atherosclerosis. We examined ASCVD event rates by National Lipid Association risk groups over 11-year follow-up and the relation of standard risk factors, biomarkers, and subclinical atherosclerosis measures with residual ASCVD event risk. Results: Overall, 5.3% of participants were at low, 12.2% at moderate, 60.3% at high, and 22.2% at very high baseline risk. Despite statin therapy, age- and race-standardized ASCVD rates per 1000 person-years for men and women were both 4.9 for low/moderate risk, 19.1 and 14.2 for high risk, and 35.6 and 26.7 for very high risk, respectively. Specific independent predictors of residual risk included current smoking, family history, diabetes, high-sensitivity C-reactive protein, low-density lipoprotein particle number, carotid intimal medial thickness, and especially coronary artery calcium score. Those on moderate- or high-intensity statins at baseline (compared with low intensity) had 39% lower risks and those who increased statin intensity 62% lower ASCVD event risks (P < .01). Conclusion: Residual risk of ASCVD remains high despite statin treatment and is predicted by specific risk factors and subclinical atherosclerosis. These findings may be helpful for identifying those at highest risk needing more aggressive treatment.

AB - Background: Residual atherosclerotic cardiovascular disease (ASCVD) risk in statin-treated US adults without known ASCVD is not well described. Objective: To quantitate residual ASCVD risk and its predictors in statin-treated adults. Methods: We studied 1014 statin-treated adults (53.3% female, mean 66.0 years) free of clinical ASCVD in the Multi-Ethnic Study of Atherosclerosis. We examined ASCVD event rates by National Lipid Association risk groups over 11-year follow-up and the relation of standard risk factors, biomarkers, and subclinical atherosclerosis measures with residual ASCVD event risk. Results: Overall, 5.3% of participants were at low, 12.2% at moderate, 60.3% at high, and 22.2% at very high baseline risk. Despite statin therapy, age- and race-standardized ASCVD rates per 1000 person-years for men and women were both 4.9 for low/moderate risk, 19.1 and 14.2 for high risk, and 35.6 and 26.7 for very high risk, respectively. Specific independent predictors of residual risk included current smoking, family history, diabetes, high-sensitivity C-reactive protein, low-density lipoprotein particle number, carotid intimal medial thickness, and especially coronary artery calcium score. Those on moderate- or high-intensity statins at baseline (compared with low intensity) had 39% lower risks and those who increased statin intensity 62% lower ASCVD event risks (P < .01). Conclusion: Residual risk of ASCVD remains high despite statin treatment and is predicted by specific risk factors and subclinical atherosclerosis. These findings may be helpful for identifying those at highest risk needing more aggressive treatment.

KW - Atherosclerosis

KW - Cardiovascular disease risk

KW - Dyslipidemia

KW - Risk factors

KW - Statins

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