Abstract P217: Cardiovascular Events Among Adults Who Qualify For Statin Therapy Based On Age Alone Alone: A Reasons For Geographical And Racial Differences In Stroke (REGARDS) Study

Background: Predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk in the Pooled Cohort equation increases substantially with age. Some older adults have estimated ASCVD risk ≥7.5% without elevated risk factors; it is unclear whether the observed ASCVD risk is high in this group. We compared the incidence of ASCVD between adults with an estimated 10-year ASCVD risk ≥7.5% based on age alone vs those with elevated risk factors. Methods: Adults ages 45-79 enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study without a history of ASCVD, diabetes mellitus, or statin use were included (i.e, a primary prevention subset). Ten-year ASCVD risk was estimated using the Pooled Cohort Risk Equation. Participants were categorized into 3 groups according to the predicted ASCVD risk: <7.5%, “age-only” ≥7.5%, and “elevated factors” ≥7.5%. Participants with “age-only” risk ≥7.5% were nonsmokers with untreated SBP <130 mmHg, total cholesterol <200 mg/dL, and HDL-C ≥50 mg/dL for women or ≥40 mg/dL for men. All other participants with predicted ASCVD ≥7.5% were considered “elevated factors” ≥7.5%. Incident ASCVD was defined as ischemic or hemorrhagic stroke, nonfatal MI, or CHD death. Results: Among 10,742 participants, 891 ASCVD events occurred over a median follow-up of 11.1 (7.1 - 13.0) years. The “age-only” risk ≥7.5% group included 352 (3.3%) participants with mean age 69.9 ± 5.0. The risk <7.5%, and “elevated factors” risk ≥7.5% had a mean age of 56.3 ± 5.9, and 66.3 ± 7.1 years, respectively. Compared to the risk <7.5% group, the “age-only” and “elevated factors” risk ≥7.5% group experienced 2.6-fold and 3.6-fold higher event rates, respectively (Table). Conclusions: Few adults in this primary prevention population had predicted risk ≥7.5% based on age alone. Even without elevated risk factors, adults with predicted ASCVD risk ≥7.5% based on age alone experienced substantial event rates consistent with their predicted risk.