† Higher Cardiovascular Event Rates for High-Risk Americans Who Did Not Meet 2018 Multidisciplinary Guideline on the Management of Blood Cholesterol Thresholds

Background/Synopsis The 2018 Multidisciplinary Guideline on the Management of Blood Cholesterol calls for initiation and intensification of lipid-lowering therapy (LLT) if low density lipoprotein cholesterol (LDL-C) exceeds thresholds in high and very high (H/VH) risk patients. Despite LDL-C being a major modifiable cardiovascular risk factor, most patients fail to meet guideline thresholds. Objective/Purpose To assess the consequences of failure to achieve LDL-C guideline thresholds using the Family Heart Database of >324 million individuals. Methods This retrospective analysis assessed annual cardiovascular event (CE) rates in H/VH risk patients as defined by the guidelines. It included individuals who had > 48 months of diagnosis, procedure, medication, and lab result data with > 3 cholesterol results. Patient histories were divided into contiguous episodes characterized by LLT use (including no therapy, mono and combination therapy), prescriptions filled, and LDL-C level. An 18-month baseline period was utilized to determine the covariates for the propensity score matching (PSM). Individuals with a cardiovascular event (CE) during the baseline were excluded. Cohorts included individuals either “Above Threshold” or “Below Threshold” for at least 70% of the study period (including baseline). Following the baseline period, individuals were observed for at least 30 months to determine the date of the first CE and annual incidence rates (AIR) were calculated. Results 39,117 and 17,232 individuals met the criteria for the Above Threshold and Below Threshold cohorts respectively. A 1:1 PSM resulted in 14,755 in each cohort. The AIRs were 2.2% and 1.5% for the Above Threshold and Below Threshold groups respectively, a 44.2% (p < 0.0002) higher rate in the Above Threshold group. Total CEs (first and subsequent) were also significantly higher 49% (p< 0.0002) in the Above Threshold than the Below Threshold group (3,510 vs 2,356). Conclusions In this real-world evaluation of H/VH risk individuals achieving lipid guideline thresholds reduces cardiovascular events. Greater emphasis on achieving LDL-C control could improve cardiac health at a population level. External Funding Yes Funding Sources The Family Heart Foundation is a 501c3 public charity research and advocacy organization that receives contributions and sponsorships from individuals, foundations, and pharmaceutical companies. This research was partially funded by Amgen, although it played no role in study design, conduct, interpretation or plans for publication. The 2018 Multidisciplinary Guideline on the Management of Blood Cholesterol calls for initiation and intensification of lipid-lowering therapy (LLT) if low density lipoprotein cholesterol (LDL-C) exceeds thresholds in high and very high (H/VH) risk patients. Despite LDL-C being a major modifiable cardiovascular risk factor, most patients fail to meet guideline thresholds. To assess the consequences of failure to achieve LDL-C guideline thresholds using the Family Heart Database of >324 million individuals. This retrospective analysis assessed annual cardiovascular event (CE) rates in H/VH risk patients as defined by the guidelines. It included individuals who had > 48 months of diagnosis, procedure, medication, and lab result data with > 3 cholesterol results. Patient histories were divided into contiguous episodes characterized by LLT use (including no therapy, mono and combination therapy), prescriptions filled, and LDL-C level. An 18-month baseline period was utilized to determine the covariates for the propensity score matching (PSM). Individuals with a cardiovascular event (CE) during the baseline were excluded. Cohorts included individuals either “Above Threshold” or “Below Threshold” for at least 70% of the study period (including baseline). Following the baseline period, individuals were observed for at least 30 months to determine the date of the first CE and annual incidence rates (AIR) were calculated. 39,117 and 17,232 individuals met the criteria for the Above Threshold and Below Threshold cohorts respectively. A 1:1 PSM resulted in 14,755 in each cohort. The AIRs were 2.2% and 1.5% for the Above Threshold and Below Threshold groups respectively, a 44.2% (p < 0.0002) higher rate in the Above Threshold group. Total CEs (first and subsequent) were also significantly higher 49% (p< 0.0002) in the Above Threshold than the Below Threshold group (3,510 vs 2,356). In this real-world evaluation of H/VH risk individuals achieving lipid guideline thresholds reduces cardiovascular events. Greater emphasis on achieving LDL-C control could improve cardiac health at a population level.