The following is the summary of “Bending the Cardiovascular Event Curve by Evaluating the Potential Impact of Achieving Low-Density Lipoprotein Cholesterol Goal Across a Large Health System Among Secondary Prevention Patients,” published in the January 2023 issue of Cardiovascular Disease by Shah, et al.
According to current guidelines, patients with atherosclerotic cardiovascular disease(ASCVD) are encouraged to reduce their low-density lipoprotein cholesterol (LDL-C) levels as much as possible. On the other hand, many people still fall short of the suggested target of LDL-C 70 mg/dL. Therefore, researchers analyzed data from the University Health System’s electronic health record to determine how many clinical events could be avoided by reaching LDL-C ≤70 mg/dL in individuals with ASCVD.
A multivariable logistic regression model was designed and verified to predict the 1-year composite of all-cause mortality, myocardial infarction, stroke, or coronary revascularization. Researchers then calculated the NNT for disease prevention. There were 56,230 patients diagnosed with ASCVD; 47% were female, and 27% were non-Hispanic Black. The median age was 68.6 (quartile 1, quartile 3: 59.9, 76.2). More than 70% of patients, or 39,566, had LDL-C levels above 70 mg/dL; these individuals were more likely to be female (51% vs. 36%), non-Hispanic Black (28% vs. 23%), and less likely to be receiving statin medication (67% vs. 91%) than those with LDL-C levels below 70 mg/dL.
If the entire population reached an LDL-C≤ 70 mg/dL, 734 clinical events (455 myocardial infarctions, 186 strokes, and 93 coronary revascularizations) could be avoided in a single year, according to a predictive model with reasonable discrimination (c-index 0.77, 95% confidence interval 0.760 to 0.77) and calibration (slope 0.99). Significant clinical outcomes in patients with ASCVD might be avoided within a year if the health system achieved LDL-C≤ 70 mg/dL. This study concludes that there is monetary value in making a system-wide effort to reduce LDL-C levels to those recommended by guidelines.
Source: sciencedirect.com/science/article/abs/pii/S0002914922011250
