Ten-year Risk of Atherosclerotic Cardiovascular Disease Predicts Long-Term Mortality in Lipid-Lowering Therapy

Document Type

Article

Abstract

Background: The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) can be effectively estimated by the ASCVD Risk Score derived from the pooled cohort equations. Current guidelines, thus, recommend primary prevention statin therapy based on ASCVD Risk Score while assessing effectiveness of statin therapy by targeting low-density lipoprotein cholesterol levels. It is unclear whether ASCVD Risk Score can also predict impact of statin therapy on mortality.

Methods: A retrospective analysis of National Health and Nutrition Examination Survey (NHANES) (III and 1999-2008) linked to the National Death Index was conducted with propensity score matching. The study included 6647 adults without lipid-lowering therapy and 2484 with lipid-lowering therapy. Follow up was truncated at 10 years. Cox regression models and C statistics were used to assess the association between ASCVD Risk Score and mortality.

Results: In the matched cohort with 4802 individuals with similar ASCVD risk profiles, ASCVD Risk Score was comparably predictive of all-cause mortality in the lipid-lowering therapy [area under curve (AUC)=0.75 ;95% confidence interval (CI)=0.73-0.77) and non-therapy (AUC=0.74; 95% CI=0.71-0.77) groups (p=0.5). Similarly, the ASCVD Risk Score was comparably predictive of cardiovascular mortality in both groups (AUC=0.75; 95% CI=0.70-0.79 versus AUC=0.77; 95% CI=0.73-0.80; p=0.5). Lipid-lowering therapy was significantly associated with reduced all-cause mortality [adjusted hazard ratio (HR)=0.70; 95% CI=0.61-0.82; p<0.01) and cardiovascular mortality (adjusted HR=0.65; 95% CI=0.51-0.83; p< 0.01), particularly in those with an ASCVD Risk Score of ≥7.5%.

Conclusions: ASCVD Risk Score comparably predicts mortality in individuals with and without lipid-lowering therapy. Individuals on lipid-lowering therapy had lower all-cause and cardiovascular mortality, compared to those without lipid-lowering therapy despite similar ASCVD Scores at baseline. These findings suggest that statin therapy may predictably reduce mortality in patients initiated on lipid lowering therapy for primary prevention based on the ASCVD Risk Score.

First Page

A11813

DOI

10.1161/circ.148.suppl_1.11813

Publication Date

11-6-2023

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