Key result
Predicted 10-year ASCVD risk ≥7.5% without established risk factors linked to ~172% higher ASCVD incidence.
Why the study?
Age strongly influences 10-year predicted ASCVD risk, and some older adults reach a predicted risk ≥7.5 % without established risk factors; their ASCVD incidence compared with other risk groups was unknown.
Does a 10-year predicted ASCVD risk ≥7.5% without established risk factors predict higher incident ASCVD compared to a predicted risk <7.5% in adults without baseline ASCVD or diabetes?
Cohort (n=11,115)
Yes
Does a 10-year predicted ASCVD risk ≥7.5% without established risk factors predict higher incident ASCVD compared to a predicted risk <7.5% in adults without baseline ASCVD or diabetes?
Effect estimate: HR 2.72 (95% CI 1.91-3.88)
Absolute Event Rate: 9.8% vs 3.6%
Adults with a 10-year predicted ASCVD risk ≥7.5% but without established risk factors still have a significantly higher incidence of ASCVD events compared to those with risk <7.5%.
May support broader use of risk equations for ASCVD screening; leaves open whether to adjust statin thresholds in this subgroup.
Objective: Age is the strongest contributor to 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk. Some older adults have a predicted ASCVD risk ≥7.5 %, without established risk factors. We sought to compare ASCVD incidence among adults with predicted ASCVD risk ≥7.5 %, with and without established ASCVD risk factors, to adults with predicted risk <7.5 %. Methods: We analyzed data from REasons for Geographic and Racial Differences in Stroke study participants, 45-79 years old, without ASCVD or diabetes, not taking statins and with low-density lipoprotein cholesterol 70-189 mg/dL. Participants were categorized into 3 groups based on their 10-year predicted ASCVD risk and presence of established risk factors: <7.5 %, ≥7.5 % with established risk factors and ≥7.5 % without established risk factors. Established risk factors included smoking, systolic blood pressure ≥130 mmHg or antihypertensive medication use, total cholesterol ≥200 mg/dL, or high-density lipoprotein cholesterol <50 mg/dL for women (<40 mg/dL for men). Participants were followed for ASCVD events. Results: Among 11,115 participants, 911 incident ASCVD events occurred over a median of 11.1 years. ASCVD incidence rates were 3.6, 12.8, and 9.8 per 1,000 person-years for participants with predicted risk <7.5 %, predicted risk ≥7.5 % with established risk factors and predicted risk ≥7.5 % without established risk factors, respectively. Compared to adults with predicted risk <7.5 %, hazard ratios for incident ASCVD in participants with risk ≥7.5 % with and without established risk factors were 3.58 (95 %CI 3.03 - 4.21) and 2.72 (95 %CI 1.91-3.88), respectively. Conclusions: Adults with a 10-year predicted ASCVD risk ≥7.5 % but without established risk factors had a high ASCVD incidence.
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Kong et al. (2023) conducted a cohort in High predicted ASCVD risk (n=11,115). Predicted ASCVD risk ≥7.5% without established risk factors vs. Predicted ASCVD risk <7.5% was evaluated on Incident ASCVD events (HR 2.72, 95% CI 1.91-3.88). Adults with a 10-year predicted ASCVD risk ≥7.5% but no established risk factors had a higher incidence of ASCVD compared to those with predicted risk <7.5% (HR 2.72; 95% CI 1.91-3.88).
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