Key result
In very high-risk Korean patients with atherosclerotic cardiovascular disease on statin therapy, the 3-year cumulative incidence of recurrent cardiovascular events was 15.3%.
Why the study?
Recurrent cardiovascular event risk needed to be estimated in a real-world Korean population with very high-risk ASCVD similar to the FOURIER trial population.
Cohort (n=15,820)
No
Effect estimate: Incidence rate 5.7 per 100 person-years (95% CI 5.5-5.9)
Very high-risk Korean patients with ASCVD on statin therapy remain at substantial risk for recurrent cardiovascular events (15.3% at 3 years), highlighting a residual risk that may require additional lipid-lowering therapies.
Real-world recurrent CV risk estimates in Korean FOURIER-like patients; leaves open whether PCSK9i benefits generalize to this population.
PURPOSE: To estimate the risk of recurrent cardiovascular events in a real-world population of very high-risk Korean patients with prior myocardial infarction (MI), ischemic stroke (IS), or symptomatic peripheral artery disease (sPAD), similar to the Further cardiovascular OUtcomes Research with proprotein convertase subtilisin-kexin type 9 Inhibition in subjects with Elevated Risk (FOURIER) trial population. METHODS: This retrospective study used the Asan Medical Center Heart Registry database built on electronic medical records (EMR) from 2000 to 2016. Patients with a history of clinically evident atherosclerotic cardiovascular disease (ASCVD) with multiple risk factors were followed up for 3 years. The primary endpoint was a composite of MI, stroke, hospitalization for unstable angina, coronary revascularization, and all-cause mortality. RESULTS: Among 15,820 patients, the 3-year cumulative incidence of the composite primary endpoint was 15.3% and the 3-year incidence rate was 5.7 (95% CI 5.5-5.9) per 100 person-years. At individual endpoints, the rates of deaths, MI, and IS were 0.4 (0.3-0.4), 0.9 (0.8-0.9), and 0.8 (0.7-0.9), respectively. The risk of the primary endpoint did not differ significantly between recipients of different intensities of statin therapy. Low-density lipoprotein cholesterol (LDL-C) goals were only achieved in 24.4% of patients during the first year of follow-up. CONCLUSION: By analyzing EMR data representing routine practice in Korea, we found that patients with very high-risk ASCVD were at substantial risk of further cardiovascular events in 3 years. Given the observed risk of recurrent events with suboptimal lipid management by statin, additional treatment to control LDL-C might be necessary to reduce the burden of further cardiovascular events for very high-risk ASCVD patients.
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Kwon et al. (2021) conducted a cohort in Atherosclerotic cardiovascular disease (n=15,820). Statin therapy was evaluated on Composite of MI, stroke, hospitalization for unstable angina, coronary revascularization, and all-cause mortality (Incidence rate 5.7 per 100 person-years, 95% CI 5.5-5.9). In very high-risk Korean patients with atherosclerotic cardiovascular disease on statin therapy, the 3-year cumulative incidence of recurrent cardiovascular events was 15.3%.
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