Ai-THERO Study: a population-based analysis of patients at high or very high risk of atherosclerotic cardiovascular disease and low-density lipoprotein cholesterol (LDL-C) levels in Cantabria, Spain

Introduction Atherosclerotic Cardiovascular Disease (ASCVD) remains a major public health challenge in developed countries, including Spain. However, large scale population-based studies describing the clinical burden of patients at high (HR) or very high (VHR) cardiovascular risk and their attainment of recommended LDL-C goals are scarce. Objectives To describe the population at HR or VHR of ASCVD in Cantabria, Spain and to assess their characteristics and achievement of LDL-C goals. Methods Observational, retrospective, population-based study analyzing electronic health records from an integrated hospital-primary care database of 493,808 individuals in the Cantabrian region (Spain) during an 8-year follow-up (January 2016 to January 2024). Natural Language Processing technology (NLP) was applied to extract structured and unstructured data into a unified database mapped to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Identification of HR or VHR patients for ASCVD and their LDL-C goal attainment were assessed according to the 2019 ESC/EAS guidelines criteria and to the most recent LDL-C available during the study period. Results A total of 97,101 subjects (19.7% of the overall adult population) were identified as HR/VHR patients [mean (SD) age 71.2 years (14.9), 49.6% female, 49.9% with diabetes and 79.7% with hypertension] (Table 1). Of these, 35,021 (36.1%) were classified as HR and 62,080 (63.9%) as VHR patients. Among VHR individuals, 41,282 (66.5%) had documented ASCVD. Prevalence estimates for the overall adult population of Cantabria are shown in Figure 1. Among VHR patients with ASCVD, 18,806 (45.6%) had coronary heart disease, 19,569 (47.4%) cerebrovascular disease and 11,075 (26.8%) peripheral artery disease. Overall, only 17,386 HR and VHR patients (17.9%) had their LDL-C at goal with lower attainment found in VHR patients without ASCVD. The mean (SD) absolute reduction needed to reach recommended LDL-C goals was 42.5 (34.1) mg/dl [1.2 mmol/L], corresponding to a mean percentage reduction of 35.8% (18.0), similar across all risk subgroups (Table 1). Conclusion To our knowledge, this is the first study to describe the characteristics of patients at HR/VHR according to the ESC/EAS guidelines across an entire region in Spain. Based on these results, 19.7% of the adult population of Cantabria was identified as HR/VHR for ASCVD. LDL-C goal attainment was suboptimal, and a substantial additional LDL-C reduction would be needed to reach the currently recommended targets. These results highlight the need for more intensive lipid-lowering therapy and optimized clinical management in HR/VHR patients.