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More than 90% of patients who’ve had a myocardial infarction (MI), stroke, or have been diagnosed with symptomatic PAD are at very high risk.1,*
Reviewing the history of major CV events and the presence of high risk conditions determines if your secondary prevention patients are at very high risk.2
Examples of very high risk ASCVD patients
Susan
Major CV event:
High risk conditions:
Barney
Major CV event:
High risk conditions:
Kenneth
Multiple major CV events:
*Based on a retrospective cohort study of 16,344 patients aged 19 years or older with a history of major ASCVD event using data from the MarketScan database. This included 7,572 patients with MI (other than recent ACS), 3,551 patients with ischemic stroke, and 5,919 patients with symptomatic PAD as their history of a major ASCVD event. Patients were followed from January 1, 2016, through December 31, 2017, for recurrent ASCVD events. Very high risk was defined according to the 2018 AHA/ACC/Multi-society guidelines. Major ASCVD events included recent ACS, history of MI other than a recent ACS, history of ischemic stroke, and symptomatic PAD.1,3
Very high risk ASCVD definition per the 2018 AHA/ACC/Multi-society guideline2
MULTIPLE MAJOR EVENTS
TWo or More of these:
Symptomatic PAD
Myocardial infarction
Stroke
Recent ACS
(within 12 months)
1 Major EVENT + multiple
HIGH RISK CONDITIONS
One of these:
Symptomatic PAD
Myocardial infarction
Stroke
Recent ACS
(within 12 months)
And two or more of these:
Age 65+
Diabetes
Hypertension
History of CABG or PCI
(outside of the major ASCVD event)
Current smoker
CKD
(eGFR 15-59 mL/min/1.73 m2)
HeFH
History of CHF
Persistently elevated LDL-C (≥ 100 mg/dL)
despite maximally tolerated statin and ezetimibe
ACS = acute coronary syndrome; ASCVD = atherosclerotic cardiovascular disease; CABG = coronary artery bypass graft; CHF = congestive heart failure; CKD = chronic kidney disease; eGFR = estimated glomerular filtration rate; HeFH = heterozygous familial hypercholesterolemia; PAD = peripheral artery disease; PCI = percutaneous coronary intervention.
†Based on a retrospective study using IQVIA claims (Longitudinal Access and Adjudication data; LAAD) and Quest Diagnostics lab databases. Study period was from January 2018 to December 2022, which included 16,406,925 patients with very high risk (VHR) ASCVD, of which 5,366,785 met criteria for VHR ASCVD and experienced an MI. VHR ASCVD was defined in alignment with the 2018 AHA/ACC/Multi-society guidelines; however, persistently elevated LDL-C ≥ 100 mg/dL was not included due to data availability.4