Risk stratification and low-density lipoprotein cholesterol goal attainment rates in patients with very high-risk or extreme high-risk atherosclerotic cardiovascular diseases regarding three guidelines
Nan Nan, Zuo Huijuan, Zhou Yuan, Zhang Min, Zhang Mingduo, Zhang Dongfeng, Tian Jinfan, Gao Bingyu, Nie Xiaolu, Liang Lirong, Lin Jie, Song Xiantao
Abstract
ObjectiveTo explore the differences of risk stratification of very high-risk or extreme high-risk atherosclerotic cardiovascular diseases (ASCVD) and the attainment rates of low-density lipoprotein cholesterol (LDL-C) management targets evaluated by three different criteria, and the causal attributions of these differences.
MethodsPatients with ASCVD were consecutively enrolled from January 1 to December 31 in 2019, and were evaluated for very high-risk or extreme high-risk and LDL-C goal attainment rates with 2018 American guideline on the management of blood cholesterol (2018AG), 2019 China Cholesterol Education Program (CCEP) Expert Advice for the management of dyslipidemias (2019EA) and 2020 Chinese expert consensus on lipid management of very high-risk ASCVD patients(2020EC), respectively. The causal attributions of the differences in attainment rates were analyzed as well.
ResultsA total of 1 864 ASCVD patients were included in this study. According to 2018AG, 2019EA and 2020EC, the proportions of the patients with very high-risk or extreme high-risk were 59.4%, 90.7%, and 65.6%, respectively. The absolute LDL-C target attainment rates were 37.2%, 15.7%, and 13.7%, respectively, the differences between each two rates were statistically significant (all P<0.001). As to the differences in attainment rates between 2020EC and 2018AG, 61.5% were due to the different LDL-C goal attainment values and 38.5% were caused by the different risk stratifications, while for the differences between 2020EC and 2019EA attainment rates, different LDL-C goal attainment values were responsible for 13.2%, and different risk stratifications were responsible for 86.8% of the differences.
ConclusionsThere are significant differences in the proportions and LDL-C attainment rates among the three different criteria for very high-risk or extreme high-risk ASCVD. 2020EC showed a moderate proportion of patients with extreme high-risk, and had the lowest LDL-C attainment rate. The differences between 2020EC and 2018AG are mainly due to the LDL-C target values, and the differences between 2020EC and 2019EA are mainly caused by the risk stratifications.
Key words:
Atherosclerosis; Cardiovascular diseases; Risk assessment; Low-density lipoprotein cholesterol; Goal attainment rates
Contributor Information
Nan Nan
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Zuo Huijuan
Department of Community Health Research, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Zhou Yuan
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Zhang Min
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Zhang Mingduo
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Zhang Dongfeng
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Tian Jinfan
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Gao Bingyu
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Nie Xiaolu
Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Liang Lirong
Department of Clinical Epidemiology,Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Lin Jie
Department of Arteriosclerosis, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Song Xiantao
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
