Incidence and Predictors of Major Adverse Cardiovascular Events in Patients With Established Atherosclerotic Disease or Multiple Risk Factors

Abstract

Background There is a paucity of contemporary data estimating the incidence of major adverse cardiovascular events (MACE) in patients with established atherosclerotic disease or multiple risk factors managed in routine practice. We estimated 1- and 4-year incidences of MACE and the association between MACE and vascular beds affected in these patients. Methods and Results Using US IBM MarketScan data from January 1, 2013 to December 31, 2017, we identified patients ≥45 years old with established coronary artery disease, cerebrovascular disease, peripheral artery disease, or the presence of ≥3 risk factors for atherosclerosis during 2013 with a minimum of 4 years of follow-up. We calculated 1- and 4-year incidences of MACE (cardiovascular death or hospitalization for myocardial infarction or ischemic stroke). A Cox proportional hazards regression model adjusted for age and sex was used to evaluate the association between vascular bed number/location(s) affected and MACE. We identified 1 302 856 patients with established atherosclerotic disease or risk factors for atherosclerosis. Coronary artery disease was present in 16.9% of patients, cerebrovascular disease in 7.6%, peripheral artery disease in 13.6%, and risk factors for atherosclerosis only in 66.0%. The 1- and 4-year incidences of MACE were 1.4% and 6.9%, respectively. At 4 years, MACE was more frequent in patients with atherosclerotic disease in a single (hazard ratio=1.51, 95% CI=1.48-1.55), 2-(hazard ratio=2.35, 95% CI=2.27-2.44), or all 3 vascular beds (hazard ratio=3.30, 95% CI=2.97-3.68) compared with having risk factors for atherosclerosis. Conclusions Patients with established atherosclerotic disease or who have multiple risk factors and are treated in contemporary, routine practice carry a substantial risk for MACE at 1- and 4- years of follow-up. MACE risk was shown to vary based on the number and location of vascular beds involved.

Keywords: cerebrovascular disease; coronary artery disease; established atherosclerotic disease; major adverse cardiovascular events; peripheral artery disease; risk factors.

Figure 1

Flow diagram of patient selection.

Figure 2

Incidence of MACE of individuals evaluated at 1 (A) and 4 years (B) of follow‐up. CAD indicates coronary artery disease; CV, cardiovascular; CVD, cerebrovascular disease; MACE, major adverse cardiovascular event; MI, myocardial infarction; PAD, peripheral artery disease.

Figure 3

Incidence of major adverse cardiovascular events including hospitalization for vascular events or procedures at 1 and 4 years of follow‐up. CV indicates cardiovascular; MACE, major adverse cardiovascular event; MI, myocardial infarction.

Figure 4

Cumulative incidence of MACE of individuals evaluated at 1 (A) and 4 years (B) of follow‐up by vascular beds. CAD indicates coronary artery disease; CVD, cerebrovascular disease; MACE, major adverse cardiovascular event; PAD, peripheral artery disease.

Figure 5

Relative hazard of MACE of individuals evaluated at 1 (A) and 4 years (B) of follow‐up by vascular beds. CAD indicates coronary artery disease; CVD, cerebrovascular disease; HR, hazard ratio; PAD, peripheral artery disease.