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. 2023 May 9;30(7):601-610.
doi: 10.1093/eurjpc/zwad038.

Unexploited potential of risk factor treatment in patients with atherosclerotic cardiovascular disease

Tinka J van Trier  1 , Marjolein Snaterse  1 , Steven H J Hageman  2 , Nienke Ter Hoeve  3   4 , Madoka Sunamura  3   5 , Eric P Moll van Charante  6 , Henrike Galenkamp  7 , Jaap W Deckers  8 , Fabrice M A C Martens  9 , Frank L J Visseren  2 , Wilma J M Scholte Op Reimer  1   10 , Ron J G Peters  1 , Harald T Jørstad  1
Affiliations

Unexploited potential of risk factor treatment in patients with atherosclerotic cardiovascular disease

Tinka J van Trier et al. Eur J Prev Cardiol. .

Abstract

Background: Most patients with atherosclerotic cardiovascular disease remain at (very) high risk for recurrent events due to suboptimal risk factor control.

Aims: This study aimed to quantify the potential of maximal risk factor treatment on 10-year and lifetime risk of recurrent atherosclerotic cardiovascular events in patients 1 year after a coronary event.

Methods and results: Pooled data from six studies are as follows: RESPONSE 1, RESPONSE 2, OPTICARE, EUROASPIRE IV, EUROASPIRE V, and HELIUS. Patients aged ≥45 years at ≥6 months after coronary event were included. The SMART-REACH score was used to estimate 10-year and lifetime risk of recurrent atherosclerotic cardiovascular events with current treatment and potential risk reduction and gains in event-free years with maximal treatment (lifestyle and pharmacological). In 3230 atherosclerotic cardiovascular disease patients (24% women), at median interquartile range (IQR) 1.1 years (1.0-1.8) after index event, 10-year risk was median (IQR) 20% (15-27%) and lifetime risk 54% (47-63%). Whereas 70% used conventional medication, 82% had ≥1 drug-modifiable risk factor not on target. Furthermore, 91% had ≥1 lifestyle-related risk factor not on target. Maximizing therapy was associated with a potential reduction of median (IQR) 10-year risk to 6% (4-8%) and of lifetime risk to 20% (15-27%) and a median (IQR) gain of 7.3 (5.4-10.4) atherosclerotic cardiovascular disease event-free years.

Conclusions: Amongst patients with atherosclerotic cardiovascular disease, maximizing current, guideline-based preventive therapy has the potential to mitigate a large part of their risk of recurrent events and to add a clinically important number of event-free years to their lifetime.

Keywords: Cardiovascular risk factors; Lifetime risk; Residual risk; Risk stratification; Secondary prevention.

Plain language summary

Patients with heart disease are at high risk of new cardiac events. This study amongst 3230 patients who had a heart attack or received a stent or bypass surgery shows missed potential for healthy life after a heart attack. The average age of study patients was 61 years, and 24% were women. At 1 year after the cardiac event, nearly one in three (30%) continued smoking, 79% were overweight, 45% reported insufficient physical activity, 40% had high blood pressure, and 65% had a too high LDL (‘bad’) cholesterol. We calculated that adherence to lifestyle advice and medications could on average halve the risk for another heart attack and add over 7 healthy years of life after a heart attack. This highlights the importance of healthy lifestyle and medication adherence after a heart attack. Key finding:• adherence to lifestyle advice and medications could add over 7 healthy years of life after a heart attack.

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Conflict of interest statement

Conflict of interest: T.T. declares to have no disclosures; M.Sn. declares to have no disclosures; S.H. has no disclosures; N.H. has no disclosures; M.Su. has no disclosures; E.M.C. has no disclosures; H.G. has no disclosures; J.D. has no disclosures; F.M. has no disclosures for this study; F.V. has no disclosures; W.S.R. has no disclosures; R.P. declares has no disclosures; H.J. received unrestricted research grants to institution from Bayer, Amgen, and Sanofi and is a member of the national advisory board Amgen (The Netherlands). These funders had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.