Clinical Characteristics of Patients Classified as Very High Risk and Not Very High Risk Based on the 2018 AHA/ACC Multi-Society Cholesterol Guideline

<p> <h2> Background </h2> <p id="x-x-x-x-p-1"> The 2018 AHA/ACC Cholesterol Guideline recommendation to classify ASCVD patients as very high-risk (VHR) vs not-VHR (NVHR) has important implications for ezetimibe and PCSK9 inhibitor eligibility. We aimed to define the clinical characteristics of these two groups within a large multi-state healthcare system in the Western U.S. <h2> Methods </h2> <p id="x-x-x-x-p-2"> We performed a retrospective cohort analysis of patients defined as having ASCVD in 2018 using EHR ICD-10 codes. VHR was defined by &ge;2 major ASCVD events (ACS &le;12 months, history of MI &gt;12 months, ischemic stroke, or symptomatic PAD) or 1 major ASCVD event and &ge;2 high-risk conditions (age &ge;65, DM, HTN, smoking, HeFH, CKD, CHF, persistently elevated LDL-C, or prior CABG/PCI). Patients not meeting these criteria were classified as NVHR. <h2> Results </h2> <p id="x-x-x-x-p-3"> A total of 180,669 ASCVD patients were identified: 104,123 (58%) were VHR and 76,546 (42%) were NVHR. Mean age and gender was 70.1&plusmn;13.4 years, 54% male and 73.1&plusmn;11.9 years, 55% male for the NVHR and VHR groups, respectively. Among patients with a history of MI or recent ACS, 99% and 96% were classified as VHR, respectively (Table). Age &ge;65, HTN and DM were the most prevalent high-risk conditions. <h2> Conclusion </h2> <p id="x-x-x-x-p-4"> Criteria used to predict future CV risk largely divide ASCVD patients into groups of similar prevalence. Nearly all ACS/MI patients were VHR. With growing emphasis on individualized risk assessment and intense LDL-C reduction, opportunity exists to further refine risk prediction within these two at-risk groups. </p> </p> </p> </p></p>