The Prevalence of Patients At Very High Risk For Cardiovascular Events In The United Kingdom

Abstract

The primary objective was to estimate the prevalence of patients at very high risk of cardiovascular events in the United Kingdom. This was a cross-sectional study using the Clinical Practice Research Datalink (CPRD). We included patients age ≥18 in 2013 with treated hypercholesterolemia (≥2 prescriptions for lipid modifying therapy [LMT]). We defined two very high risk populations based on 2016 European Society of Cardiology guidelines: documented cardiovascular disease (CVD) and type 2 diabetes without documented CVD (DM2w/oCVD). CVD included acute coronary syndrome ([ACS]: myocardial infarction, unstable angina, revascularization, stable angina, or cardiac ischemia), ischemic stroke ([IS] also included transient ischemic attack or carotid stenosis), and peripheral arterial disease ([PAD] also included abdominal aortic aneurysm). In 2013, 9.4% of all CPRD patients (504,907) received LMT (>95% received statins) and 4.8% were at very high risk for CVD (2.8% CVD and 2% DM2w/oCVD). In the CVD population, 73% had ACS, 18% had IS, and 9% had PAD. The ACS subgroup included 35% with myocardial infarction and 65% with stable or unstable angina, revascularization, or cardiac ischemia; in the IS subgroup 31% of patients had ischemic stroke and 69% had carotid stenosis; and the PAD subgroup included 93% with PAD and 7% with abdominal aortic aneurysm. In the overall CVD population, 25% had type 2 diabetes, 25% had recurrent CVD, and 7% had both. In the CVD and DM2w/oCVD populations, 24% and 14% respectively received a high-intensity statin or statin with ezetimibe. A substantial proportion of the CVD population had LDL-cholesterol levels above commonly suggested thresholds: 24% above 2.6 mmol/L (100 mg/dL) and 62% above 1.8 mmol/L (70 mg/dL). In the DM2w/oCVD population the respective proportions were 23% and 59%. Our analysis shows the need for additional intensive LDL lowering in well-defined populations at very high risk for cardiovascular events.