Prevention Of Atherosclerotic Cardiovascular Disease Research Articles

A comparative study of the hypolipidemic effects and mechanisms of action of Laminaria japonica- and Ascophyllum nodosum-derived fucoidans in apolipoprotein E-deficient mice.

The structural characteristics of fucoidans exhibit species and regional diversity. Previous studies have demonstrated that Laminaria japonica- and Ascophyllum nodosum-derived fucoidans have type I and type II fucosyl chains, respectively. These chemical differences may contribute to distinct hypolipidemic effects and mechanisms of action. Chemical analysis demonstrated that the percentage contents of sulfate, glucuronic acid, and galactose were higher in L. japonica-derived fucoidans than those of A. nodosum-derived fucoidans. In hyperlipidemic apolipoprotein E-deficient mice, both A. nodosum- and L. japonica-derived fucoidans significantly decreased the plasma and hepatic levels of total cholesterol and triglyceride, leading to the reduction of atherosclerotic plaques. Western blotting experiments demonstrated that these fucoidans significantly enhanced the expression and levels of scavenger receptor B type 1, cholesterol 7 alpha-hydroxylase A1, and peroxisome proliferator-activated receptor (PPAR)-α, contributing to circulating lipoprotein clearance and fatty acid degradation, respectively. Differentially, L. japonica-derived fucoidan significantly increased the LXR/ATP-binding cassette G8 signaling pathway in the small intestine, as revealed by real-time quantitative PCR, which may lead to further cholesterol and other lipid excretion. Collectively, these data are useful for understanding the hypolipidemic mechanisms of action of seaweed-derived fucoidans, and their potential application for the prevention and/or treatment of atherosclerotic cardiovascular diseases.

Effects of omega-3, omega-6, and total dietary polyunsaturated fatty acid supplementation in patients with atherosclerotic cardiovascular disease: a systematic review and meta-analysis.

Background: Uncertainty exists about the link between omega-3 fatty acid, omega-6 fatty acid, and total polyunsaturated fatty acid (PUFA) intake and mortality in atherosclerotic cardiovascular disease (ASCVD) patients, and no meta-analyses summarize the relationship between these various types of PUFAs and ASCVD. Methods: Web of Science, PubMed, EBSCO and Cochrane Library up to November 30, 2022 were searched for prospective randomized controlled studies investigating the relationships among omega-3, omega-6, and PUFA intake and mortality and cardiovascular events in ASCVD patients. This study has been registered at PROSPERO (No. CRD42023407566). Results: This meta-analysis included 21 publications from 17 studies involving 40 861 participants published between 1965 and 2022. In ASCVD patients, omega-3 may lower all-cause mortality (RR: 0.90, 95% CI [0.83, 0.98], I2 = 8%), CVD mortality (RR: 0.82, 95% CI [0.73, 0.91], I2 = 34%) and CVD events (RR: 0.90, 95% CI [0.86, 0.93], I2 = 79%). Subgroup analyses showed that EPA or EPA ethyl ester supplementation reduced CVD events, while the mixture of EPA and DHA had no significant impact. Long-chain omega-3 consumption of 1.0-4.0 g per d reduced death risk by 3.5% for each 1 g per d increase. Omega-6 and PUFA had no significant effect on mortality or CVD events, with low-quality evidence and significant heterogeneity. Conclusions: omega-3 intake is associated with a reduced risk of all-cause mortality, CVD mortality, and CVD events in ASCVD patients, while omega-6 or total PUFA intake showed no significant association. Increasing the omega-3 intake by 1 g per d resulted in a 3.5% decrease in the risk of death. These findings support the recommendation of supplements with omega-3 fatty acids for the secondary prevention of ASCVD.

Is there still a place for fenofibrate-statin combination therapy?

Although low-density lipoprotein cholesterol (LDL-C) is the main target for the prevention of atherosclerotic cardiovascular disease (ASCVD), hypertriglyceridaemia (HTG), a common condition characterised by elevated blood triglyceride (TG) levels, contributes to residual cardiovascular risk independently of LDL-C levels. Elevated TG levels are a feature of atherogenic dyslipidaemia, which also includes low HDL-C levels and high levels of atherogenic small, dense LDL, together with accumulation of atherogenic remnant particles. Treatment of HTG includes lifestyle interventions, but these are not always sufficient to significantly reduce TG levels in people at high cardiovascular risk. Current guidelines for the treatment of dyslipidaemias recommend the use of statins as the first choice in people with HTG (TG >200 mg/dL) and high CV risk, and consideration of the use of specific TG-lowering drugs, such as fenofibrate, bezafibrate or icosapent ethyl if HTG persists. Fenofibrate acts by activating the peroxisome proliferator receptor alpha (PPARα), a nuclear receptor that plays an important role in lipid and lipoprotein metabolism, glucose homeostasis and inflammation. Several clinical trials have shown that fibrates may reduce the incidence of major cardiovascular events only in patients with high TG levels and low HDL-C levels, a finding that was also observed with fenofibrate in combination with a statin compared to statin therapy alone. The recent failure of the PROMINENT trial with pemafibrate in combination with a statin highlighted the notion that treatment with fibrates provides a clinical benefit only if they lower apoB levels.

A nano-bioconjugate modified with anti-SIRPα antibodies and antisense oligonucleotides of mTOR for anti-atherosclerosis therapy

Atherosclerosis is the main cause of a series of fatal cardiovascular diseases, characterized by pathological accumulation of apoptotic cells and lipids. Pro-phagocytic antibody-based or pro-autophagy gene-based therapies are currently being explored to stimulate the phagocytic clearance of apoptotic cells and lipid metabolism; however, monotherapies are only moderately effective or require high doses with unacceptable side effects. Herein, we engineered a specific nano-bioconjugate loaded with antisense oligonucleotides (ASOs) of mammalian target of rapamycin (mTOR) and modified with anti-signal-regulated protein-α antibody (aSIRPα) for macrophage-mediated atherosclerosis therapy. The specific nano-bioconjugate utilized acid-responsive calcium phosphate (CaP) as a carrier to load mTOR ASOs, coated with lipid on the surface of CaP nanoparticles (ASOs@CaP), and subsequently modified with aSIRPα. The resulting nano-bioconjugates could accumulate within atherosclerotic plaques, target to macrophages and reactivate lesional phagocytosis through blocking the CD47-SIRPα signaling axis. In addition, efficient delivery of mTOR ASOs inhibited mTOR expression, which significantly restored impaired autophagy. The combined action of mTOR ASOs and aSIRPα reduced apoptotic cells and lipids accumulation. This nanotherapy significantly reduced plaque burden and inhibited progression of atherosclerotic lesions. These results show the potential of specific nano-bioconjugates for the prevention of atherosclerotic cardiovascular disease. Statement of significanceAtherosclerosis is the main cause of a series of fatal cardiovascular diseases. Pro-phagocytic antibody-based or pro-autophagy gene-based therapies are currently being explored to stimulate the phagocytic clearance of apoptotic cells and lipid metabolism; however, monotherapies are only moderately effective or require high doses with unacceptable side effects. Herein, we engineered a specific nano-bioconjugate loaded with antisense oligonucleotides (ASOs) of mammalian target of rapamycin (mTOR) and modified with anti-signal-regulated protein-α antibody (aSIRPα) for macrophage-mediated atherosclerosis therapy. Our study demonstrated that the combined action of mTOR ASOs and aSIRPα reduced apoptotic cells and lipids accumulation. This nanotherapy significantly reduced plaque burden and inhibited progression of atherosclerotic lesions. These results show the potential of specific nano-bioconjugates for the prevention of atherosclerotic cardiovascular disease.

Landscape of Statin as a Cornerstone in Atherosclerotic Cardiovascular Disease.

Atherosclerosis, the key pathogenesis of cardiovascular disease, is a leading cause of death and disability worldwide. Statins are first-line lipid-lowering drugs, which have been demonstrated to be powerful agents for anti-atherosclerosis. Numerous studies have confirmed the cardiovascular benefits and long-term safety of statins in a wide range of patients. Statins play an indispensable and irreplaceable part in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). In this article, we summarize the evolution of statins and their role in the treatment of cholesterol. The anti-atherosclerotic mechanism of statins, its efficacy, safety and clinical outcomes in secondary and primary prevention of ACSVD in different patient populations, the combination treatment effects, and guideline recommendations are also detailed. This paper highlights the profound significance of statins as the most successful anti-atherogenic drug in the cardiovascular field.

Development and first steps towards implementing population health management in Belgium.

Background: Although the recent pilot projects on integrated care for the chronically ill fit within a population needs-based approach in Belgium, awareness and implementation of population health management is still limited and in its early stages. Therefore, this study aims to identify the views of Belgian stakeholders on hurdles and avenues to introduce population health management, to design a population health management approach to secondary prevention of atherosclerotic cardiovascular disease, and to propose actionable recommendations to roll out population health management in Belgium.
 Methods: Eleven Belgian high-level decision makers in medicine, policy and science participated in two focus group sessions held between October and December 2021. Discussions were informed by a literature review and a semi-structured guide. Focus group sessions were recorded and discussions were transcribed ad verbatim. An inductive thematic analysis of discussions was carried out.
 Results: Focus group participants highlighted multiple inter-related barriers and recommendations towards the introduction of population health management in Belgium. In particular, they referred to the responsibilities of the three policy levels within the Belgian political system, the shared accountability for the health of the population, the importance of a learning health system supporting population health management, the development of appropriate payment models, data and knowledge infrastructure, collaborative relationships and community involvement. These barriers and recommendations were illustrated by a case study setting up a population health management approach to secondary prevention of atherosclerotic cardiovascular disease in Belgium.
 Conclusions: In order to speed up the introduction of population health management in Belgium, this study advocates: to instill a sense of urgency starting from a joint population-oriented vision; to move to a learning health system which makes use of a data and knowledge infrastructure; to set up new payment model pilots; to impose collaborative relationships and responsibilities; and to engage in continuous dialogue with communities of practice.

Association of cardiorespiratory fitness level with vascular function and subclinical atherosclerosis in the elderly.

Physical exercise is crucial for healthy aging and plays a decisive role in the prevention of atherosclerotic cardiovascular disease (ASCVD). A higher level of cardiorespiratory fitness (CRF) in the elderly is associated with lower cardiovascular and all-cause mortality. This study investigated the association of CRF level with vascular function and cardiovascular risk factors in the elderly. We examined 79 apparently healthy and physically active subjects aged > 55years (64 ± 4years). Cardiovascular functional parameters assessed included brachial and central blood pressure (BP), pulse wave velocity (PWV), augmentation index (Aix), and ankle-brachial index. Sonography of the common carotid artery was performed. CRF level was determined by a cardiopulmonary exercise test, and everyday activity was quantified with an accelerometer. All participants had a higher CRF level than the reported age-specific normative values. Twenty-nine subjects had subclinical atherosclerosis of the common carotid artery. Compared with participants without atherosclerosis, they were older (p = 0.007), displayed higher brachial systolic BP (p = 0.006), and higher central systolic BP (p = 0.014). Lower brachial (p = 0.036) and central (p = 0.003) systolic BP, lower PWV (p = 0.004), lower Aix (p < 0.001), lower body fat percentage (< 0.001), and lower LDL cholesterol (p = 0.005) were associated with a higher CRF level. In this cohort of healthy and physically active individuals, subjects with subclinical atherosclerosis displayed higher systolic brachial and central BP. A higher CRF level was associated with enhanced vascular function, consistent with an influence of CRF on both BP and vascular function in the elderly.

Effectiveness of buffered acetylsalicylic acid compared to other drugs in diseases patients in clinical practice: results of the CARDINAL observational retrospective study

Aim. To evaluate the effectiveness of acetylsalicylic acid (ASA) drugs for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in clinical practice and compare the effectiveness of the Cardiomagnyl with other ASA drugs.Material and methods. This observational, non-interventional, retrospective study included data from electronic medical records of 18199 patients with ASCVD who were divided into 2 following groups: patients who received ASA 75-100 mg (n=9784) and patients who did not receive ASA (n=8325). The prescription rate of ASA, the choice of the first drug, the duration of ASA therapy, the frequency of switching ASA during treatment, and the choice of the second ASA drug when changing therapy were assessed. Due to the heterogeneity of patients in the above groups, to assess the clinical outcomes, propensity score matching was performed and comparable groups were selected to evaluate the effectiveness of ASA drugs 75-100 mg in patients with ASCVD (n= 427) in comparison with patients not receiving ASA (n=427) and to assess the effectiveness of Cardiomagnyl 75 mg (n=1308) in comparison with enterosoluble ASA 100 mg (CRA) (n=1308) taking into account 24 parameters.Results. The average proportion of patients with ASCVD taking ASA drugs was 58%. During treatment, 54% of patients underwent a change in drug therapy from one ASA drug to another. The prescription rate of Cardiomagnyl as a first-choice drug was 33%, and as a second drug when changing therapy — 21%. The duration of Cardiomagnyl therapy was the longest compared to other ASA drugs and amounted to 16,3 months. The incidence of ischemic stroke, myocardial infarction and major adverse cardiovascular events in the group of patients who received ACS 75-100 mg was significantly lower than in patients who did not take ASA drugs and amounted to 4,7% vs 8,7%, 0,9% vs 3,3%, 5,6% vs 11,9%, respectively. Significantly lower incidence of unstable angina (0,8% vs 2,0%), myocardial infarction (1,5% vs 3,9%) and major adverse cardiovascular events (5,4% vs 7,8%) in group of patients who received Cardiomagnyl 75 mg as opposed to enterosoluble ASA.Conclusion. Significant advantages of buffered ASA (Cardiomagnyl) were revealed in comparison with enterosoluble ASA in clinical practice.

Intensity of and adherence to lipid-lowering therapy as predictors of goal attainment and major adverse cardiovascular events in primary prevention

The effectiveness of lipid-lowering therapy (LLT) for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in routine care may depend on treatment intensity and adherence. Observational study of adults with newly initiated LLT for primary prevention of ASCVD in Stockholm, Sweden, during 2017-2021. Study exposures were LLT adherence [proportion of days covered (PDC)], LLT intensity (expected reduction of LDL cholesterol), and the combined measure of adherence and intensity. At each LLT fill, adherence and intensity were calculated during the previous 12 months, and the patients estimated ASCVD risk was categorized. Study outcomes were major adverse cardiovascular events (MACE) and LDL-C goal attainment. Thirty-six thousand two hundred eighty-three individuals (mean age 63 years, 47% women, median follow-up 2 years), with a baseline low-moderate (40%), high (49%), and very-high (11%) ASCVD risk started LLT. Increases in LLT adherence, intensity, or adherence-adjusted intensity of 10% over 1 year were associated with lower risks of MACE (with hazard ratios of 0.95 [95% CI, 0.93-0.98]; 0.93 [0.86-1.00]; and 0.90 [0.85-0.95], respectively) and higher odds of attaining LDL goals. Patients with good adherence (≥80%) had similar risks of MACE and similar odds ratios for LDL-C goal attainment with low-moderate and high-intensity LLT. Treatment discontinuation was associated with increased MACE risk. The relative and absolute benefits of good adherence were greatest in patients with very high ASCVD risk. In routine-care primary prevention, better adherence to LLT was associated with a lower risk of MACE across all treatment intensities. Improving adherence is especially important among patients with very high ASCVD risk.

Statins, Mortality, and Major Adverse Cardiovascular Events Among US Veterans With Chronic Kidney Disease

There are limited data for the utility of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) and death in adults with chronic kidney disease (CKD). To evaluate the association of statin use with all-cause mortality and major adverse cardiovascular events (MACE) among US veterans older than 65 years with CKD stages 3 to 4. This cohort study used a target trial emulation design for statin initiation among veterans with moderate CKD (stages 3 or 4) using nested trials with a propensity weighting approach. Linked Veterans Affairs (VA) Healthcare System, Medicare, and Medicaid data were used. This study considered veterans newly diagnosed with moderate CKD between 2005 and 2015 in the VA, with follow-up through December 31, 2017. Veterans were older than 65 years, within 5 years of CKD diagnosis, had no prior ASCVD or statin use, and had at least 1 clinical visit in the year prior to trial baseline. Eligibility criteria were assessed for each nested trial, and Cox proportional hazards models with bootstrapping were run. Analysis was conducted from July 2021 to October 2023. Statin initiation vs none. Primary outcome was all-cause mortality; secondary outcome was time to first MACE (myocardial infarction, transient ischemic attack, stroke, revascularization, or mortality). Included in the analysis were 14 828 veterans. Mean (SD) age at CKD diagnosis was 76.9 (8.2) years, 14 616 (99%) were men, 10 539 (72%) White, and 2568 (17%) Black. After expanding to person-trials and assessing eligibility at each baseline, there were 151 243 person-trials (14 685 individuals) of nonstatin initiators and 2924 person-trials (2924 individuals) of statin initiators included. Propensity score adjustment via overlap weighting with nonparametric bootstrapping resulted in covariate balance, with mean (SD) follow-up of 3.6 (2.7) years. The hazard ratio for all-cause mortality was 0.91 (95% CI, 0.85-0.97) comparing statin initiators to noninitiators. The hazard ratio for MACE was 0.96 (95% CI, 0.91-1.02). Results remained consistent in prespecified subgroup analyses. In this target trial emulation of statin initiation in US veterans older than 65 years with CKD stages 3 to 4 and no prior ASCVD, statin initiation was significantly associated with a lower risk of all-cause mortality but not MACE. Results should be confirmed in a randomized clinical trial.

Recommendations for the primary prevention of atherosclerotic cardiovascular disease in primary care: study protocol for a systematic guideline review

IntroductionAtherosclerotic cardiovascular disease (ASCVD) was the main cause of death in Germany in 2021, with major risk factors (ie, hypertension, diabetes, dyslipidaemia, obesity and certain lifestyle factors) being highly prevalent....

PCSK9 inhibition: a new alternative to reduce cholesterol and prevent atherosclerotic cardiovascular disease

Introduction: atherosclerotic cardiovascular disease is the leading cause of mortality and morbidity worldwide. One of the key factors in its development is elevated LDL cholesterol. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a molecule that regulates LDL cholesterol levels.Objective: the purpose of this review is to provide a comprehensive analysis of the evidence surrounding PCSK9 inhibition as an effective therapy for reducing cholesterol and preventing atherosclerotic cardiovascular disease.Methodology: a comprehensive literature review was conducted using medical databases, including PubMed, Embase, and Cochrane Library. Search terms included "PCSK9," "PCSK9 inhibitors," "cholesterol," "LDL," and "atherosclerotic cardiovascular disease."Results: evidence suggests that PCSK9 inhibitors are effective in reducing LDL cholesterol levels in patients with hypercholesterolemia. Several clinical trials have demonstrated that these drugs can reduce LDL cholesterol by up to 60 % compared to placebo. Additionally, PCSK9 inhibitors appear to have a favorable safety profile and are well-tolerated by most patients. Several studies have also shown that PCSK9 inhibitors can reduce the risk of cardiovascular events in patients with pre-existing atherosclerotic disease.Conclusion: PCSK9 inhibitors represent a promising therapeutic strategy for LDL cholesterol control and prevention of atherosclerotic cardiovascular disease. Future studies should focus on determining the long-term effect of these drugs on cardiovascular morbidity and mortality and exploring ways to improve access and affordability to these therapies

Lipid-lowering therapy and LDL-C control for primary prevention in persons with diabetes across 90 health systems in the United States

ObjectiveNational guidelines recommend statin therapy for patients with type 2 diabetes. We assessed the extent of moderate- to high-intensity statin therapy utilization in community practice. MethodsWe evaluated lipid-lowering therapy (LLT) and low-density lipoprotein cholesterol (LDL-C) levels at baseline and 1-year follow-up in patients aged 40–75 years with type 2 diabetes but without atherosclerotic cardiovascular disease (ASCVD), across 90 health systems in the United States participating in an electronic health record–derived dataset, Cerner Real-World Data. Multivariable logistic regression was used to evaluate factors associated with utilization of moderate- to high-intensity statin. ResultsWe identified 241,232 patients with type 2 diabetes (58.1 % on moderate- to high-intensity statin, 7.0 % on low-intensity statin, and 34.9 % on no statin). Predictors of moderate- to high-intensity statin therapy included retinopathy (adjusted odds ratio [aOR], 1.26; 95 % confidence interval [CI], 1.15–1.38), hypertension (aOR, 1.52; 95 % CI, 1.43–1.61), and stage 3 chronic kidney disease (aOR, 1.14; 95 % CI, 1.07–1.21). Women (aOR, 0.85; 95 % CI, 0.82–0.87), and those with rheumatoid arthritis (aOR, 0.79; 95 % CI, 0.71–0.87), psoriasis (aOR, 0.85; 95 % CI, 0.75–0.96), and hepatitis C (aOR, 0.40; 95 % CI, 0.39–0.46), had reduced odds of moderate- to high-intensity statin treatment. Utilization of ezetimibe was rare (2.0 %). LDL-C control was suboptimal at baseline (37.0 % and 27.9 % had LDL-C ≥100 mg/dL and <70 mg/dL, respectively). At 1-year follow-up, the rate of moderate- to high-intensity statin therapy utilization was 65.3 %. ConclusionIncreased efforts are needed to improve LDL-C control and LLT use for primary prevention of ASCVD in adults with type 2 diabetes, in particular among women and those with risk-enhancing inflammatory conditions.

Association of statin use and outcomes in elderly with multiple risk factors: insight from the CORE registry Thailand

Abstract Introduction Statin is recommended by for lipid management in adults aged between 40 and 75 years old at risk for atherosclerotic cardiovascular disease (ASCVD). The evidence from meta-analysis suggested that the benefit of statin for primary prevention in the elderly was less robust than in the non-elderly. A dedicated randomized controlled trial of primary prevention with a statin in the elderly is currently ongoing. We aimed to study the association of statin use as a primary prevention for ASCVD on major adverse cardiac events in the elderly versus non-elderly in the Cohort Of patients with a high Risk of cardiovascular Events (CORE). Method The CORE registry was a nationwide study enrolling patients with established ASCVD or those with multiple risk factors (MRFs) between April 2011 and March 2014 in 25 hospitals. Patients with MRFs were included in the present analysis. Patients were stratified according to age and the status of statin use. The Elderly was defined as age over 75 years old. Any type and intensity of statin at baseline were counted as statin use. The primary outcome was the major adverse cardiac events (MACE), defined as the composite of all-cause death, stroke, or myocardial infarction. The association between statin use and outcomes was assessed overall and in the two groups of elderly versus non-elderly in the adjusted Cox regression models. Factors associated with both likelihood of statin use, and outcomes were used as adjusted variables. Results Of the 4,529 patients in the study, 729 patients were elderly (16.1%). The proportion of females was 57%, with a mean age of 65.6 years. The rate of statin use at baseline was similar between the elderly (84.9%) and non-elderly (83.6%) (p 0.41). The average follow-up time was 45.3 months. Statin use was associated with a significantly lower risk of MACE at five years. The incidence of MACE was highest in the elderly without statin use and lowest in non-elderly with statin use. Statin use at baseline was associated with a lower risk of MACE in both the elderly and non-elderly (p interaction 0.29). The risk of heart failure (HF) in the elderly treated with a statin was significantly lower than elderly without statin use (adjusted HR 0.37, 95%CI 0.14-0.96), while the risk of HF was similar between non-elderly with or without statin (adjusted HR 0.58, 95%CI 0.30-1.15). Statin use was associated with a lower risk of peripheral arterial disease in the elderly (adjusted HR 0.07, 95%0.01-0.73) but not in the non-elderly (adjusted HR 0.57, 95%CI 0.18-1.82). There was a trend toward lower risk of stroke, MI, or PAD in the elderly treated with statin than those without statin use (adjusted HR 0.48, 95% 0.22-1.07). Conclusion Statin use was associated with a significantly lower risk of MACE, HF, and PAD in the elderly with multiple risk factors of ASCVD in the CORE registry.MACE according to statin and age groupOutcomes according to statin and elderly

Abstract 12070: An Implementation Study to Improve Statin Optimization in Primary Prevention Patients at a Resident Run Clinic in Rural US

Introduction: Despite the benefit of statin in primary prevention of atherosclerotic cardiovascular disease (ASCVD), guideline-concordant statin use (statin optimization) remains low. Methods: We previously showed that among 325 consecutive 40-75 years old patients at baseline 35.4% did not have lipids ordered and 49.2% had lipid results unavailable over 3 years in electronic medical record (EMR). Using mixed-methods design, we previously identified provider and patient-related barriers; lack of automated ASCVD risk score reporting in EMR, insufficient clinic time and follow up visits. We identified and used several implementation strategies: 1) designed and disseminated a simplified process map and a guideline directed algorithm, 2) developed an automated ASCVD risk score reporting in EMR, 3) conducted telemedicine follow up, and 4) provided several refresher trainings/reminders. Now, we report two-year results among 354 consecutive patients with hypertension following the program adoption. Results: Mean age was 59.2 (61.9% male) and 50.6% were White patients and mean BMI was 30.2 (7.1). Compared with baseline, percentage of lipid labs ordering (64.6% vs 95.5%), lipid lab orders completion (78.6% vs 95.3%), ASCVD risk score assessment (3% vs 91%) and primary prevention statin optimization (34.6% vs 90.1%), all increased at 2 years (Table). Conclusions: Contextually appropriate implementation strategies can be helpful to address provider- and system-level barriers in cholesterol management and using statin for primary prevention.

Abstract 15944: Aspirin Use for Primary Prevention in High-Risk Patients: Insights From a Large Healthcare Network

Background: Recently, the value of routine use of aspirin in primary prevention for atherosclerotic cardiovascular disease (ASCVD) has come into question. We investigated patients with a high 10-year ASCVD risk profile to evaluate the magnitude of protection afforded by aspirin with and without statin in prevention of ASCVD events. Methods: Primary prevention patients were stratified based on 10-year ASCVD risk (High [20%]). Aspirin use was categorized over the 6-year follow-up period as “None”, “seldom” (&lt;30% of follow up time), “sometimes” (&gt;30 to =&lt;70%), and often used (≥70% of the time). Cox regression models were used to assess HRs of MI, ischemic stroke and mortality with aspirin or statin use alone compared to a combination of aspirin and statin. Results: 69,955 patients qualified as “high” 10-year ASCVD risk. In fully adjusted models, aspirin use ≥ 30% was associated with significantly lower risk of MI [HR ASA use ≥ 70% 0.76 (0.72-0.80), p &lt;0.001], ischemic stroke [HR ASA use ≥ 70% 0.83 (0.77-0.90), p &lt;0.007], and mortality [HR ASA use ≥ 70% 0.78 (0.74-0.82), p &lt;0.001] in high-risk patients compared to no aspirin use ( Table ). Compared to patients on both a statin and aspirin, patients on statin alone had increased risk of MI [HR 1.30 (1.06-1.60), p = 0.013]. Patients on aspirin alone had increased risk of MI [HR 1.74 (1.34-2.26), p &lt;0.001] and mortality [HR 1.70 (1.27-2.28), p &lt; 0.0004] versus those on aspirin and statin. Patients not on any aspirin or statin were at significantly increased risk for MI [HR 2.28 (2.08-2.49), p&lt;0.001], ischemic stroke [HR 1.77 (1.56-2.00), p&lt;0.001), and mortality [HR 2.16 (1.60-2.90), p&lt;0.001] compared to those taking both aspirin and statin. Conclusions: Low dose aspirin may still have a role in primary prevention of ASCVD events amongst high-risk patients when added to statin therapy. Risk-benefit profile of each high-risk primary prevention patient should be assessed for initiating or discontinuing low dose aspirin therapy

Abstract 12292: Lipid-Lowering Therapy and LDL-C Control for Primary Prevention in Persons With Diabetes Across 90 Health Systems in the United States

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in persons with type 2 diabetes, and national guidelines recommend statin therapy for primary prevention of ASCVD in persons with type 2 diabetes (T2DM). Aim: To evaluate the degree of utilization of appropriate intensity statin therapy for primary prevention in patients with T2DM in community practice. Methods: We evaluated lipid-lowering therapy (LLT) and LDL-cholesterol (LDL-C) levels in patients aged 40–75 years with T2DM but without atherosclerotic cardiovascular disease (ASCVD), across 90 health systems in the United States participating in an EHR-derived dataset, Cerner Real World Data at baseline and one year follow-up. Multivariable logistic regression was used to evaluate factors associated with guideline-recommended (moderate- to high-intensity) statin therapy use. Results: We identified 241,232 patients with T2DM (58.1% on appropriate statin, 7.0% on low-intensity statin, and 34.9% on no statin. Predictors of appropriate statin therapy included retinopathy (adjusted odds ratio [aOR], 1.26; 95% CI, 1.15–1.38), hypertension [aOR 1.52 (1.43-1.61)], and stage 3 chronic kidney disease [CKD; aOR 1.14(1.07–1.21]. Women (aOR, 0.85, 95% CI, 0.82-0.87), and those with rheumatoid arthritis [aOR, 0.79 (0.71–0.87)], psoriasis [aOR, 0.85 (0.75–0.96)], and hepatitis C [aOR, 0.4 (0.39–0.46)] had reduced odds of appropriate statin treatment. Utilization of ezetimibe was rare (2.0%). LDL-C control was suboptimal (36.9% and 27.9% had LDL-cholesterol ≥100 mg/dL and &lt;70 mg/dL, respectively). Therapy uptitration was infrequent; at one-year only 65.3% of patients were on appropriate statin intensity (Figure). Conclusions: Increased efforts are needed to improve primary prevention of ASCVD in adults with T2DM, particularly among women and those with risk-enhancing inflammatory conditions.

Abstract 16145: Statin Prescription and Cholesterol Control Among Persons With HIV Without Existing Atherosclerotic Cardiovascular Disease

Introduction: Persons with HIV (PWH) have significantly increased risk for atherosclerotic cardiovascular disease (ASCVD) including acute MI. The REPRIEVE trial recently demonstrated that statins reduce cardiac events in PWH at low-intermediate ASCVD risk. However, statins are underutilized even among PWH who are at high ASCVD risk. Accordingly, we sought to characterize current gaps in cholesterol management in a population of PWH and identify factors associated with statin prescription. Methods: We conducted a retrospective study of PWH 40 years and older without existing ASCVD at three HIV clinics in San Francisco, U.S. from 2019-2022. We used ICD-10 codes and electronic health record data to assess cholesterol screening and treatment. Multivariable logistic regression models evaluated clinical factors associated with statin prescription among those eligible. Results: The clinical cohort included 2,567 PWH, of which 14% were female, 54% White, 24% Hispanic, and 18% Black, with a median age of 55 years. Among those with complete data on the components of the ASCVD Risk Estimator, the median 10-year ASCVD risk was 7.6%. The majority of PWH (87%) had undergone cholesterol screening, and 43% were eligible for statin therapy based on current guidelines (Figure 1). Of the 1,097 PWH eligible for statins, only 478 (44%) were prescribed statins. Among statin-eligible PWH, statin prescription was positively associated with older age, antiretroviral therapy, undetectable viral load, and chronic kidney disease and negatively associated with hepatitis C. Cholesterol control (non-HDL cholesterol &lt;130 mg/dL) was achieved in 47% of the study population. Conclusions: PWH in this study demonstrate suboptimal rates of statin prescription and cholesterol control. Identification of PWH eligible for statin therapy, prescribing statins, and ensuring lipid control are opportunities for improving primary prevention of ASCVD among PWH at heightened risk.

Ancestry-specific polygenic risk scores are risk enhancers for clinical cardiovascular disease assessments

Clinical implementation of new prediction models requires evaluation of their utility in a broad range of intended use populations. Here we develop and validate ancestry-specific Polygenic Risk Scores (PRSs) for Coronary Artery Disease (CAD) using 29,389 individuals from diverse cohorts and genetic ancestry groups. The CAD PRSs outperform published scores with an average Odds Ratio per Standard Deviation of 1.57 (SD = 0.14) and identify between 12% and 24% of individuals with high genetic risk. Using this risk factor to reclassify borderline or intermediate 10 year Atherosclerotic Cardiovascular Disease (ASCVD) risk improves assessments for both CAD (Net Reclassification Improvement (NRI) = 13.14% (95% CI 9.23–17.06%)) and ASCVD (NRI = 10.70 (95% CI 7.35-14.05)) in an independent cohort of 9,691 individuals. Our analyses demonstrate that using PRSs as Risk Enhancers improves ASCVD risk assessments outlining an approach for guiding ASCVD prevention with genetic information.

Identifying and reducing inappropriate aspirin use in primary care

ObjectiveRecent studies have called into question the safety of aspirin use for the primary prevention of atherosclerotic cardiovascular disease, particularly in older adults. Therefore, the objectives of this study were...