Patient characteristics and acute cardiovascular event rates among patients with very high‐risk and non‐very high‐risk atherosclerotic cardiovascular disease

Background The risk for subsequent major cardiovascular (CV) events among patients with very high‐risk (VHR) atherosclerotic CV disease (ASCVD) remains to be fully elucidated. Hypothesis We assessed the characteristics and major CV event rates of patients with VHR versus non‐VHR ASCVD in a real‐world setting in the United States (US), hypothesizing that patients with VHR ASCVD would have higher CV event rates. Methods This was a retrospective cohort study conducted from January 01, 2011, to June 30, 2018, in the US using the Prognos LDL‐C database linked to the IQVIA PharMetrics Plus® database supplemented with the IQVIA prescription claims (Dx/LRx) databases. Patients were ≥18 years old and had  ≥2 non‐ancillary medical claims in the linked databases at least 30 days apart. The study was conducted in 2 stages: (1) identification of patients with ASCVD who met the definition of VHR ASCVD and a matched cohort of non‐VHR ASCVD patients using the incidence density sampling (IDS) approach; (2) estimation of the occurrence of major CV events. Results Among patients with ≥1 major ASCVD event ( N =147,679), most qualified as VHR ASCVD (79.5%). There were 115,460 patients each in IDS‐matched VHR and non‐VHR ASCVD cohorts. The composite myocardial infarction/ischemic stroke event rates in the VHR and non‐VHR ASCVD cohorts were 8.04 (95% confidence interval [95% CI]: 7.87‐8.22) and 0.82 (95% CI: 0.77‐0.88) events per 100 patient‐years, respectively, during the 1‐year post‐index period. Conclusions Most patients with ≥1 previous major ASCVD event treated in real‐world US clinical practice qualified as VHR ASCVD. Patients with VHR ASCVD had much higher rates of major CV events versus non‐VHR ASCVD patients.