OBJECTIVES: We developed a prognostic strategy for quantifying the long-term risk of coronary heart disease (CHD) events in survivors of acute coronary syndromes (ACS). BACKGROUND: Strategies for quantifying long-term risk of CHD events have generally been confined to primary prevention settings. The Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) study, which demonstrated that pravastatin reduces CHD events in ACS survivors with a broad range of cholesterol levels, enabled assessment of long-term prognosis in a secondary prevention setting. METHODS: Based on outcomes in 8,557 patients in the LIPID study, a multivariate risk factor model was developed for prediction of CHD death or nonfatal myocardial infarction. Prognostic indexes were developed based on the model, and low-, medium-, high- and very high-risk groups were defined by categorizing the prognostic indexes. RESULTS: In addition to pravastatin treatment, the independently significant risk factors included: total and high density lipoprotein cholesterol, age, gender, smoking status, qualifying ACS, prior coronary revascularization, diabetes mellitus, hypertension and prior stroke. Pravastatin reduced coronary event rates in each risk level, and the relative risk reduction did not vary significantly between risk levels. The predicted five-year coronary event rates ranged from 5% to 19% for those assigned pravastatin and from 6.4% to 23.6% for those assigned placebo. CONCLUSIONS: Long-term prognosis of ACS survivors varied substantially according to conventional risk factor profile. Pravastatin reduced coronary risk within all risk levels; however, absolute risk remained high in treated patients with unfavorable profiles. Our risk stratification strategy enables identification of ACS survivors who remain at very high risk despite statin therapy.
RCT Entities:
OBJECTIVES: We developed a prognostic strategy for quantifying the long-term risk of coronary heart disease (CHD) events in survivors of acute coronary syndromes (ACS). BACKGROUND: Strategies for quantifying long-term risk of CHD events have generally been confined to primary prevention settings. The Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) study, which demonstrated that pravastatin reduces CHD events in ACS survivors with a broad range of cholesterol levels, enabled assessment of long-term prognosis in a secondary prevention setting. METHODS: Based on outcomes in 8,557 patients in the LIPID study, a multivariate risk factor model was developed for prediction of CHD death or nonfatal myocardial infarction. Prognostic indexes were developed based on the model, and low-, medium-, high- and very high-risk groups were defined by categorizing the prognostic indexes. RESULTS: In addition to pravastatin treatment, the independently significant risk factors included: total and high density lipoprotein cholesterol, age, gender, smoking status, qualifying ACS, prior coronary revascularization, diabetes mellitus, hypertension and prior stroke. Pravastatin reduced coronary event rates in each risk level, and the relative risk reduction did not vary significantly between risk levels. The predicted five-year coronary event rates ranged from 5% to 19% for those assigned pravastatin and from 6.4% to 23.6% for those assigned placebo. CONCLUSIONS: Long-term prognosis of ACS survivors varied substantially according to conventional risk factor profile. Pravastatin reduced coronary risk within all risk levels; however, absolute risk remained high in treated patients with unfavorable profiles. Our risk stratification strategy enables identification of ACS survivors who remain at very high risk despite statin therapy.
Authors: Kaushala S Jayawardana; Piyushkumar A Mundra; Corey Giles; Christopher K Barlow; Paul J Nestel; Elizabeth H Barnes; Adrienne Kirby; Peter Thompson; David R Sullivan; Zahir H Alshehry; Natalie A Mellett; Kevin Huynh; Malcolm J McConville; Sophia Zoungas; Graham S Hillis; John Chalmers; Mark Woodward; Ian C Marschner; Gerard Wong; Bronwyn A Kingwell; John Simes; Andrew M Tonkin; Peter J Meikle Journal: JCI Insight Date: 2019-07-11
Authors: Deepa Jagtap; Carol A Rosenberg; Lisa W Martin; Mary Pettinger; Janardan Khandekar; Dorothy Lane; Ira Ockene; Michael S Simon Journal: Cancer Date: 2012-03-20 Impact factor: 6.860
Authors: Graciela E Delgado; Marcus E Kleber; Hubert Scharnagl; Bernhard K Krämer; Winfried März; Jürgen E Scherberich Journal: J Am Soc Nephrol Date: 2017-02-27 Impact factor: 10.121
Authors: Jisheng Cui; Andrew Forbes; Adrienne Kirby; Ian Marschner; John Simes; David Hunt; Malcolm West; Andrew Tonkin Journal: BMC Med Res Methodol Date: 2010-04-01 Impact factor: 4.615
Authors: Piyushkumar A Mundra; Christopher K Barlow; Paul J Nestel; Elizabeth H Barnes; Adrienne Kirby; Peter Thompson; David R Sullivan; Zahir H Alshehry; Natalie A Mellett; Kevin Huynh; Kaushala S Jayawardana; Corey Giles; Malcolm J McConville; Sophia Zoungas; Graham S Hillis; John Chalmers; Mark Woodward; Gerard Wong; Bronwyn A Kingwell; John Simes; Andrew M Tonkin; Peter J Meikle Journal: JCI Insight Date: 2018-09-06