TY - JOUR
T1 - Incidence and Predictors of Major Adverse Cardiovascular Events in Patients With Established Atherosclerotic Disease or Multiple Risk Factors
AU - Miao, Benjamin
AU - Hernandez, Adrian V.
AU - Alberts, Mark J.
AU - Mangiafico, Nicholas
AU - Roman, Yuani M.
AU - Coleman, Craig I.
N1 - Funding Information:
Funding was provided by Bayer AG, Berlin, Germany and a Medical Staff Internal Grant from Hartford Hospital, Hartford, CT. MarketScan data used in this study were obtained from IBM under a third‐party license agreement with Bayer AG, Berlin, Germany. The funders of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors have approved the final manuscript.
PY - 2020/1/21
Y1 - 2020/1/21
N2 - Background: There is a paucity of contemporary data estimating the incidence of major adverse cardiovascular events (MACE) in patients with established atherosclerotic disease or multiple risk factors managed in routine practice. We estimated 1- and 4-year incidences of MACE and the association between MACE and vascular beds affected in these patients. Methods and Results: Using US IBM MarketScan data from January 1, 2013 to December 31, 2017, we identified patients ≥45 years old with established coronary artery disease, cerebrovascular disease, peripheral artery disease, or the presence of ≥3 risk factors for atherosclerosis during 2013 with a minimum of 4 years of follow-up. We calculated 1- and 4-year incidences of MACE (cardiovascular death or hospitalization for myocardial infarction or ischemic stroke). A Cox proportional hazards regression model adjusted for age and sex was used to evaluate the association between vascular bed number/location(s) affected and MACE. We identified 1 302 856 patients with established atherosclerotic disease or risk factors for atherosclerosis. Coronary artery disease was present in 16.9% of patients, cerebrovascular disease in 7.6%, peripheral artery disease in 13.6%, and risk factors for atherosclerosis only in 66.0%. The 1- and 4-year incidences of MACE were 1.4% and 6.9%, respectively. At 4 years, MACE was more frequent in patients with atherosclerotic disease in a single (hazard ratio=1.51, 95% CI=1.48–1.55), 2-(hazard ratio=2.35, 95% CI=2.27–2.44), or all 3 vascular beds (hazard ratio=3.30, 95% CI=2.97–3.68) compared with having risk factors for atherosclerosis. Conclusions: Patients with established atherosclerotic disease or who have multiple risk factors and are treated in contemporary, routine practice carry a substantial risk for MACE at 1- and 4- years of follow-up. MACE risk was shown to vary based on the number and location of vascular beds involved.
AB - Background: There is a paucity of contemporary data estimating the incidence of major adverse cardiovascular events (MACE) in patients with established atherosclerotic disease or multiple risk factors managed in routine practice. We estimated 1- and 4-year incidences of MACE and the association between MACE and vascular beds affected in these patients. Methods and Results: Using US IBM MarketScan data from January 1, 2013 to December 31, 2017, we identified patients ≥45 years old with established coronary artery disease, cerebrovascular disease, peripheral artery disease, or the presence of ≥3 risk factors for atherosclerosis during 2013 with a minimum of 4 years of follow-up. We calculated 1- and 4-year incidences of MACE (cardiovascular death or hospitalization for myocardial infarction or ischemic stroke). A Cox proportional hazards regression model adjusted for age and sex was used to evaluate the association between vascular bed number/location(s) affected and MACE. We identified 1 302 856 patients with established atherosclerotic disease or risk factors for atherosclerosis. Coronary artery disease was present in 16.9% of patients, cerebrovascular disease in 7.6%, peripheral artery disease in 13.6%, and risk factors for atherosclerosis only in 66.0%. The 1- and 4-year incidences of MACE were 1.4% and 6.9%, respectively. At 4 years, MACE was more frequent in patients with atherosclerotic disease in a single (hazard ratio=1.51, 95% CI=1.48–1.55), 2-(hazard ratio=2.35, 95% CI=2.27–2.44), or all 3 vascular beds (hazard ratio=3.30, 95% CI=2.97–3.68) compared with having risk factors for atherosclerosis. Conclusions: Patients with established atherosclerotic disease or who have multiple risk factors and are treated in contemporary, routine practice carry a substantial risk for MACE at 1- and 4- years of follow-up. MACE risk was shown to vary based on the number and location of vascular beds involved.
KW - cerebrovascular disease
KW - coronary artery disease
KW - established atherosclerotic disease
KW - major adverse cardiovascular events
KW - peripheral artery disease
KW - risk factors
KW - Cerebrovascular Disorders/diagnosis
KW - Prognosis
KW - Risk Assessment
KW - Humans
KW - Middle Aged
KW - Male
KW - Incidence
KW - Coronary Artery Disease/diagnosis
KW - Atherosclerosis/diagnosis
KW - Peripheral Arterial Disease/diagnosis
KW - United States/epidemiology
KW - Aged, 80 and over
KW - Female
KW - Aged
KW - Heart Disease Risk Factors
KW - Retrospective Studies
KW - Databases, Factual
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U2 - 10.1161/JAHA.119.014402
DO - 10.1161/JAHA.119.014402
M3 - Article
C2 - 31937196
SN - 2047-9980
VL - 9
SP - e014402
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e014402
ER -