OBJECTIVES: The primary objective was to estimate the prevalence of patients at very high risk of cardiovascular events in the United Kingdom.

METHODS: 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).

RESULTS: 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%.

CONCLUSIONS: Our analysis shows the need for additional intensive LDL lowering in well-defined populations at very high risk for cardiovascular events.