OBJECTIVES: Atherosclerotic cardiovascular disease (ASCVD) patients with recurrent events or poly-vascular disease represent very high-risk sub-populations. Their increased CV risk is not well-quantified in the literature, making assessment of the clinical and economic value of CV risk reduction interventions in these populations challenging. We assess the increased CV risk in these ASCVD sub-populations by re-estimating and refining the REACH (Wilson 2012) CV risk equation, for use in economic evaluations.

METHODS: Patients in the United Kingdom's Clinical Practice Research Datalink (CPRD) were included on January 1, 2005 if they were ≥40 years old, had ≥2 years of prior data, received ≥1 moderate or high-intensity statin in the previous year and had history of myocardial infarction (MI), ischemic stroke (IS) or other ASCVD (oASCVD). Patients were followed until endpoint (MI, IS or CV death), loss to follow-up or end of observation. Two proportional hazards models were fitted. Model 1 re-estimated the REACH CV risk equation and Model 2 considered more granular CV history categories.

RESULTS:

CONCLUSIONS: CV risk in patients with recurrent events or poly-vascular ASCVD is higher than in those patients with history of MI, IS or oASCVD only. CV history is relevant when assessing the value of CV risk reduction interventions.