Time-Dependent Risk for Recurrence in Survivors of Major Adverse Cardiovascular Events
Anderson Bermon1,2, Belem Trejo-Valdivia3, Carlos Federico Molina Castaño4,2
1Centro de Investigaciones, Fundación Cardiovascular de Colombia, Bucaramanga, COL.
Insights
Recurrent cardiovascular events are a growing concern. This study found severe depression and high LDL cholesterol levels significantly increase the risk of recurrence in patients with prior cardiovascular events.
Area of Science:
- Cardiology
- Epidemiology
- Clinical Research
Background:
- Increasing prevalence of occlusive cardiovascular events leads to higher risks of fatal recurrence.
- Identifying risk factors for recurrent cardiovascular events is crucial for patient management.
Purpose of the Study:
- To determine variables associated with the time to recurrent cardiovascular events.
- To analyze the association between changes in low-density lipoprotein cholesterol (LDL-C) levels and time-to-event.
Main Methods:
- Prospective observational cohort study of 727 adults with a history of occlusive cardiovascular events.
- Follow-up period of up to 33 months to assess major adverse cardiovascular events (MACE).
- Analysis using proportional hazard and time-dependent hazard models.
Main Results:
- The two-year recurrence rate for major adverse cardiovascular events (MACE) was 12.38%.
- Severe depression (Hazard Ratio: 8.25) and LDL-C ≥120 mg/dl (Hazard Ratio: 2.12) were significant predictors of recurrence.
- Sustained LDL-C >120 mg/dl over time increased recurrence risk (Hazard Ratio: 1.017).
Conclusions:
- Identified patient profiles at high risk for recurrent coronary events.
- Highlights the need for prompt, interdisciplinary treatment to prevent cardiovascular event recurrence.
Introduction:
The prevalence of the population with a history of an occlusive cardiovascular event has been increasing in recent years, which means that a large number of patients will have a higher risk of presenting a fatal recurrence. The aim is to determine variables associated with time-to-recurrent cardiovascular events and analyze how changes in low-density lipoprotein cholesterol (LDL-C) levels during follow-up may be associated with this time-to-event.
Materials And Methods:
This is a prospective observational cohort study of 727 adults with a history of at least one occlusive cardiovascular event recruited at a referral hospital in northeastern Colombia. Data from a follow-up period of a maximum of 33 months (median 26 months) (one death) were used to define how clinical and sociodemographic variables impact the recurrence of major adverse cardiovascular events (MACE). Analyses were performed based on proportional hazard models and time-dependent hazard models.
Results:
Upon enrollment, 215 (30%) of the participants reported experiencing their most recent cardiovascular event within the preceding year. After two years, the recurrence rate was 12.38% (90/727). The risk of recurrence before two years was 3.9% (95% CI 2.7-5.6). In the multiple models, the presence of severe depression gives a Hazard Ratio of 8.25 (95% CI 2.98-22.86) and LDL ≥120 md/dl Hazard Ratio of 2.12 (95% CI 1.2 -3.9). It was found that LDL >120 mg/dl maintained over time increases the chances of recurrence by 1.7% (Hazard Ratio: 1.017, 95% CI 0.008-0.025).
Conclusions:
The present study allows us to identify a profile of patients who should be treated promptly in an interdisciplinary manner to avoid recurrences of coronary events.
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