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Optimizing Long-term Cardiovascular Risk Stratification: Integrating Biomarkers into the Very High-Risk ASCVD
Jiaxi Cheng1,2,3,4, Hao-Yu Wang1,2,3,4, Chenxi Song1,2,3,4
1Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
The very high-risk (VHR) definition effectively identifies Asian patients with atherosclerotic cardiovascular disease (ASCVD). Integrating biomarkers into a Very Very High Risk (VVHR) category further refines stratification for intensive therapy.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- The 2018 AHA/ACC cholesterol guideline defines very high-risk (VHR) atherosclerotic cardiovascular disease (ASCVD) patients to guide intensive lipid-lowering therapy.
- Evaluating the effectiveness of the VHR definition in an Asian population is crucial for accurate cardiovascular (CV) risk assessment.
Purpose of the Study:
- To assess the effectiveness of the VHR definition for CV risk stratification in an Asian population.
- To examine the predictive value of additional biomarkers in enhancing risk stratification among ASCVD patients.
Main Methods:
- Prospective enrollment of 26,752 ASCVD patients at Fuwai Hospital (2017-2018).
- VHR definition: multiple major ASCVD events or one major event with multiple high-risk conditions.
- Primary outcome: composite of 3-year CV events (mortality, MI, stroke, revascularization).
Main Results:
- VHR patients (54.1%) exhibited higher 3-year event rates (9.6%) than non-VHR patients (7.3%).
- Hemoglobin (Hb), hs-CRP, Lp(a), and HDL-C significantly influenced CV risk in VHR patients.
- A Very Very High Risk (VVHR) category (≥2 abnormal biomarkers) showed higher event rates (11.7%) than those with fewer abnormal biomarkers (8.9%).
Conclusions:
- The VHR definition effectively identifies high-risk Asian ASCVD patients.
- Integrating biomarker-based high-risk conditions refines VHR stratification.
- The proposed VVHR category enhances risk stratification for intensive lipid-lowering and residual risk management.
Background:
The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline defines very high-risk (VHR) atherosclerotic cardiovascular disease (ASCVD) patients to guide intensive lipid-lowering therapy.
Objectives:
This study sought to evaluate VHR's effectiveness in assessing cardiovascular (CV) risk in an Asian population and examine the predictive value of additional biomarkers for improving risk stratification.
Methods:
26,752 ASCVD patients were prospectively enrolled at Fuwai Hospital (2017-2018). VHR was defined as multiple major ASCVD events or one major event with multiple high-risk conditions. The primary outcome was a composite of 3-year CV events, including cardiovascular mortality, myocardial infarction, stroke, and coronary revascularization.
Results:
14,475 (54.1 %) patients were classified as VHR, with higher 3-year event rates than non-VHR (9.6 % vs. 7.3 %). Hemoglobin (Hb), high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) (Lp(a)), and high-density lipoprotein cholesterol (HDL-C) were significant CV risk influencers in VHR patients (hazard ratios [95 % CI]: 0.93 [0.90-0.96], 1.13 [1.06-1.21], 1.07 [1.04-1.11], 0.73 [0.61-0.89], respectively), but not in non-VHR patients. Within the VHR category, patients with ≥2 abnormal biomarkers (Hb <12 g/dL for men, <11 g/dL for women; hs-CRP >3 mg/L; Lp(a) ≥50 mg/dL; HDL-C < 1 mmol/L) were categorized as Very Very High Risk (VVHR), showing significantly higher event rates than those with fewer abnormal biomarkers (11.7 % vs. 8.9 %, P < 0.001).
Conclusions:
The VHR definition effectively identifies high-risk Asian patients but can be refined by integrating biomarker-based high-risk conditions. The proposed VVHR category enhances risk stratification, identifying those who may benefit most from intensive lipid-lowering and residual risk management.
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