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Residual Atherosclerotic Cardiovascular Disease Risk in Statin Users: A Systematic Review and Meta-Analysis

Alexandre H Watanabe1, Lori D Bash1, Tracy Westley2

  • 1Merck & Co, Inc Rahway NJ.

Journal of the American Heart Association
|August 20, 2026
PubMed

Insights

Even with statin therapy, individuals face significant residual atherosclerotic cardiovascular disease (ASCVD) risk. This highlights ongoing gaps in treatment and the need for optimized risk management strategies.

Area of Science:

  • Cardiology
  • Public Health
  • Pharmacology

Background:

  • Statins are primary lipid-lowering agents for adults.
  • Residual atherosclerotic cardiovascular disease (ASCVD) risk in statin users requires further investigation.
  • This study quantifies real-world residual ASCVD risk in patients on statin therapy.

Purpose of the Study:

  • To estimate the residual ASCVD risk in adult statin users in a real-world setting.
  • To synthesize current evidence on ASCVD events and mortality among statin users.
  • To identify potential gaps in cardiovascular risk management for patients on statins.

Main Methods:

  • Systematic literature review and meta-analysis adhering to PRISMA guidelines.
  • Inclusion of observational studies published between January 2013 and August 2023.
  • Assessment of five key outcomes: composite ASCVD events/all-cause death, myocardial infarction, ischemic stroke, cardiovascular death, and coronary revascularization.

Main Results:

  • Pooled residual composite risk was 12.3 per 1000 person-years (PPY), higher in those with prior ASCVD (15.8 PPY) than those at risk (6.4 PPY).
  • Specific event rates included myocardial infarction (8.23 PPY), ischemic stroke (6.0 PPY), cardiovascular death (4.3 PPY), and coronary revascularization (7.4 PPY).
  • Significant variability was observed across studies for all assessed outcomes.

Conclusions:

  • A meaningful residual ASCVD risk exists among statin users in real-world practice.
  • Findings underscore persistent gaps in achieving optimal cardiovascular risk reduction.
  • Comprehensive and optimized risk management strategies are crucial for statin-treated patients.
Abstract

Keywords:
atherosclerotic cardiovascular diseaselow‐density lipoprotein cholesterolmeta‐analysisreal worldresidual riskstatinssystematic literature review

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