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After hospitalisation for ischaemic heart disease, a considerable proportion (39%) of patients aged 71–80 years had no low-density lipoprotein cholesterol (LDL-c) and/or systolic blood pressure (SBP) measurements.
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Dutch targets for LDL‑c (< 2.6 mmol/l) and SBP (< 140 mm Hg) were both met by 84% of the study population, while 23% met the European target for LDL‑c (< 1.4 mmol/l) and 61% met that for SBP (< 130 mm Hg).
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The greatest treatment effect—i.e. a gain of median 1.7 event-free years—could be attained by implementing European LDL‑c and SBP targets, with higher potential gains in patients with poorer risk factor control.
Introduction
Methods
Source population
Study population and data extraction
Definitions
Outcome measures
Statistical analysis
Results
Patient population
Characteristic | Eligible patients (N = 3003) | Patients included in primary analysis (n = 1817) | Patients without LDL‑c and/or SBP measurements (n = 1186) | P-valuea |
---|---|---|---|---|
Socio-demographics | ||||
Age at event, years | 74 (72–77) | 74 (72–77) | 74 (72–77) | |
Women | 36 | 36 | 32 | |
Urban | 45 | 45 | 46 | |
Index hospitalisation | ||||
Diagnosis of acute coronary syndrome | 42 | 42 | 50 | < 0.001 |
Deceased before end of study period | 3 | 3 | 10 | < 0.001 |
Follow-up time, months | 33 (24–41) | 33 (24–41) | 25 (17–36) | < 0.001 |
Cardiovascular medical comorbidity | ||||
Prior ischaemic heart disease | 48 | 48 | 41 | < 0.001 |
Cerebrovascular disease | 9 | 9 | 8 | |
Peripheral arterial disease | 6 | 6 | 7 | |
Diabetes mellitus | 15 | 15 | 15 | |
Heart failure | 13 | 13 | 19 | < 0.001 |
Atrial fibrillation | 19 | 19 | 21 | |
Reaching lifestyle targetsb | ||||
Non-smoking | 91 | 91 | 86 | |
BMI, kg/m2 mean ± SD | 27 ± 4 | 27 ± 4 | 27 ± 5 | |
BMI < 25 kg/m2 | 33 | 33 | 34 | |
BMI < 30 kg/m2 | 79 | 79 | 77 |
Current risk factor levels
Target | Patients (n = 1817) | Men (n = 1165) | Women (n = 652) | P-valuea | |||
---|---|---|---|---|---|---|---|
Reaching guideline-recommended targets | |||||||
Dutch | |||||||
– SBP < 150 mm Hgb | 94 | 94 | 94 | ||||
– SBP < 140 mm Hg | 84 | 85 | 83 | ||||
– LDL-c < 2.6 mmol/l | 84 | 88 | 77 | < 0.01 | |||
European | |||||||
– SBP < 130 mm Hg | 61 | 62 | 60 | ||||
– LDL-c < 1.8 mmol/lb | 49 | 53 | 41 | < 0.01 | |||
– LDL-c < 1.4 mmol/l | 23 | 25 | 19 | 0.02 | |||
Overall SMART-REACH estimates | |||||||
Current | |||||||
– 10-year risk of recurrent events | 29 (24–36) | 30 (26–38) | 26 (22–32) | < 0.01 | |||
– Lifetime risk of recurrent events | 39 (35–46) | 41 (36–47) | 37 (33–43) | < 0.01 | |||
– Event-free life expectancy | 84 (82–86) | 83 (82–84) | 86 (84–87) | < 0.01 | |||
If Dutch targets are met by all patients | |||||||
– 10-year risk of recurrent events | 28 (23–35) | 29 (24–37) | 25 (21–31) | < 0.01 | |||
– Lifetime risk of recurrent events | 38 (33–44) | 39 (34–36) | 25 (30–42) | < 0.01 | |||
– Benefit in event-free years | 0.0 (0.0–0.1) | 0.0 (0.0–0.0) | 0.0 (0.0–0.4) | < 0.01 | |||
If European targets are met by all patients | |||||||
– 10-year risk of recurrent events | 24 (19–32) | 26 (21–34) | 21 (16–27) | < 0.01 | |||
– Lifetime risk of recurrent events | 34 (27–41) | 36 (29–43) | 31 (24–38) | < 0.01 | |||
– Benefit in event-free years | 0.5 (0.2–1.2) | 0.4 (0.1–0.9) | 0.7 (0.3–1.7) | < 0.01 | |||
Subgroup reaching Dutch but not European SBP or LDL‑c targets | |||||||
N | 1281 | 833 | 448 | ||||
Age, years | 74 (72–77) | 74 (72–77) | 74 (72–77) | ||||
SBP ≥ 130 mm Hg | 46 | 42 | 48 | ||||
LDL-c ≥ 1.4 mmol/l | 93 | 93 | 94 | ||||
SMART-REACH estimates | |||||||
– Current 10-year risk of recurrent events | 28 (24–35) | 30 (35–37) | 25 (22–31) | < 0.01 | |||
– Current lifetime risk of recurrent events | 39 (34–45) | 40 (35–46) | 37 (33–43) | < 0.01 | |||
– Benefit in event-free years if European targets are met | 0.6 (0.3–1.0) | 0.5 (0.2–0.8) | 0.8 (0.4–1.4) | < 0.01 | |||
Subgroup not reaching Dutch SBP or LDL‑c targets | |||||||
N | 501 | 272 | 229 | ||||
Age, years | 75 (72–78) | 75 (72–78) | 75 (72–78) | ||||
SBP ≥ 140 mm Hg | 56 | 63 | 48 | < 0.01 | |||
LDL-c ≥ 2.6 mmol/l | 57 | 50 | 66 | < 0.01 | |||
SMART-REACH estimates | |||||||
– Current 10-year risk of recurrent events | 28 (23–34) | 30 (25–37) | 25 (21–30) | < 0.01 | |||
– Current lifetime risk of recurrent events | 38 (33–44) | 39 (35–45) | 35 (31–41) | < 0.01 | |||
– Benefit in event-free years if Dutch targets are met | 0.6 (0.2–1.2) | 0.5 (0.2–1.0) | 0.7 (0.3–1.5) | < 0.01 | |||
– Benefit in event-free years if European targets are met | 1.7 (1.2–2.5) | 1.5 (1.0–2.1) | 2.0 (1.5–2.9) | < 0.01 |