Impact of the 2021 European Society for Cardiology prevention guideline’s stepwise approach for cardiovascular risk factor treatment in patients with established atherosclerotic cardiovascular disease
Authors' conclusion
With current treatment, residual CV risk in patients with ASCVD remains high across all European risk regions. The intensified Step 2 treatment options result in marked further reduction of residual CV risk in patients with established ASCVD.
Study context
- Population
- Patients with established atherosclerotic CVD (ASCVD) in UCC-SMART and European parts of REACHUCC-SMART and REACH · European parts of REACH 18,364
- Comparison
- ESC 2021 Step 2 vs Step 1 vs current treatment
- Outcome
- 10-year CV risk (SMART2)
- Follow-up
- 10 years
Methodological detailsSMART2 risk prediction, treatment effects from meta-analyses and trials
- SMART2 risk prediction
- Treatment effects from meta-analyses and trials
Pooled result
As reported in the abstract
Residual 10-year CV risk and events prevented, by European risk region
| Group | Residual cardiovascular (CV) risk, low risk region | Residual CV risk, moderate risk region | Residual CV risk, pooled (very) high risk regions | Events prevented per 1000 treated, low risk region | Events prevented per 1000 treated, moderate risk region | Events prevented per 1000 treated, (very) high risk regions |
|---|---|---|---|---|---|---|
| Current treatment | 22% | 32% | 60% | |||
| Step 2 | 198 | 223 | 245 |
Residual cardiovascular (CV) risk, low risk region
Current treatment22%
Step 2Not reported in the abstract
Residual CV risk, moderate risk region
Current treatment32%
Step 2Not reported in the abstract
Residual CV risk, pooled (very) high risk regions
Current treatment60%
Step 2Not reported in the abstract
Events prevented per 1000 treated, low risk region
Current treatmentNot reported in the abstract
Step 2198
Events prevented per 1000 treated, moderate risk region
Current treatmentNot reported in the abstract
Step 2223
Events prevented per 1000 treated, (very) high risk regions
Current treatmentNot reported in the abstract
Step 2245
Further pooled results
| Outcome | Current treatment | Step 1 | Step 2 | |
|---|---|---|---|---|
| Patients with CV risk <10%, by risk region (low, moderate, (very) high) | ||||
| Low risk region | Not reported in the abstract | 20% | 63% | Current treatment: not reported in the abstract |
| Moderate risk region | Not reported in the abstract | 6.4% | 48% | Current treatment: not reported in the abstract |
| (Very) high risk regions | Not reported in the abstract | 0.5% | 12% | Current treatment: not reported in the abstract |
Events prevented by individual Step 2 options applicable to most patients
- Intensified LDLc reduction, events prevented per 1000 treated
- 57
- Colchicine, events prevented per 1000 treated
- 74
- Dual-pathway inhibition (DPI), events prevented per 1000 treated
- 59
- Up to
Original publication
Impact of the 2021 European Society for Cardiology prevention guideline’s stepwise approach for cardiovascular risk factor treatment in patients with established atherosclerotic cardiovascular disease. Eur J Prev Cardiol. Published 7 February 2024. doi:10.
Summarised from the published abstract; every number is checked against it