Assessing the Validity of the Criteria for the Extreme Risk Category of Atherosclerotic Cardiovascular Disease: A Nationwide Population-Based Study

Abstract

Objective To validate the criteria for the extreme risk category for atherosclerotic cardiovascular disease (ASCVD). Methods An observational cohort study of 35,464 individuals with established ASCVD was performed using the National Health Information Database. Incident myocardial infarction (MI), ischemic stroke, and death in patients with established ASCVD was investigated to validate the criteria for the extreme risk category of ASCVD defined as the presence of diabetes mellitus (DM), chronic kidney disease (CKD), and history of premature ASCVD. Results Among 35,464 patients, 77.97% of them were classified into the extreme risk group of ASCVD. A total of 28.10%, 39.61%, and 32.12% had DM, CKD, and a history of premature ASCVD, respectively. During a mean follow-up of 8.39 years, MI, ischemic stroke, and all-cause death were found in 3.87%, 8.51%, and 23.98% of participants, respectively. In multivariate analysis, patients with DM had higher risk for MI (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.45–1.81), ischemic stroke (HR, 1.39; 95% CI, 1.29–1.50), and all-cause death (HR, 1.52; 95% CI, 1.45–1.59) than those without DM. Patients with CKD had 1.56 times higher risk for MI, 1.12 times higher risk for ischemic stroke, and 1.34 times higher risk for death than those without CKD. However, the risk for MI, ischemic stroke, and all-cause death was not different between patients with and without a history of premature ASCVD. Conclusion DM and CKD, but not a history of premature ASCVD, could be considered as reasonable criteria of an extreme risk for ASCVD.

Are Only p-Values Less Than 0.05 Significant? A p-Value Greater Than 0.05 Is Also Significant!

“…Therefore, in the “suggested sentences” column in Table 1 , the proposed sentence for the sentence described in the existing paper was modified and described. For example, in Kim et al, 1 the sentence “There were no significant differences in statin use, HDL-cholesterol, or LDL-cholesterol between patients with and without an extreme risk for ASCVD.” It is suggested to add only since “ p -value less than 0.05 was considered statistically significant” was described in the content of statistical analysis, it is not necessary to include the significance level value. However, in Cho et al, 2 there was no description of the significance level set in the statistical analysis, so “The risks of MI ( p for interaction <0.001) and death ( p for interaction=0.0006) for the 4th quartile The sentence expressed as “of the TyG index in women were significantly higher than those of men.” added the words “statistically” and “at the 5% significance level” to obtain “The risks of MI ( p for interaction <0.001) and death ( p for interaction=0.0006) for the 4th quartile of the TyG index in women were significantly higher than those of men at the 5% significance level.”…”

Clinical Characteristics of Patients With Statin Discontinuation in Korea: A Nationwide Population-Based Study

“…Dyslipidemia is an important risk factor for cardiovascular disease (CVD) and increases global healthcare burden. 1 2 Treatment with statins is effective in reducing lipid levels and is an essential component of CVD prevention. 3 4 5 Currently, it is one of the most widely studied and used medications in the world.…”