Supplementary Material – Hagström et al.
Cardiovascular Event Rates After Myocardial Infarction or Ischaemic Stroke in Patients with Additional Risk Factors
Patient Population
The original data set on which our subanalysis was based [1] was identified by applying inclusion criteria similar to those in the FOURIER study [2] to real-world clinical practice data. Three study cohorts were originally identified within patients with prevalent
atherosclerotic cardiovascular (CV) disease: myocardial infarction (MI), ischaemic stroke (IS), or peripheral artery disease (PAD). Our analyses focused on the subset of patients with a history of MI or IS.
In the original data set, patients were aged 40–85 years at index date, with at least one major risk factor or two minor risk factors, and at least one filled prescription of moderate- or high-intensity statin, with or without ezetimibe, within 1 year before the index date. Major risk factors were diabetes (type 1 or 2), age 65–85 years, MI (during the 6 months before the index date, or concomitantly with a history of IS and/or PAD in the baseline period), or IS (during the 6 months before the index date, or concomitantly with a history of MI and/or PAD in the baseline period). Minor risk factors were coronary revascularization with no history of MI, coronary artery disease, or metabolic syndrome. Statin intensity was defined in
accordance with the 2018 American College of Cardiology/American Heart Association cholesterol guidelines [3].
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Table S1 First MACE, coronary revascularization or unstable angina rates, overall and in subgroups. (A) Patients with a history of MI. (B) Patients with a history of IS
(A)
n Events (n) Follow-up (person-years)
Rate per 100 person-years
10-year risk (%)
Incident MI cohort
Overall 45 895 24 806 114 472 21.7 –
Subgroups
Diabetes with TOD CKD stages 3 or 4 Prior MI or ISa Polyvascular disease
6152 591 7759 5191
3669 319 2217
882
12 500 754 8364 2920
29.4 42.3 26.5 30.2
–
Prevalent MI cohort
Overall 37 480 16 511 235 738 7.0 50
Subgroups
Diabetes with TOD CKD stages 3 or 4 Prior MI or ISa Polyvascular disease
2760 447 3998 2205
1566 201 2348 1318
12 945 1388 19 546 10 667
12.1 14.5 12.0 12.4
70 77 70 71
(B)
n Events (n) Follow-up (person-years)
Rate per 100 person-years
10-year risk (%)
Incident IS cohort
Overall 36 134 14 470 112 351 12.9 –
Subgroups
Diabetes with TOD CKD stages 3 or 4 Prior MI or ISa Polyvascular disease
4319 383 3022 7176
2030 263 1704 3549
11 223 1404 8698 18 592
18.1 18.7 19.6 19.1
–
Prevalent IS cohort
Overall 19 024 8722 114 888 7.6 53
Subgroups
2
Diabetes with TOD CKD stages 3 or 4 Prior MI or ISa Polyvascular disease
1589 213 2422 2008
825 87 1257 1209
7815 648 12 181
9611
10.6 13.4 10.3 12.6
65 74 64 72
a Index event within 2 years after prior MI or IS
CKD chronic kidney disease, IS ischaemic stroke, MACE major cardiovascular events, MI myocardial infarction, TOD target organ damage
Table S2 First MACE rates, overall and in subgroups, in an ad hoc analysis of data from the
placebo arm of the FOURIER study (Amgen, data on file). (A) Patients with a history of MI.
(B) Patients with a history of IS
(A)
n Events (n) Follow-up (person-years)
Rate per 100 person-years
Overall 11 206 832 24 577 3.4
Recent MIa 2890 248 6545 3.8
Subgroups
Diabetes with TOD CKD stages 3 or 4 Prior MI or ISb Polyvascular disease
3847 600 4432 1618
356 81 376 214
8335 1285 10 022
3549
4.3 6.3 3.8 6.0
(B)
n Events (n) Follow-up (person-
years)
Rate per 100 person-years
Overall 265
1
224 5672 4.0
Recent ISa 600 56 1295 4.3
Subgroups
3
Diabetes with TOD CKD stages 3 or 4 Prior MI or ISb Polyvascular disease
107 9 223 111 0 980
116 32 111 115
2273 481 2389 2128
5.1 6.7 4.7 5.4
a Index event < 1 year before randomization
b Index event within 2 years after prior MI or IS
CKD chronic kidney disease; IS ischaemic stroke, MACE major cardiovascular events, MI myocardial infarction, TOD target organ damage
REFERENCES
1. Lindh M, Banefelt J, Fox KM, Hallberg S, Tai MH, Eriksson M, et al. Cardiovascular event rates in a high atherosclerotic cardiovascular disease risk population: estimates from Swedish population-based register data. Eur Heart J Qual Care Clin Outcomes
2019;5:225–232.
2. Sabatine, MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, et al.
Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017;376:1713–1722.
3. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Circulation 2019;139:e1082-e1143.
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