Distribution of Traditional and Novel Risk Factors and Their Relation to Subsequent Cardiovascular Events in Patients With Acute Coronary Syndromes (from the PROVE IT-TIMI 22 Trial)

Current guidelines recommend risk stratification largely based on traditional risk factors such as those in the Framingham Risk Score. We studied the distribution of 12 traditional and non-traditional risk markers (age ≥65 years, male gender, family history of premature coronary heart disease, low-density lipoprotein cholesterol ≥70 mg/dl, high-density lipoprotein cholesterol <40 mg/dl in men and <50 mg/dl in women, systolic blood pressure >130 mm Hg, diabetes mellitus, smoking, C-reactive protein ≥2 mg/L, triglycerides >150 mg/dl, prediabetes defined as a fasting glucose level 100 to 125 mg/dl or hemoglobin A1c >6, and obesity defined as body mass index ≥30 kg/m2) in 3,675 patients from the PROVE IT-TIMI 22 trial at 4 months and evaluated the risk of cardiovascular events stratified by the number of risk factors. The median number of risk factors was 5. In individual risk factor subgroups, men, smokers, hypertensives, and patients with increased low-density lipoprotein cholesterol had just that added risk factor compared to their counterparts (median 5 vs 4). In contrast, patients with diabetes, prediabetes, and increased triglycerides, C-reactive protein, or body mass index had not only that, but also another added risk factor (median 6 vs 4). A higher risk factor count was strongly related with increased rate of death, myocardial infarction, unstable angina, stroke, or revascularization, from 0% to 38.6% at 2 years for 0 to ≥9 risk factors (p <0.0001). In conclusion, with the observed “clustering” of risk factors and the link between increasing risk factor count and adverse outcomes in a patient with 1 diagnosed risk factor, a comprehensive review of traditional and novel risk factors is important to fully assess cardiovascular risk.