# APBA Kısa Özet
Residual atherosclerotic cardiovascular disease (ASCVD) risk persists in statin users, with pooled incidence rates per 1000 person-years of 12.3 for composite risk, 8.23 for myocardial infarction, 6.0 for ischemic stroke, 4.3 for cardiovascular-related death, and 7.4 for coronary revascularization. Risk is lower in adults at risk of ASCVD (6.4 PPY) and higher in those with prior ASCVD (15.8 PPY).
# Çalışma neyi araştırdı?
This systematic review and meta-analysis synthesized evidence on residual ASCVD risk among adult statin users. Despite the proven benefits of statin therapy in lowering low-density lipoprotein cholesterol, cardiovascular events continue to occur. The authors conducted a comprehensive literature review following PRISMA guidelines, including observational studies published between January 1, 2013, and August 1, 2023. Five specific outcomes were assessed: composite risk (major adverse cardiovascular events or all-cause death), myocardial infarction, ischemic stroke, cardiovascular-related death, and coronary revascularization. The analysis aimed to quantify the burden of residual disease in real-world practice where patients remain on statin therapy.
# Yöntem
The research team identified eligible studies through systematic database searching, applying strict inclusion criteria: adult populations receiving statin therapy, reporting incident ASCVD events, and providing sufficient data for meta-analysis. Random-effects meta-analysis methods were used to synthesize study-specific incidence rates into pooled estimates per 1000 person-years (PPY). Forest plots were generated for each outcome to visualize study-level estimates and heterogeneity. Subgroup analyses stratified risk by patient status: adults at risk of ASCVD versus those with prior ASCVD. The review adhered to methodological standards for systematic reviews, though the included observational designs inherently limit causal inference.
# Temel bulgular
The pooled incidence rates per 1000 person-years for the overall statin-using population were as follows: composite ASCVD risk (major adverse cardiovascular events or all-cause death) at 12.3 PPY; myocardial infarction at 8.23 PPY; ischemic stroke at 6.0 PPY; cardiovascular-related death at 4.3 PPY; and coronary revascularization at 7.4 PPY. Subgroup findings revealed a significant disparity in risk profiles. Adults without prior ASCVD but at risk of developing the disease experienced a lower composite risk of 6.4 PPY (range, 3.7-9.8 PPY). In contrast, adults with a prior history of ASCVD had a substantially higher composite risk of 15.8 PPY (range, 0.2-72.0 PPY). These stratified rates highlight that prior disease status is a key modifier of residual risk, even among those receiving guideline-directed statin therapy.
# Bulgular ne anlama geliyor?
These findings indicate that statin therapy, while effective, does not eliminate atherosclerotic cardiovascular disease risk. The pooled estimates provide contemporary benchmarks for clinicians monitoring patients on statins. The marked increase in risk for patients with prior ASCVD (15.8 PPY vs. 6.4 PPY for those at risk) suggests that additional risk-reduction strategies may be necessary for this higher-risk subgroup. The results underscore the importance of comprehensive risk assessment, including evaluation of residual factors such as blood pressure, diabetes control, smoking status, and lipid levels, even in patients adherent to statin therapy. The data also support the need for individualized treatment targets and potential intensification of therapy in patients with established disease.
# Klinik önem
The clinical implications are significant for cardiovascular risk management. The pooled incidence rates offer objective data to guide follow-up and treatment decisions. For patients with prior ASCVD, the elevated residual risk (15.8 PPY) may warrant more aggressive management of concomitant risk factors and consideration of additional therapeutic agents beyond statin monotherapy. For patients at risk of ASCVD without prior disease, the lower but still present risk (6.4 PPY) supports continued vigilance and optimization of modifiable risk factors. These data provide a quantitative foundation for shared decision-making regarding the need for adjunctive therapies, lifestyle modifications, and more frequent monitoring in statin-treated populations.
# Sınırlılıklar
Several limitations should be considered when interpreting these results. Heterogeneity across included studies was substantial, noted across different populations, statin regimens, and follow-up durations. The observational study design limits the ability to establish causal relationships between statin use and observed event rates, as residual confounding by indication cannot be fully ruled out. The analysis may have limited generalizability to diverse populations, as the included studies may not fully represent all demographic groups or clinical settings. Additionally, publication bias was possible but not formally assessed in the review. The precision of the pooled estimates was imprecise, and consistency across studies was inconsistent, which affects the confidence intervals around the reported incidence rates.