{"doi":"10.1016/j.ahjo.2022.100201","title":"Estimated number and percentage of US adults with atherosclerotic cardiovascular disease recommended add-on lipid-lowering therapy by the 2018 AHA/ACC multi-society cholesterol guideline","abstract":"Study objective: The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline recommends a maximally-tolerated statin with add-on lipid-lowering therapy, ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) for adults with very-high atherosclerotic cardiovascular disease (ASCVD) risk to achieve a low-density lipoprotein cholesterol (LDL-C) <70 mg/dL. We estimated the percentage of US adults with ASCVD recommended, by the 2018 AHA/ACC cholesterol guideline, and receiving add-on lipid-lowering therapy. Design setting and participants: Cross-sectional study including 805 participants from the US National Health and Nutrition Examination Survey (NHANES) 2013-2020 data. NHANES sampling weights were used to obtain estimates for the US adult population. Main measures: Very-high ASCVD risk was defined as either: ≥2 ASCVD events, or one ASCVD event with ≥2 high-risk conditions. Being recommended add-on lipid-lowering therapy was defined as having very-high ASCVD risk and LDL-C ≥ 70 mg/dL, or LDL-C < 70 mg/dL while taking ezetimibe or a PCSK9 inhibitor. Results: An estimated 18.7 (95%CI, 16.0-21.4) million US adults had ASCVD, of whom 81.6 % (95%CI, 76.7 %-86.4 %) had very-high ASCVD risk, and 60.1 % (95%CI, 54.5 %-65.7 %) had very-high ASCVD risk and LDL-C ≥ 70 mg/dL. Overall, 61.4 % (95%CI, 55.8 %-66.9 %) were recommended add-on lipid-lowering therapy and 3.2 % (95 % CI, 1.2 %-5.3 %) were taking it. Smokers, adults with diabetes, hypertension and chronic kidney disease were more likely, while those taking atorvastatin or rosuvastatin were less likely, to be recommended add-on lipid-lowering therapy. Conclusion: The majority of US adults with ASCVD are recommended add-on lipid-lowering therapy by the 2018 AHA/ACC cholesterol guideline but few are receiving it.","journal":"American Heart Journal Plus Cardiology Research and Practice","year":2022,"id":270345,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":14,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9582,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":537912,"name":"Vera Bittner","orcid":"0000-0001-9456-850X","position":1,"is_corresponding":false},{"id":342609,"name":"Todd M. Brown","orcid":"0000-0002-9820-5738","position":2,"is_corresponding":false},{"id":469613,"name":"Lisandro D. Colantonio","orcid":"0000-0001-8742-1788","position":3,"is_corresponding":false},{"id":934151,"name":"Nafeesa Dhalwani","orcid":"0000-0003-3204-1328","position":4,"is_corresponding":false},{"id":934595,"name":"Jenna Jones","orcid":null,"position":5,"is_corresponding":false},{"id":934152,"name":"Bethany Kalich","orcid":"0000-0002-1220-3484","position":6,"is_corresponding":false},{"id":790378,"name":"Jason Exter","orcid":null,"position":7,"is_corresponding":false},{"id":377000,"name":"Elizabeth A. Jackson","orcid":"0000-0002-5086-0418","position":8,"is_corresponding":false},{"id":342610,"name":"Emily B. Levitan","orcid":"0000-0002-5429-3852","position":9,"is_corresponding":false},{"id":787851,"name":"Bharat Poudel","orcid":"0000-0003-2958-2561","position":10,"is_corresponding":false},{"id":831205,"name":"Zhixin Wang","orcid":"0000-0003-2383-1010","position":11,"is_corresponding":false},{"id":925,"name":"Mark Woodward","orcid":"0000-0001-9800-5296","position":12,"is_corresponding":false},{"id":74980,"name":"Paul Muntner","orcid":"0000-0002-4711-5492","position":13,"is_corresponding":false},{"id":707485,"name":"Robert S. Rosenson","orcid":"0000-0002-5599-0633","position":14,"is_corresponding":false},{"id":934150,"name":"Chibuike J Alanaeme","orcid":"0000-0003-2792-1259","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T00:27:26.772098Z","pmid":"37168932","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}