Abstract
Aims:
Secondary prevention in
patients with
coronary artery disease and
peripheral artery disease involves antithrombotic
therapy and optimal control of
cardiovascular risk factors. In the Cardiovascular Outcomes for People Using Anticoagulation
Strategies (COMPASS) study, adding low-
dose rivaroxaban on top of
aspirin lowered cardiovascular events, but there is limited data about
risk factor control in
secondary prevention. We studied the
association between
risk factor status and outcomes, and the impact of
risk factor status on the
treatment effect of
rivaroxaban, in a large contemporary
population of
patients with
coronary artery disease or
peripheral artery disease.
Methods and
results:
We reported ischemic events (cardiovascular
death,
stroke, or
myocardial infarction) in participants from the randomized, double-blind COMPASS study by individual
risk factor (
blood pressure,
smoking status,
cholesterol level, presence of diabetes,
body mass index, and level of
physical activity), and by number of
risk factors. We compared rates and
hazard ratios of
patients treated with
rivaroxaban plus
aspirin vs
aspirin alone within each
risk factor category and tested for interaction between
risk factor status and antithrombotic regimen. Complete baseline
risk factor status was available in 27,117 (99%)
patients. Status and number of
risk factors were both associated with increased
risk of ischemic events. Rates of ischemic events (
hazard ratio 2.2; 95%
confidence interval 1.82.6) and cardiovascular
death (
hazard ratio 2.0; 1.52.7) were more than twofold higher in
patients with 46 compared with 01
risk factors (p<0.0001 for both).
Rivaroxaban reduced event rates independently of the number of
risk factors (p interaction 0.93), with the largest absolute benefit in
patients with the highest number of
risk factors.
Conclusion:
More favorable
risk factor status and low-
dose rivaroxaban were independently associated with lower
risk of cardiovascular events. (AU)