Risk Factor control and treatment among People with Atherosclerotic Cardiovascular Disease in the All of Us Study

Background: Understanding the spectrum of atherosclerotic cardiovascular disease (AS-CVD) risks found in persons with ASCVD in a contemporary population of U.S. adults can help target the intensity of therapeutic approaches to prevent future adverse outcomes.Methods: Data from the NIH All of Us study who were at least 18 years of age with a history of ASCVD (n=34,195) were analyzed. We categorized the sample into three different ASCVD risk groups and used ANOVA/Chi-square test to compare the extent of adherence to lifestyle measures, risk factor control, and extent of recommended medication use. Multiple logistic regressions were applied to examine the association between risk factors/ medication use and ASCVD risk. Results: Overall, 15,238 (44.6%) participants with ASCVD met the definition of very-high risk of which 3,692 (24.2%) had two or more major ASCVD conditions. Statin use ranged from 62.8% to 88.0%, blood pressure control from 41.6% to 46.8%, and HbA1c control from 75.1% to 82.6% across ASCVD risk groups. After adjusting for demographic factors (age, gender, race/ethnicity, education, insurance coverage, income, BMI, and smoking), diabetes mellitus and hypertension seemed to be most related to the very-high ASCVD risk, with an odds ratio of 1.93 (95% CI: 1.71, 2.17) and 3.13 (95% CI: 1.93, 5.22), respectively. In terms of target control and medication adherence, Hispanic or Latino had the best LDL-C control and high-intensity statin use, and Non-Hispanic White and Asian patients had better control of BP and Hba1c. Males and patients with very high ASCVD risk were likely to have a higher proportion of medication use and better control of LDL-C level, but the pattern was opposite in BP and Hba1c control (females and patients without very-high ASCVD risk tended to have better target control). Conclusion: The patterns of adherence to medication and target control of risk factors are different among gender, ethnicity, and ASCVD risk groups. Other interventions towards hypertension and diabetes should be kept implementing to optimize the ASCVD risk. Keywords: Atherosclerotic cardiovascular disease, diabetes, risk assessment, treatment, precision medicin