{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T14:31:28Z","timestamp":1793802688537,"version":"4.6.1"},"reference-count":112,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Statins are the cornerstone of lipid\u2010lowering therapy, reducing low\u2010density lipoprotein cholesterol in adults. However, residual atherosclerotic cardiovascular disease (ASCVD) risk among statin users remains unclear. This study estimated residual ASCVD risk in statin users in practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a systematic literature review and meta\u2010analyses following Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines, including observational studies published January 1, 2013, to August 1, 2023, that reported ASCVD risk in adult statin users. Five outcomes were assessed: composite risk (major adverse cardiovascular events or all\u2010cause death), myocardial infarction, ischemic stroke, cardiovascular\u2010related death, and coronary revascularization. Meta\u2010analysis methods were used to synthesize individual study estimates. For each outcome, forest plots present study\u2010level estimates and the pooled incidence rate per 1000 person\u2010years (PPY).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">The meta\u2010analysis of residual composite risk (major adverse cardiovascular events or all\u2010cause death) in the overall population was 12.3 PPY (range, 0.2\u201372.0). Rates were lower in adults at risk of ASCVD (6.4 PPY [range, 3.7\u20139.8 PPY]) and higher in adults with prior ASCVD (15.8 PPY [range, 0.2\u201372.0 PPY]). Meta\u2010analysis for myocardial infarction showed 8.23 PPY (range, 1.1\u201388.82 PPY) in the overall patient population, and a lower rate of ischemic stroke with a rate of 6.0 PPY (range, 1.4\u201318.8 PPY). A rate of 4.3 PPY (range, 0.4\u201322.9 PPY) was estimated for cardiovascular\u2010related death, and 7.4 PPY for coronary revascularization (range, 3.1\u201327.6 PPY).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Despite substantial between\u2010study variability, this real\u2010world meta\u2010analysis indicates meaningful residual ASCVD risk among statin users, underscoring persistent treatment gaps and need for comprehensive, optimized risk management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044840","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:48:36Z","timestamp":1787226516000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Residual Atherosclerotic Cardiovascular Disease Risk in Statin Users: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3100-6569","authenticated-orcid":false,"given":"Alexandre H.","family":"Watanabe","sequence":"first","affiliation":[{"name":"Merck & Co, Inc","place":["Rahway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6036-2498","authenticated-orcid":false,"given":"Lori D.","family":"Bash","sequence":"additional","affiliation":[{"name":"Merck & Co, Inc","place":["Rahway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8209-2858","authenticated-orcid":false,"given":"Tracy","family":"Westley","sequence":"additional","affiliation":[{"name":"Lumanity","place":["Sheffield, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4388-2608","authenticated-orcid":false,"given":"Andrea","family":"Garcia","sequence":"additional","affiliation":[{"name":"Lumanity","place":["Utrecht, the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2395-7263","authenticated-orcid":false,"given":"Emily","family":"Aiello","sequence":"additional","affiliation":[{"name":"Lumanity","place":["Sheffield, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0311-5711","authenticated-orcid":false,"given":"Jasmine","family":"Bradbury","sequence":"additional","affiliation":[{"name":"Lumanity","place":["Sheffield, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyoti","family":"Garg","sequence":"additional","affiliation":[{"name":"Lumanity","place":["Gurugram, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vyshnavi","family":"Telukuntla","sequence":"additional","affiliation":[{"name":"Lumanity","place":["Gurugram, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-1636","authenticated-orcid":false,"given":"Michael G.","family":"Nanna","sequence":"additional","affiliation":[{"name":"Yale School of Medicine","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","unstructured":"World Health Organization . Cardiovascular diseases. 2026. Accessed May 26 2026. https:\/\/www.who.int\/health\u2010topics\/cardiovascular\u2010diseases#tab=tab_1."},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.982815"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.05.042"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.031356"},{"key":"e_1_3_1_6_2","unstructured":"Higgins JPT Thomas J Chandler J Cumpston M Li T Page MJ Welch VA. Cochrane handbook for systematic reviews of interventions version 6.4. 2023. Accessed May 26 2026. https:\/\/training.cochrane.org\/handbook."},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_1_8_2","unstructured":"ROBINS\u2010E Development Group Higgins JMR Rooney A Taylor K Thayer K Silva R Lemeris C Akl A Arroyave W Bateson T et\u00a0al. Risk Of Bias In Non\u2010randomized Studies \u2010 of Exposure (ROBINS\u2010E). 2023 Accessed May 26 2026. https:\/\/www.riskofbias.info\/welcome\/robins\u2010e\u2010tool."},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100141"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.31.4.875"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1885-5857(09)60028-1"},{"key":"e_1_3_1_12_2","volume-title":"Cochrane handbook for systematic reviews of interventions","author":"Deeks JJ","year":"2022","unstructured":"Deeks JJ, Higgins JPT, Altman DG. Chapter\u00a010: Analysing data and undertaking meta\u2010analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, eds Cochrane handbook for systematic reviews of interventions. Cochrane; 2022."},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_3_1_14_2","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2026","unstructured":"R Core Team . R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2026. Accessed May 26, 2026. https:\/\/www.R\u2010project.org\/"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2019.08.028"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.028310"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.14609"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-021-07255-2"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacasi.2022.12.011"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-023-01826-3"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCA.0000000000001085"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.21037\/apm-21-3464"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.5551\/jat.63004"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-022-01667-6"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-022-01466-z"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.024379"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0268709"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.1024780"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.1004264"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2021.08.021"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacasi.2021.07.004"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245609"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.033152"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2020.03391"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1536\/ihj.19-686"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2020.01.013"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l5125"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.5603\/cj.a2018.0020"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2017.10.009"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487318798927"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2017.09.018"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12944-017-0560-0"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000007351"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0186861"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.08.229"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.03.386"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0144602"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.064440"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12103410"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2022.101362"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11185298"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-021-01852-1"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.4414\/smw.2021.w30067"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.23437"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2019.07.001"},{"key":"e_1_3_1_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2019.09.034"},{"key":"e_1_3_1_57_2","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2018.1463211"},{"key":"e_1_3_1_58_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002501"},{"key":"e_1_3_1_59_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCA.0000000000000560"},{"key":"e_1_3_1_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acvd.2017.07.007"},{"key":"e_1_3_1_61_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005435"},{"key":"e_1_3_1_62_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-017-1248-1"},{"key":"e_1_3_1_63_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.116.026336"},{"key":"e_1_3_1_64_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011306"},{"key":"e_1_3_1_65_2","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S107992"},{"key":"e_1_3_1_66_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0137733"},{"key":"e_1_3_1_67_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-022-02993-z"},{"key":"e_1_3_1_68_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.04.018"},{"key":"e_1_3_1_69_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0254008"},{"key":"e_1_3_1_70_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2021.04.008"},{"key":"e_1_3_1_71_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.007485"},{"key":"e_1_3_1_72_2","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S216606"},{"key":"e_1_3_1_73_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.180853"},{"key":"e_1_3_1_74_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-019-06864-2"},{"key":"e_1_3_1_75_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13537"},{"key":"e_1_3_1_76_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2018.03.084"},{"key":"e_1_3_1_77_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2018.09.034"},{"key":"e_1_3_1_78_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2017-000722"},{"key":"e_1_3_1_79_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.09.051"},{"key":"e_1_3_1_80_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-00470"},{"key":"e_1_3_1_81_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.11.084"},{"key":"e_1_3_1_82_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-016-0153-7"},{"key":"e_1_3_1_83_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2016.4052"},{"key":"e_1_3_1_84_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.08.011"},{"key":"e_1_3_1_85_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2017.06.015"},{"key":"e_1_3_1_86_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2016.06.013"},{"key":"e_1_3_1_87_2","doi-asserted-by":"publisher","DOI":"10.1148\/ryct.210225"},{"key":"e_1_3_1_88_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2018.11.004"},{"key":"e_1_3_1_89_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu080"},{"key":"e_1_3_1_90_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.06.046"},{"key":"e_1_3_1_91_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-024-01039-5"},{"key":"e_1_3_1_92_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2019.25.5.544"},{"key":"e_1_3_1_93_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12093187"},{"key":"e_1_3_1_94_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcrp.2025.200385"},{"key":"e_1_3_1_95_2","doi-asserted-by":"publisher","DOI":"10.36660\/abc.20230623"},{"key":"e_1_3_1_96_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2023.09.013"},{"key":"e_1_3_1_97_2","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2023.2270901"},{"key":"e_1_3_1_98_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-024-02365-x"},{"key":"e_1_3_1_99_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2023.107717"},{"key":"e_1_3_1_100_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.41402"},{"key":"e_1_3_1_101_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.1048398"},{"key":"e_1_3_1_102_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000625"},{"key":"e_1_3_1_103_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001251"},{"key":"e_1_3_1_104_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001309"},{"key":"e_1_3_1_105_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz455"},{"key":"e_1_3_1_106_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.07.006"},{"key":"e_1_3_1_107_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.014415"},{"key":"e_1_3_1_108_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpc.2023.100472"},{"key":"e_1_3_1_109_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaf229"},{"key":"e_1_3_1_110_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2023.09.021"},{"key":"e_1_3_1_111_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14020493"},{"key":"e_1_3_1_112_2","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.122.009787"},{"key":"e_1_3_1_113_2","doi-asserted-by":"publisher","DOI":"10.1080\/14779072.2024.2398444"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.044840","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T14:17:34Z","timestamp":1793801854000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.044840"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":112,"journal-issue":{"issue":"17","published-print":{"date-parts":[[2026,9,1]]}},"alternative-id":["10.1161\/JAHA.125.044840"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.044840","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]},"assertion":[{"value":"2025-07-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e044840"}}