The study goal was to estimate prevalence of population in secondary prevention for Atherosclerotic Cardiovascular Disease (ASCVD) stratified by the pharmacological treatment and related outcomes using Health Information Systems (HIS).

From HIS of Marche and Umbria Regions (1.8 millions of inhabitants) which collect information related to hospitalizations, drugs prescriptions, outpatient visits and results of laboratory tests, we identified all patients aged ≤ 80 years with one or more hospitalization with DRG related to Acute Coronary Syndrome, Peripheral Artery Disease, Ischemic Stroke and Transient Ischemic Attack and discharge date between 2011 and 2014 (study period). Pharmacological treatment for each subject was defined selecting all prescriptions of Statins, Ezetimibe and Simvastatin/Ezetimibe, retrieved between the date of the last prescription in the study period and the previous 90 days. We stratified patient in no-treated, treated with low/medium intensity statins (LMS), high-dose statins (HDS) and other Lipid-Lowering Therapies (LLTs). Furthermore, for Umbria region, we selected the last blood levels test of LDL-cholesterol occurred in period 2011-2016. Starting from test date, we defined the pharmacological treatment in the previous 90 days. Subject were stratified based on LDL-C levels in target (<70) and not at-target (≥70) patients.

Population in secondary prevention for ASCVD in period 2011-2014 in Marche and Umbria was estimated in 23,043 (prevalence: 4.3 x 1,000 inhabitants), corresponding to more than 800,000 subjects in Italian population. Within treated patients: 51.3% received LMS, 38.1% HDS and 10.6% other LLTs. No-treated patients were 27.8%. LDL-C target was achieved by 34.9% of patients treated with LMS and by 46.1% of patients treated with other LLTs.

The study, based on Italian administrative databases, allowed to estimate the very high risk population in secondary prevention for ASCVD. It highlighted a relevant proportion of no-treated patients, and an high proportion of patients that did not achieve recommended LDL-C target.