The rising prevalence of cardiovascular (CV) risk factors in Portugal translates into more than 35 000 annual deaths due to CV diseases, representing 30% of the total mortality in 20191,2 Moreover, CV risk factors such as dyslipidemia, obesity, hypertension, type 2 diabetes, smoking, coronary artery disease, history of stroke, myocardial infarction, among others can significantly increase the risk of subsequent CV events.3

The evolution of CV medicine has made it possible to intervene on risk factors for which the definition of public health measures has a direct impact on clinical practice and prognosis.

In Europe, the most widely used CV-risk classification scheme was proposed by the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). It divides patients into 4 risk categories ranging from low CV-risk to very-high CV-risk.4, 5, 6 The 2019 ESC/EAS Guidelines recommend the assessment of CV-risk using the Systematic Coronary Risk Evaluation (SCORE) system for adults (40–70 years), except for people with documented atherosclerotic cardiovascular disease (ASCVD), type 1 diabetes mellitus, type 2 diabetes, chronic kidney disease, familial hypercholesterolemia, or very-high categories of individual risk (i.e. carotid or femoral plaques, coronary artery calcium score >100 or extreme Lp(a) elevation) which correspond to high or very-high CV-risk and should be managed accordingly.4,5

In order to control CV-risk, the ESC/EAS specifies goal values for low density lipoprotein cholesterol (LDL-C) to be achieved for each risk category and, when required, recommends lipid lowering therapies (LLT) that significantly reduce LDL-C.4,7

This study aims to analyze the 10-year adjusted hazard-ratio (aHR) of the composite endpoint of CV death or hospitalization for non-fatal ASCVD events per ESC/EAS 2019 CV-risk category, as well as the secondary endpoints of CV death and all-cause death.