Given the availability of an effective but expensive lipid-lowering medication, proprotein convertase subtilisin/kexin type 9 inhibitors, the American Heart Association and the American College of Cardiology 2018 cholesterol guideline introduced a new classification of “very high-risk” (i.e., multiple major atherosclerotic cardiovascular diseases [ASCVDs] or a major ASCVD þ multiple high-risk conditions) versus “high-risk” for patients with prior ASCVD. A few recent studies reported risk variation within very high-risk ASCVD, with multiple ASCVDs conferring higher risk than 1 ASCVD þ $2 high-risk conditions. However, these studies did not evaluate whether the constellation of high-risk conditions in 1 ASCVD may equate to the risk of multiple ASCVDs or whether the new classification has implications for heart failure
