Secondary prevention 1301 to examine adherence to antiplatelet and statin therapy for participants in a vas- cular screening trial diagnosed with AAA or PAD. Methods: Data from the VIVA screenings cohort for vascular disease were com- bined with data from Danish registers from 2007 to 2016. Initiation of antiplatelet and statin treatment was measured within 90 days for non-users at baseline. Per- sistence was measured by time to first break of >100 days. Proportion of days covered ≥80% was used as categorical cut-off for adherence during 5 years of follow-up. Result: Among 18,748 screened participants, we identified 619 with AAA and 2,052 with PAD. Among non-users at baseline 64% and 61% initiated antiplatelet and statin within 90 days, 49% and 45% were persistence and 43% and 38% were adherent. Only drug user status at baseline provided important information on antiplatelet and statin adherence. Conclusion: The 5-year adherence to antiplatelet and statin treatment was sub- optimal for participants in a screening program for vascular disease. For non- users at screening adherence was low. Research initiatives are required to in- crease adherence among non-users at screening to improve screening efficacy and cost effectiveness in future trials. Funding Acknowledgements: This work was supported by grants Central Den- mark Region Health Science Research Fund, Family Hede Nielsen Fund and Frimodt-Heineke Fund. P6257 Missed opportunities with underprescription of appropriate secondary prevention treatment at discharge in AMI patients at high risk. The FAST-MI programme E. Puymirat 1 , M. Bonaca 2 , G. Lemesle 3 , A. Furber 4 , S. Leborgne 5 , D. Angoulvant 6 , J.N. Labeque 7 , L. Orion 8 , D. Harbaoui 9 , L. Bonelo 10 , J. Ferrieres 11 , F. Schiele 12 , T. Simon 13 , N. Danchin 1 . 1 European Hospital Georges Pompidou, Cardiology, Paris, France; 2 Harvard Medical School, Boston, United States of America; 3 Lille University Hospital, Lille, France; 4 University Hospital of Angers, Angers, France; 5 Hospital Center of Avignon, Avignon, France; 6 University Hospital of Tours, Tours, France; 7 Centre hospitalier, Bayonne, France; 8 Centre Hospitalier Départemental Les Oudairies, La Roche-sur-Yon, France; 9 Croix Rousse, Lyon, France; 10 Hospital Nord of Marseille, Marseille, France; 11 Toulouse Rangueil University Hospital (CHU), Toulouse, France; 12 University of Besançon, Besançon, France; 13 Hospital Saint-Antoine, Paris, France Background and aim: Full secondary prevention medication regimen is often under prescribed after AMI. We studied the relationship between prescription of appropriate secondary prevention medication and one-year mortality according to risk level in patients discharged after AMI. Aim: To analyze rates of appropriate medical treatment at discharge after AMI across risk categories defined by the TIMI Risk Score for Secondary Prevention (TRS-2P), in a routine-practice population and to determine the efficacy of appro- priate therapy according to risk level, both in relative and absolute terms. Methods: We used data from the 2005, 2010 and 2015 FAST-MI registries, in- cluding 12,290 consecutive AMI patients admitted to cardiac intensive care units in metropolitan France and discharged alive. Level of risk was stratified in 3 groups using the TRS-2P score calculated at discharge: Group 1 (Low-risk; TRS- 2P=0 or 1); Group 2 (Intermediate-risk; TRS-2P=2); and, Group 3 (High-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined accord- ing to the latest ESC guidelines (dual antiplatelet therapy and statins for all, and ACEi/ARB and beta-blockers as indicated). Results: Prevalence of Groups 1, 2, and 3 was 43%, 25% and 32% respectively. Appropriate secondary prevention treatment was used in 76%, 62% and 46%, respectively. After multivariate adjustment, appropriate therapy at discharge was associated with improved survival in all risk categories: 0.60 (0.38–0.97, P=0.03) in group 1, 0.61 (0.40–0.91, P=0.02) in group 2, and 0.67 (0.55–0.82, P<0.001) in group 3. Lack of appropriate treatment at discharge resulted in an increased absolute risk of death which was considerably higher in the high-risk group (Table 1). Table 1 Low risk Intermediate risk High risk % with appropriate Rx 76% 62% 46% Adjusted HR of one-year death 0.60 (0.38–0.97) 0.61 (0.40–0.91) 0.67 (0.55–0.82) Absolute number of deaths due to lack of appropriate Rx per 100 patient-years 0.22 0.70 3.1 Conclusions: Use of appropriate medical treatment at discharge is inversely cor- related with patient risk. It is associated with similar relative risk reductions in one-year death across risk categories, but in absolute terms, the increased haz- ard related to lack of prescription of recommended medications is much greater in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients. P6258 Higher cardiovascular disease incidence by increasing number of vascular territories affected and hypercholesterolemia level in population with existing cardiovascular disease I. Roman Degano 1 , R. Ramos 2 , M. Garcia-Gil 2 , A. Zamora 3 , M. Comas-Cufi 2 , A. Frances 4 , J. Marrugat 5 . 1 Hospital del Mar, Municipal Institute for Medical Research (IMIM), Barcelona, Spain; 2 Primary Care Research Institute (IDIAP), Barcelona, Spain; 3 University of Girona, Medical Sciences, Girona, Spain; 4 Hospital del Mar, Barcelona, Spain; 5 CIBERCV, Health Institute Carlos III/Hospital del Mar Medical Research Institute (IMIM), Madrid/Barcelona, Spain Background: Cardiovascular disease (CVD) patients are at higher risk of recur- rence and of progression into a new territory than individuals without CVD. Low- density lipoprotein cholesterol (LDL-C) is an important determinant of CVD risk and prognosis. Purpose: Our goal was to determine the combined effect of CVD extension and LDL-C plasma levels on 3-year CVD incidence and overall mortality. Methods: A Spanish primary care database was used to select a cohort of 186,117 CVD patients aged ≥35 years with a lipid profile determined before Jan- uary 2011 who were followed for CVD events until end of 2013. Patients’ choles- terol levels were classified as familial hypercholesterolemia phenotype (FH-P), hypercholesterolemia, and normal cholesterol levels. Baseline number of vascu- lar territories (cerebral, coronary or lower limbs) affected was classifies as 1, 2 or 3. Results: Annual age-standardized incidence of coronary heart disease (CHD) was significantly higher in patients with FH-P than in those with hypercholes- terolemia or normal cholesterol levels (45.2, 38.6, and 35.6/1000 person-years (p-y), respectively), while incidence of ischemic stroke (IS) and all-cause mor- tality were significantly lower (Figure). Incidence of all CVD outcomes increased significantly with the number of vascular territories initially affected in all hyper- cholesterolemia groups (incidence in individuals with 1–3 territories affected of CHD [36.8–131.5/1000 p-y], peripheral artery disease [18.3–139.1/1000 p-y], and IS [22.6–70.1/1000 p-y]). Number of vascular territories affected was a stronger predictor of CHD (Table) and all-cause mortality than LDL-C group. Multivariate prediction of CHD incidence IRR (95% CI) Affected territories 2 1.67 [1.61, 1.72] 3 2.51 [2.34, 2.70] Cholesterol level Hypercholesterolemia 1.09 [1.05, 1.12] FH-P 1.24 [1.07, 1.44] Adjusted for age, sex, hypertension, smoking, diabetes, obesity, and chronic kidney disease. CI: confidence interval; IRR: Incidence rate ratio. Conclusions: CVD patients with polyvascular disease and with FH-P showed the highest incidence of CVD, suggesting that these individuals should be prioritized for more intensive secondary prevention. The large effect on CHD incidence and all-cause mortality of number of vascular territories affected recommends review- ing global strategies for CVD management in patients with polyvascular disease. Funding Acknowledgements: Carlos III Health Institute; EU ERDF Funds; Catalan Government; AGAUR; Sanofi Downloaded from https://academic.oup.com/eurheartj/article/39/suppl_1/ehy566.P6258/5080393 by guest on 06 September 2020