Three Decades of Atherosclerotic Reno-vascular Disease Management - Changing Outcomes in an Observational Study

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Medical Therapy

Background:

• Optimized medical therapy has improved cardiovascular outcomes in the general population.
• Atherosclerotic renovascular disease (ARVD) management has evolved over time.
• Investigating the impact of these changes on ARVD patient outcomes is crucial.

Purpose of the Study:

• To investigate whether changes in the management of atherosclerotic renovascular disease (ARVD) have impacted clinical outcomes.
• To assess the effect of evolving treatment strategies on ARVD patient prognosis.

Main Methods:

• Single-center prospective cohort study with retrospective data analysis.
• Patients divided into four groups based on diagnosis year relative to landmark randomized controlled trials (RCTs).
• Data collected from 1986 to 2014, encompassing pre-large RCT, early RCT, ASTRAL study recruitment, and post-ASTRAL eras.

Main Results:

• Increased utilization of renin-angiotensin blockade (RAB), statins, and beta-blockers over successive time periods.
• Median time to death, end-stage kidney disease, and cardiovascular events improved.
• Fewer investigative angiograms performed in later periods, with patients presenting with more cardiovascular comorbidities.

Conclusions:

• Fewer patients are being investigated for ARVD, but they present with greater cardiovascular comorbidity.
• Optimized medical therapy likely contributed to improved proteinuria, renal function, and clinical outcomes in ARVD patients.
• Evolving treatment paradigms in ARVD management show positive impacts on patient prognosis.