Overlaps of risk factors between different cardiovascular phenotypes

Background: Atherosclerotic cardiovascular disease (ASCVD) encompasses a diverse range of disease manifestations including coronary, lower extremity peripheral (PAD), carotid, or extensive (e.g., polyvascular) arterial disease. However, a paucity of data exists with regard to the prevalence, shared risk factors, and rate of prescribed secondary preventive medications in different ASCVD subgroups. We sought to investigate this from a population-based perspective using data derived from the contemporary Hamburg City Health Study (HCHS). Patients and methods: In the population-based HCHS participants between 45 and 74 years were recruited at random. In the current cross-sectional analysis of the first 10,000 participants enrolled between February 2016 and November 2018, participants were stratified by the arterial vascular bed affected by atherosclerosis, e.g., carotid artery disease, lower extremity PAD, or coronary artery disease, as well as a combination of at least two entities (polyvascular disease). Baseline characteristics including risk factor profiles, prescribed preventive medications as well as cardiovascular risk scores (ESC SCORE 2, Stroke score) were compared. Results: A total of 6,324 individuals with complete cardiovascular screening data were included. Overall, 2,258 (35.7%), 732 (11.6%) and 174 (2.8%) participants were diagnosed with isolated carotid artery disease, lower extremity PAD, or coronary artery disease, respectively. In 739 (11.7%) participants polyvascular disease was noted. Across the subgroups, different patterns of risk factor profiles were documented. Participants with polyvascular disease were the oldest, most often unemployed, diabetic, and current smokers. Individuals with coronary artery disease or polyvascular disease were noted to have the highest cardiovascular risk scores and highest rates of prescribed preventive medications. Conclusions: In this contemporary population-based analysis, different risk factor profiles, cardiovascular risk scores and prescribed secondary preventive medications were noted according to the diseased vascular bed. Our findings suggest differences between best medical treatment which could be targeted to improve cardiovascular event rates in patients with ASCVD.