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Overview of atherosclerosis
1Department of Preventive Medicine and Epidemiology, Evans Department of Clinical Research, Boston University School of Medicine, Massachusetts, USA.
Insights
Atherosclerotic cardiovascular disease is a widespread and costly health issue, particularly affecting older adults. Comprehensive preventive strategies targeting risk factors can mitigate various manifestations and reduce mortality from heart disease and stroke.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality and morbidity, representing 44% of national deaths.
- Atherosclerotic cardiovascular disease (ASCVD) is increasingly prevalent due to an aging population, with coronary heart disease being a major cause of death.
- ASCVD incurs substantial economic costs, estimated at $259 billion in 1997, and affects the heart, brain, and peripheral arteries.
Purpose of the Study:
- To highlight the generalized nature of atherosclerotic cardiovascular disease and its interconnected clinical manifestations.
- To emphasize the importance of comprehensive preventive measures for both primary and secondary prevention of ASCVD.
- To underscore the role of risk factor modification in preventing diverse atherosclerotic outcomes.
Main Methods:
- Review of epidemiological data on cardiovascular disease prevalence, mortality, and economic burden.
- Analysis of the generalized nature of atherosclerosis and its coexisting clinical manifestations across different arterial territories.
- Examination of meta-analyses of randomized trials on antiplatelet agents for secondary prevention.
Main Results:
- ASCVD is a systemic process, with manifestations in one area increasing the likelihood of others due to shared risk factors.
- Meta-analyses show that low-dose aspirin and antiplatelet agents reduce myocardial infarctions, strokes, and cardiovascular mortality by approximately 25% in patients with existing CVD.
- Correction of risk factors or prevention of one ASCVD outcome is associated with the prevention of other atherosclerotic disease outcomes.
Conclusions:
- Comprehensive preventive measures are crucial for individuals at high risk of initial atherosclerotic events and those with existing disease.
- Preventive strategies targeting major risk factors can address multiple arterial territories simultaneously.
- Implementing unified preventive approaches for ASCVD is essential for healthcare professionals to reduce disease burden and mortality.
Abstract:
Cardiovascular disease is a serious threat to both life and health, accounting for 44% of the nation's mortality and much of its morbidity. Moreover, atherosclerotic cardiovascular disease is a growing problem because of the aging population. Coronary heart disease is the most common cause of lethal atherosclerotic disease, accounting for two thirds of all deaths resulting from heart disease and 70% of all deaths in those older than 75. A 1997 estimate put the economic cost of atherosclerotic cardiovascular disease at a staggering $259 billion. Indications are that atherosclerotic cardiovascular disease is a generalized process that involves the heart, brain, and peripheral arteries. Clinical manifestations tend to coexist, and the presence of one manifestation increases the likelihood of developing others, because major risk factors tend to affect all arterial territories. Also, clinical atherosclerosis in one area may directly predispose the patient to occurrence of atherosclerosis in another vascular territory. Therefore, measures taken to prevent one clinical manifestation of atherosclerosis should prevent the others as well. Multivariate risk profiles can identify persons at risk for atherosclerotic cardiovascular disease and target them for preventive treatment. Primary preventive measures also appear to be applicable to secondary prevention. Meta-analyses of randomized trials of the efficacy of low-dose aspirin and other antiplatelet agents in persons with overt cardiovascular disease have shown reductions of approximately 25% in the incidences of subsequent myocardial infarctions, strokes, and cardiovascular mortality. Comparison of the risk profiles for atherosclerotic cardiovascular disease indicates that correction of any particular set of risk factors or prevention of any cardiovascular disease outcome prevents other atherosclerotic disease outcomes as well. The challenge for all health care professionals is to implement comprehensive preventive measures for those at high risk for initial atherosclerotic events and even more vigorous measures for those who already have the disease.