Real-world cardiovascular disease burden in patients with atherosclerotic cardiovascular disease: a comprehensive systematic literature review

Abstract

Objective: Based on randomized controlled trials (RCTs), non-fatal myocardial infarction (MI) rates range between 9 and 15 events per 1000 person-years, ischemic stroke between 4 and 6 per 1000 person-years, CHD death rates between 5 and 7 events per 1000 person-years, and any major vascular event between 28 and 53 per 1000 person-years in patients with atherosclerotic cardiovascular disease (ASCVD). We reviewed global literature on the topic to determine whether the real-world burden of secondary major adverse cardiovascular events (MACEs) is higher among ASCVD patients. Methods: We searched PubMed and Embase using MeSH/keywords including cardiovascular disease, secondary prevention and observational studies. Studies published in the last 5 years, in English, with 50 subjects with elevated low-density lipoprotein cholesterol (LDL-C) or on statins, and reporting secondary MACEs were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of each included study. Results: Of 4663 identified articles, 14 studies that reported MACE incidence rates per 1000 personyears were included in the review (NOS grades ranged from 8 to 9; 2 were prospective and 12 were retrospective studies). Reported incidence rates per 1000 person-years had a range (median) of 12.01-39.9 (26.8) for MI, 13.8-57.2 (41.5) for ischemic stroke, 1.0-94.5 (21.1) for CV-related mortality and 9.7-486 (52.6) for all-cause mortality. Rates were 25.8-211 (81.1) for composite of MACEs. Multiple event rates had a range (median) of 60-391 (183) events per 1000 person-years. Conclusions: Our review indicates that MACE rates observed in real-world studies are substantially higher than those reported in RCTs, suggesting that the secondary MACE burden and potential benefits of effective CVD management in ASCVD patients may be underestimated if real-world data are not taken into consideration. ARTICLE HISTORY

Cardiovascular Event Rates After Myocardial Infarction or Ischaemic Stroke in Patients with Additional Risk Factors: A Retrospective Population-Based Cohort Study

“…The evidence on CV event rates in patients with ASCVD comes primarily from clinical trials, and so the impact of CV events in clinical practice may be underestimated as a result of patient selection bias and a higher quality of care received by participants compared with real-world settings [10][11][12][13][14]. There is, therefore, a need for observational data on CV event rates in very high-risk patients in routine clinical practice.…”

No Independent Influence of Statins on the Chronic Obstructive Pulmonary Disease Exacerbation Rate: A Cohort Observation Study Over 10 Years

“… 1 These drugs are used to treat hypercholesterolemia to prevent cardiovascular diseases, such as stroke, heart attack, and vascular diseases. 2 The different types of statins include the following: atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin, pravastatin, and simvastatin. 3 These substances influence lipid metabolism in various ways: via the competitive inhibition of the key enzyme in cholesterol synthesis, 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA reductase); by reducing cholesterol biosynthesis in the liver; by increasing the concentration of low-density lipoprotein receptors in the liver cells; and through the modification of lipoproteins.…”

Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population

“…Although it is important to understand the burden of CVD in these high‐risk populations, few studies have systematically examined the real‐world pattern of recurrent cardiovascular events in older patients overall or by diabetes status. A recent systematic literature review found that the rates of secondary major adverse cardiovascular events among patients with atherosclerotic CVD were greater in real‐world studies compared with randomized clinical trials; however, this study did not investigate the risk in elderly patients or patients with diabetes . We estimated cumulative recurrence rates of MI and ischemic stroke (IS) after hospital discharge and cumulative incidence of other cardiovascular events, all‐cause death, and composite measures of multiple events after MI or IS over long‐term follow‐up in a 2008 cohort of older patients.…”

“…A recent systematic literature review found that the rates of secondary major adverse cardiovascular events among patients with atherosclerotic CVD were greater in realworld studies compared with randomized clinical trials; however, this study did not investigate the risk in elderly patients or patients with diabetes. 15 We estimated cumulative recurrence rates of MI and ischemic stroke (IS) after hospital discharge and cumulative incidence of other cardiovascular events, all-cause death, and composite measures of multiple events after MI or IS over long-term follow-up in a 2008 cohort of older patients. We also examined the association between diabetes status and 1-year risk of MI or IS recurrence and the incidence of other CVD outcomes in a 2012 cohort.…”