2013

DOI: 10.1161/01.cir.0000436752.99896.22

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Secondary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults

Jerome L. Fleg¹,

Daniel E. Forman²,

et al.

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Cited by 179 publications

(131 citation statements)

References 191 publications

(285 reference statements)

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“…One exception was when both ABIs were greater than 1.0 and at least 1 ABI was higher than 1.3. In this situation, to capture pathophysiological information of high ABI (indicating arterial noncompressibility),2, 24, 25, 26 we used the higher ABI value for our analysis.…”

Section: Methodsmentioning

confidence: 99%

“…In the United States, PAD affects over 8 million individuals,2 with particularly high prevalence among people aged over 70 years 3, 4. Persons with PAD have 3‐ to 5‐fold higher mortality risk compared with those without PAD.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lower Extremity Peripheral Artery Disease and Quality of Life Among Older Individuals in the Community

¹

,

²

,

³

et al. 2017

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BackgroundEvidence regarding the association of lower extremity peripheral arterial disease with quality of life (QOL) is mainly from selected clinical populations or relatively small clinical cohorts. Thus, we investigated this association in community‐derived populations.Methods and ResultsUsing data of 5115 participants aged 66 to 90 years from visit 5 (2011‐2013) of the Atherosclerosis Risk in Communities Study, we quantified the associations of ankle‐brachial index (ABI) with several QOL parameters, including 12‐item Short‐Form Health Survey (SF‐12), after accounting for potential confounders using linear and logistic regression models. Peripheral arterial disease defined by an ABI <0.90 (n=402), was independently associated with a low SF‐12 Physical Component Summary score (−3.26 [95% CI −5.60 to −0.92]), compared to the ABI reference 1.10 to 1.19 (n=1900) but not with the Mental Component Summary score (−0.07 [−2.21 to 2.06]). A low ABI was significantly associated with poorer status of all SF‐12 physical domains (physical functioning, role‐physical, bodily pain, and general health) but only vitality out of 4 mental domains. Similarly, low ABI values were more consistently associated with other physically related QOL parameters (leisure‐time exercise/activity/walking) than mentally related parameters (significant depressive symptoms and hopeless feeling). Lower physical QOL was observed even in individuals with borderline low ABI (0.90 to 0.99; n=426).ConclusionsLow ABI (even borderline) was independently associated with poor QOL, especially for physical components, in community‐dwelling older adults. QOL is a critical element for older adults, and thus, further studies are warranted to assess whether peripheral arterial disease‐specific management can improve QOL in older populations.

“…One exception was when both ABIs were greater than 1.0 and at least 1 ABI was higher than 1.3. In this situation, to capture pathophysiological information of high ABI (indicating arterial noncompressibility),2, 24, 25, 26 we used the higher ABI value for our analysis.…”

Section: Methodsmentioning

confidence: 99%

“…In the United States, PAD affects over 8 million individuals,2 with particularly high prevalence among people aged over 70 years 3, 4. Persons with PAD have 3‐ to 5‐fold higher mortality risk compared with those without PAD.…”

Section: Introductionmentioning

confidence: 99%

Lower Extremity Peripheral Artery Disease and Quality of Life Among Older Individuals in the Community

¹

,

²

,

³

et al. 2017

View full text Add to dashboard Cite

BackgroundEvidence regarding the association of lower extremity peripheral arterial disease with quality of life (QOL) is mainly from selected clinical populations or relatively small clinical cohorts. Thus, we investigated this association in community‐derived populations.Methods and ResultsUsing data of 5115 participants aged 66 to 90 years from visit 5 (2011‐2013) of the Atherosclerosis Risk in Communities Study, we quantified the associations of ankle‐brachial index (ABI) with several QOL parameters, including 12‐item Short‐Form Health Survey (SF‐12), after accounting for potential confounders using linear and logistic regression models. Peripheral arterial disease defined by an ABI <0.90 (n=402), was independently associated with a low SF‐12 Physical Component Summary score (−3.26 [95% CI −5.60 to −0.92]), compared to the ABI reference 1.10 to 1.19 (n=1900) but not with the Mental Component Summary score (−0.07 [−2.21 to 2.06]). A low ABI was significantly associated with poorer status of all SF‐12 physical domains (physical functioning, role‐physical, bodily pain, and general health) but only vitality out of 4 mental domains. Similarly, low ABI values were more consistently associated with other physically related QOL parameters (leisure‐time exercise/activity/walking) than mentally related parameters (significant depressive symptoms and hopeless feeling). Lower physical QOL was observed even in individuals with borderline low ABI (0.90 to 0.99; n=426).ConclusionsLow ABI (even borderline) was independently associated with poor QOL, especially for physical components, in community‐dwelling older adults. QOL is a critical element for older adults, and thus, further studies are warranted to assess whether peripheral arterial disease‐specific management can improve QOL in older populations.

“…Compared with patients without CHD, the risk of MI trended higher for patients with one vessel non-obstructive CHD [hazard ratio (HR) 2.0; 95% CI: 0.8-5.1] and was significantly greater for patients with non-obstructive CHD involving two (HR 4.6; 95% CI: 2.0-10.5) or three heart vessels (HR 4.5; 95% CI: 1.6-12.5). Finally, patients with non-obstructive CHD should be considered for usual secondary prevention measures (37).…”

Section: Introduction and Definitionsmentioning

confidence: 99%

Epidemiology of coronary heart disease and acute coronary syndrome

Sanchís-Gomar¹,

Pérez-Quilis²,

et al. 2016

Ann. Transl. Med.

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The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. This evidence, along with the fact that mortality from CHD is expected to continue increasing in developing countries, illustrates the need for implementing effective primary prevention approaches worldwide and identifying risk groups and areas for possible improvement.

“…Age-adjusted death rates due to coronary heart disease and stroke have been falling since 1968, although this fall may be lessening 7 . Conversely, a progressive rise in the incidence and prevalence of atherosclerosis and coronary heart disease continues with increasing longevity in both men and women 8 . Atherosclerotic cardiovascular disease (ASCVD), a diffuse condition that involves the build-up of plaque in arterial walls, is directly associated with elevated levels of low-density lipoprotein cholesterol (LDL-C) 9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…Yet, a lack of a relevant claim in the database does not guarantee absence of an event of interest; thus, the mortality rates in Huang et al 22 were likely underestimated. The growing burden of CVD and the changing landscape of CVD management have also been well documented worldwide 4,8,[36][37][38][39][40][41][42][43][44] . Most recent projections indicate that up to 45% of the US population will have CVD by 2035, with costs skyrocketing from $555 billion in 2016 to $1.1 trillion by 2035 4 .…”

mentioning

confidence: 99%

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

¹

,

²

,

³

et al. 2018

Current Medical Research and Opinion

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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

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