Decline in risk of recurrent cardiovascular events in the period 1996 to 2014 partly explained by better treatment of risk factors and less subclinical atherosclerosis.

Gijs F.N Berkelmans,Jannick A.N Dorresteijn,Gert Jan De Borst,Jan Westerink,Maarten J Cramer,Frank L.J Visseren,Yolanda Van Der Graaf,L Jaap Kappelle

doi:10.1016/j.ijcard.2017.07.026

Gijs F.N Berkelmans, Jannick A.N Dorresteijn + Show 6 more

Open Access

https://doi.org/10.1016/j.ijcard.2017.07.026

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Abstract

To quantify the decline in recurrent major cardiovascular events (MCVE) risk in patients with clinically manifest vascular disease between 1996 and 2014 and to assess whether the improvements in recurrent MCVE-risk can be explained by reduced prevalence of risk factors, more medication use and less subclinical atherosclerosis. The study was conducted in the Second Manifestations of ARTerial disease (SMART) cohort in patients entering the cohort in the period 1996-2014. The prevalence of risk factors and subclinical atherosclerosis was measured at baseline. Incidence rates per 100person-years for recurrent MCVE (including stroke, myocardial infarction, retinal bleeding, retinal infarction, terminal heart failure, sudden death, fatal rupture of abdominal aneurysm) were calculated, stratified by the year of study enrolment. For the attributable risk of changes in risk factors, risk factor treatment, and subclinical atherosclerosis on the incidence rates of recurrent MCVE, adjusted rate ratios were estimated with Poisson regression. 7216 patients had a median follow-up of 6.5years (IQR 3.4-9.9). The crude incidence of recurrent MCVE declined by 53% between 1996 and 2014 (from 3.68 to 1.73 events per 100person-years) and by 75% adjusted for age and sex. This improvement in vascular prognosis was 36% explained by changes in risk factors, medication use and subclinical atherosclerosis. The risk of recurrent MCVE in patients with clinically manifest vascular disease has strongly declined in the period between 1996 and 2014. This is only partly attributable to lower prevalence of risk factors, improved medication use and less subclinical atherosclerosis.

Highlights

The incidence of cardiovascular disease (CVD) has decreased in recent decades, and the 2010 Global Burden of Disease study [1] for Western countries has estimated a 20–50% decrease in the years of life lost due to premature mortality as a result of CVD between 1990 and 2010
It is unknown whether the long-term risk decreased for recurrent major cardiovascular events (MCVE) and for all-cause mortality, and to what extent this is caused by improved risk factor management or treatment of less advanced stages of atherosclerosis
Incidence in recurrent MCVE decreased in patients with coronary artery disease, cerebrovascular disease, peripheral artery disease and polyvascular disease, but remained the same for patients with abdominal aortic aneurysm (Fig. 2; Supplemental Table 2)

Summary

Introduction

The incidence of cardiovascular disease (CVD) has decreased in recent decades, and the 2010 Global Burden of Disease study [1] for Western countries has estimated a 20–50% decrease in the years of life lost due to premature mortality as a result of CVD between 1990 and 2010. The crude incidence of recurrent MCVE declined by 53% between 1996 and 2014 (from 3.68 to 1.73 events per 100 person-years) and by 75% adjusted for age and sex This improvement in vascular prognosis was 36% explained by changes in risk factors, medication use and subclinical atherosclerosis. Conclusion: The risk of recurrent MCVE in patients with clinically manifest vascular disease has strongly declined in the period between 1996 and 2014 This is only partly attributable to lower prevalence of risk factors, improved medication use and less subclinical atherosclerosis

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