Pharmacological Primary Cardiovascular Prevention and Subclinical Atherosclerosis in Men: Evidence from the Aragon Workers' Health Study.

Isabel Aguilar-Palacio,Belén Moreno-Franco,Sara Malo,Luisa Compés,Lina Maldonado,Estibaliz Jarauta,Mª José Rabanaque,José Antonio Casasnovas

doi:10.3390/jcm10050945

Abstract

The objective of this study is to describe the profile of primary preventive treatment for cardiovascular disease in adult males and to analyze the association between treatment profile and subclinical atherosclerosis. We selected male workers who had undergone ultrasound imaging and had no previous history of cardiovascular disease (n = 2138). Data on the consumption of primary cardiovascular drugs from the previous year were obtained. We performed bivariate analyses to compare patient characteristics according to cardiovascular treatment and the presence of subclinical atherosclerosis, and logistic regression models to explore the association between these two variables. Among participants with no personal history of cardiovascular disease, subclinical atherosclerosis was present in 77.7% and 31.2% had received some form of preventive treatment. Of those who received no preventive treatment, 73.6% had subclinical atherosclerosis. Cardiovascular preventive treatment was associated only with CACS > 0 (odds ratio (OR), 1.37; 95% confidence interval (95% CI), 1.06–1.78). Statin treatment was associated with a greater risk of any type of subclinical atherosclerosis (OR, 1.73) and with CACS > 0 (OR, 1.72). Subclinical atherosclerosis existed in almost 75% of men who had no personal history of cardiovascular disease and had not received preventive treatment for cardiovascular disease.

Highlights

Cardiovascular disease is the main cause of morbidity and mortality in Spain and in developed countries [1]
The presence of cardiovascular risk factors increased in parallel with calcium score (CACS) values, with significant differences between CACS groups for all cardiovascular risk factors analyzed (p < 0.05)
Subclinical atherosclerosis was present in 73.6% of workers who had received no preventive treatment for cardiovascular disease, and in 90% of participants who had been treated with statins

Summary

Introduction

Cardiovascular disease is the main cause of morbidity and mortality in Spain and in developed countries [1]. Primary cardiovascular prevention strategies are based on the combination of a healthy lifestyle [2] and the use of preventive cardiovascular medication [3,4]. The use of hypotensive, lipid-lowering, antidiabetic, and antiplatelet drugs is effective in controlling cardiovascular risk factors and preventing cardiovascular disease [5]. Atherosclerosis is typically a slow process that develops over several years before the appearance of clinical signs [6,7]. Few evidence-based studies have examined the correlation between subclinical atherosclerosis and subsequent development of cardiovascular disease. It seems plausible that cardiovascular medication could provide the greatest benefits if initiated during the early stages of subclinical arterial disease [9]

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