Cardiovascular Risk Factor Control and Lifestyle Factors in Young to Middle-Aged Adults with Newly Diagnosed Obstructive Coronary Artery Disease

© 2019 S. Karger AG, Basel. Background: While progress in the prevention of cardiovascular disease (CVD) has been noted over the past several decades, there are still those who develop CVD earlier in life than others. Objective: We investigated traditional and lifestyle CVD risk factors in young to middle-aged patients compared to older ones with obstructive coronary artery disease (CAD). Methods: A retrospective analysis of patients with a new diagnosis of obstructive CAD undergoing coronary intervention was performed. Young to middle-aged patients were defined as those in the youngest quartile (n = 281, mean age 50 ± 6 years, 81% male) compared to the other three older quartiles combined (n = 799, mean age 69 ± 7.5 years, 71% male). Obstructive CAD was determined by angiography. Results: Young to middle-aged patients compared to older ones were more likely to be male (p \u3c 0.01), smokers (21 vs. 9%, p \u3c 0.001), and have a higher body mass index (31 ± 6 vs. 29 ± 6 kg/m2, p \u3c 0.001). Younger patients were less likely to eat fruits, vegetables, and fish and had fewer controlled CVD risk factors (2.7 ± 1.2 vs. 3.0 ± 1.0, p \u3c 0.001). Compared to older patients, higher levels of psychological stress (aOR 1.6, 95% CI 1.1-2.4), financial stress (aOR 1.8, 95% CI 1.3-2.5), and low functional capacity (aOR 3.3, 95% CI 2.4-4.5) were noted in the young to middle-aged population as well. Conclusion: Lifestyle in addition to traditional CVD risk factors should be taken into account when evaluating risk for development of CVD in a younger population

Statin utilization and cardiovascular outcomes in a real-world primary prevention cohort of older adults

Background: Statins are a cost-effective therapy for prevention of atherosclerotic cardiovascular disease (ASCVD). Guidelines on statins for primary prevention are unclear for older adults (\u3e75 years).Objective: Investigate statin utility in older adults without ASCVD events, by risk stratifying in a large healthcare network.Methods: We included 8,114 older adults, without CAD, PVD or ischemic stroke. Statin utilization based on ACC/AHA 10-year ASCVD risk calculation, was evaluated in intermediate (7.5%-19.9%) and high-risk patients (≥ 20%); and categorized using low and \u27moderate or high\u27 intensity statins with a follow up period of ∼7 years. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization. Data was adjusted for competing risk using Elixhauser Comorbidity Index.Results: Compared with those on moderate or high intensity statins, high-risk older patients not on any statin had a significantly increased risk of MI [HR 1.51 (1.17-1.95); p\u3c0.01], stroke [HR 1.47 (1.14-1.90); p\u3c0.01] and all-cause mortality [HR 1.37 (1.19-1.58); p\u3c0.001] in models adjusted for Elixhauser Comorbidity Index. When comparing the no statin group versus the moderate or high intensity statin group in the intermediate risk cohort, although a trend for increased risk was seen, it did not meet statistical significance thresholds for MI, stroke or all-cause mortality.Conclusion: Lack of statin use was associated with increased cardiovascular events and mortality in high-risk older adults. Given the benefits appreciated, statin use may need to be strongly considered for primary ASCVD prevention among high-risk older adults. Future studies will assess the risk-benefit ratio of statin intervention in older adults

Leveraging clinical decision support tools to improve guideline-directed medical therapy in patients with atherosclerotic cardiovascular disease at hospital discharge.

BACKGROUND:Guidelines recommend moderate to high-intensity statins and antithrombotic agents in patients with atherosclerotic cardiovascular disease (ASCVD). However, guideline-directed medical therapy (GDMT) remains suboptimal. METHODS:In this quality initiative, best practice alerts (BPA) in the electronic health record (EHR) were utilized to alert providers to prescribe to GDMT upon hospital discharge in ASCVD patients. Rates of GDMT were compared for 5 months pre- and post-BPA implementation. Multivariable regression was used to identify predictors of GDMT. RESULTS:In 5985 pre- and 5568 post-BPA patients, the average age was 69.1 ± 12.8 years and 58.5% were male. There was a 4.0% increase in statin use from 67.3% to 71.3% and a 3.1% increase in antithrombotic use from 75.3% to 78.4% in the post-BPA cohort. CONCLUSIONS:This simple EHR-based initiative was associated with a modest increase in ASCVD patients being discharged on GDMT. Leveraging clinical decision support tools provides an opportunity to influence provider behavior and improve care for ASCVD patients, and warrants further investigation

CARDIOVASCULAR RISK FACTORS PROFILE OF YOUNG PATIENTS WITH CORONARY ARTERY DISEASE: THE YOUNG HEART STUDY

Therapeutic Area: ASCVD/CVD Risk Factors Background: The increasing trends in acute myocardial infarction among the young suggest potential increases in specific cardiovascular risk profiles. As traditional risk calculators underperform in the younger groups, early identification of specific risk factors and therapeutic management are critical. We sought to evaluate traditional and non-traditional risk factors in this population, rates of guideline-directed therapy and the impact of a risk reduction program on residual risk. We report the baseline characteristics of this population. Methods: We enrolled 60 patients, ≤59 years old, with angiographically proven coronary artery plaque and at least two uncontrolled risk factors: BMI>25 kg/m2, A1C >7% in diabetic patients and >5.6 in those without, systolic blood pressure >130 mmHg, LDL>70 mg/dL, smoking. These cross-sectional, baseline data were collected through structured questionnaires on socio-demographic and lifestyle factors, blood samples, and angiographic data. Continuous variables were analyzed using median and quartiles (Q1-Q3) and the Wilcoxon rank-sum test. Categorical variables were analyzed using frequency (percentage) and the Chi-Square or Fisher's Exact test. Results: The median age (Q1-Q3) was 51 (45-55), 70% were male, 46.7% were white. 76.7% had hypertension, 91.7% had hyperlipidemia, 36.7% had diabetes, 28.3% had prediabetes, 88.3% had obstructive CAD and 38.3% had a history of myocardial infarction. The median (IQR) BMI was 28.8 (26.8-33.8), SBP 129 mmHg (121-138), LDL 69 mg/dL (53-96), Lp (a) 57.8 nmol/L (19.8-129.6), HbA1c 6.1% (5.5-7.5), hsCRP 1.25 mg/L (0.60-4.45), TMAO 2.95 µmol/L (1.9-5.2).Uncontrolled risk factors were prevalent: gender-specific waist circumference goals were unmet in 54.6%, metabolic syndrome in 60%, 47.5% had an LDL >=70, 42.4% had Lp(a) >=75nmol/L, 41.7% had hsCRP >=2, 28.3% had suboptimal TMAO, 68.2% of diabetics had an HbA1c >=7% and 26.7% were either current smokers or had quit smoking within the last year. Only 83% of the patients were on antiplatelet therapy, and 70% were on a guideline dose of statin. Conclusion: These data from the Young Heart study suggest a high prevalence of cardiometabolic disease related to obesity/overweight and abnormal glucometabolic state. However, entry criteria may also dictate these findings. Interestingly, elevated CRP, elevated TMAO and Lp(a) were high and may warrant future investigation