Burden of atherosclerosis
How many patients are affected by atherosclerosis?
It is impossible to know exactly how many people are affected by atherosclerosis, because it develops over many years and is often asymptomatic until a patient has an acute event.1,2
Although the number of patients affected by atherosclerosis cannot be determined exactly, it has been shown that vascular disease is the most frequent cause of death in the world with over 25% of deaths in 2016 attributed to coronary artery disease (CAD) or stroke.3
Furthermore, as the global population ages, the burden of cardiovascular diseases such as atherosclerosis is expected to increase. For example, in the US, the number of people aged 65 years and over is expected to double between 2010 and 2040; correspondingly, over the same time frame, the number of deaths from CAD is expected to increase from around 400,000 to around 600,000 per year.4
Mortality from coronary artery disease will increase as the population ages.
Effect of increasing age on mortality related to coronary artery disease
What are the major outcomes associated with atherosclerosis?
As would be expected, the manifestation of the acute event depends on the organs and tissues affected by the ischaemia.
Occlusion of coronary arteries leads to angina or myocardial infarction (MI); cerebral ischaemia manifests as a stroke or transient ischaemic attack; and atherothrombosis in the lower limbs leads to claudication, rest pain, gangrene and necrosis.5-7
Patients with manifest atherosclerosis in one arterial bed are likely to have diffuse disease.6 In practice, this means that, for example, patients with a diagnosis of coronary artery disease often also have peripheral artery disease, and vice versa. Patients with polyvascular disease have an increased risk of MI, stroke and cardiovascular death compared with patients with vascular disease in a single location.8
Atherosclerosis in the coronary arteries can have severe consequences.
Explanation of the causes and consequences of coronary artery disease
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Atherosclerosis in the peripheral arteries can have severe consequences.
Explanation of the causes and consequences of peripheral artery disease
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What is the risk of cardiovascular (CV) events in well-managed patients?
Real-world data from 38,602 patients with documented coronary artery disease (CAD) in the multinational REACH registry show that approximately 5% of patients with CAD experienced a major CV event at 1 year follow-up and 12% of patients experienced one at 3 years follow-up, respectively, despite the majority of patients receiving guideline-recommended secondary prevention strategies.9,10
More up-to-date data are provided by the COMPASS trial, which recruited 27,395 patients with stable atherosclerotic disease. These patients were receiving a high standard of risk factor management, with approximately 90% receiving a lipid-lowering agent and over 70% receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. However, among those patients in the comparator arm, the incidence of myocardial infarction, stroke or CV death remained high, at 5.4% over a mean follow-up of 23 months.11
Risk of CV events in well-managed patients with stable atherosclerotic disease.
Risk of CV events despite the use of guideline-recommended therapies
References
- Insull W, Jr. The pathology of atherosclerosis: plaque development and plaque responses to medical treatment. Am J Med 2009;122:S3–S14. Return to content
- Alsheikh-Ali AA, Kitsios GD, Balk EM et al. The vulnerable atherosclerotic plaque: scope of the literature. Ann Intern Med 2010;153:387–395. Return to content
- World Health Organization. The top 10 causes of death. 2018. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/ [accessed 3 March 2020]. World Health Organization. The top 10 causes of death. 2018. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/ [accessed 3 March 2020]. Return to content
- Odden MC, Coxson PG, Moran A et al. The impact of the aging population on coronary heart disease in the United States. Am J Med 2011;124:827–833.e825. Return to content
- Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res 2014;114:1852–1866. Return to content
- Drouet L. Atherothrombosis as a systemic disease. Cerebrovasc Dis 2002;13 Suppl 1:1–6. Return to content
- Norgren L, Hiatt WR, Dormandy JA et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45:S5–S67. Return to content
- Steg PG, Bhatt DL, Wilson PW et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 2007;297:1197–1206. Return to content
- Bhatt DL, Steg PG, Ohman EM et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006;295:180–189. Return to content
- Alberts MJ, Bhatt DL, Mas JL et al. Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry. Eur Heart J 2009;30:2318–2326. Return to content
- Eikelboom JW, Connolly SJ, Bosch J et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 2017;377:1319–1330. Return to content
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Updated date 10/10/2022
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