Contemporary outcomes studies to identify and mitigate the risk in patients with premature cardiovascular disease

ABSTRACT

Introduction: As the leading cause of death globally, atherosclerotic cardiovascular disease (ASCVD) carries substantial cost burden for patients and the healthcare system. Although overall mortality rates have recently decreased in certain groups, such improvements were not observed in younger ASCVD patients. This review focuses on premature ASCVD and explores risk factors affecting this younger cohort of patients.

Areas covered: We performed a literature search for studies assessing premature ASCVD, defined as ischemic heart disease (IHD), ischemic cerebrovascular disease (ICVD), or peripheral arterial disease (PAD) occurring in men aged ≤55 years and women aged ≤65 years.

Expert opinion: Premature ASCVD patients often suffer from multiple traditional cardiovascular risk factors, in addition to genetic predisposition or unique non-traditional features, such as substance abuse and chronic inflammatory conditions. Consequently, identification and management of at-risk individuals pose a great challenge for clinicians. In this younger patient cohort, control of traditional risk factors, optimization of primary and secondary prevention therapies, and lifestyle modifications are imperative to saving potential disability-adjusted life years and other costs associated with premature atherosclerosis.

KEYWORDS:

• Aspirin
• atherosclerosis
• atherosclerotic cardiovascular disease
• Cardiovascular disease
• coronary Disease
• premature ASCVD
• secondary prevention
• statins

Article highlights

• Recent improvements in overall cardiovascular disease mortality have masked decreased gains in premature atherosclerotic cardiovascular disease (ASCVD) outcomes.

• Predisposition to accelerated atherosclerosis includes genetic factors, traditional cardiovascular risk factors, and unique non-traditional features, such as substance abuse, chronic inflammatory conditions, human immunodeficiency virus, and pregnancy-related disorders.

• Suboptimal secondary prevention in premature ASCVD patients has been attributed to therapeutic inertia, involving clinician, patient, and healthcare system factors.

Declaration of interest

SSV declares an honorarium for the American College of Cardiology (Associate Editor of Innovation, acc.org). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosure

Peer reviewers in this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

The authors declare funding from: the American Diabetes Association, 1–14-CE-44 American Heart Association, 14BGIA20460366 Health Services Research and Development, CIN13–413, IIR 16–072