Risk and reoccurrence in Cardiovascular Disease

Friday, 15 May 2015

The term ‘secondary prevention’ is becoming ever-present in the cardiovascular disease (CVD) space and as I look ahead to this week’s ACC meeting in San Diego, CA, I expect it to be a hot topic of discussion. However, I wanted to take this opportunity to really drill down into some of the factors surrounding this growing issue. These include, access to effective and innovative therapies, patient adherence to treatment and ‘beyond the pill’ information and awareness. The thread that runs throughout all of this is a clear understanding of the disease and associated risks from a patient, carer and HCP perspective.

The growing CVD problem

First, taking a step back, let’s think about some of the facts surrounding CVD. In 2008 an estimated 17.3 million people died from CVD and this is predicted to reach 23.3 million by 2030.1 More people currently die from CVD than diabetes, chronic respiratory diseases and cancer combined.2 Inevitably this has serious implications for healthcare systems and patients.3-5

For healthcare systems, cardiovascular events are expensive, both in terms of direct medical costs at the time of the event and follow-up healthcare afterwards.3 For patients, a prior myocardial infarction (MI) markedly reduces their life expectancy and increases risk of cardiovascular mortality.4,5

The risk of reoccurrence

Many patients who experience an MI may have multiple vulnerable plaques within their vasculature.6 Each of these vulnerable plaques represents a risk; recurrent atherothrombotic events are as likely to originate from a new atherosclerotic plaque as from the initial culprit lesion.7

That ongoing risk has now been quantified by new evidence from APOLLO, a global real-world evidence programme that includes more than 150,000 post-MI patients. The APOLLO analyses found that from the overall study population, 18.3% of patients who were event-free for the first year after an MI went on to suffer an MI, stroke or CV death within the subsequent 3 years.8,9

Our focus is therefore on the high and persistent risk of recurrent antithrombotic events in many post-MI patients. By finding effective prevention strategies we hope to improve patient outcomes and ultimately limit the burden of CVD.

Building effective prevention strategies

At AstraZeneca, we firmly believe that addressing secondary prevention in CVD goes beyond solely providing effective treatments. Patients, carers and HCPs need access to the right data and information to navigate through what has to be described as a post-MI ‘journey’, with the goal of preventing a second event.

Again referring to the APOLLO data, we know that even after an event-free year, many post-MI patients remain at significant atherothrombotic risk. Therefore, an important step is to ensure that patients and healthcare providers have access to the most effective treatment. At this stage, we’re becoming more reliant upon personalised treatment options for patients and in some cases, looking to “rewind the clock” of damaged tissue through the use of cardiac regeneration.

We should also consider adherence to treatment and the psychology of the patient – to what extent do we naturally become complacent after a healthy year, even following such a life threatening experience? My colleague, Peter Smethurst, has also been blogging on this topic – read more here.

Patients also need support and information around any required changes to their lifestyle, which is often the case post-MI.10 You could in fact argue that the adherence issue is also central to continued improvements to diet and regular exercise and giving up smoking, both of which should play a crucial part in secondary prevention.

What’s next?

AstraZeneca is committed to improving cardiovascular outcomes by enhancing our understanding of patients at high risk of atherothrombotic events, due to their underlying disease. Innovative science and collaboration with external partners is helping pave the way to more effective and personalised treatment options, but the on-going support and awareness around that is also crucial.

References:

  1. World Health Organization. Cardiovascular diseases (CVDs). Available at www.who.int/mediacentre/factsheets/fs317/en/ [last accessed January 2015].
  2. World Health Organization. Global Status Report on noncommunicable diseases 2014. Available at http://www.who.int/nmh/publications/en/ [last accessed January 2015]
  3. Chapman RH et al. BMC Cardiovascular Disorders 2011;11:11.
  4. Peeters A et al. Eur Heart J 2002;23:458–466.
  5. Norgaard ML et al. Diabetologia 2010;53:1612–1619.
  6. Goldstein JA et al. N Engl J Med 2000;343:915–22.
  7. Stone GW et al. N Engl J Med 2011;364:226–235.
  8. Jernberg T et al. Eur Heart J 2015: doi:10.1093/eurheartj/ehu505.
  9. Rapsomaniki E et al. ESC Late Breaking Registry abstract 2014: In press.
  10. Halcox J et al. Br J Cardiol 2011;18;e1-e5