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Premature atherosclerotic cardiovascular disease : challenges in risk assessment and prevention Vikulova, Diana
Abstract
Atherosclerotic cardiovascular disease (ASCVD), the leading cause of death globally, is largely preventable through the implementation of a healthy lifestyle or effective and safe treatments. The global effort to improve screening and prevention has led to a decrease in the overall incidence of ASCVD and its major component, coronary artery disease (CAD). However, rates of premature ASCVD have remained stagnant or even rising. There are different reasons hypothesized to contribute to this lack of improvement amongst younger people, including rise in the prevalence of cardiovascular risk factors, challenges in risk assessments, and younger patients being less likely to seek medical attention or participate in population-based prevention programs. The objectives of this work were to evaluate trends in cardiovascular health, barriers to the prevention of premature CAD, and a possible solution in the form of a family-based screening program. We used an observational cohort study design to analyze data collected in a) a prospective observational study of patients with premature CAD and their first-degree relatives (FDRs) and b) pan-provincial administrative data databases to investigate several questions essential for guiding preventive efforts. From this work several conclusions can be made. First, despite the high and further increasing burden of cardiovascular risk factors, very few patients with premature CAD received lipid lowering therapy (LLT) before presentation. Despite the nearly universal eligibility for lipid screening and frequent interactions with healthcare, half of these patients were not eligible for preventive LLT due to low or moderate calculated cardiovascular risk. Females, smokers, and rural residents were less likely to receive LLT and novel risk enhancers did not affect the likelihood of LLT initiation. Adherence to LLT was low in primary and secondary preventive settings leading to non-achievement of treatment targets. Finally, a screening program that includes clinical assessment and cardiovascular imaging of FDRs has a high diagnostic yield and impacts patient management. In summary, rates of premature cardiovascular disease are static, are associated with cardiovascular risk factors, and have a large familial component which can be addressed by screening first degree relatives of patients but adherence to therapy remains a challenge.
Item Metadata
Title |
Premature atherosclerotic cardiovascular disease : challenges in risk assessment and prevention
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Creator | |
Supervisor | |
Publisher |
University of British Columbia
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Date Issued |
2024
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Description |
Atherosclerotic cardiovascular disease (ASCVD), the leading cause of death globally, is largely preventable through the implementation of a healthy lifestyle or effective and safe treatments. The global effort to improve screening and prevention has led to a decrease in the overall incidence of ASCVD and its major component, coronary artery disease (CAD). However, rates of premature ASCVD have remained stagnant or even rising. There are different reasons hypothesized to contribute to this lack of improvement amongst younger people, including rise in the prevalence of cardiovascular risk factors, challenges in risk assessments, and younger patients being less likely to seek medical attention or participate in population-based prevention programs.
The objectives of this work were to evaluate trends in cardiovascular health, barriers to the prevention of premature CAD, and a possible solution in the form of a family-based screening program. We used an observational cohort study design to analyze data collected in a) a prospective observational study of patients with premature CAD and their first-degree relatives (FDRs) and b) pan-provincial administrative data databases to investigate several questions essential for guiding preventive efforts.
From this work several conclusions can be made. First, despite the high and further increasing burden of cardiovascular risk factors, very few patients with premature CAD received lipid lowering therapy (LLT) before presentation. Despite the nearly universal eligibility for lipid screening and frequent interactions with healthcare, half of these patients were not eligible for preventive LLT due to low or moderate calculated cardiovascular risk. Females, smokers, and rural residents were less likely to receive LLT and novel risk enhancers did not affect the likelihood of LLT initiation. Adherence to LLT was low in primary and secondary preventive settings leading to non-achievement of treatment targets. Finally, a screening program that includes clinical assessment and cardiovascular imaging of FDRs has a high diagnostic yield and impacts patient management.
In summary, rates of premature cardiovascular disease are static, are associated with cardiovascular risk factors, and have a large familial component which can be addressed by screening first degree relatives of patients but adherence to therapy remains a challenge.
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Genre | |
Type | |
Language |
eng
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Date Available |
2024-09-23
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Provider |
Vancouver : University of British Columbia Library
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Rights |
Attribution-NonCommercial-NoDerivatives 4.0 International
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DOI |
10.14288/1.0445429
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Degree | |
Program | |
Affiliation | |
Degree Grantor |
University of British Columbia
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Graduation Date |
2024-11
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Campus | |
Scholarly Level |
Graduate
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DSpace
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Rights
Attribution-NonCommercial-NoDerivatives 4.0 International