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Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary heart disease: baseline results from the STABILITY study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
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2013 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 20, no 4, 678-685 p.Article in journal (Refereed) Published
Abstract [en]

Aim:

There is limited contemporary data on achievement of risk factor goals for secondary prevention of cardiovascular (CV) disease from countries in many regions of the world. This report describes the global and regional prevalence of CV risk factors and use of preventive medications at baseline in participants in the ongoing STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial.

Methods and Results:

Detailed individual data on CV risk factors were obtained before randomization in 15,828 patients with chronic coronary heart disease (CHD) from 39 countries on five continents. Subjects had a history of myocardial infarction, prior coronary revascularization, or multi-vessel CHD without revascularization and at least one additional CV risk factor. The majority were taking a statin (97%), antiplatelet therapy (96%), beta-blocker (79%), or angiotensin converting enzyme inhibitor/angiotensin receptor blocker (77%). However, a large proportion of patients did not achieve guideline-recommended targets. For instance, in 29% low-density lipoprotein (LDL) cholesterol was >2.5 mmol/l and in 46% blood pressure was ≥140/90 mmHg or ≥130/80 mmHg in those with diabetes or renal impairment. The body mass index was >30 kg/m2 in 36%, waist circumference ≥102 cm for men or ≥88 cm for women in 54%, and 18% were smoking. Regional differences in risk factor prevalence and target achievement were observed and were more marked for LDL cholesterol and obesity.

Conclusion:

The prevalence of modifiable CV risk factors was generally high in the STABILITY population. Although, most patients were receiving evidence-based secondary preventive therapy many subjects from all regions did not reach recommended secondary prevention goals.

Place, publisher, year, edition, pages
2013. Vol. 20, no 4, 678-685 p.
Keyword [en]
acute coronary syndromes, anticoagulants, apixaban, atrial fibrillation, dabigatran etexilate, edoxaban, rivaroxaban, vitamin K antagonists
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-190608DOI: 10.1177/2047487312444995ISI: 000321671400017PubMedID: 22496275OAI: oai:DiVA.org:uu-190608DiVA: diva2:583820
Available from: 2013-01-08 Created: 2013-01-08 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Prevalence and Prognostic Impact of Periodontal Disease and Conventional Risk Factors in Patients with Stable Coronary Heart Disease
Open this publication in new window or tab >>Prevalence and Prognostic Impact of Periodontal Disease and Conventional Risk Factors in Patients with Stable Coronary Heart Disease
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to assess the prevalence and management of established cardiovascular (CV) risk factors and the prevalence and influence of self-reported markers (number of teeth and frequency of gum bleeding) of periodontal disease (PD), a less explored CV risk factor, in patients with stable chronic coronary heart disease (CHD).

We studied patients from the global STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial (n=15,828), in which patients with stable chronic CHD were randomized to either darapladib or placebo. Our studies were performed using descriptive statistics and multivariable linear, logistic and Cox regression models.

The use of secondary preventive medications was generally high across the whole study population. Despite this, CV risk factors were highly prevalent, including obesity, hypertension and hypercholesterolemia. Achievement of guideline-recommended treatment targets was lacking and little improvement was seen throughout the study duration.

Approximately 40% of patients reported having <15 remaining teeth and 25% reported gum bleeding. More tooth loss was associated with a greater CV risk factor burden after adjustment, while the associations for gum bleeding were less evident.

After multivariable adjustment for CV risk factors and socioeconomic status, more tooth loss was associated with an increased risk of major adverse CV events (a composite of CV death, myocardial infarction and stroke), CV mortality, all-cause mortality and fatal or non-fatal stroke.

We found associations between a higher degree of tooth loss and elevated levels of several prognostic biomarkers known to reflect various pathophysiological mechanisms involved in CV morbidity and mortality. Most biomarkers had little attenuating effect on the relationship between tooth loss and outcomes in a multivariable model.

In conclusion, we found an inadequate CV risk factor control despite a high use of evidence-based pharmacological therapies, likely to explain some of the excess risk in CHD patients. Further, we demonstrated a high prevalence of PD markers, tooth loss in particular, that were associated with a wide range of established CV risk factors, prognostic biomarkers and outcomes. Collectively, these findings indicate that tooth loss may be a significant risk factor among patients with stable chronic CHD.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1129
Keyword
Coronary heart disease, Secondary prevention, Prevention, Periodontal Disease, Tooth loss, Risk prediction, Risk factors, Myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-260564 (URN)978-91-554-9308-0 (ISBN)
Public defence
2015-10-09, Konferensvinge, Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-16 Created: 2015-08-20 Last updated: 2015-10-01

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Vedin, OlaHagström, EmilWallentin, LarsHeld, Claes

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