Cardiovascular disease: Impact of COVID-19 on patient outcomes

PME: Cardiovascular disease (CVD) remains the leading cause of death worldwide. How prevalent is CVD in the UK?
Joanne Hoody (JF): Cardiovascular disease continues to be the leading cause of death in the UK. According to the latest data, up to 7.6 million people are living with her CVD in the UK (figures are for 2019, before the COVID-19 pandemic). Although CVD prevalence continues to increase, trends in CVD mortality are improving. Nonetheless, the UK recorded more than 160,000 deaths from CVD in 2019, accounting for about 27% of all recorded deaths. In 2019, the age-adjusted CVD mortality rate was 255 per 100,000.

PME: How has the COVID-19 pandemic impacted CVD patient care?
JF: The relationship between CVD and COVID-19 is highly complex. Patients with CVD had a significantly higher risk of severe illness and death from COVID-19. Though alarming in itself, the pandemic has disrupted care, early detection, and management of her CVD patients. Add to this the behavioral changes due to isolation (such as weight gain, excessive alcohol consumption, and sedentary behavior), and you have a perfect storm of poor prognosis for heart and blood vessel problems. Since the novel coronavirus disease (COVID-19), CVD morbidity and mortality have increased worldwide.

PME: What is the role of statins and non-statins in improving long-term CVD outcomes?
JF: It is clear that one of the largest, if not the largest, modifiable risk factors contributing to the development of atherosclerotic heart disease (ASCVD) is elevated LDL-C. If you start there, it’s no wonder that lipid-lowering therapy has played an important role in improving long-term outcomes in her patients with established ASCVD. Data from the 2010 Cholesterol Treatment Trial List (CTT) Collaboration suggest a 1 mmol/L reduction in LDL. -C reduces the risk of major vascular events from statins by 22%. Several select therapies have also proven beneficial in preventing first CV events (also called primary prevention) in patients at high risk of ASCVD. Statins have proven to be highly beneficial for patients, but statin intolerance, inability to meet LDL-C targets, and the challenge of pursuing even lower LDL-C targets based on evidence-based A need has been established for new treatment options to add to those of Serves as an alternative to statin therapy or when statin use is not possible.

PME: How important is the improvement in patient outcomes provided by statins?
JF: At least in the UK, the rapid rise in lipid-lowering drugs is almost entirely driven by increased use of statins. In 2019, 95.8% of all locally prescribed lipid-lowering strategies were statins, up from 93.1% in 2009. Declining prevalence (2009: 3.5-4.4%, 2019: 3.1-3.9%, based on UK country) The increase in CVD can be attributed in part directly to the large increase in lipid control strategies There is a nature.

PME: How have the positive results from the clinical trial impacted CVD care?
JF: Clinical trials are having a major impact on how ASCVD patients are treated. As treatments and trials have evolved over time, so has our understanding of the role of LDL-C lowering on clinical outcomes relative to achieved LDL-C levels. When researchers evaluated multiple large clinical trials involving all types of lipid-lowering therapy, there was a linear relationship indicating that lower LDL-C levels were associated with a lower risk of vascular events. Therefore, I anticipate that a combined approach to achieving lower LDL-C levels earlier in patient treatment will become the norm.

PME: How has research into drug treatment of CVD progressed over the past decade?
JF: CVD pharmacotherapy research has moved from a “multiple treatment” such as quantitative blood pressure lowering and LDL-C lowering to also focus on “challenging outcomes to treat patients”. Endpoints used in CVD trials have moved to disease-specific endpoints (e.g., non-fatal stroke, non-fatal MI, hospitalization for heart failure) rather than broad endpoints (e.g., all-cause mortality). ing. The change in focus of the trial’s primary endpoint successfully translates to understanding the cost-effectiveness of treatments and the large patient population needed to power all-cause mortality primary endpoint trials. It can also demonstrate efficacy and safety results for CVD drug candidates without the need.

PME: What steps can people take to minimize their risk of developing CVD?
JF: In 2019, 79.2% of all CVD deaths in the UK were due to factors such as hypertension, smoking and dietary risks. These are known in medicine as treatable or modifiable risk factors, in other words, something can be done to remove (modify) these risks from the equation. Additional risks include high or abnormal cholesterol levels, irregular heartbeat, high blood sugar levels, diabetes, chronic kidney disease, inadequate physical activity, obesity, and excessive alcohol consumption. In the UK, therapeutic interventions such as sustained reductions in smoking, improved treatment and control of hypertension, and widespread use of statins to lower circulating cholesterol levels may all contribute to preventing the development of CVD. People cannot change their biological sex, age, or genetic makeup, but they should maintain a healthy lifestyle and receive treatment as directed by their health care provider to minimize risks that are within our control. should be encouraged.

Reference materials are available upon request.