Risk factors in adults with cardiovascular disease worsen over time despite advances in secondary prevention, study finds


In an analysis of medical information from more than 6,000 American adults with a history of cardiovascular disease (CVD), Johns Hopkins Medicine researchers conclude that CVD risk “profiles” in secondary prevention have not improved over the of the last two decades.

Secondary prevention refers to the prevention of recurrent cardiovascular events such as heart attacks or strokes in people who already have cardiovascular disease. Despite recent advances in safe and effective therapies reflected in guideline recommendations, trends in CVD risk profiles in adults with the disease were less than ideal from 1999 to 2018. An ideal risk profile is based on targets that health professionals agree to consider desirable. The study was published July 4 in the Journal of the American College of Cardiology.

The risk factor profiles analyzed included blood sugar, blood pressure, cholesterol, body mass index, smoking, physical activity and diet. All factors showed worsening or unchanged trend except cholesterol, which showed modest improvement. However, only 30% of adults with CVD had an ideal cholesterol profile in 2015-2018.

“We’re not really moving the needle on these risk factors, and that leaves a lot of people at risk for recurrent events,” says study corresponding author Seth S. Martin, MD, MHS, associate professor of Medicine in the Division of Cardiology at Johns Hopkins University School of Medicine. He called for “rethinking preventive care”.

“Our numbers are disappointing and alarming,” says study co-first author Yumin Gao, Sc.M., a premedicine student and biostatistician at the Johns Hopkins Digital Health Innovation Lab.

“Our study shows that there remains a critical need and opportunity to effectively translate established guidelines into patient care,” says study co-first author Nino Isakadze, MD, MHS, Cardiac Electrophysiology Fellow at the hospital. Johns Hopkins. “We need to innovate how to reach diverse patient groups and improve secondary prevention for all people with cardiovascular disease.”

The study also found persistent racial and ethnic disparities in heart health. Isakadze says access to health care, patient education, and affordability of medications are likely the main drivers of the disparities seen in high-risk populations.

Researchers assessed trends in cardiovascular risk factor profiles in 6,335 American adults from data collected by the National Health and Nutrition Survey from 1999 to 2018. About 50% of participants were male, with a average age of 64.5 years, and 13% of them were black, 10% were Hispanic and 3% were Asian.

Specifically, the new analysis showed:

  • Blood glucose trends in the ideal profile fell from 59% in 1999-2002 to 52% in 2015-2018, with the worst profiles observed among Asian adults.
  • Arterial pressure ideal levels dropped after 2010, with 49% having an ideal profile in 2015-2018, with the worst profiles seen among black adults.
  • Cholesterol ideal profiles showed an overall increase from 7% in 1999-2002 to 30% in 2015-2018—likely due to widespread use of lipid-lowering drugs—but with a worsening trend in Hispanic adults.
  • Body mass index (BMI), a measure of overweight, saw an overall ideal profile deteriorate from 24% in 1999-2002 to 18% in 2015-2018.
  • Smoking, Physical Activity and Dietary Profiles showed no significant change over time overall, but the analysis revealed a worsening tendency to smoke in black adults and an improvement in the tendency to physical activity in Hispanic adults.

The researchers cautioned that their study had some caveats, including that history of CVD was self-reported and so they may have missed identifying some people with the disease.

Martin directs the Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH) and Digital Health Lab. He works with a multidisciplinary team to find creative technology-driven solutions to help improve cardiovascular disease prevention. He points out that things like telemedicine and devices like smartphone apps known as digital health interventions will help engage and motivate patients with a history of CVD to live healthier lifestyles for the heart.

“We’re really good at inpatient care, but our healthcare system needs to improve optimally to provide preventative care as patients go through the transition from hospital to home and then long-term chronic care. term,” says Martin. “This is where we believe technology can help fill the gaps seen with traditional episodic care, as it could be something that lives in the hands and wrists of our patients, allowing for a deeper understanding of their condition and facilitating more ongoing and active engagement in preventive care outside the doctor’s office at home and in the community.”

Martin adds that it cannot depend solely on technology. He and his colleagues believe it will take the collaborative creativity of multiple stakeholders to continue efforts to redesign health systems and reimbursement, and healthcare professionals around the world to develop new approaches to care delivery. health and public health education to eliminate racial and ethnic problems. disparities and improve the implementation of the recommendations of the prevention guidelines.

Other researchers include Qicong Sheng, Jie Ding, and Zane MacFarlane of Johns Hopkins University School of Medicine; Yingying Sang, Elizabeth Selvin, and Kunihiro Matsushita of the Johns Hopkins Bloomberg School of Public Health; Eamon Duffy of Columbia University; and Scott McClure of Shenandoah University.

Martin is one of the founders and owns shares of Corrie Health; received hardware support from Apple and iHealth; has received funding from the Maryland Innovation Initiative, Wallace H. Coulter Translational Research Partnership, Louis B. Thalheimer Fund, Johns Hopkins Individualized Health Initiative, American Heart Association, Patient-Centered Outcomes Research Institute, National Institutes of Health, the David and June Trone Family Foundation, the Pollin Digital Innovation Fund, the PJ Schafer Cardiovascular Research Fund, Sandra and Larry Small, CASCADE FH, Google and Amgen; and is a co-inventor of a low density lipoprotein cholesterol estimation system. All other authors reported no conflict of interest regarding the content of the study.


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