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More recently, several additional factors have been associated with an increased risk of cardiovascular (CV) disease. These include:3
Although atherosclerosis is a systemic disease with overlapping risk factors, the relative importance of different risk factors appears to be subtly different in patients with different manifestations of the disease.4,5 However, modifying these risk factors, both through lifestyle modifications and medication targeted at controlling cholesterol, blood pressure and diabetes, is a cornerstone of prevention in patients with atherosclerotic disease.3,6,7
The risk of CV events is heavily dependent on the extent of atherosclerosis. In the REACH registry, the 1-year risk of CV death, stroke or myocardial infarction (MI) was 7.1% in patients with polyvascular disease (two or more of coronary artery disease, peripheral artery disease or cerebrovascular disease) and 4.1% in patients with atherosclerotic disease in a single bed; the highest risk (9.2%) was in patients with all three conditions.8
Multiple disease locations increase the 1-year risk of CV events.
1-year risk of CV death, stroke or MI dependent on the number of symptomatic disease locations
Another analysis of the REACH registry looked at specific risk factors for CV death, stroke or MI. As well as polyvascular disease, significant risk factors were heart failure, prior ischaemic events – with a greater risk for events within 1 year – and diabetes were the most important risk factors.9
Peripherial Artery Disease: causes and consequences
Professor Gabriel Steg explains how patient characteristics affect the risk of CV events.
Risk of CV events in patient registries
Although the majority of patients with stable atherosclerotic disease stand to benefit from vascular protection, patients with a high baseline risk of ischaemic events stand to benefit the most.10
In the COMPASS study, the high risk of cardiovascular (CV) death, stroke or myocardial infarction in patients with coronary artery disease (CAD) and diabetes, CAD and renal impairment (estimated glomerular filtration rate 15–60 ml/min), CAD and prior myocardial infarction and those with both CAD and peripheral artery disease meant that these patients experienced the highest absolute reductions in the risk of events.10
Furthermore, because the absolute increase in the risk of bleeding associated with the COMPASS regimen versus an antiplatelet alone was consistent in patients with and without these risk factors, the overall benefit–risk ratio was high.10