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28th March 2022
Both recurrent cardiovascular events (CVs) and death have been found to occur mainly within the first 6 months after the primary event according to a real-world analysis of registry data by researchers from the Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Cardiovascular disease (CVD) is the leading cause of deaths and disability worldwide and the World Health Organization estimates that CVD is response for 17.9 million lives lost each year. Despite falls in the mortality rates of CVD across Europe, more than 4 million people continue to die each year from the disease, with more than 1.4 million dying prematurely, before the age of 75 years. Moreover, recurrent cardiovascular events are not uncommon and one study among patients with acute coronary syndrome (ACS) found that 9% of patients experienced a recurrent cardiovascular event in the post-ACS setting during a median follow-up of 1 year.
But which factors are associated with an increased risk of recurrent CVs and death among secondary prevention patients, and when are these most likely to occur, was the subject of the present, registry-based study by the Finnish team. They undertook a retrospective analysis, using hospital data, of adult patients who experienced their first atherosclerotic cardiovascular disease (ACVD) event between 2012 and 2016. The team defined an ACVD event as a myocardial infraction (MI), unstable angina (UA), ischaemic stroke (IS) or a transient ischaemic attack (TIA). In addition, a recurrent event as a new diagnosis of the same condition as the index event, a minimum of 7 days from the first episode and all mortality data were retrieved from the hospital database.
Characteristics of cardiovascular events
In total, 48,405 adults with a median age of 71.5 years (53.8% male) were followed for a mean of 2.2 years. Among the whole cohort, 40.1% had an IS, 29.4% and MI and 19.5% a TIA as their index event. Co-morbidities included hypertension (12.9%) and diabetes (16.7%).
Among the current CVs, death was the most common subsequent event (61.5%) and a recurrent event occurred in 38.5% of patients. It was also clear that the category of subsequent events mirrored the initial episode (i.e., a second MI after the first). The cardiovascular events rate also increased after each recurrence. For instance, the combined recurrent/deaths events rate increased from 13.4 per 100 patient-years for the first event, to 36.8 for the third recurrent event.
In terms of the time to the recurrent event, after 6 months, 14% of patients had suffered any recurrent event or had died. This stabilised over time, so that after 5 years, 41.5% of patients had either suffered an event or died.
When considering the risk factors most significantly associated with risk of subsequent cardiovascular events, this increased with each increased year of age (hazard ratio, HR = 1.02 (95% CI 1.02 – 1.02, p < 0.001). Other significant factors included the presence of diabetes (HR = 1.21, 95% CI 1.11 – 1.32, p < 0.001) and hypertension (HR = 1.18). The risk of death was also significantly associated with male gender (HR = 1.18) but the only co-morbidity was diabetes (HR = 1.63, 95% CI 1.53 – 1.73, p < 0.001). Moreover, male gender and diabetes were also significantly associated with the risk of recurrency to death.
The authors concluded that given their findings, an acute CV event should be promptly followed by secondary prevention measures.
Toppila I et al. Cardiovascular event rate and death in high‐risk secondary prevention patient cohort in Finland: A registry study Clin Cardiol 2022