The Challenges of Contemporary Atherosclerotic Cardiovascular Disease Management DOI Creative Commons
Beth L. Abramson,

Jean Grégoire

Canadian Journal of Cardiology, Journal Year: 2024, Volume and Issue: 40(8), P. S1 - S3

Published: Aug. 1, 2024

In the wake of COVID-19 pandemic, we must refocus our attention to another insidious threat: cardiovascular disease (CVD). The persistent and devastating effects CVD on population health is alarming underappreciated, it time for a Canadian coordinated response.1Ruel M. Tackling other pandemic: rise in diseases.Can J Cardiol. 2022; 38: 849-851Google Scholar A group 20 experts have come together develop this supplement with aim identifying care gaps systemic issues that undermine ability reduce risk effectively their patients atherosclerotic (ASCVD) explore potential solutions toward improved outcomes. mortality rate from major nearly halved between 2001 2021, decline can partially be credited introduction pharmacotherapies such as statins angiotensin converting enzyme inhibitors.2Statistics CanadaTable 13-10-0392-01: Deaths Age-Specific Mortality Rates, by Selected Grouped Causes.https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039201Date accessed: October 27, 2023Google However, downtrend has been predominantly observed geriatric population, specifically those aged 80 years older.2Statistics contrast, rates exhibit plateauing curve among younger cohorts, negligible declines documented within 35- 55-year-old demographic. Furthermore, data suggest pronounced burden attributed high low-density lipoprotein cholesterol (LDL-C) patient (aged 20-64 years), compared older age groups. fact, LDL-C responsible 42.0% deaths 20- 64-year-old group, which 1.7-fold than 65 years.3The Conference Board CanadaData First Report: Atherosclerotic Cardiovascular Disease Canada. Canada, Ottawa2023Google This statistic suggests individuals are experiencing greater relative effect counterparts.4Khoury Bigras J.L. Cummings E.A. et al.The detection, evaluation, management dyslipidemia children adolescents: Society/Canadian Pediatric Cardiology Association clinical practice update.Can 1168-1179Google also carries disproportionate related body mass index, 1.9-fold increased Interestingly, disparity not factors systolic blood pressure or fasting glucose levels. point substantial these demographic, emphasizing need focused prevention strategies adults mitigate premature events death. Beyond ASCVD mortality, consider its economic effect. costs associated Canada multifaceted. total expenditure newly diagnosed approximately CAD$6.89 billion.3The first-year average cost $37,000. These figures, adjusted Consumer Price Index 2022 values, highlight financial managing conditions. Finally, imperative underscore confront disconcerting epidemiological trend: prevalence women 40-44 disproportionately high, manifesting at 2.3 times male counterparts.3The difference emphasizes targeted investigative therapeutic address unique challenges faced demographic.5Longpré-Poirier C. Dougoud J. Jacmin-Park S. al.Sex gender allostatic mechanisms disease.Can 1812-1827Google Society guidelines dyslipidemia, published serve valuable reference discrepancies recommendations actual practice.6Pearson G.J. Thanassoulis G. Anderson T.J. al.2021 adults.Can 2021; 37: 1129-1150Google Scholar,7Watts G.F. Gidding S.S. Hegele R.A. al.International Atherosclerosis guidance implementing best familial hypercholesterolaemia.Nat Rev 2023; 20: 845-869Google Indeed, realities lack public reimbursement recommended therapies, medication burden, knowledge represent barriers application guideline-directed medical therapy. focus clear: treatment intensification beyond statin therapy high-risk required decrease morbidity CVD. Yet, despite comprehensive use innovative multiple impediments, access inertia, prevent widespread adoption. impediments exacerbated recent publications that, an attempt simplify care, ultimately distort evidence will unintentionally increase care.8Kolber M.R. Klarenbach Cauchon al.PEER simplified lipid guideline 2023 update: primary care.Can Fam Physician. 69: 675-686Google reveal undeniable truth there clear pressing heightened awareness decisive action medicine colleagues, governmental authorities, policymakers, public. We dedicated response teams akin mobilized crises, advocacy groups successfully collaborated governments hasten policy formulation, approval, access. many not-for-profit organizations succeeded where failed, namely mobilizing government opinion support includes structured processes inclusive therapies shown effective safe basis high-quality evidence. To points contention, present begins overview "current state" ASCVD, starting first review epidemiology highlighting trends age-standardized ASCVD.9Lonn E. Brunham L.R. Mehta S.R. Dyslipidemia current state disease: epidemiology, factors, lowering.Can 2024; 40: S4-S12Google article provides further insights into disparities prevalence, effect, urging strategies. "What say about reduction: link lowering outcomes," authors evolving principles management, focusing role apolipoprotein B-containing lipoproteins.10Thanassoulis Welsh R.C. What outcomes.Can S13-S19Google contrasts global underscoring importance personalized assessment tailored interventions. "Traditional novel markers: target vs marker risk," third series, brings forefront reevaluating markers context risk.11Mancini Poirier P. Esau D. Traditional risk.Can S20-S25Google It emerging significance triglycerides lipoprotein(a), limitations traditional like LDL-C. "Medications control: newer drugs" highlights crucial dietary choices efficacy combining nonstatin medications prevention.12McPherson R. Sharma A. Adreak N. Medications drugs.Can S26-S34Google underlines lifestyle changes alongside pharmacological interventions reduction. "Care system delivering reduction lipid-lowering secondary prevention" examines practices implementation Canada.13Marquis-Gravel Brown V. Bhatia Goodman S.G. Care prevention.Can S35-S42Google educational enhanced physician education. Cheng al. propose transformative shift person-centred management.14Cheng Krauter Mullen K.A. Liu continuing scourge multidisciplinary approaches.Can S43-S52Google They emphasize strategies, integration technology enhance engagement adherence. Last, practical tool presented form 3 therapy—secondary checklists used specific (posthospitalization, months, 1 year).15Bell Giacomantonio Guideline-directed therapy; checklist.Can S53-S56Google Through collection articles tools (Fig. 1), coauthors intends elevate stature areas gathered appropriate close gaps. foster concerted approach justify deployment bearing mind pill phenotype, evidence, pharmacoeconomics. Critically, provide professionals resources advance management. silent crisis warrants immediate action. place agendas, mobilize resources, champion cause urgency commitment rightly deserves. Only then hope curb pervasive yet overshadowed pandemic. thank Jonathan Agnew, PhD, MBA providing writing EOCI Pharmacomm Ltd administrative support. Because references already sources, consent was necessary. Funding provided way grant through Novartis Pharmaceuticals Inc.

Language: Английский

Anticancer Chemotherapy-Induced Atherosclerotic Cardiovascular Disease: A Comprehensive Review DOI Creative Commons
Juan S. Izquierdo‐Condoy, Marlon Arias-Intriago, Daniel Cardona

et al.

Life, Journal Year: 2025, Volume and Issue: 15(2), P. 245 - 245

Published: Feb. 6, 2025

The introduction of anticancer agents has transformed oncology, significantly improving survival rates. However, these therapies have introduced unintended cardiovascular risks, with atherosclerovascular disease (ASCVD) emerging as a leading cause morbidity and mortality among cancer survivors. development ASCVD in this population involves multifactorial mechanisms, including endothelial dysfunction, oxidative stress, systemic inflammation, disrupted lipid metabolism. This review examines the various mechanisms through which chemotherapy contributes to highlights strategies for risk assessment management. Each class presents distinct challenges: anthracyclines induce stress damage, promoting foam cell formation plaque progression; taxanes vascular growth factor (VEGF) inhibitors impair metabolism stability; anti-metabolites exacerbate injury reactive oxygen species; mTOR inhibitors, hormonal therapies, tyrosine kinase immune checkpoint disrupt profiles inflammatory pathways, increasing rupture thrombosis. Mitigating chemotherapy-induced necessitates comprehensive, multidisciplinary approach. Detailed pre-treatment assessments must address traditional cancer-specific factors, demographics, pre-existing conditions, modifiable behaviors such smoking inactivity. Pharmacological interventions like statins angiotensin-converting enzyme (ACE) paired lifestyle modifications, are essential reducing risk. In resource-limited settings, cost-effective should be prioritized enhance accessibility. Establishing cardio-oncology units facilitates care coordination, while long-term surveillance enables timely detection intervention. These collectively improve outcomes survivorship diverse patient populations.

Language: Английский

Citations

0
The Challenges of Contemporary Atherosclerotic Cardiovascular Disease Management DOI Creative Commons
Beth L. Abramson,

Jean Grégoire

Canadian Journal of Cardiology, Journal Year: 2024, Volume and Issue: 40(8), P. S1 - S3

Published: Aug. 1, 2024

In the wake of COVID-19 pandemic, we must refocus our attention to another insidious threat: cardiovascular disease (CVD). The persistent and devastating effects CVD on population health is alarming underappreciated, it time for a Canadian coordinated response.1Ruel M. Tackling other pandemic: rise in diseases.Can J Cardiol. 2022; 38: 849-851Google Scholar A group 20 experts have come together develop this supplement with aim identifying care gaps systemic issues that undermine ability reduce risk effectively their patients atherosclerotic (ASCVD) explore potential solutions toward improved outcomes. mortality rate from major nearly halved between 2001 2021, decline can partially be credited introduction pharmacotherapies such as statins angiotensin converting enzyme inhibitors.2Statistics CanadaTable 13-10-0392-01: Deaths Age-Specific Mortality Rates, by Selected Grouped Causes.https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039201Date accessed: October 27, 2023Google However, downtrend has been predominantly observed geriatric population, specifically those aged 80 years older.2Statistics contrast, rates exhibit plateauing curve among younger cohorts, negligible declines documented within 35- 55-year-old demographic. Furthermore, data suggest pronounced burden attributed high low-density lipoprotein cholesterol (LDL-C) patient (aged 20-64 years), compared older age groups. fact, LDL-C responsible 42.0% deaths 20- 64-year-old group, which 1.7-fold than 65 years.3The Conference Board CanadaData First Report: Atherosclerotic Cardiovascular Disease Canada. Canada, Ottawa2023Google This statistic suggests individuals are experiencing greater relative effect counterparts.4Khoury Bigras J.L. Cummings E.A. et al.The detection, evaluation, management dyslipidemia children adolescents: Society/Canadian Pediatric Cardiology Association clinical practice update.Can 1168-1179Google also carries disproportionate related body mass index, 1.9-fold increased Interestingly, disparity not factors systolic blood pressure or fasting glucose levels. point substantial these demographic, emphasizing need focused prevention strategies adults mitigate premature events death. Beyond ASCVD mortality, consider its economic effect. costs associated Canada multifaceted. total expenditure newly diagnosed approximately CAD$6.89 billion.3The first-year average cost $37,000. These figures, adjusted Consumer Price Index 2022 values, highlight financial managing conditions. Finally, imperative underscore confront disconcerting epidemiological trend: prevalence women 40-44 disproportionately high, manifesting at 2.3 times male counterparts.3The difference emphasizes targeted investigative therapeutic address unique challenges faced demographic.5Longpré-Poirier C. Dougoud J. Jacmin-Park S. al.Sex gender allostatic mechanisms disease.Can 1812-1827Google Society guidelines dyslipidemia, published serve valuable reference discrepancies recommendations actual practice.6Pearson G.J. Thanassoulis G. Anderson T.J. al.2021 adults.Can 2021; 37: 1129-1150Google Scholar,7Watts G.F. Gidding S.S. Hegele R.A. al.International Atherosclerosis guidance implementing best familial hypercholesterolaemia.Nat Rev 2023; 20: 845-869Google Indeed, realities lack public reimbursement recommended therapies, medication burden, knowledge represent barriers application guideline-directed medical therapy. focus clear: treatment intensification beyond statin therapy high-risk required decrease morbidity CVD. Yet, despite comprehensive use innovative multiple impediments, access inertia, prevent widespread adoption. impediments exacerbated recent publications that, an attempt simplify care, ultimately distort evidence will unintentionally increase care.8Kolber M.R. Klarenbach Cauchon al.PEER simplified lipid guideline 2023 update: primary care.Can Fam Physician. 69: 675-686Google reveal undeniable truth there clear pressing heightened awareness decisive action medicine colleagues, governmental authorities, policymakers, public. We dedicated response teams akin mobilized crises, advocacy groups successfully collaborated governments hasten policy formulation, approval, access. many not-for-profit organizations succeeded where failed, namely mobilizing government opinion support includes structured processes inclusive therapies shown effective safe basis high-quality evidence. To points contention, present begins overview "current state" ASCVD, starting first review epidemiology highlighting trends age-standardized ASCVD.9Lonn E. Brunham L.R. Mehta S.R. Dyslipidemia current state disease: epidemiology, factors, lowering.Can 2024; 40: S4-S12Google article provides further insights into disparities prevalence, effect, urging strategies. "What say about reduction: link lowering outcomes," authors evolving principles management, focusing role apolipoprotein B-containing lipoproteins.10Thanassoulis Welsh R.C. What outcomes.Can S13-S19Google contrasts global underscoring importance personalized assessment tailored interventions. "Traditional novel markers: target vs marker risk," third series, brings forefront reevaluating markers context risk.11Mancini Poirier P. Esau D. Traditional risk.Can S20-S25Google It emerging significance triglycerides lipoprotein(a), limitations traditional like LDL-C. "Medications control: newer drugs" highlights crucial dietary choices efficacy combining nonstatin medications prevention.12McPherson R. Sharma A. Adreak N. Medications drugs.Can S26-S34Google underlines lifestyle changes alongside pharmacological interventions reduction. "Care system delivering reduction lipid-lowering secondary prevention" examines practices implementation Canada.13Marquis-Gravel Brown V. Bhatia Goodman S.G. Care prevention.Can S35-S42Google educational enhanced physician education. Cheng al. propose transformative shift person-centred management.14Cheng Krauter Mullen K.A. Liu continuing scourge multidisciplinary approaches.Can S43-S52Google They emphasize strategies, integration technology enhance engagement adherence. Last, practical tool presented form 3 therapy—secondary checklists used specific (posthospitalization, months, 1 year).15Bell Giacomantonio Guideline-directed therapy; checklist.Can S53-S56Google Through collection articles tools (Fig. 1), coauthors intends elevate stature areas gathered appropriate close gaps. foster concerted approach justify deployment bearing mind pill phenotype, evidence, pharmacoeconomics. Critically, provide professionals resources advance management. silent crisis warrants immediate action. place agendas, mobilize resources, champion cause urgency commitment rightly deserves. Only then hope curb pervasive yet overshadowed pandemic. thank Jonathan Agnew, PhD, MBA providing writing EOCI Pharmacomm Ltd administrative support. Because references already sources, consent was necessary. Funding provided way grant through Novartis Pharmaceuticals Inc.

Language: Английский

Citations

2