Heart attack prevention lags for people with stroke, peripheral artery disease: Study

Preventon of heart attack efforts are found to be unequal in patients who usually reach the stage after several cardovascular diseases and stroke, according to a recent study, whch advocated early treatment methods to ward off such eventualites among patients.

The findings were presented at the American Heart Association’s Quality of Care & Outcomes Research Scientific Sessions 2020, which had its virtual conference, May 15-16, at a global level exchangng the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, health care professionals and policymakers.

Researchers found that patients with peripheral artery disease or stroke were less likely than those with coronary artery disease to receive proper treatment to prevent heart attack. All three are types of atherosclerotic cardiovascular disease — coronary artery disease, stroke and peripheral artery disease — lead to heart attack. The 2016 AHA/ACC guidelines recommend aspirin for patients with symptomatic peripheral artery disease, while 2018 guidelines undeerscore that statin therapy reduces the risk of atherosclerotic events.

Heart Diseases

Worldwide, a major contributor to cardiovascular disease is atherosclerosis, which occurs when cholesterol, fat and inflammatory cells build up and form plaque that blocks the arteries and impedes blood flow. Depending on its location, atherosclerosis increases the risk for the three serious conditions. Coronary artery disease results from damaged heart arteries. A common type of stroke occurs when clogged arteries block blood flow to brain. Peripheral artery disease results from damaged arteries in the extremities such as legs, and can lead to amputation.

“Our study highlights the need for public health campaigns to direct equal attention to all three major forms of atherosclerotic cardiovascular disease,” said senior study author Erin Michos, from the Johns Hopkins University School of Medicine in Baltimore. “We need to generate awareness among both clinicians and patients that all of these diseases should be treated with aggressive secondary preventive medications, including aspirin and statins, regardless of whether people have heart disease or not.”

Guidelines to treat all 3 cardiovascular diseases alike

Since atherosclerosis can affect arteries in more than one part, guidelines are to treat coronary artery disease, stroke and peripheral artery disease similarly with lifestyle changes and medication, including statins to lower cholesterol levels and aspirin to prevent blood clots.

Lifestyle changes include eating a healthy diet, being physically active, quitting smoking, controlling high cholesterol, controlling high blood pressure, treating high blood sugar and losing weight. If people with stroke and peripheral artery disease received the same treatments prescribed for those with coronary artery disease, the results would be encouragng, said the study.

For the study, researchers compared more than 14,000 U.S. adults enrolled in the 2006-2015 Medical Expenditure Panel Survey, and slightly more than half of the patients were men, the average age was 65, and all had either coronary artery disease, stroke or peripheral artery disease. These individuals were representative of nearly 16 million U.S. adults living with one of the three forms of atherosclerotic cardiovascular disease.

“Our study highlights a missed opportunity for implementing life-saving preventive medications among these high-risk individuals,” Michos said. “Peripheral artery disease and stroke should generally be treated with the same secondary prevention medications as coronary artery disease.”

Compared to participants with coronary artery disease:

1. Participants with peripheral artery disease were twice more likely to report no statin use and three times more likely to report no aspirin use;
2. People with peripheral artery disease had the highest, annual, total out-of-pocket expenditures among the three atherosclerotic conditions;
3. Participants with stroke were more than twice as likely to report no statin or aspirin use; and
4. Those with stroke were more likely to report poor patient-provider communication, poor health care satisfaction and more emergency room visits.