Patients with Premature Cardiovascular Diseases in Ambulatory Practice: Demographic Characteristics, Risk Factors and Adherence to the Medical Therapy (Data of RECVASA Registry)

Aim. To evaluate the gender characteristics, educational level, cardiovascular diseases (CVD) risk factors and adherence to drug treatment in patients with premature CVD in an outpatient prospective registerу.   

Material and methods. 3690 patients with hypertension, coronary artery disease, chronic heart failure, atrial fibrillation and their combinations were enrolled in the RECVASA registry in Ryazan region of Russia. Groups of patients with early development of CVD (criterion 1 – the age of 18-49 years old, criterion 2 – the age of men 18-54 years old and women – 18-64 years old) were compared with the corresponding older groups. The gender characteristics, educational level, CVD risk factors, and adherence to drug treatment were analyzed.   

Results. According to criterion 1, the age groups of 18-49 years old and ≥50 years old included 347 (9.4%) and 3343 (90.6%) patients, respectively, 144 (41.5%) and 902 (27, 0%), respectively were   men, p<0.0001. According to criterion 2, 1369 (37.1%) patients were assigned to the group with early development of CVD, of which 254 (18.6%) were men under 55 and 1115 (81.4%) were women under 65. The group of older patients included 2321 individuals, of which 792 were men (34.1%) and 1529 were women (65.9%). According to criterion 2, the proportion of men in the group of patients with early development of CVD, was 2.2 times lower, than in the older age group (18.6% vs 41.5%, respectively; p<0.0001). Patients <50 years old were more likely to have higher education, than the group of patients ≥50 years old (42.3 vs 25.9%; p<0.0001), including among both men and women. According to criterion 2, the same statistically significant differences were observed (36.2 vs 21.3%; p<0.0001), including among both men and women. The proportion of smokers was 2 times higher in patients younger than 50 years old, than in patients ≥50 years old (44.0 vs 21.7%; p<0.0001). The largest proportion of smokers was among men and women <50 years old (69.4% and 24.1%, respectively). According to criterion 1, hypercholesterolemia (>5 mmol/L) was diagnosed significantly less frequently in patients with early development of CVD than in the older age group (47.8 vs 54.6%; p=0.047); these differences were obtained due to women (46.9 vs 58.8%; p=0.008), the proportion of individuals with hypercholesterolemia did not significantly differ among men. According to criterion 2, statistically significant differences in the frequency of hypercholesterolemia were not detected among both men and women. There was no differences in the incidence of family history (FH) of premature CVD in the study groups, while the proportion of patients with FH of premature CVD was significantly higher in men <55 years old than in women <65 years old (44.8 vs 37.7%; p<0.0001). According to criterion 1 the proportion of patients with low adherence to treatment was higher in patients with early development of CVD than in the older age group (57.1% vs 46.1%; p=0.0006), the proportion of patients with high adherence was 22.9% and 32.4% (p=0.0013), respectively. According to criterion 2, there were no differences in adherence to treatment.   

Conclusions. According to RECVASA registry, patients with early development of CVD were more likely to be men, in accordance with criterion 1. Patients with early development of CVD, including men and women, according to both criteria, were characterized by a significantly higher proportion of individuals with higher education and a higher proportion of smokers. In patients with early development of CVD using criterion 1, in contrast to criterion 2, hypercholesterolemia was diagnosed significantly less often than in the older age group. It is preferable to use criterion 1 to assess hypercholesterolemia in patients with early development of CVD. The proportion of individuals with FH of premature CVD was significantly higher in men <55 years old than in women <65 years old. Patients with early development of CVD according to criterion 1 were characterized by a lower adherence to drug treatment. Individuals with early development of CVD, especially <50 years old are the target group for comprehensive prevention, not only due to improving the quality of proven effective drug therapy, but also by correcting risk factors and increasing level of adherence to treatment. 

1. Cardiovascular disease statistics. Eurostat. Statistics Explained [cited by March 06, 2020]. Available from: https://ec.europa.eu/eurostat/statistics-explained/pdfscache/37359.pdf.

2. Ageeva L.I., Aleksandrova G.A., Zajchenko N.M., et al. Healthcare in Russia 2017. Moscow: Federal State Statistics Service; 2017 (In Russ.)

3. Statistical materials “The incidence rate of adult population of Russia.” Ministry of health [cited by March 06, 2020]. Available from: http://mednet.ru/ru/statistika/zabolevaemost-naseleniya.html. (In Russ.)

4. Piepoli M.F., Hoes A.W., Agewall S., et al. 2016 European Guidelineson Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2016;37:2315-81. DOI:10.1093/eurheartj/ehw106.

5. Developed by the committee of experts of the Russian Society of Cardiology (RSC), Russian Society of Preventive Cardiology (RSPC) RS of N-CD. Cardiovascular prevention 2017. Russ J Cardiol. 2017;23(6):7-122 (In Russ.) DOI: 10.15829/1560-4071-2018-6-7-122.

6. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. DOI:10.1093/eurheartj/ehy339.

7. Boytsov S.A., Martsevich S.Y., Kutishenko N.P., et al. Registers in cardiology: their principles, rules, and real-word potential. Cardiovascular Therapy and Prevention. 2013;12(1):4-9 (In Russ.) DOI: 10.15829/1728-8800-2013-1-4-9.

8. Andreenko E.Y., Lukyanov M.M., Yakushin S.S., et al. Young ambulatory patients with cardiovascular diseases: age and gender characteristics, comorbidity, medication and outcomes (according to RECVASA register). Cardiovascular Therapy and Prevention. 2019;18(6):99-106 (In Russ.) DOI:10.15829/1728-8800-2019-6-99-106.

9. Boytsov S.A., Lukyanov M.M., Yakushin S.S., et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatientpolyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):44-50 (In Russ.) DOI:10.15829/1728-8800-2014-6-44-50.

10. Loria C.M., Liu K., Lewis C.E., et al. Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA study. J Am Coll Cardiol. 2007;49(20):2013-20. DOI:10.1016/j.jacc.2007.03.009.

11. Dib J.G., Alameddine Y., Geitany R., Afiouni F. National cholesterol education panel III performance in preventing myocardial infarction in young adults. Ann Saudi Med. 2008;28(1):22-7. DOI:10.5144/0256-4947.2008.22.

12. Arnett D.K., Jacobs D.R., David R., et al. Twenty-year trends in serum cholesterol, hypercholesterolemia, and cholesterol medication use: the Minnesota Heart Survey, 1980-1982 to 2000-2002. Circulation. 2005;112(25):3884-91. DOI:10.5144/0256-4947.2008.22.

13. Marma A.K., Berry J.D., Ning H., et al. Distribution of 10-year and lifetime predicted risks for cardiovascular disease in US adults: findings from the National Health and Nutrition Examination Survey 2003 to 2006. Circ Cardiovasc Qual Outcomes. 2010;3(1):8-14. DOI:10.1161/CIRCOUTCOMES.109.869727.

14. Muromtseva G.A., Kontsevaya A.V., Konstantinov V.V., et al. The prevalence of non-infectious diseases risk factors in Russian population in 2012-2013 years. The results of ECVD-RF. Cardiovascular Therapy and Prevention. 2014;13(6):4-11 (In Russ.) DOI:10.15829/1728-8800-2014-6-4-11.

15. Khot U.N., Khot M.B., Bajzer C.T., et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003;290(7):898-904. DOI:10.1001/jama.290.7.898.

16. Larsen G.K., Seth M., Gurm H.S. The ongoing importance of smoking as a powerful risk factor for ST-segment elevation myocardial infarction in young patients. JAMA Intern Med. 2013;173 (13):1261-2. DOI:10.1001/jamainternmed.2013.6075.

17. Meshkov A.N., Ershova А.I., Deev А.D., et al. Distribution of lipid profile values in economically active men and women in Russian Federation: results of the ESSE-RF study for the years 2012- 2014. Cardiovascular Therapy and Prevention. 2017;16(4):62-7 (In Russ.) DOI:10.15829/1728-8800-2017-4-62-67.

18. Chen L., Chester M., Kaski J.C. Clinical factors and angiographic features associated with premature coronary artery disease. Chest. 1995;108(2):364-9. DOI:10.1378/chest.108.2.364.

19. Stamler J., Daviglus M.L.,Garside D.B., et al. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA. 2000;284(3):311-8. DOI:10.1001/jama.284.3.311.

20. Schober S.E., Carroll M.D., Lacher D.A., Hirsch R. High serum total cholesterol an indicator for monitoring cholesterol lowering efforts: U.S. adults, 2005-2006. NCHS Data Brief. 2007;(2):1-8.

21. Lloyd-Jones D.M., Nam B.H., D’Agostino R.B., et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. JAMA J Am Med Assoc. 2004;291:2204-11. DOI:10.1001/jama.291.18.2204.

22. Otaki Y., Gransar H., Berman D.S., et al. Impact of family history of coronary artery disease in young individuals (from the CONFIRM registry). Am J Cardiol. 2013;111(8):1081-6. DOI:10.1016/j.amjcard.2012.12.042.

23. Mackenbach J.P., Stirbu I., Roskam A.J., et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468-81. DOI:10.1056/NEJMsa0707519.

24. Gerber Y., Goldbourt U., Drory Y. Interaction between income and education in predicting long-term survival acute myocardial infarction. Eur J Cardiovasc Prev Rehabil. 2008;15:526-32. DOI:10.1097/HJR.0b013e328304feac.

25. Chowdhury R., Khan H., Heydon E., et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013;34(38):2940-8. DOI:10.1093/eurheartj/eht295.

26. Martsevich S.Y., Semenova Y.V., Kutishenko N.P., et al. Assessment of patients compliance for ambulatory institutions visits and its influence on the quality of treatment before development of acute coronary syndrome, by the LIS-3 Registry. Russian Journal of Cardiology. 2016;(6):55-60 (In Russ.) DOI:10.15829/1560-4071-2016-6-55-60.

27. Kutishenko N.P., Kalaydzhyan E.P., Sichinava D.P., et al. Outpatient Registry of Patients with Acute Myocardial Infarction (PROFILE-IM): Data on Prehospital Therapy in Comparison with the LIS-3 Registry. Rational Pharmacotherapy in Cardiology. 2018;14(1):88-93 (In Russ). DOI: 10.20996/1819-6446-2018-14-1-88-93.