An observational study of natural history of cardiovascular diseases

Abstract

Atherosclerosis is a chronic, progressive, inflammatory disease with a long asymptomatic phase that can be identified by several methods when the disease is still in a subclinical stage. Lifestyle modifications and medical managements such as statin therapy can slow, halt or even reverse the progression of atherosclerotic disease. Whether to screen and treat patients for subclinical atherosclerosis remains controversial. Demographic data and risk factors were collected retrospectively from 300,000 asymptomatic individuals who attended for self-funding, private cardiovascular screening in the UK and Ireland. Invitations were sent to men and women aged over 50 years in all UK and Ireland postcodes and regions for a cardiovascular health check. Detailed health questionnaire were self-reported by attendees and investigations were completed by trained technicians. Tests included ultrasound screening for AAA, ankle:brachial pressure index (ABPI), carotid duplex imaging for carotid atherosclerosis, electrocardiography for atrial fibrillation and rapid blood test for cholesterol, blood sugar and creatinine levels. The association between risk factors and prevalence of subclinical atherosclerosis and atrial fibrillation in different subgroups were determined using univariable analysis and odds ratios. After recoding continuous variables that were not normally distributed, significant risk factors were included in a multivariable linear logistic regression analysis in different models establishing two models to identify women at high risk of developing Abdominal Aortic Aneurysm. In addition, Analysis of newly diagnosed cases of Atrial Fibrillation showed a noticeable detection rate of new cases with high 3 CHA2DS2-VASc score, indicating initiation of anticoagulation for stroke prevention. Moreover, data related to kidney function and cardiovascular risk factors showed significantly higher prevalence of subclinical atherosclerosis among those with stage 3 or worse Chronic Kidney Disease. A small cohort of participants were prospectively followed up to assess the correlation between asymptomatic Carotid Artery disease and cardiovascular events which established that smoking history and the presence of asymptomatic Carotid artery disease as well as peripheral arterial disease were statistically significant and predictors of cardiovascular event. These findings highlights the value of ultrasound as a non-invasive and inexpensive tool to identify common and important conditions and sub-clinical atherosclerosis early in order to manage the atherosclerotic process at early stages where individual and healthcare system has the most benefit to achieve.