In an analysis of medical information of more than 6,000 American adults with a history of cardiovascular disease (CVD), researchers at Johns Hopkins Medicine conclude that CVD risk “profiles” in secondary prevention have failed to improve over the last two decades.
Secondary prevention refers to prevention of recurrent cardiovascular events such as heart attack or stroke in individuals who already have CVD. Despite recent advancements in safe and effective therapies reflected in guideline recommendations, trends in CVD risk profiles in adults with the condition were not ideal from 1999 through 2018. An ideal risk profile is based on targets that health professionals agree to be considered desirable. The study was published July 4 in the Journal of the American College of Cardiology.
Risk-factor profiles analyzed included blood glucose, blood pressure, cholesterol, body mass index, smoking, physical activity and diet. All factors showed a worsening or unchanged trend, except for cholesterol, which showed a modest improvement. However, only 30% of adults with CVD had an ideal cholesterol profile in 2015-2018.
“We’re not really moving the needle on these risk factors, and that’s leaving a lot of people at risk for recurrent events,” says corresponding author of the study, Seth S. Martin, M.D., M.H.S., associate professor of medicine in the division of cardiology at the Johns Hopkins University School of Medicine. He called for “re-engineering preventive care.”
“Our numbers are disappointing and alarming,” says co-first author of the study Yumin Gao, Sc.M., premedical student and biostatistician at the Johns Hopkins Digital Health Innovation Lab.
“Our study shows that there remains a critical need and opportunity to effectively translate established guidelines into patient care,” says co-first author of the study Nino Isakadze, M.D., M.H.S., Cardiac Electrophysiology Fellow at the Johns Hopkins Hospital. “We have to get innovative about how to reach diverse groups of patients, and to improve secondary prevention in everyone with cardiovascular disease.”
The study also revealed persistent racial and ethnic disparities in heart-related health. Isakadze says access to healthcare, patient education and affordability of medications are likely the main drivers of disparities seen in high-risk populations.
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