Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort

Abstract

Background: Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI). Methods: The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk. Results: Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9. Conclusions: In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk.

Ictus isquémico y factores de riesgo vascular en el adulto joven y el adulto mayor. Estudio retrospectivo de base comunitaria (2011-2020)

“…Además, no hay ningún registro de estos factores en el grupo sin seguimiento en atención primaria, tanto en el grupo de adultos jóvenes como en el de adultos mayores. Teóricamente, todas las personas que sobreviven a un ictus deberían tener seguimiento en ambos niveles de atención, al menos durante el primer año, ya que en este período es cuando hay mayor riesgo de recurrencias 19 , 20 , 21 , 22 . Aun así, se conoce que una tercera parte de las personas con ictus no visitan su centro de atención primaria; por ello, actualmente en nuestro territorio se están llevando a cabo nuevas propuestas de atención, como el programa Strack, un modelo de atención integral que busca reducir la recurrencia del ictus mediante un plan de cuidados personalizado de enfermería.…”

Novel Low-Density Lipoprotein Cholesterol Reduction Therapies for the Secondary Prevention of Cardiovascular Disease

“…A previous cohort study reported that the longer-term risk of recurrent cardiovascular events is about 46%. In addition, diabetes mellitus is associated with recurrence [ 3 ].…”