Polyvaskuläre Atherosklerose: Prävalenz und Prognose

Polyvaskuläre Erkrankungen sind eine schwere, generalisierte Form atherosklerotischer Erkrankungen. Sie werden im klinischen Alltag oft nicht berücksichtigt, wenngleich sie sich durch eine der höchsten kardiovaskulären Ereignis- und Mortalitätsraten auszeichnen. Die Entwicklung, Häufigkeit und Auswirkung dieser schwersten Form der Atherosklerose wird in diesem Übersichtsartikel abgehandelt.

Abstract

Polyvascular diseases are a severe, generalized form of atherosclerotic disease. They are often overlooked in routine clinical practice, despite being characterized by one of the highest cardiovascular event and mortality rates. Registry studies (e.g., REACH) recognized and investigated the severity of the disease early on. Randomized trials specifically designed for polyvascular diseases are needed in the future, especially with a view to adapting therapy accordingly. Until appropriate adaptations are scientifically supported, polyvascular patients should be identified and, if necessary, treated more strictly regarding their risk constellation.

Schlüsselwörter

polyvaskuläre Erkrankungen - periphere arterielle - koronare Herzerkrankung - Verschlusskrankheit - zerebrovaskulär - Mortalitätsrate - Ereignisrate - kardiovaskulär

Keywords

polyvascular disease - peripheral artery disease - coronary artery disease - cerebrovascular disease - mortality - event rate - cardiovascular

• Literatur

• 1 Mensah GA, Roth GA, Fuster V. The Global Burden of Cardiovascular Diseases and Risk Factors: 2020 and Beyond. J Am Coll Cardiol 2019; 74 (20) 2529-2532
• 2 Lindstrom M, DeCleene N, Dorsey H. et al. Global Burden of Cardiovascular Diseases and Risks Collaboration, 1990–2021. J Am Coll Cardiol 2022; 80 (25) 2372-2425
• 3 Lopez AD, Adair T. Is the long-term decline in cardiovascular-disease mortality in high-income countries over? Evidence from national vital statistics. Int J Epidemiol 2019; 48 (06) 1815-1823
• 4 Steffel J, Eikelboom JW, Anand SS. et al. The COMPASS Trial: Net Clinical Benefit of Low-Dose Rivaroxaban Plus Aspirin as Compared With Aspirin in Patients With Chronic Vascular Disease. Circulation 2020; 142 (01) 40-48
• 5 Aday AW, Matsushita K. Epidemiology of Peripheral Artery Disease and Polyvascular Disease. Circ Res 2021; 128 (12) 1818-1832
• 6 Mazzolai L, Teixido-Tura G, Lanzi S. et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024; 45 (36) 3538-3700
• 7 Alberts MJ, Bhatt DL, Mas JL. et al. Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry. Eur Heart J 2009; 30 (19) 2318-2326
• 8 Aboyans V, Ricco J-B, Bartelink M-LEL. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: The European Stroke Organization (ESO), the Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). European Heart Journal 2018; 39 (09) 763-816
• 9 Dikilitas O, Satterfield BA, Kullo IJ. Risk Factors for Polyvascular Involvement in Patients With Peripheral Artery Disease: A Mendelian Randomization Study. J Am Heart Assoc 2020; 9 (24) e017740
• 10 Ding N, Sang Y, Chen J. et al. Cigarette Smoking, Smoking Cessation, and Long-Term Risk of 3 Major Atherosclerotic Diseases. J Am Coll Cardiol 2019; 74 (04) 498-507
• 11 Klarin D, Lynch J, Aragam K. et al. Genome-wide association study of peripheral artery disease in the Million Veteran Program. Nat Med 2019; 25 (08) 1274-1279
• 12 Gutierrez JA, Mulder H, Jones WS. et al. Polyvascular Disease and Risk of Major Adverse Cardiovascular Events in Peripheral Artery Disease: A Secondary Analysis of the EUCLID Trial. JAMA Netw Open 2018; 1 (07) e185239
• 13 Bonaca MP, Nault P, Giugliano RP. et al. Low-Density Lipoprotein Cholesterol Lowering With Evolocumab and Outcomes in Patients With Peripheral Artery Disease: Insights From the FOURIER Trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). Circulation 2018; 137 (04) 338-350
• 14 Jukema JW, Szarek M, Zijlstra LE. et al. Alirocumab in Patients With Polyvascular Disease and Recent Acute Coronary Syndrome: ODYSSEY OUTCOMES Trial. J Am Coll Cardiol 2019; 74 (09) 1167-1176
• 15 Creager MA, Luscher TF, Cosentino F. et al. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation 2003; 108 (12) 1527-1532
• 16 Luscher TF, Creager MA, Beckman JA. et al. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part II. Circulation 2003; 108 (13) 1655-1661
• 17 Bonaca MP, Gutierrez JA, Cannon C. et al. Polyvascular disease, type 2 diabetes, and long-term vascular risk: a secondary analysis of the IMPROVE-IT trial. Lancet Diabetes Endocrinol 2018; 6 (12) 934-943
• 18 Anand SS, Caron F, Eikelboom JW. et al. Major Adverse Limb Events and Mortality in Patients With Peripheral Artery Disease: The COMPASS Trial. J Am Coll Cardiol 2018; 71 (20) 2306-2315
• 19 Klarin D, Patel VI, Zhang S. et al. Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates. J Vasc Surg 2020; 72 (02) 589-96 e3