Epidemiology and clinical characteristics of patients eligible for novel cardiovascular preventive therapies: a real-world analysis of data from general practice doctors in Italian population
P Cozzolino, P A Cortesi, I C Antonazzo, A Scoccia Baragiola, R Vinci, D Fina, C Bette, A Cazzato, L G Mantovani, G MazzagliaAbstract
Background
High-risk patients with previous atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) are eligible for novel therapeutic strategies targeting the inflammatory pathway of atherosclerosis.
Purpose
This study aimed to assess the prevalence of patients with ASCVD and CKD in the Italian population, along with associated demographic and clinical characteristics, including their systemic inflammatory status.
Methods
Patients with ASCVD and CKD in Italy were selected between January 1, 2017, and June 30, 2022, from The Health Improvement Network (THIN®) database. The prevalence of ASCVD and CKD patients was calculated as the proportion of individuals fulfilling the inclusion criteria (Age≥18, evidence of ASCVD and CKD 3+), with an available look-back of at least three years from the index date, over the total study population. Descriptive statistics (mean (SD), median (IQR), frequencies, and proportions) was used to summarize baseline characteristics among identified patients, as well as across key sub-populations.
Results
Out of 921,922 active subjects, 9,426 (1.02%) reported ASCVD with CKD. Among these patients, 6,963 fulfilled the look-back criteria. Of them, 4,310 (61.9%) had a diagnosis of coronary heart disease, 2,899 (41.6%) of cerebrovascular disease, and 643 (9.2%) of peripheral artery disease, with the presence of ≥2 ASCVD in 819 (11.8%) individuals. Among subjects included in the analysis, the mean (SD) age was 79.1 (8.2) years and 46.5% were female (Table 1). Hypertension (N=5,062; 72.7%), dyslipidemia (N=2,197; 31.6%), and diabetes (N=1,496; 21.5%) were the most frequently reported comorbidities. The majority of patients presented a Charlson Comorbidity Index ≥4 (N=4,538; 65.2%). During the study period, the overall prevalence of subjects with ASCVD and CKD was 0.755 per 100 people (0.654 among females and 0.872 among males). The estimated prevalence of subjects with ASCVD and CKD ranged from 0.002 per 100 people in individuals aged 18-44 years to 3.395 in those aged 85+ years, the men reported a higher prevalence in all age-groups. Prevalence data stratified by age and gender are reported in Figure 1.
Conclusion
These findings reveal a significant prevalence of patients with concomitant ASCVD and CKD in the Italian population, particularly among the elderly. The high frequency of multiple atherosclerotic manifestations highlights the clinical complexity and the substantial disease burden in this cohort. Identifying this high-risk population assessing the inflammatory status using high sensitivity C reactive protein (hsCRP) is a crucial step in defining the Italian patient care pathway, thereby implementing novel therapeutic strategies that may be essential to improving cardiovascular outcomes and reducing morbidity and mortality in these patients.Table 1Figure 1