Atherosclerotic cardiovascular disease

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Cardiovascular disease is the leading cause of mortality worldwide, accounting for an estimated 18 million deaths per year.¹

In the UK, cardiovascular disease:

Is responsible for a quarter (25%) of all deaths²
- Causes more than 160,000 deaths each year²
Is a clinical priority for the NHS³

graphical map of the united kingdom on a globe

Most cardiovascular disease cases can be prevented by addressing behavioural risk factors, such as:⁴

Other risk factors include:^5–7

Atherosclerotic cardiovascular disease, a type of cardiovascular disease, that is caused by dyslipidaemia and the accumulation of lipoproteins within the arterial wall, which leads to the formation of atherosclerotic plaques. These plaques grow due to continued accumulation of lipoproteins and the proliferation of smooth muscle and fibrous tissue. All these factors contribute to narrowing of the artery, with subsequent plaque rupture and thrombosis.⁸ Depending on the location of the obstruction, this can cause a number of cardiovascular conditions, including: coronary heart disease, stroke, and peripheral arterial disease.⁹

The risk of atherosclerotic cardiovascular disease is increased in patients with familial hypercholesterolaemia (FH) – a common autosomal inherited disorder affecting around one in 250 people in the UK.^10,11 Individuals with FH have a higher risk of premature ASCVD and death than the general population.^10,12 FH is usually caused by mutations in the gene encoding the LDL receptor. As a result, the function of the LDL receptor is decreased and levels of LDL-C are abnormally high from birth.¹⁰

Role of lipoproteins in atherosclerosis

The risk of experiencing an acute atherosclerotic cardiovascular disease event rises rapidly as more ApoB-containing lipoproteins – for example, LDL-C and Lp(a) – become retained and atherosclerotic plaque burden increases.¹³

Watch the video below to learn more about the consequences of long-term exposure to persistently elevated LDL-C.

LDL-C goals for primary and secondary prevention¹³

LDL-C-lowering interventions are recommended for both the primary prevention of atherosclerotic cardiovascular disease and the secondary prevention of recurrent cardiovascular events.

The 2019 ESC/EAS guidelines recommend a risk-based approach with more aggressive LDL-C goals for those at higher risk of ASCVD.¹³

Cardiovascular risk categories

Very-high-risk

ASCVD (clinical/imaging)
SCORE ≥10% for 10-year risk of fatal CVD
FH with ASCVD or with another major risk factor
Severe CKD (eGFR <30 mL/min)
DM and target organ damage, or ≥3 major risk factors; or early onset of T1DM of long duration (>20 years)

High-risk

SCORE ≥5% and <10% for 10-year risk of fatal CVD
Markedly elevated single risk factors, in particular TC >8 mmol/L (310 mg/dL) or LDL-C >4.9 mmol/L (190 mg/dL) or BP ≥180/110 mmHg
FH without other major risk factors
Moderate CKD (eGFR 30–59 mL/min)
DM without target organ damage, with DM duration ≥10 years or other additional risk factor

Moderate-risk

SCORE ≥1% and <5% for 10-year risk of fatal CVD
Young patients (T1DM <35 years; T2DM <50 years) with DM duration <10 years without other risk factors

Low-risk

Calculated SCORE <1% for 10-year risk of fatal CVD

Adapted from Mach F et al. 2020.¹³

LDL-C target value

LDL-C target value graph

Adapted from Mach F et al. 2020.¹³

For more information, refer to the guidelines here.

It is estimated that there are over 3.5 million people with atherosclerotic cardiovascular disease in the UK¹⁴

ApoB, apolipoprotein B; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; ESC/EAS, European Society of Cardiology/European Atherosclerosis Society; FH, familial hypercholesterolaemia; LDL, low-density lipoprotein; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein(a); NHS, National Health Service; SCORE, Systematic Coronary Risk Estimation; TC, total cholesterol; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus

References

WHO. Cardiovascular diseases. Available at: https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1 .
BHF. UK factsheet (July 2021). Available at: https://www.bhf.org.uk/what-we-do/our-research/heart-statistics .
NHS England. Cardiovascular disease (CVD). Available at: https://www.england.nhs.uk/ourwork/clinical-policy/cvd/ .
WHO. Cardiovascular diseases (CVDs). Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) .
NHS. Cardiovascular disease. Available at: https://www.nhs.uk/conditions/cardiovascular-disease/ .
Tsimikas S. J Am Coll Cardiol 2017;69:692–711.
Tsimikas S et al. J Am Coll Cardiol 2018;71(2):177–192.
IntechOpen. Dyslipidemia and its role in the pathogenesis of atherosclerotic cardiovascular disease: implications for evaluation and targets for treatment of dyslipidemia based on recent guidelines. Available at: https://www.intechopen.com/chapters/66725 .
National Research Council (US) Committee on Diet and Health. Atherosclerotic Cardiovascular Diseases (19) in Diet and Health: Implications for Reducing Chronic Disease Risk, 1989. National Academies Press (US).
Reiner Ž. Nat Rev Cardiol 2015;12(10):565–575.
BHF. Familial hypercholesterolaemia (FH). Available at: www.bhf.org.uk/informationsupport/conditions/familial-hypercholesterolaemia .
Hu P et al. Circulation 2020;141(22):1742–1759.
Mach F et al. Eur Heart J 2020;41(1):111–188.
INC-DOF-014.