Cardiovascular disease
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Cardiovascular disease is the leading cause of death worldwide, and is closely interconnected with other cardiovascular, renal and metabolic (CVRM) conditions.1,2
What is cardiovascular disease?
Approximately 523 million people across the world live with cardiovascular (CV) disease, often with declining CV health.3 Not only is CV disease the leading cause of death worldwide,1 it is also closely connected to other cardiovascular conditions.2
Coronary artery disease (CAD), is a chronic and persistent condition in which the arteries that supply the heart with blood are narrowed.4,5 Atherosclerotic plaque, a build-up of deposits of fatty material, cholesterol, cellular waste products and other substances, accumulate in the coronary arteries, obstructing the blood flow to the heart muscle.5 The plaque can cause partial or complete blockage of blood supply to the heart muscle, which can cause a heart attack.4,5
For those who survive a heart attack, it may often be the start of a journey into declining cardiovascular health. Over 30% of those who have had a heart attack go on to have a subsequent attack, stroke or death within the first year, underlining the importance of early diagnosis, developing treatments to reduce or stop coronary heart disease progression, and addressing uncontrolled risk factors.6
Approximately one in three
patients with acute coronary artery disease will also have type-2 diabetes 7
Risk of experiencing a major cardiovascular event doubles
for people living with both CAD and T2D, compared with those diagnosed with T2D alone8
Risk factors including chronic kidney disease
also increases the chances of someone having an additional cardiovascular event, such as a heart attack9
Addressing residual risk of cardiovascular disease
Why is hypertension called a silent killer?
Hypertension, or high blood pressure, is a common condition that relates to increased force of the blood pushing against the artery walls. It is sometime referred to as a silent killer as patients frequently do not experience obvious symptoms, although the condition is actively deteriorating the overall health of the individual:10
- High blood pressure can lead to damage in multiple organs (this is called “end-organ damage”), which is often associated with the heart, as your heart needs to work harder to pump blood.10
- Other organs can also be impacted, including your kidneys because the small vessels in the kidneys are affected, your eyes, and even your brain vessels.10,11
Normal blood pressure is defined as 120 mmHg or less for the systolic measurement, and 80 mmHg or less for the diastolic measurement.13 People with hypertension continually have blood pressure levels higher than those, although some people might have short-term elevations during certain activities such as exercise.
Individuals with hypertension are considered to have a chronic condition and require several interventions to keep their blood pressure levels in the proper range. However, not all people respond to treatment in the same way. Some persons continue to present with elevated blood pressure despite lifestyle changes and taking medication, and this is known as uncontrolled hypertension (uHTN).14 Then there is a smaller group of patients whom, despite the concurrent use of three or more antihypertensive medications from different drug classes, are unable to normalise their blood pressure. This situation is known specifically as resistant hypertension (rHTN).15
Treatment-resistant hypertension (rHTN) impacts over 50 million patients
~50%
achieve SBP control through anti-hypertensive medications
>10%
remain uncontrolled with residually high SBP, despite being on 3+ anti-hypertensive medications (rHTN)
= 10 million patients
NCD Risk Factor Collaboration (NCD-RisC). Lancet. 2022 Feb 5;399(10324):520.
Addressing dyslipidaemia as a high residual risk
Dyslipidemia is defined as an abnormally high concentration of lipids in the blood and is associated with both lifestyle causes as well as genetic disorders. The key clinical indicators of change in the lipid profile include hypertriglyceridemia, reduced high-density lipoprotein (HDL) cholesterol level, and elevated small dense low-density lipoprotein-cholesterol (LDL-C) particles.18
High levels of LDL-C is estimated to cause 2.6 million deaths worldwide every year.19 Present alongside other comorbidities, such as hypertension, dyslipidaemia is a key risk factor for cardiovascular disease.18 More effective therapies are needed as more than half of CVD patients at high-risk of a major secondary event still struggle to meet their LDL-C goals, despite taking a high-intensity statin. 20,21 We are exploring both genetic targets as well as comorbid disease drivers, such as obesity, with the aim of developing new medicines to treat dyslipidaemia, and related cardio-metabolic diseases.
Emergency setting care for people at risk of cardiovascular events
Millions of people across the globe are prescribed blood thinners, specifically direct oral anticoagulants (DOACs).22 Clinicians often prescribe these medicines for the prevention and treatment of thrombotic events, or in patients at high risk of developing a stroke due to an irregular heart rate (atrial fibrillation).22-25 Their usage is expected to continue to rise even more as cardiovascular (CV) disease remains a leading cause of death across the globe. 25
These medicines are intended to prevent blood from coagulating and forming clots, which can obstruct blood flow and potentially harm different organs in the body such as the heart. While DOACs are a potentially lifesaving, effective and reliable medication, they carry a small but significant risk of an uncontrolled or major bleed such as an intracranial haemorrhage (ICH), trauma or gastrointestinal (GI) bleed. This increased risk is linked to the blood’s lowered ability to clot. 23,24,26
Each year 2-4% of those prescribed the medicines will experience the uncommon complication of a major bleed.27 Anticoagulant-related bleeding may occur spontaneously or because of trauma, complications from invasive procedures, or other illnesses or conditions.28 Reversal of DOACs is critical to slow or stop a major bleed and take further medical interventions.28 Managing these major bleeds requires speed, efficiency and clear hospital protocols based on current guidelines. 30
Collaborations to support cardiovascular disease innovation
We are proud to be working with HCPs, patients, governments and policy makers to improve access to healthcare, remove barriers to diagnosis and optimal treatment, changing how CVRM diseases are detected, diagnosed and treated to accelerate medical practice change together to make a difference for patients.
Patient Navigator Program
The Patient Navigator Program is a transition-care improvement initiative implemented in 35 US hospitals designed to reduce the 30-day all-cause readmission rate following hospitalised heart failure (HF), improving patients’ long-term outcomes, which may also lead to reduction of regulatory penalties and optimised financial results for hospitals. Developed with the American College of Cardiology (ACC), the program successfully reduced the readmission rate among primary HF inpatients by using a patient-tailored approach.31
Healthy Heart Africa
Our Healthy Heart Africa programme is committed to tackling hypertension and the increasing burden of cardiovascular disease (CVD) in Africa. Since launching in Kenya in 2014, we have conducted over 11 million blood pressure screenings, identified over two million elevated readings, trained over 5,800 healthcare workers, and activated over 700 healthcare facilities. In support of the United Nations targets to reduce the risk of premature death from non-communicable diseases, we aspire to reach 10 million people with elevated blood pressure across Africa by 2025.32
GULLIVE-R
GUideline adherence and risk assessment after acute myocardial infarction in real LIfe in Germany - a quality improVEment and awareness Registry of the German Cardiac Society) is a real-world evidence registry following patients from up to 250 hospitals and office-based centres in Germany for nine to 18 months post-myocardial infarction. Launched in partnership with DGK-Zentrum, the programme provides counselling and lifestyle change support for patients and their treatment, whether risk stratification or routine management. 33
Our people
Built on an impressive legacy in CVRM research, we are uniquely positioned to build a healthier and longer future for people with these diseases. Our team of over 1,000 people spans more than 23 functions including early and late R&D, medical and commercial.
Our employees are accomplished and experienced scientists, researchers, clinicians, and healthcare and commercial professionals dedicated to advancing novel science and driving practice change to benefit patients with CVRM diseases.
References
1. World Health Organization [Internet]. Cardiovascular Diseases (CVDs). (cited 2023 August 3) Available from: http s://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
2. Rangaswami J, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. Apr 16 2019;139(16):e840-e878.
3. Roth G, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology. 2020.11.010
4. Knuuti J, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019.
5. American Heart Association [Internet]. Atherosclerosis [cited 2023 August 3]. Available from: http://www.heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis.
6. Li S, et al. Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population. Clin Cardiol. 2019 Mar; 42(3): 391–399.
7. Mak KH, et al. Prevalence of diabetes and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographical regions and ethnicities. Eur J Prev Cardiol. Jan 11 2022;28(16):1795-1806.
8. Cavender MA, et al. Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years from the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Circulation. 2015;132(10):923–31.
9. Lindholm D, et al. Association of key risk factors and their combinations on ischemic outcomes in patients with invasively managed myocardial infarction in Sweden. Presented at: ESC Congress 2018, 2018 Aug 25-29, Munich, Germany.
10. World Health Organization [Internet]. Hypertension. [cited 2023 August 3]. Available from: http://www.who.int/news-room/fact-sheets/detail/hypertension .
11. Cheung CY, et al. Hypertensive eye disease. Nat Rev Dis Primers. 2022: 10;8(1):14.
12. Faith Hearing Specialist. [Internet] What is the link between hypertension (high blood pressure) and hearing loss? [cited 2023 August 3]. Available from: http://faithhearing.com/hypertension-high-blood-pressure-hearing-loss
13. Elliott WJ, et al. Systemic hypertension. Curr Probl Cardiol. 2007: 32(4):201-59.
14. Spence JD, et al. Controlling resistant hypertension. Stroke Vasc Neurol. 2018: 24;3(2):69-75.
15. Freeman MW, et al. Phase 2 Trial of Baxdrostat for Treatment-Resistant Hypertension. N Engl J Med. 2023: 388(5):395-405
16. Noubiap JJ, et al (2019). Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients. Heart (British Cardiac Society), 105(2), 98–105.
17. Zeng B, et al (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet, 398(10304), 957–980.
18. StatPearls [Internet]. Dyslipidemia. [cited 2023 August 3]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560891/
19. World Health Organization [Internet]. The Global Health Observatory - Raised Cholesterol. [cited 2023 August 3]. Available from: http://www.who.int/data/gho/indicator-metadata-registry/imr-details/3236
20. Ridker PM, et al. Percent reduction in LDL cholesterol following high-intensity statin therapy: potential implications for guidelines and for the prescription of emerging lipid-lowering agents. Eur Heart J. May 01 2016;37(17):1373-9.
21. Ray KK, et al. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. Eur J Prev Cardiol. Sep 20 2021;28(11):1279-1289.
22. Afzal S, et al (2021). Prescribing trends of oral anticoagulants in England over the last decade: a focus on new and old drugs and adverse events reporting. Journal of thrombosis and thrombolysis, 52(2), 646–653.
23. Chen A, et al. Direct oral anticoagulant use: a practical guide to common clinical challenges. J Am Heart Assoc. 2020;9:e017559.
24. Milling TJ, et al. Exploring indications for the use of direct oral anticoagulants and the associated risks of major bleeding. Am J Manag Care. 2017 Apr; 23(4 Suppl): S67–S80.
25. World Health Organization [Internet]. Cardiovascular diseases (CVDs) [cited 2023 August 3]. Available from: http://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
26. Kauvar DS, et al. The epidemiology and modern management of traumatic hemorrhage: US and International Perspectives. Critical Care. 9 (Suppl 5), S1 (2005).
27. Siegal DM (2019). What we have learned about direct oral anticoagulant reversal. Hematology. American Society of Hematology. Education Program, 2019(1), 198–203.
28. Ageno W, et al. Breadth of complications of long-term oral anticoagulant care. Hematology Am Soc Hematol Educ Program. 2018(1): 432–438.
29. Dabi A, et al. Reversal Strategies for Intracranial Hemorrhage Related to Direct Oral Anticoagulant Medications. Crit Care Res Pract. 2018: 4907164.
30. Standardized protocols for Optimizing Emergency Department care [Internet]. American College of Emergency Physicians. ACEP; 2021 [cited 2023 July 26]. Available from: http://www.acep.org/patient-care/policy-statements/standardized-protocols-for-optimizing-emergency-department-care/
31. ACC Release [Internet]. New Program to Help Heart Patients Navigate Care, Reduce Readmissions. [cited 2023 August 3]. Available from: http://www.acc.org/about-acc/press-releases/2013/06/05/10/50/patient-navigator-program-announcement
32. AstraZeneca [Internet]. Healthy Heart Africa. [cited 2023 August 3] . Available from: http://fsau.zo23.com/sustainability/access-to-healthcare/healthy-heart-africa.html
33. Zeymer, U (2019). Neues Versorgungsforschungsprojekt GULLIVE-R zur Langzeitversorgung von Herzinfarkt-Patienten in Deutschland. DGK Pressemitteilung, 25. April 2019. [cited 2023 August 3] Available from: http://dgk.org/pressemitteilungen/2019-jahrestagung/2019-jt-statements/2019-jt-statements-tag2/neues-versorgungsforschungsprojekt-gullive-r-zur-langzeitversorgung-von-herzinfarkt-patienten-in-deutschland/