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. 2018 Jul;104(14):1180-1186.
doi: 10.1136/heartjnl-2017-312391. Epub 2018 Jan 5.

Trends in cardiovascular risk factor and disease prevalence in patients undergoing non-cardiac surgery

Nathaniel R Smilowitz  1 , Navdeep Gupta  2 , Yu Guo  1 , Joshua A Beckman  3 , Sripal Bangalore  1 , Jeffrey S Berger  1   4
Affiliations

Trends in cardiovascular risk factor and disease prevalence in patients undergoing non-cardiac surgery

Nathaniel R Smilowitz et al. Heart. 2018 Jul.

Abstract

Objectives: Cardiovascular risk factors are prevalent in the population undergoing non-cardiac surgery. Changes in perioperative cardiovascular risk factor profiles over time are unknown. The objective of this study was to evaluate national trends in cardiovascular risk factors and atherosclerotic cardiovascular disease (ASCVD) among patients undergoing non-cardiac surgery.

Methods: Adults aged ≥45 years old who underwent non-cardiac surgery were identified using the US National Inpatient Sample from 2004 to 2013. The prevalence of traditional cardiovascular risk factors (hypertension, dyslipidaemia, diabetes mellitus, obesity and chronic kidney disease) and ASCVD (coronary artery disease, peripheral artery disease and prior stroke] were evaluated over time.

Results: A total of 10 581 621 hospitalisations for major non-cardiac surgery were identified. Between 2008 and 2013, ≥2 cardiovascular risk factors and ASCVD were present in 44.5% and 24.3% of cases, respectively. Over time, the prevalence of multiple (≥2) cardiovascular risk factors increased from 40.5% in 2008-2009 to 48.2% in 2012-2013, P<0.001. The proportion of patients with coronary artery disease (17.2% in 2004-2005 vs 18.2% in 2012-2013, P<0.001), peripheral artery disease (6.3% in 2004-2005 vs 7.4% in 2012-2013, P<0.001) and prior stroke (3.5% in 2008-2009 vs 4.7% 2012-2013, P<0.001) also increased over time. The proportion of patients with a modified Revised Cardiac Risk Index score ≥3 increased from 6.6% in 2008-2009 to 7.7% in 2012-2013 (P<0.001).

Conclusions: Among patients undergoing major non-cardiac surgery, the burden of cardiovascular risk factors and the prevalence of ASCVD increased over time. Adverse trends in risk profiles require continued attention to improve perioperative cardiovascular outcomes.

Keywords: coronary artery disease; risks factors.

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Conflict of interest statement

Competing interests: JAB reports serving on advisory boards for AstraZeneca, Sanofi, Aralez and Abbott Vascular and has received research grants from Merck. The remainder of the authors report no relationships that could be construed as a conflict of interest.

Figures

Figure 1.
Figure 1.
Panel A: Trends in individual cardiovascular risk factors over time among all patients hospitalized for major non-cardiac surgery (p for trend <0.001 for all cardiovascular risk factors). Panel B: Burden of cardiovascular risk factors over time among patients hospitalized for major non-cardiac surgery. Cardiovascular risk factors were defined as ≥1 of the following: hypertension, dyslipidemia, diabetes mellitus, chronic kidney disease, and obesity.
Figure 2.
Figure 2.
Panel A: Trends in the prevalence of cardiovascular disease (history of CAD, PAD, TIA/CVA) over time among patients hospitalized for major non-cardiac surgery (p for trend <0.001 for CAD, PAD, and prior stroke). Panel B: The burden of cardiovascular disease by number of vascular beds affected (CAD, PAD, Stroke) over time among patients hospitalized for major non-cardiac surgery.
Figure 3.
Figure 3.
Trends in CAD, prior myocardial infarction, and coronary revascularization over time among patients hospitalized for major non-cardiac surgery. P-value for trend <0.001 for prior MI, PCI and CAD and p-value for trend = 0.11 for CABG.
Figure 4.
Figure 4.
Modified Revised Cardiac Risk Index over time among patients hospitalized for major non-cardiac surgery from 2008–2013. Modified Revised Cardiac Risk Index (RCRI) score using ICD-9 codes for ischemic heart disease, heart failure, prior TIA or stroke, chronic kidney disease, diabetes mellitus, and high-risk surgery. Due to the introduction of an ICD9 diagnosis code for prior stroke or TIA in mid-2007, modified RCRI scores were calculated from 2008–2013 data.
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