Burden of Coronary Artery Disease and Peripheral Artery Disease: A Literature Review

Abstract

Background: Atherothrombotic disease, including coronary artery disease (CAD) and peripheral artery disease (PAD), can lead to cardiovascular (CV) events, such as myocardial infarction, stroke, limb ischemia, heart failure, and CV death.

Aim: Evaluate the humanistic and economic burden of CAD and PAD and identify unmet needs through a comprehensive literature review.

Methods: Relevant search terms were applied across online publication databases. Studies published between January 2010 and August 2017 meeting the inclusion/exclusion criteria were selected; guidelines were also included. Two rounds of screening were applied to select studies of relevance.

Results: Worldwide data showed approximately 5-8% prevalence of CAD and 10-20% prevalence of PAD, dependent on the study design, average age, gender, and geographical location. Data from the REACH registry indicated that 18-35% of patients with CAD and 46-68% of patients with PAD had disease in one or more vascular beds. Use of medication to control modifiable CV risk factors was variable by country (lower in France than in Canada); statins and aspirin were the most widely used therapies in patients with chronic disease. Survival rates have improved with medical advancements, but there is an additional need to improve the humanistic burden of disease (i.e., associated disability and quality of life). The economic burden of atherothrombotic disease is high and expected to increase with increased survival and the aging population.

Conclusion: CAD and PAD represent a substantial humanistic and economic burden worldwide, highlighting a need for new interventions to reduce the incidence of atherothrombotic disease.

Figure 1

Baseline characteristics and medication use and clinical outcomes in patients with CAD and PAD from the REACH Registries of (a) Canada,^a (b) France,^b and (c) Germany^c [1, 2]. ^aPatients enrolled from January to October 2004; mean age 68.4 ± 9.9. ^bPercentage of patients experiencing at least one CV event (Figure (a): CAD n = 1356, PAD n = 146; Figure (b): CAD n = 2397, PAD n = 882; Figure (c): CAD n = 3328, PAD n = 1303). ^cPatients enrolled from December 2003 to June 2014; mean age 69.1–71.7 across risk groups. ^dPatients enrolled from December 2003 to June 2014; mean age 68.0–69.4 across risk groups. ACE, angiotensin-converting enzyme; ASA, acetylsalicylic acid; CAD, coronary artery disease; CV, cardiovascular; PAD, peripheral artery disease.

Figure 2

The persistent risk of MACE (a) up to 3 years following an index MI (adapted from Blin et al., 2016) [3] and (b) up to 4.5 years following an index MI stratified by age (<72 years old versus ≥72 years old) and risk category (low versus high^a) (adapted from Jernberg et al., 2015) [4]. ^aHigh-risk patients were predefined as those with ≥1 of the following risk factors prior to index; MI: diabetes mellitus, at least one MI prior to index MI event, CABG (proxy for multi-vessel CAD), PAD, stroke, heart failure, or diagnosis of chronic renal dysfunction. CABG, coronary artery bypass graft; CAD, coronary artery disease; CV, cardiovascular; HR, high risk; LR, low risk; MACE, major adverse cardiovascular events; MI, myocardial infarction; PAD, peripheral artery disease.