Can we prevent cardiovascular disease in young people?

A doctor examines a young patient with a stethoscope

Significant progress in the prevention of cardiovascular diseases (CVD) has been achieved in many countries in the past two decades. The major contributor to this improvement is primary prevention focussing on modifiable risk factors such as hypertension, hyperlipidemia, smoking, diabetes mellitus, and obesity. However, this positive tendency has not extended to younger generations, for whom rates of atherosclerotic cardiovascular disease (ASCVD) are stable or decreasing much more slowly.

The current clinical practice guidelines are mainly focused on risk evaluation and prevention in the older population, which accounts for the majority of patients with atherosclerosis. However, growing interest and concern directed toward younger generations of patients with ASCVD has been noted globally in the past few years.

Younger patients have a lower in-hospital mortality, but the longer-term consequences in terms of morbidity from heart failure, angina, need for revascularization procedures, and quality of life can be devastating. Cardiovascular risk estimation and prevention in this population is particularly difficult as young people with high risk for ASCVD often are not identified. Consequently, contemporary data about trends in risk factor distribution, clinical characteristics, morbidity and mortality among young patients with CVD are still lacking.

A recently-approved research project by Dr. Diana Vikulova at the Centre for Heart Lung Innovation at St. Paul's Hospital, aims to gather sufficient data to perform a comprehensive assessment of patients with very premature ASCVD. The project is part of Dr. Vikulova’s thesis studies under the supervision of Dr. Liam Brunham, Associate Professor, Division of General Internal Medicine at the University of British Columbia (UBC) and Canada Research Chair in Precision Cardiovascular Disease Prevention, and Dr. Simon Pimstone, Clinical Associate Professor, Division of General Internal Medicine at UBC.

“The burden of CVD in the young is an important public health issue taking into consideration the potential loss of lifetime productivity and increased lifetime healthcare utilization,” says Dr. Vikulova. “A provincial program carefully designed to optimize identification, screening and long-term follow-up of young patients at high cardiovascular risk can remove some of the barriers to population-based risk reduction and potentially lead to improved cardiovascular outcomes in a cost-effective manner.”

Dr. Vikulova hopes that the results will provide a better understanding of this population, lead to better identification, assessment, and treatment of the group, and also help to identify and manage potential challenges prior to implementing a larger scale registry of premature ASCVD in British Columbia.

PopData will link five data sets from the BC Ministry of Health with data from the Cardiac Services Registry (HEARTis) for the project.

The study is a part of a long-term prospective SAVE BC study project, the overall objective of which is to identify, manage and assess longitudinally over decades, individuals in British Columbia with premature cardiovascular disease and their first-degree relatives.