From the Guidelines
Established cardiovascular disease is characterized by a history of coronary heart disease, congestive heart failure, or stroke, as defined by clinical evaluation and testing, including electrocardiograms, echocardiograms, stress tests, cardiac catheterization, or imaging studies that show structural or functional abnormalities 1.
Definition and Diagnosis
Established cardiovascular disease refers to the presence of confirmed heart or blood vessel conditions that have been diagnosed through clinical evaluation and testing. These conditions include:
- Coronary artery disease (with or without previous heart attacks)
- Peripheral arterial disease
- Cerebrovascular disease (including stroke and transient ischemic attacks)
- Heart failure
- Valvular heart disease The diagnosis typically requires evidence from tests that show structural or functional abnormalities.
Clinical Presentation and Management
Patients with established cardiovascular disease often exhibit symptoms like:
- Chest pain (angina)
- Shortness of breath
- Fatigue
- Claudication Though some may be asymptomatic despite having significant disease. These patients are at higher risk for future cardiovascular events and typically require comprehensive management, including:
- Medications (such as statins, antiplatelets, beta-blockers, ACE inhibitors)
- Lifestyle modifications
- Sometimes interventional procedures or surgery The underlying pathophysiology usually involves atherosclerosis, where plaque builds up in arterial walls, causing narrowing and reduced blood flow to vital organs, though other mechanisms like inflammation, thrombosis, and electrical or structural abnormalities can also contribute to established cardiovascular disease 1.
Risk Assessment and Prevention
Established cardiovascular disease is also defined as a history of acute coronary syndrome or myocardial infarction, stable or unstable angina, coronary heart disease with or without revascularization, other arterial revascularization, stroke, or peripheral artery disease assumed to be atherosclerotic in origin 1. Individuals at high risk for cardiovascular disease include those with end-organ damage or multiple cardiovascular risk factors, and may benefit from specific medications, such as SGLT2 inhibitors or GLP-1 RA, in addition to lifestyle modifications and other treatments 1.
From the Research
Established Cardiovascular Disease
An established cardiovascular (CV) disease is characterized by the presence of one or more of the following conditions:
- Coronary heart disease (CHD) 2, 3, 4
- Peripheral arterial disease (PAD) 2, 3, 4
- Heart failure 2, 3
- Stroke 2, 3, 5
Comorbid Conditions
Patients with established CV disease often have comorbid conditions, including:
- Diabetes mellitus 2, 3, 6
- Chronic obstructive pulmonary disease (COPD) 2, 3
- Low vision 2
- Back/neck problems 2
- Osteoarthritis 2
- Cancer 2
Burden of Disease
The burden of CV disease is high, with a significant impact on quality of life and survival rates 3, 4, 5. The economic burden of atherothrombotic disease is also substantial, and is expected to increase with the aging population 3.
Risk Factors
Established CV disease is associated with an increased risk of cardiovascular events, including myocardial infarction, stroke, and CV death 3, 4. Inflammatory biomarkers are a strong risk factor contributing to the excess risk of CV events in patients with PAD 4.