Perspectives on Cardiovascular Disease: a Multi-Faceted Condition

By Steven Zelenkofske, DO, Vice President, US Medical Affairs, Cardiovascular, AstraZeneca

The 2016 American College of Cardiology (ACC) scientific sessions provides AstraZeneca an opportunity to interact with some of the top clinicians and researchers in the cardiology field, and discuss the difficult clinical questions that they face when treating patients.

With ACC coming up this weekend, I caught up with Roxana Mehran, MD, of Mount Sinai School of Medicine to discuss the multi-faceted nature of cardiovascular disease (CVD) and how research and science is helping to evolve the way we view the causes and management of CVD.

Here’s a snapshot from our recent conversation:

Dr. Zelenkofske: CVD is a common condition that many people see as one singular condition, but it’s actually a chronic and complex disease state with diverse risk factors and sub-conditions.

What’s your perspective on this view of CVD and the varying levels of risk patients with different forms of the disease face?

Dr. Mehran: When you think about CVD, particularly from a patient perspective, it’s a really complicated disease because it’s caused by a range of factors, like high cholesterol and hypertension – and is often a consequence of other co-morbidities like diabetes and chronic kidney disease (CKD). While there are several issues that make up CVD, the one unifying concern for healthcare professionals in treating it is managing risk – the risk of the disease worsening, the risk of having an event like a heart attack and the risk of recurring events that may take place over time.

Dr. Zelenkofske: You mention managing recurring events. This is an important point because when people think of a heart-related event, they think of it as something that happens once, which is not something we necessarily see in clinical practice.

Dr. Mehran: That’s definitely true. What many people may not realize is recurrent events like a heart attack often take place in patients who’ve already had one because of an underlying atherothrombotic disease. Recent research has shown that one in five patients who has had a heart attack will likely have another cardiovascular (CV) event, such as a heart attack, stroke or CV death in the subsequent three years, even if patients were event free after 12 months. These patients very often have other co-morbidities, such as high cholesterol, so preventing subsequent events, also referred to as secondary prevention, is an important health priority.

Dr. Zelenkofske: Can you share some of your insights on approaches that help patients prevent those recurrent events?

Dr. Mehran: Managing the recurrent risk of events is an ongoing journey that begins in the hospital and continues in the long term once a patient returns to ‘normal life’ back at home. In addition to lifestyle changes, patients should speak to their doctors about treatment approaches which have been shown to help reduce the likelihood of having an event post-heart attack.

And since we’re on the topic of managing risk factors, what’s your perspective on the evolving landscape for managing high cholesterol and high blood pressure?

Dr. Zelenkofske: AstraZeneca has a long-standing history in managing high cholesterol and blood pressure. We continue to follow the science of those medicines, to better understand their role in addressing unmet needs for patients to help them manage their conditions. In fact, at ACC this year, we continue to have data for our legacy CV medicines, including an independently studied late-breaker that evaluates whether cholesterol lowering medicine and a combination of blood pressuring lowering medicine used alone or together can reduce play a role in primary prevention for patients at average risk. As a science-driven organization, I am encouraged to see the clinical community continuing efforts to understand appropriate treatments in managing these conditions.

Dr. Mehran: Often, we know that conditions can be asymptomatic, so patients may not even know that they have them.

Dr. Zelenkofske: I agree. In the U.S., 71 million American adults have high LDL-C or bad cholesterol, yet only 1 out of every 3 adults with high LDL-C has their condition under control. Additionally, an estimated 80 million American adults age 20 years of age or older have high blood pressure.

Dr. Mehran: As you’ve talked about a holistic approach to CVD, what’s on the horizon for AstraZeneca as it relates to associated conditions such as CKD?

Dr. Zelenkofske: CKD is a global health problem that affects more than 10% of the world’s population. Individuals living with CKD are more likely to die of CVD than to develop kidney failure. Hyperkalaemia, a complication of CKD, affects more than 3 million patients suffering from CKD and chronic heart failure (CHF) in the U.S. alone. It can be a life threatening condition for which there are limited treatment options. Because we know that CVD is a well-known consequence of CKD, AstraZeneca draws on its deep understanding of cardiovascular treatment to help identify solutions in CKD as well. AstraZeneca recognizes there are unmet needs in hyperkalemia, among other complications from CKD. As a result, we continuously seek opportunities, both independently and in partnership, to investigate treatment options that can help reduce the burden of CKD.


Roxana Mehran, MD, FACC, FACP, FCCP, FESC, FAHA, FSCAI is Professor of Medicine and Director of Interventional Cardiovascular Research and Clinical Trials at the Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine. Her clinical focus includes Acute Coronary Syndrome (ACS), angina, coronary artery disease and hyperlidemia among other therapeutic areas.