Dr. Marc Bonaca, a cardiologist with the Brigham and Women’s Hospital in Boston, recently gave a presentation at the Las Vegas 2019 VIVA conference on trends in vascular disease. As reported in Vascular News, Dr. Bonaca urged those in attendance to combat the challenging issues of health disparities and cost increases as a community.
Dr. Bonaca noted many cardiovascular advances but at the same time acknowledged an increase in mortality. He sees it as ever-increasing in tandem with the aging population. Dr. Bonaca pointed out that it is still our leading cause of death.
He included a brief discussion of obesity and diabetes as one of the drivers of vascular disease. He noted that there is an increasing trend towards obese and overweight men and women. This, he pointed out, is not always associated with certain geographic areas.
Improved Therapies
Dr. Bonaca discussed the improved preventive therapies that are available for vascular disease patients.
LDL cholesterol has been lowered in many cases due to patient awareness towards smoking, or understanding LDL cholesterol as a toxin that can be modified.
About Relying on Demographics
Dr. Bonaca touched briefly on the increase in e-cigarettes. In general, tobacco products are known to be more in use in the South East and southern areas of the U.S.
Then he discussed the thirteen percent reduction in strokes among people living in countries with a wealthy population due to improved prevention techniques. He contrasted that with middle and lower-income countries where the same level of reduction in strokes does not apply.
He summarized the demographics saying that they are seeing higher numbers of older patients with vascular disease due to improper diet, obesity, inactivity, and diabetes.
As an example, Dr. Bonaca mentioned an increase in venous thromboembolism (VTE). That there is an obvious correlation between VTE, age, obesity, and inflammation caused by diabetes. He believes at some time in the future there will be a reverse in this trend when there are more preventive options.
About Atrial Fibrillation (AF)
AF is associated with diabetes and BMI (body mass index). Therefore Dr. Bonaca believes that the current increase in AF will continue.
With respect to Peripheral Arterial Disease [PAD], he referenced a 2017 article published in The Lancet that shows a 23.5% increase in PAD during a ten year period.
PAD is a very common circulatory disorder characterized by narrowed arteries that reduce blood flow mostly affecting the legs. Currently, about two million people are reported to have PAD. It is generally associated with diabetes.
Dr. Bonaca suggested that in the case of PAD, the trend will eventually shift from young smokers to diabetics, people who are obese and those with multiple illnesses.
About Critical Limb Ischemia (CLI)
CLI is a severe form of PAD causing lower extremity blockage and reduction in blood flow. If it is not given medical attention, complications from CLI will result in amputation of the affected limb.
Although Dr. Bonaca stated that they are seeing decreasing mortality along with decreasing rates of amputations, on the other side of the coin there is an increase in obesity, diabetes, chronic kidney disease, and hypertension.
And Lastly the Economics
Dr. Bonaca put forward the complex dynamics facing vascular specialists by explaining that an aging population translates into increased costs from cardiovascular disease. Aside from treating the disease there is the cost of developing new drugs.
He points out the complexities of treating patients who will have concurrent diseases such as polyvascular and chronic kidney disease making treatment more complicated.
As a final thought, Dr. Bonaca told the professional assembly that in the future they can expect to meet many challenges. An example would be found in dosing or prioritizing whether to either lower lipid therapy or begin with the antithrobotic.
The theme of Dr. Bonaca’s presentation has been multidisciplinary care teams. He emphasized the need for teamwork as the optimum way to cope with future challenges.
What are your thoughts about Dr. Bonaca’s vision of the future of cardiovascular disease?
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Rose Duesterwald November 24, 2019
