Department of Medicine, University of British Columbia, Healthy Heart Program Prevention Clinic, St Paul's Hospital, Vancouver, British Columbia, Canada.
McMaster University, Population Health Research Institute, Heart Failure Program and Cardiac Health and Rehabilitation Program, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Can J Cardiol. 2024 Aug;40(8S):S4-S12. doi: 10.1016/j.cjca.2024.04.017.
Ischemic heart disease and stroke are the leading causes of death worldwide. Herein we review the burden, epidemiology, and risk factors for atherosclerotic cardiovascular disease (ASCVD). The focus of this review is on the current state of ASCVD in Canada, however, the findings regarding epidemiological trends are likely to be reflective of global trends, particularly in high-income countries, and the discussion regarding risk factors and lipid lowering is universally applicable. In Canada, the burden of death from ASCVD is second only to cancer deaths. There are major differences in disease burden related to sex, geography, and socioeconomic status. The major risk factors for ASCVD have been identified, although new and emerging risk factors are an active area of research. Recent developments such as polygenic risk scores provide potential to identify individuals at risk for ASCVD earlier in life and institute preventative measures. Dyslipidemia, and in particular elevated concentrations of low-density lipoprotein cholesterol and apolipoprotein B are a major cause of ASCVD. Therapies to lower low-density lipoprotein/apolipoprotein B levels are key components to treating and preventing ASCVD. Addressing the causal risk factors for ASCVD in a manner that comprehensively considers the clinical, social, and economic implications of prevention strategies will be essential to reduce the burden of ASCVD and improve outcomes for patients.
缺血性心脏病和中风是全球范围内主要的死亡原因。在此，我们回顾了动脉粥样硬化性心血管疾病（ASCVD）的负担、流行病学和危险因素。本综述的重点是加拿大目前的 ASCVD 状况，然而，关于流行病学趋势的发现可能反映了全球趋势，特别是在高收入国家，关于危险因素和降脂的讨论具有普遍适用性。在加拿大，死于 ASCVD 的人数仅次于癌症。与性别、地理位置和社会经济地位相关的疾病负担存在重大差异。已经确定了 ASCVD 的主要危险因素，尽管新出现的危险因素是一个活跃的研究领域。最近的发展，如多基因风险评分，为更早地识别 ASCVD 风险个体并采取预防措施提供了潜力。血脂异常，特别是低密度脂蛋白胆固醇和载脂蛋白 B 浓度升高，是 ASCVD 的主要原因。降低低密度脂蛋白/载脂蛋白 B 水平的治疗方法是治疗和预防 ASCVD 的关键组成部分。以一种全面考虑预防策略的临床、社会和经济影响的方式来解决 ASCVD 的因果危险因素，对于减轻 ASCVD 的负担和改善患者的预后至关重要。
