Detection of cardiovascular disease and cardiovascular risk factors in a changing world

Abstract

In the past 40 years, the cardiovascular landscape has changed with dropping cardiovascular mortality rates due to improvements in primary and secondary prevention of cardiovascular disease (CVD) and more effective treatment in the acute setting. Even though much has improved, cardiovascular disease is still cause of death number 2 in the Netherlands. The dissertation entitled 'Detection of cardiovascular diseases and cardiovascular risk factors in a changing world' aims to give insight into the changing cardiovascular landscape and evaluate current and explore new strategies to detect CVD and cardiovascular risk factors. If detected, controlling for modifiable CVD risk factors can prevent a substantial proportion of CVD, or if CVD is detected at an early stage, further development can be prevented. In a screening program, it is important to screen those people who actually have a chance of having the disease. To make a screening program more efficient or effective, you can in advance select a group of people with a higher risk of developing the disease and measure only that group. For example, people with cardiovascular disease are more likely to have a dilation of their large abdominal artery (abdominal aortic aneurysm). When these people are screened you will find more dilations than if you do not make a selection in advance. In the case of a screening program for an increased risk of cardiovascular disease, it appears that more than three-quarters of men over 40 and women over 50 already have had their blood pressure and cholesterol measured by their GP within a five year window. Using this information, the group of people eligible for screening is already a lot smaller. In addition, previous research has shown that people who have an increased cardiovascular risk do not participate if you invite them for screening. An alternative to this so-called systematic screening method is to measure people when they visit on their own. This is called opportunistic screening. An example of such a place could be the general practice. We know that 75% of the inhabitants of the Netherlands visit their GP at least once a year. In a period of 5 years this will be almost everyone. The general practice could potentially be a good place to offer screening. Investing in complete, standardized, and accurate registration of morbidity and patient characteristics in primary care electronic health records is required to facilitate identification and prioritization of eligible individuals, and allows for a scientific evaluation of opportunistic screening efforts.