Despite its undeniable impact, AtheroSclerotic CardioVascular Disease (ASCVD) is generally unknown. ASCVD is an umbrella term used to describe a variety of cardiovascular diseases that are caused by buildup of fatty deposits (plaque) in the lining of arterial walls resulting in blocked arteries.¹ Many people do not experience significant symptoms until this plaque unexpectedly breaks off causing a heart attack, stroke or death.
ASCVD is the prominent cause behind heart attacks and strokes, and accounts for 85% of cardiovascular-related deaths.² There are many factors that may contribute to ASCVD including family history (genetics), smoking, obesity, physical activity, diet, high cholesterol levels, high blood pressure and diabetes.³ Almost 40% of the adult population is at risk of ASCVD and are too often undiagnosed until a cardiovascular event, such as a heart attack or stroke, occurs.⁴
References:
1. GoodRx Health. What Is Atherosclerotic Cardiovascular Disease (ASCVD)? Accessed December 6, 2022. Available at: https://www.goodrx.com/health-topic/heart/atherosclerotic-cardiovascular-disease-ascvd. [note to reviewer: old reference has been replaced with this more relevant page]
2. World Health Organization (WHO). Cardiovascular diseases (CVDs). Accessed December 6, 2022. Available at: https://www.who.int/ news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
3. American Heart Association. Causes of high cholesterol. Accessed December 6, 2022. Available at: https://www.heart.org/en/health- topics/cholesterol/causes-of-high-cholesterol [note to reviewer: old reference has been replaced with this more relevant page]
4. World Health Organization WHO. Global Atlas on cardiovascular disease prevention and control. 2011. Accessed December 6, 2022. Available at: https://www.who.int/publications/i/item/9789241564373
Who is at risk?
Given how widespread and devastating this chronic disease can be, it is important to identify who is vulnerable.¹⁻⁴ Key causes of ASCVD include high levels of cholesterol (dyslipidemia), high blood pressure (hypertension), smoking, diabetes, family history and certain genetic pre-conditions, such as inherited high cholesterol that starts at a young age (familial hypercholesterolemia or FH). Other risk factors that contribute to ASCVD include a poor diet, low levels of physical activity, being overweight, excessive alcohol intake, and stress. Age and gender are also contributory factors, especially in women after menopause.
Reducing our risks: the right level
Maintaining healthy levels of cholesterol and triglycerides is important for our health. Like blood pressure, a high cholesterol level does not generally cause any symptoms. Your cholesterol level can be measured by taking a simple blood test, which will usually report your overall cholesterol level (total cholesterol); your HDL (good cholesterol); LDL (bad cholesterol); non-HDL-C (bad cholesterol) and triglycerides. It is recommended that adults have their cholesterol checked regularly if they have a cardiac history or are already on cholesterol lowering treatment.⁴
It is important to acknowledge that some people are not able to achieve the recommended levels of cholesterol through lifestyle changes alone and will require medication if their levels of LDL-cholesterol are too high.⁴ Medication is not a substitute but an add-on to exercise, relaxation, and balanced nutrition. There are different types of treatments that can be prescribed by your doctor to reduce LDL-cholesterol. It is important that your doctor evaluates which is the right medication for you. The adoption of positive lifestyle changes and use of appropriate medical therapies slow down the progression of ASCVD.⁵ This will help lower the risk of cardiac events such as strokes and heart attacks.
References:
1. GoodRx Health. What Is Atherosclerotic Cardiovascular Disease (ASCVD)? Accessed December 6, 2022. Available at: https://www.goodrx.com/health-topic/heart/atherosclerotic-cardiovascular-disease-ascvd. [note to reviewer: old reference has been replaced with this more relevant page]
2. World Health Organization (WHO). Cardiovascular diseases (CVDs). Accessed December 6, 2022. Available at: https://www.who.int/ news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
3. American Heart Association. Causes of high cholesterol. Accessed December 6, 2022. Available at: https://www.heart.org/en/health- topics/cholesterol/causes-of-high-cholesterol [note to reviewer: old reference has been replaced with this more relevant page]
4. World Health Organization WHO. Global Atlas on cardiovascular disease prevention and control. 2011. Accessed December 6, 2022. Available at: https://www.who.int/publications/i/item/9789241564373
KNOWING ASCVD
UNDERSTANDING THE HEALTH RISKS OF ASCVD
CHOLESTEROL AND THE HEART
“Good” cholesterol vs “bad” cholesterol
Cholesterol is a fatty substance which is essential to the normal functioning of your body. A certain amount of cholesterol is healthy, however if there is too much cholesterol in the blood, the body is unable to get rid of it and it lodges in the walls of the arteries, forming atheroma (a fatty material or plaque). It is carried throughout the body by molecules called lipoproteins. Over time this fatty build-up of atheroma can narrow the arteries. This process is called atherosclerosis which can result in a heart attack or stroke.
“Good cholesterol” or high-density lipoprotein cholesterol (HDL-cholesterol) helps remove bad cholesterol from your arteries. A high level of HDL-cholesterol protects against heart disease.
“Bad cholesterol” or low-density lipoprotein cholesterol (LDL-cholesterol) contributes to the build-up of fat deposits in your arteries (atherosclerosis). Over time this build-up leads to a hardening and narrowing of your arteries which can lead to a heart attack or stroke.
Too much bad cholesterol (LDL-cholesterol) is a major driver of atherosclerotic cardiovascular disease (ASCVD).
Inherited High Cholesterol
Plasma lipid levels are, to a very large extent, determined by genetic factors. Genetic abnormalities may cause high level of LDL-C which is known as Familial Hypercholesterolemia (FH). Individuals with FH are at a higher risk of cardiovascular disease from a young age and require more intensive lipid-lowering treatment. FH is diagnosed by family and clinical history, physical examination, laboratory assessment and if required by DNA analysis.
References:
1. Kronenberg, F. (2021). Lipoprotein(a). In: von Eckardstein, A., Binder, C.J. (eds) Prevention and Treatment of Atherosclerosis. Handbook of Experimental Pharmacology, vol 270. 201-232. Springer, Cham. https://doi.org/10.1007/164_2021_504
2. McNeal CJ, Peterson AL. Lipoprotein (a) in Youth. [Updated 2020 Feb 9]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK395570/
3. Cybulska B, Kłosiewicz-Latoszek L, Penson PE, Banach M. What do we know about the role of lipoprotein(a) in atherogenesis 57 years after its discovery?. Prog Cardiovasc Dis. 2020;63(3):219-227. doi:10.1016/j.pcad.2020.04.004.
4. Wilson DP, Jacobson TA, Jones PH, et al. Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. J Clin Lipidol. 2019;13(3):374-392. doi:10.1016/j.jacl.2019.04.010
KNOWING LP(A)
Lipoprotein(a), also known as Lp(a) is a type of lipoprotein that carries cholesterol, fats, and proteins in the blood. However, elevated levels of Lp(a) increase the risk for cardiovascular diseases (CVD).1,2 More specifically, it doubles the risk of ASCVD events, such as heart attack or stroke.3,4
Elevated Lp(a) is a genetically determined condition, which means it can be passed down in families.5-7 Approximately, one in five individuals worldwide has elevated Lp(a) levels.8,9
Who should get tested for Lp(a)?
Most people do not know if they are at risk of elevated Lp(a) due to the lack of awareness and testing of this genetic condition. Nonetheless, it is important to know your Lp(a) levels as it can help you better understand your overall CVD risks, such as predisposition to premature or recurrent CVD events, and take action to benefit your overall health.10-14
The test for elevated Lp(a) is a simple, reliable and non-fasting blood test which only needs to be done once.15,16
You should consider Lp(a) testing if you are at a higher risk of heart disease, such as those with:17,18
• A family history of elevated Lp(a) levels
• A family history of ASCVD at an early age (under 55 years for men and under 65 years for women)
• Familial hypercholesterolemia (FH)
• A history of heart attack or stroke with no other associated risk factors, such as smoking, high LDL-C, diabetes or obesity
• High LDL-C, even when taking medication to bring it down
References:
1.Chakraborty A, Am J Prev Cardiol. 2022;10:100343
2. AMA Style Insider. Condition, Disease, Disorder. Accessed February 2024. Available at: https://amastyleinsider.com/2011/11/21/condition-disease-disorder
3. Tsimikas S. J Am Coll Cardiol. 2017;69(6):692–711
4. Tsimikas S et al. J Am Coll Cardiol. 2018;71:177–192
5. Boerwinkle E, et al. J Clin Invest. 1992;90(1):52–60
6. Kraft HG, et al. Hum Genet. 1992;90(3):220–230
7. Kronenberg F. Cardiovasc Drugs Ther. 2016;30(1):87–100
8. Wilson DP et al. J Clin Lipidol. 2019;13(3):374-392
9. Kronenberg F. Handbook of Experimental Pharmacology. 2021;270:201-232
10. Mehta A, et al. J Am Coll Cardiol. 2020;76(7):781-793
11. Rallidis LS, et al. Atherosclerosis. 2018;269:29–34
12. Beheshtian A, et al. Atherosclerosis. 2016;253:47–53
13. Madsen CM, et al. Arterioscler Thromb Vasc Biol. 2020;40(1):255–266
14. Arnold M, et al. Eur Heart J. 2021;42(22):2186–2196
15. Wilson DP, et al. J Clin Lipidol. 2019;13(3):374–392
16. Nordestgaard BG. J Am Coll Cardiol. 2017;70(13):1637–1646
17. American College of Cardiology. Lipoprotein(a) in Clinical Practice. 2019. Accessed August 2020. Available at: https://www.acc.org/latest-in-cardiology/articles/2019/07/02/08/05/lipoproteina-in-clinical-practice
18. Scientific American. Lipoprotein “Little A” Can Cause More Than a Little Damage to the Heart. 2019. Available at: https://www.scientificamerican.com/blog/observations/lipoprotein-little-a-can-cause-more-than-a-little-damage-to-the-heart/
NOVARTIS’ VISION FOR ASCVD
We envision a world where ASCVD is eliminated so patients can live longer and healthier lives. To turn our vision into a reality, we are making a lasting commitment to pioneering groundbreaking treatments, forging productive partnerships with healthcare systems, and finding innovative approaches to tackle major ASCVD risk factors for the larger population.
At the forefront of our efforts to revolutionize treatments is our belief in the possibilities unlocked by RNA technology. RNA-targeting therapies have the potential to disrupt almost any disease process in the body, and make once-perceived undruggable targets druggable. These novel mechanisms will be the foundations of a portfolio built to address major ASCVD risk factors.
With 30 years of leading science in CVD, our global footprint, and our commitment to the future, Novartis in ASCVD will transform the standard of care for twice as many patients, twice as fast, and lead a generational decline in CV death.
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