Rational Pharmacotherapy in Cardiology

Advanced search

Cardiovascular Comorbidity: Patient with Coronary Artery Disease and Peripheral Artery Atherosclerosis. How to Identify and Manage the Risks of Ischemic Events?

Full Text:


Modern data on comorbidity in coronary artery disease (CAD) are presented in the article, as well as its frequency, dependence on the age, clinical and prognostic significance, and increasing relevance for practical health care. The positions of one of the components of cardiovascular comorbidity – multifocal atherosclerosis – are presented. The existing approaches to the detection and clinical assessment of multifocal atherosclerosis, as well as to the management of the high risk of ischemic events in such patients, are outlined. The main positions on the prevention of the risk of cardiovascular complications in patients with CAD and atherosclerosis of the peripheral arteries using a combination of the anticoagulant – rivaroxaban and the antiplatelet agent – acetylsalicylic acid, are highlighted on the basis of the results of clinical studies. Promising possibilities of using such a therapeutic approach to the management of comorbid patients in routine clinical practice are presented.

About the Authors

O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Olga L. Barbarash – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director

Sosnoviy bulv. 6, Kemerovo, 650002

V. V. Kashtalap
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Vasiliy V. Kashtalap – MD, PhD, Head of Clinical Cardiology Department

Sosnoviy bulv. 6, Kemerovo, 650002

I. A. Shibanova
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Irina A. Shibanova – MD, PhD, Senior Researcher, Laboratory of Rehabilitation, Clinical Cardiology Department

Sosnoviy bulv. 6, Kemerovo, 650002


1. Kontsevaya A.V., Mukaneeva D.K., Myrzamatova A.O., et al. Economic damage of risk factors due to their contribution to morbidity and mortality from major chronic noncommunicable diseases in the Russian Federation in 2016. Cardiovascular Therapy and Prevention. 2020; 19 (1): 23-96 (In Russ.) DOI:10.15829/1728-8800-2020-1-2396.

2. Drapkina O.M., Shalnova S.A., Nikonov E.L., et al., on behalf of the participants in the EGIDA-Moscow study. Epidemiological monitoring of risk factors and health in the metropolis (EGIDA-MOSCOW). Socio-demographic characteristics of the population. Preventive Medicine. 2020;23(1):69-76 (In Russ.) DOI:10.17116/profmed20202301169.

3. Menotti A., Puddu P.E., Kromhout D., et al. Coronary heart disease mortality trends during 50 years as explained by risk factor changes: The European cohorts of the Seven Countries Study. Eur J Prev Cardiol. 2020;27:988-98. DOI:10.1177/2047487318821250.

4. Komajda M., Cosentino F., Ferrari R., et al. Profile and treatment of chronic coronary syndromes in European Society of Cardiology member countries: The ESC EORP CICD-LT registry. Eur J Prev Cardiol. 2020;2047487320912491. DOI:10.1177/2047487320912491.

5. Knuuti J., Wijns W., Saraste A., et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41:407-77. DOI:10.1093/eurheartj/ehz425.

6. Oganov R.G., Simanenkov V.I., Bakulin I.G., et al. Comorbid pathology in clinical practice. Algorithms for diagnosis and treatment. Cardiovascular Therapy and Prevention. 2019;18:5-66 (In Russ.) DOI:10.15829/1728-8800-2019-1-5-66.

7. Salive M.E. Multimorbidity in older adults. Epidemiol Rev. 2013;35:75-83. DOI:10.1093/epirev/mxs009.

8. Drapkina O.M., Samorodskaya I.V., Larina V.N., Lukyanov M.M. Questions of organization of care for patients with multimorbid pathology: an analytical review of international and Russian recommendations. Preventive Medicine. 2019;22:107-14 (In Russ.) DOI:10.17116/profmed201922021107.

9. Drapkina O.M., Shutov A.M., Efremov E.V. Comorbidity, multimorbidity, dual diagnosis - synonyms or different concepts? Cardiovascular Therapy and Prevention. 2019;18:65-9 (In Russ.) DOI:10.15829/1728-8800-2019-2-65-69.

10. Zykov M.V., Kashtalap V.V., Bykova I.S., et al. Relationship of multimorbidity with the risk of cardiovascular complications in patients with acute coronary syndrome. Cardiological Bulletin. 2018;2:59- 65 (In Russ.) DOI:10.17116/Cardiobulletin201813259.

11. Marengoni A., Angleman S., Melis R., et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10:430-9. DOI:10.1016/j.arr.2011.03.003.

12. Valderas J.M., Starfield B., Sibbald B., et al. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7:357-63. DOI:10.1370/afm.983.

13. Feinstein A.R. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis. 1970;23:455-68. DOI:10.1016/0021-9681(70)90054-8.

14. Wong C., Gange S.J., Moore R.D., et al. Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States. Clin Infect Dis. 2018;66:1230-8. DOI:10.1093/cid/cix998.

15. Barbarash O.L., Semenov V.Yu., Samorodskaya I.V., et al. Comorbid pathology in patients with coronary artery disease with coronary artery bypass grafting: experience of two cardiac surgery centers. Russian Cardiological Journal. 2017;3:6-13 (In Russ.) DOI:10.15829/1560-4071-2017-3-6-13

16. Belyalov F.I. Selection and classification of drugs for comorbid diseases. Archive of Internal Medicine. 2020;10:57-60 (In Russ.) DOI:10.20514/2226-6704-2020-10-1-57-60.

17. Belyalov F.I. Comorbidity problems in diseases of internal organs. Bulletin of Modern Clinical Medicine. 2010;3:44-7 (In Russ.)

18. Belyalov F.I. Personalized therapy approaches. Rational Pharmacotherapy in Cardiology. 2018;14(3):418-24 (In Russ.) DOI: 10.20996/1819-6446-2018-14-3-418-424.

19. Daly C.A., De Stavola B., Sendon J.L., et al. Predicting prognosis in stable angina-results from the Euro heart survey of stable angina: prospective observational study. BMJ. 2006;332:262-7. DOI:10.1136/bmj.38695.605440.AE.

20. Bhatt D.L., Steg P..G, Ohman E.M., et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2006;295:180-9. DOI:10.1001/jama.295.2.180.

21. Sorbets E., Greenlaw N., Ferrari R., et al. Rationale, design, and baseline characteristics of the CLARIFY registry of outpatients with stable coronary artery disease. Clin Cardiol. 2017;40:797-806. DOI:10.1002/clc.22730.

22. Sorbets E., Fox K.M., Elbez Y., et al. Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry. Eur Heart J. 2020;41:347-56. DOI:10.1093/eurheartj/ehz660.

23. Crowe F., Zemedikun D.T., Okoth K., et al. Comorbidity phenotypes and risk of mortality in patients with ischaemic heart disease in the UK. Heart. 2020;106:810-6. DOI:10.1136/heartjnl-2019-316091.

24. Panchenko E.P. Results of a three-year follow-up of outpatients with clinical manifestations of atherothrombosis (analysis of the Russian population of the REACH register). Kardiologiia. 2009;49:9-15 (In Russ.)

25. Barbarash O.L., Voevoda M.I., Galstyan G.R., et al. Prediabetes as an interdisciplinary problem: definition, risks, approaches to the diagnosis and prevention of type 2 diabetes mellitus and cardiovascular complications. Russian Cardiological Journal. 2019;4:83-91 (In Russ.) DOI:10.15829/1560-4071-2019-4-83-91.

26. Cosentino F., Grant P.J., Aboyans V., et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. DOI:10.1093/eurheartj/ehz486.

27. Bockeria L.A., Pokrovsky A.V. National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities 2019. Angiology and Vascular Surgery. 2019;25(2) Appendix 2:1- 109 (In Russ.)

28. Barbarash O.L., Zykov M.V., Kashtalap V.V., et al. Acute coronary syndrome, renal dysfunction and multifocal atherosclerosis: general pathogenetic mechanisms and modern aspects of the problem. Kemerovo: Kuzbassvuzizdat; 2016 (In Russ.)

29. Aboyans V., Ricco J.B., Bartelink M.E.L., Björck M., et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39:763-821. DOI:10.1093/eurheartj/ehx095.

30. Gallino A., Aboyans V., Diehm C., et al. Non-coronary atherosclerosis. Eur Heart J. 2014;35:1112- 9. DOI:10.1093/eurheartj/ehu071.

31. Barbarash O.L., Kashtalap V.V. A patient with ischemic heart disease and multifocal atherosclerosis. How to optimize your forecast? Medical Advice. 2018;16:32-8 (In Russ.) DOI:10.21518/2079-701X2018-16-32-38.

32. Sumin A.N., Gaifulin R.A., Bezdenezhnykh A.V., et al. The prevalence of multifocal atherosclerosis in different age groups. Kardiologiia. 2012;52:28-34 (In Russ.)

33. Barbarash O.L., Kashtalap V.V. Detection of latent non-coronary atherosclerosis in patients with acute coronary syndrome. Is there any reason? Complex Problems of Cardiovascular Diseases. 2012; 1:12-6 (In Russ.) DOI:10.17802/2306-1278-2012-1-12-16.

34. Subherwal S., Bhatt D.L., Li S., et al. Polyvascular disease and long-term cardiovascular outcomes in older patients with non-ST-segment-elevation myocardial infarction. Circ Cardiovasc Qual Outcomes. 2012;5:541-549. DOI:10.1161/CIRCOUTCOMES.111.964379.

35. Ferreira-González I., Permanyer Miralda G., Heras M., et al. Prognosis and management of patients with acute coronary syndrome and polyvascular disease. Rev Esp Cardiol. 2009;62:1012-21. DOI:10.1016/s1885-5857(09)73267-0.

36. Mukherjee D., Eagle K.A., Kline-Rogers E., et al. Impact of prior peripheral arterial disease and stroke on outcomes of acute coronary syndromes and effect of evidence-based therapies (from the Global Registry of Acute Coronary Events). Am J Cardiol. 2007;100(1):1-6. DOI:10.1016/j.amjcard.2007.02.046.

37. Al Thani H., El-Menyar A., Alhabib K.F., et al. Polyvascular disease in patients presenting with acute coronary syndrome: its predictors and outcomes. Sci World J. 2012;2012:284851. DOI:10.1100/2012/284851.

38. Barbarash O.L., Zykov M.V., Pecherina T.B., et al. The Prognostic Value of Peripheral Artery Diseases in Patients with ST-Segment Elevation Myocardial Infarction. Dis Marker. 2013;35:877-82. DOI:10.1155/2013/487807.

39. Steg P.G., Bhatt D.L., Wilson P.W., et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007;297:1197-206. DOI:10.1001/jama.297.11.1197.

40. Komarov A.L., Panchenko E.P. Frequency of lesions of various vascular basins and drug treatment of patients with a high risk of atherothrombotic complications. Russian results of the AGATHA international study. Kardiologiia. 2004;11:97-102 (In Russ.)

41. Tarlovskaya E.I. Comorbidity and polymorbidity is a modern interpretation and urgent tasks facing the therapeutic community. Kardiologiia. 2018;58(S9):29-38 (In Russ.) DOI:10.18087/cardio.2562.

42. Bhatt D.L., Fox K.A., Hacke W., et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354(16):1706-17. DOI:10.1056/NEJMoa060989.

43. Morrow D.A., Braunwald E., Bonaca M.P., et al. Vorapaxar in the secondary prevention of atherothrombotic events. N Engl J Med. 2012;366(15):1404-13. DOI:10.1056/NEJMoa1200933.

44. Bonaca M.P., Bhatt D.L., Cohen M., et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372(19):1791-800. DOI:10.1056/NEJMoa1500857.

45. Steg P.G., Bhatt D.L., Simon T., et al. Ticagrelor in Patients with Stable Coronary Disease and Diabetes. N Engl J Med. 2019;381(14):1309-20. DOI:10.1056/NEJMoa1908077.

46. Eikelboom J.W., Connolly S.J., Bosch J., et al. COMPASS Investigators. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017;377(14):1319-30. DOI:10.1056/NEJMoa1709118.

47. de Vries T.I., Eikelboom J.W., Bosch J., et al. Estimating individual lifetime benefit and bleeding risk of adding rivaroxaban to aspirin for patients with stable cardiovascular disease: results from the COMPASS trial. Eur Heart J. 2019;40(46):3771-8a. DOI:10.1093/eurheartj/ehz404.

48. Connolly S.J., Eikelboom J.W., Bosch J., et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet. 2018;391(10117):205-18. DOI:10.1016/S0140-6736(17)32458-3.

49. Anand S.S., Eikelboom J.W., Dyal L., et al. Rivaroxaban Plus Aspirin Versus Aspirin in Relation to Vascular Risk in the COMPASS Trial. J Am Coll Cardiol. 2019;73(25):3271-80. DOI:10.1016/j.jacc.2019.02.079.

For citation:

Barbarash O.L., Kashtalap V.V., Shibanova I.A. Cardiovascular Comorbidity: Patient with Coronary Artery Disease and Peripheral Artery Atherosclerosis. How to Identify and Manage the Risks of Ischemic Events? Rational Pharmacotherapy in Cardiology. 2020;16(4):607-613. (In Russ.)

Views: 47

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)