Cardiovascular Events In Older Patients Research Articles

Prediction of cardiovascular events in older patients with hypertension in primary care: a cohort study.

Accurate risk stratification identifying patients with hypertension at risk of future cardiovascular disease in primary care would be desirable. To investigate the association between elevated brain natriuretic peptide (BNP), left ventricular hypertrophy (LVH) on an electrocardiogram (ECG), and LVH on an echocardiogram and the development of cardiovascular events (CVEs), especially heart failure and all-cause mortality (ACM), in a primary care population with hypertension without symptoms of heart failure. A prospective cohort study in five Dutch general practices between 2010-2012 and 2020. In total, 530 patients (aged 60-85 years) underwent laboratory testing, ECGs, and echocardiograms at baseline. The incidence of new CVEs and ACM at up to 9 years' follow-up was recorded by data extraction from the digital information systems. Among the 530 participants, 31 (5.8%) developed a coronary event, 44 (8.3%) a cerebrovascular accident, 53 (10.0%) atrial fibrillation, 23 (4.3%) heart failure, and 66 (12.5%) died. Cox regression analyses, adjusting for relevant Framingham covariates, showed that elevated BNP increased the risk of ACM, CVEs, and specifically heart failure independently by 44% (hazard ratio [HR] 1.44, 95% confidence interval [CI] = 1.07 to 1.94, P = -0.017), 45% (HR 1.45, 95% CI = 1.15 to 1.82, P = 0.002), and 288% (HR 3.88, 95% CI = 2.13 to 7.10, P<0.001), respectively. LVH on ECG increased the risk of ACM independently by 108% (HR 2.08, 95% CI = 1.14 to 3.81, P = 0.017). LVH either on an ECG and/or echocardiogram increased the risk of heart failure independently by 309% (HR 4.09, 95% CI = 1.34 to 12.49, P = 0.014). In primary care patients with hypertension, BNP seems to be an important marker predicting future CVEs, especially heart failure, as well as all-cause mortality.

Effect of Integrative Chinese and Western Medicine Therapy on Long-Term Clinical Outcomes in Patients with Heart Failure: A Real-World Study Including 394 Patients.

Objective To explore the effect of integrative Chinese and Western medicine therapy on the clinical outcomes of patients with heart failure. Methods This is a retrospective cohort study in the real world. Patients were divided into “conventional therapy” and “integrative therapy” groups according to treatment modality. The occurrence of cardiovascular events (CVE) was determined during follow-up. Survival curves were plotted, and survival analysis was performed using Cox regression to report survival in both groups. Further subgroup tests were performed as sensitivity analyses. A Markov model was constructed to predict patients with distant heart failure conditions based on real follow-up data. Results Based on diagnostic criteria, 394 patients with heart failure were included. The integrative therapy group had (N = 181) older patients (P=0.005), higher proportion of renal insufficiency (P < 0.001), higher creatinine (P=0.040), hypersensitive C-reactive protein (P=0.007), N-terminal pro-B type natriuretic peptide (P=0.019) levels, more patients in cardiac function class IV (P=0.004), and longer hospital days (P=0.003) than the conventional therapy group (N = 213). Survival was better in the integrative therapy group than in the conventional therapy group (log-rank P < 0.001). Multifactorial Cox regression identified “conventional therapy” or “integrative therapy” as an independent factor affecting the risk of CVE in patients with heart failure, with the risk of CVE being lower in the integrative therapy group (HR = 0.322, 95% CI = 0.185–0.561). A subgroup analysis found no significant association between therapy modality and risk of CVE in older patients (age ≥65 years, P=0.210) and those who had renal insufficiency (P=0.062). The Markov model predicted better cardiac function in the integrative therapy group than in the conventional therapy group at all time points (all P < 0.001). Conclusion In patients with heart failure, integrative therapy of Chinese and Western medicine had better long-term outcomes than conventional therapy. However, patients with advanced age and renal insufficiency had no significant advantage. Trials Registration. This trial is registered with China Clinical Trials Registry, ChiCTR2100050927, registered 8 September 2021, https://www.chictr.org.cn/showproj.aspx?proj=133451.

Association between instrumental activities of daily living frequency and clinical outcomes in older patients with cardiovascular disease.

Impairment in activities of daily living (ADL) is an independent predictor of poor prognosis in older patients. Nevertheless, the effects of instrumental ADL (IADL) frequency on prognosis in older patients with cardiovascular disease (CVD) are unclear. We investigate the associations between IADL frequency and all-cause mortality and hospital readmission due to cardiovascular events in older patients with CVD. A total of 638 consecutive outpatients ≥65 years old with CVD were enrolled. A questionnaire, including Frenchay Activities Index (FAI) parameters, was used to determine IADL frequency at the start of the study as the baseline observation. The primary endpoint was all-cause mortality, and the secondary endpoint was readmission for cardiovascular events. We examined the relationship between IADL frequency and each endpoint. Among the 632 patients evaluated {median age 74.0 [interquartile range (IQR) 70.0-78.0] years; 439 males}, there were 39 deaths and 105 cardiovascular events during the median follow-up period of 4.0 (IQR, 2.3-4.0) years. After adjusting for clinical confounding factors, the hazard ratios for all-cause mortality and cardiovascular events in the FAI points were 0.957 [95% confidence interval (CI), 0.920-0.996] and 0.973 (95% CI, 0.950-0.997), respectively. A higher IADL frequency was independently associated with better outcomes in older patients with CVD, suggesting that the preservation of instrumental activities should be focused on as the components of cardiovascular rehabilitation.

Renin-Angiotensin System Inhibitors Prognostic Benefit in Older Patients with Atrial Fibrillation

ObjectivesAngiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) have shown antiarrhythmic effects that are useful as part of the upstream therapy for atrial fibrillation (AF), both for primary and secondary prevention. Nevertheless, the potential prognosis value of these drugs in terms of mortality and major cardiovascular events is unclear, especially in older population with AF. Scientific evidence is scarce in this population and shows contradictory results. The aim of this study was to assess the potential benefit of ACEi and ARB in terms of mortality and major cardiovascular outcomes (hospitalization for heart failure, acute myocardial infarction and stroke) in older patients with AF, based on a real-world data analysis. DesignObservational: analysis of a retrospective registry. Settings and ParticipantsThe study included 9365 patients of 75 years or older diagnosed with AF, from CardioCHUVI-AF_75 registry: ClinicalTrials.gov Identifier: NCT04364516. Date of registration: November 26, 2018. MethodsWe performed propensity score matching techniques to obtain 2 comparable groups of 3601 patients with and without ACEi or ARB treatment. We compared survival and cardiovascular outcomes in both groups of patients using Cox proportional hazards models. ResultsWe did not find significant differences in terms of survival between using or not using ACEi or ARB for the older population (hazard ratio for mortality: 0.959, 95% confidence interval 0.872–1.054). There were no significant differences regarding cardiovascular major events between the 2 groups. Conclusions and ImplicationsTreatment with ACEi or ARB did not improve outcomes in terms of survival and cardiovascular events in older patients with AF. These results should prompt the conduct of randomized clinical trials specifically in the older AF patient population to robustly address this issue.

Ezetimibe Lipid-Lowering Trial on Prevention of Atherosclerotic Cardiovascular Disease in 75 or Older (EWTOPIA 75): A Randomized, Controlled Trial.

Evidence regarding the primary prevention of coronary artery disease events by low-density lipoprotein cholesterol (LDL-C) lowering therapy in older individuals, aged ≥75 years, is insufficient. This trial tested whether LDL-C-lowering therapy with ezetimibe is useful for the primary prevention of cardiovascular events in older patients. This multicenter, prospective, randomized, open-label, blinded end-point evaluation conducted at 363 medical institutions in Japan examined the preventive efficacy of ezetimibe for patients aged ≥75 years, with elevated LDL-C without history of coronary artery disease. Patients, who all received dietary counseling, were randomly assigned (1:1) to receive ezetimibe (10 mg once daily) versus usual care with randomization stratified by site, age, sex, and baseline LDL-C. The primary outcome was a composite of sudden cardiac death, myocardial infarction, coronary revascularization, or stroke. Overall, 3796 patients were enrolled between May 2009 and December 2014, and 1898 each were randomly assigned to ezetimibe versus control. Median follow-up was 4.1 years. After exclusion of 182 ezetimibe patients and 203 control patients because of lack of appropriate informed consent and other protocol violations, 1716 (90.4%) and 1695 (89.3%) patients were included in the primary analysis, respectively. Ezetimibe reduced the incidence of the primary outcome (hazard ratio [HR], 0.66; 95% CI, 0.50-0.86; P=0.002). Regarding the secondary outcomes, the incidences of composite cardiac events (HR, 0.60; 95% CI, 0.37-0.98; P=0.039) and coronary revascularization (HR, 0.38; 95% CI, 0.18-0.79; P=0.007) were lower in the ezetimibe group than in the control group; however, there was no difference in the incidence of stroke, all-cause mortality, or adverse events between trial groups. LDL-C-lowering therapy with ezetimibe prevented cardiovascular events, suggesting the importance of LDL-C lowering for primary prevention in individuals aged ≥75 years with elevated LDL-C. Given the open-label nature of the trial, its premature termination and issues with follow-up, the magnitude of benefit observed should be interpreted with caution. Clinical Registration: URL: https://www.umin.ac.jp. Unique identifier: UMIN000001988.

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Different transcriptional profiling between senescent and non-senescent human coronary artery endothelial cells (HCAECs) by Omeprazole and Lansoprazole treatment.

Recent evidence suggests that high dose and/or long term use of proton pump inhibitors (PPIs) may increase the risk of adverse cardiovascular events in older patients, but mechanisms underlying these detrimental effects are not known. Taking into account that the senescent endothelial cells have been implicated in the genesis or promotion of age-related cardiovascular disease, we hypothesized an active role of PPIs in senescent cells. The aim of this study is to investigate the changes in gene expression occurring in senescent and non-senescent human coronary artery endothelial cells (HCAECs) following Omeprazole (OPZ) or Lansoprazole (LPZ) treatment. Here, we show that atherogenic response is among the most regulated processes in PPI-treated HCAECs. PPIs induced down-regulation of anti-atherogenic chemokines (CXCL11, CXCL12 and CX3CL1) in senescent but not in non-senescent cells, while the same chemokines were up-regulated in untreated senescent cells. These findings support the hypothesis that up-regulated anti-atherogenic chemokines may represent a defensive mechanism against atherosclerosis during cellular senescence, and suggest that PPIs could activate pro-atherogenic pathways by changing the secretory phenotype of senescent HCAECs. Moreover, the genes coding for fatty acid binding protein 4 (FABP4) and piezo-type mechanosensitive ion channel component 2 (PIEZO2) were modulated by PPIs treatment with respect to untreated cells. In conclusions, our results show that long-term and high dose use of PPI could change the secretory phenotype of senescent cells, suggesting one of the potential mechanisms by which use of PPI can increase adverse outcomes in older subjects.

N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in older patients with type 2 diabetes: the Edinburgh Type 2 Diabetes Study.

The aim of this study was to investigate the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with traditional cardiovascular risk factors and incident cardiovascular events in older people with type 2 diabetes. In the prospective phase of the Edinburgh Type 2 Diabetes Study, 1066 men and women aged 60 to 75 years with type 2 diabetes mellitus were followed for 4 years; 112 participants had an incident cardiovascular event. At baseline, cardiovascular risk factors, pre-existing cardiovascular disease and levels of NT-proBNP were evaluated. Raised plasma NT-proBNP levels were associated with these classical cardiovascular risk factors: increased duration of diabetes, use of insulin, raised BMI, reduced HDL-cholesterol, reduced renal function and use of lipid-lowering and anti-hypertensive medication (all p < 0.05). In the prospective analysis, NT-proBNP was strongly associated with subsequent risk of all cardiovascular disease events (HR per one SD increase in NT-proBNP 1.39; 95% CI 1.10, 1.75), independent of cardiovascular risk factors traditionally used to predict vascular events. NT-proBNP was also independently associated with incident coronary artery disease events (1.48, 95% CI 1.10, 1.98). The addition of NT-proBNP to multivariate models improved the C-index by 0.019 for the 'hard' cardiac endpoint (fatal and non-fatal myocardial infarction). In older people with type 2 diabetes, NT-proBNP is associated with the development of coronary and cerebrovascular events, independent of a wide range of other vascular and metabolic risk factors, and may prove a useful addition to current vascular risk scores in diabetes populations.

Olmesartan in the Treatment of Hypertension in Elderly Patients: a Review of the Primary Evidence

Hypertension, particularly systolic hypertension, is prevalent in the elderly and increases with advancing age, in part because of age-related endothelial dysfunction and increased arterial stiffness. There is strong evidence from randomized clinical trials that supports the use of antihypertensive treatment for effective and sustained blood pressure (BP) control in older patients to reduce the risk of vascular-related morbidity and mortality, particularly cerebrovascular accidents, including stroke. Furthermore, current evidence and guidelines suggest that all major classes of antihypertensive agents are equally effective in controlling BP and preventing cardiovascular events in older patients. Diuretics are commonly used in elderly patients, but recent outcomes data have raised doubt about their long-term benefits. Renin-angiotensin system inhibitors have a better tolerability profile than diuretics. Extensive clinical evidence has demonstrated the excellent efficacy and tolerability profile of olmesartan medoxomil (OM)--an angiotensin II receptor blocker AT1 receptor antagonist--including in elderly patients. Randomized and observational studies have shown that OM provides effective BP control across the 24 h dosing interval in the elderly. It also has a good tolerability profile, a pharmacokinetic profile unaffected by age and a low propensity for drug interactions. An additional factor is that OM once-daily regimens are simple and straightforward, which can be an important factor in maintaining adherence to therapy in elderly patients. This article provides an overview of the main recent clinical evidence supporting the use of OM-based therapy in elderly patients with hypertension.

Diabetes Mellitus and Cardiovascular Events in Older Patients With Myocardial Infarction Prescribed Intensive-Dose and Moderate-Dose Statins

Practice guidelines recommend intensive-dose statins for patients with acute coronary syndrome, but recent data about the risk of new-onset diabetes mellitus have raised concerns about its use. Our main objective was to evaluate the association between intensive statin therapy and new-onset diabetes mellitus in patients with myocardial infarction and to evaluate the association of intensive statin therapy with long-term adverse clinical outcomes. A propensity score-matched cohort was created consisting of 17 080 patients with myocardial infarction aged >65 years old, hospitalized in Ontario, Canada, from 2004 to 2010. Clinical outcomes were compared in patients prescribed intensive-dose versus moderate-dose statins at hospital discharge. At 5 years, 13.6% of patients receiving intensive-dose statins and 13.0% of patients receiving moderate-dose statins had new-onset diabetes, which was not significantly different (P=0.19). By contrast, the 5-year rate of death or acute coronary syndrome was significantly lower at 44.8% in the intensive-dose statin group compared with 46.5% in the moderate-dose group (P=0.044). The reduction in combined clinical outcome was driven mainly by a significantly lower rate of acute coronary syndrome (P=0.039) associated with intensive-dose statins. No significant difference in mortality rates (34.8% in both groups) was observed between the treatment groups during the study period (P=0.89). In older patients with myocardial infarction, we found intensive-dose statin therapy to be effective in reducing repeat hospitalization for acute coronary syndrome. The rate of new-onset diabetes mellitus at long term was not significantly different between intensive-dose and moderate-dose statins.

Analysis of Efficacy and Safety in Patients Aged 65–75 Years at Randomization

Rates of cardiovascular disease are highest in the elderly. Lipid-lowering statin therapy reduces the proportional risk as effectively in older patients as in younger individuals; however, limited data are available for elderly patients with type 2 diabetes. We conducted a post hoc analysis to compare the efficacy and safety of atorvastatin among 1,129 patients aged 65-75 years at randomization with 1,709 younger patients in the Collaborative Atorvastatin Diabetes Study (CARDS). CARDS was a randomized placebo-controlled trial of 10 mg/day atorvastatin for primary prevention of cardiovascular disease in patients aged 40-75 years with LDL cholesterol concentrations </=4.14 mmol/l followed for a median of 3.9 years. The primary end point was time to first occurrence of acute coronary heart disease events, coronary revascularizations, or stroke. Atorvastatin treatment resulted in a 38% reduction in relative risk ([95% CI -58 to -8], P = 0.017) of first major cardiovascular events in older patients and a 37% reduction ([-57 to -7], P = 0.019) in younger patients. Corresponding absolute risk reductions were 3.9 and 2.7%, respectively (difference 1.2% [95% CI -2.8 to 5.3], P = 0.546); numbers needed to treat for 4 years to avoid one event were 21 and 33, respectively. All-cause mortality was reduced nonsignificantly by 22% ([-49 to 18], P = 0.245) and 37% ([-64 to 9], P = 0.98), respectively. The overall safety profile of atorvastatin was similar between age-groups. Absolute and relative benefits of statin therapy in older patients with type 2 diabetes are substantial, and all patients warrant treatment unless specifically contraindicated.

Beta-blockers are poorly tolerated by the elderly: myth or reality?

beta-blocker therapy can reduce mortality and risk of major cardiovascular events in older patients. Even though ss-blockers can provide benefits nearly equal to those experienced by younger patients, the drugs remain underutilized by the elderly. Consequently, underuse contributes to higher mortality and hospitalization rates among these patients. This derives, in part, from many factors that include physiologic changes accompanying aging, presence of comorbid diseases, use of multiple medications, issues of drug tolerability, and poor patient compliance; however, education can overcome some of these to facilitate more widespread use among elderly patients.

Sustained favorable long-term prognosis of negative stress echocardiography following uncomplicated myocardial infarction

vival Study (4S). Circulation 1997;96:4211–4218. 3. Lewis SJ, Moye LA, Sacks FM, Johnstone DE, Timmis G, Mitchell J, Limacher M, Kell S, Glasser SP, Grant J, et al, for the CARE Investigators. Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range. Results of the Cholesterol and Recurrent Events (CARE) trial. Ann Intern Med 1998;129:681–689. 4. Hunt D, Young P, Simes J, Hague W, Mann S, Owensby D, Lane G, Tonkin A, for the LIPID Investigators. Benefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients: results from the LIPID trial. Ann Intern Med 2001;134:931–940. 5. Aronow WS, Ahn C. Incidence of new coronary events in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol 125 mg/dl treated with statins versus no lipid-lowering drug. Am J Cardiol 2002;89: 67–69. 6. Aronow WS, Ahn C, Gutstein H. Incidence of new atherothrombotic brain infarction in older persons with prior myocardial infarction and serum lowdensity lipoprotein cholesterol 125 mg/dL treated with statins versus no lipidlowering drug. J Gerontol Med Sci 2002:57A:M333–M335. 7. Joint National Committee. The Sixth Report of the Joint National Committee on the Detection Evaluation, and Treatment of High Blood Pressure (JNC VI). Arch Intern Med 1997;157:2413–2444. 8. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997;20:1183–1197. 9. Aronow WS, Ahn C, Kronzon I. Prognosis of congestive heart failure in elderly patients with normal versus abnormal left ventricular systolic function associated with coronary artery disease. Am J Cardiol 1990;66:1257–1259. 10. Kjekshus J, Pedersen TR, Olsson AG, Faergeman O, Pyorala K. The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease. J Card Fail 1997;3:249–254.

Frequency of congestive heart failure in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol ≥125 mg/dl treated with statins versus no lipid-lowering drug

Coronary artery disease is a major significant independent risk factor for the development of congestive heart failure (CHF) in older persons, and had a risk ratio of 4.0 for the development of CHF in 2,902 persons, mean age 81 years. 1 Aronow W.S. Ahn C. Kronzon I. Comparison of incidences of congestive heart failure in older African-Americans, Hispanics, and whites. Am J Cardiol. 1999; 84: 611-612 Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Older persons with coronary artery disease and elevated serum low-density lipoprotein (LDL) cholesterol treated with statin drugs had a significant reduction in new coronary events. 2 Miettinen T.A. Pyorala K. Olsson A.G. Musliner T.A. Cook T.J. Faergeman O. Berg K. Pedersen T. Kjekshus J. Scandinavian Simvastatin Study GroupCholesterol-lowering therapy in women and elderly patients with myocardial infarction or angina pectoris Findings from the Scandinavian Simvastatin Survival Study (4S). Circulation. 1997; 96: 4211-4218 Crossref PubMed Scopus (468) Google Scholar , 3 Lewis S.J. Moye L.A. Sacks F.M. Johnstone D.E. Timmis G. Mitchell J. Limacher M. Kell S. Glasser S.P. Grant J. et al. CARE InvestigatorsEffect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range Results of the Cholesterol and Recurrent Events (CARE) trial. Ann Intern Med. 1998; 129: 681-689 Crossref PubMed Scopus (425) Google Scholar , 4 Hunt D. Young P. Simes J. Hague W. Mann S. Owensby D. Lane G. Tonkin A. LIPID InvestigatorsBenefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients results from the LIPID trial. Ann Intern Med. 2001; 134: 931-940 Crossref PubMed Scopus (230) Google Scholar , 5 Aronow W.S. Ahn C. Incidence of new coronary events in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol ≥125 mg/dl treated with statins versus no lipid-lowering drug. Am J Cardiol. 2002; 89: 67-69 Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar We previously reported data from an observational study of 1,410 older men and women with prior myocardial infarction and a serum LDL cholesterol ≥125 mg/dl showing that older persons treated with statins had a 50% significant independent reduction in the incidence of new coronary events 5 Aronow W.S. Ahn C. Incidence of new coronary events in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol ≥125 mg/dl treated with statins versus no lipid-lowering drug. Am J Cardiol. 2002; 89: 67-69 Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar and a 60% significant independent reduction in the incidence of new atherothrombotic brain infarction. 6 Aronow W.S. Ahn C. Gutstein H. Incidence of new atherothrombotic brain infarction in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol ≥125 mg/dL treated with statins versus no lipid-lowering drug. J Gerontol Med Sci. 2002; 57A: M333-M335 Crossref Scopus (61) Google Scholar This article reports data from this observational study investigating the effect of statins on the incidence of CHF in these patients followed prospectively for the incidence of CHF.

Response to Antihypertensive Therapy in Older Patients With Sustained and Nonsustained Systolic Hypertension

The goal of the present study was to assess the effect of antihypertensive therapy on clinic (CBP) and ambulatory (ABP) blood pressures, on ECG voltages, and on the incidence of stroke and cardiovascular events in older patients with sustained and nonsustained systolic hypertension. Patients who were >/=60 years old, with systolic CBP of 160 to 219 mm Hg and diastolic CBP of <95 mm Hg, were randomized into the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) Trial. Treatment consisted of nitrendipine, with the possible addition of enalapril, hydrochlorothiazide, or both. Patients enrolled in the Ambulatory Blood Pressure Monitoring Side Project were classified according to daytime systolic ABP into 1 of 3 subgroups: nonsustained hypertension (<140 mm Hg), mild sustained hypertension (140 to 159 mm Hg), and moderate sustained hypertension (>/=160 mm Hg). At baseline, patients with nonsustained hypertension had smaller ECG voltages (P<0.001) and, during follow-up, a lower incidence of stroke (P<0.05) and of cardiovascular complications (P=0.01) than other groups. Active treatment reduced ABP and CBP in patients with sustained hypertension but only CBP in patients with nonsustained hypertension (P<0.001). The influence of active treatment on ECG voltages (P<0.05) and on the incidence of stroke (P<0.05) and cardiovascular events (P=0.06) was more favorable than that of placebo only in patients with moderate sustained hypertension. Patients with sustained hypertension had higher ECG voltages and rates of cardiovascular complications than did patients with nonsustained hypertension. The favorable effects of active treatment on these outcomes were only statistically significant in patients with moderate sustained hypertension.

Pravastatin reduced cardiovascular events in older patients with myocardial infarction and average cholesterol levels

Source Citation Lewis SJ, Moye LA, Sacks FM, et al. Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range. Results ...