Primary Prevention Of Cardiovascular Disease Events Research Articles

Do coping strategies really affect cardiovascular events? The Isfahan cohort study of adults in Eastern Mediterranean Regional Office.

Psychological factors are among the most suspected indicators which may cause atherosclerosis. Coping strategies modifying psychological stress may be significantly associated with health outcomes. However, little is known about the influence of adaptive and maladaptive coping strategies on major adverse cardiovascular disease (CVD) events. The purpose of this study is to examine this idea among a sample of adults. Design: cohort study. The Isfahan cohort study (ICS) is a longitudinal population-based, prospective study. Participants (N=6323 individuals aged 35 years or greater at baseline) were selected by multistage random sampling with 6-year intervals (i.e. 2001: 6323 individuals, 2007: 3296 individuals, and 2013: 1706 individuals). Adaptive and maladaptive coping strategies were evaluated by a multicomponent self-administered stress management paper-based questionnaire. All CVD events were confirmed by a blinded panel of experts and a marginal cox regression model was used to model the survival data. Adaptive coping strategies could be protective against CVD events with hazard ratios (95% confidence interval) [0.97 (0.95-0.99)] and maladaptive coping strategies seem to be a risk factor, 1.02 (1.01-1.04) in the whole population. Individuals younger than 60 showed similar results, with 0.96 (0.93-0.98) and 1.04 (1.01-1.07) for adaptive and maladaptive coping strategies, respectively. However, these findings were not replicated among seniors older than age 60. Based on our results, coping strategies have an important role in cardiovascular events, particularly among young adults. According to the results, informing patients about adaptive stress management may promote primary prevention of CVD events.

Fibrates for primary prevention of cardiovascular disease events.

Fibrates are effective for modifying atherogenic dyslipidaemia, and particularly for lowering serum triglycerides. However, evidence that fibrates reduce mortality and morbidity associated with cardiovascular disease (CVD), or overall mortality and morbidity, in the primary prevention of CVD is lacking. This Cochrane Review and meta-analysis aimed to evaluate the clinical benefits and harms of fibrates versus placebo or usual care or fibrates plus other lipid-modifying drugs versus other lipid-modifying drugs alone for the primary prevention of cardiovascular disease (CVD) morbidity and mortality. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and Web of Science (all from inception to 19 May 2016). We searched four clinical trial registers (last searched on 3 August 2016) with the help of an experienced professional librarian. We searched the databases to identify randomised controlled trials (RCTs) evaluating the clinical effects of fibrate therapy in the primary prevention of CVD events. We did not impose any language restrictions. We aimed to include all RCTs comparing the effects of fibrate monotherapy versus placebo or usual care, or fibrates plus other lipid-modifying drugs versus other lipid-modifying drugs alone. Included studies had a follow-up of at least six months for the primary prevention of CVD events. We excluded trials with clofibrate, because it was withdrawn from the market in 2002. Two review authors independently screened titles and abstracts for potential study inclusion. Two review authors independently retrieved the full-text papers and extracted data. Disagreements were resolved by consensus. We calculated risk ratios (RRs) and accompanying 95% confidence intervals (CIs) for aggregate data on primary and secondary outcomes. We tested for heterogeneity with the Cochrane Q-test and used the I2 statistic to measure inconsistency of treatment effects across studies. Using the GRADE approach, we assessed the quality of the evidence and used the GRADE profiler software (GRADEpro GDT) to import data from Review Manager 5 to create 'Summary of findings' tables. We identified six eligible trials including 16,135 individuals. The mean age of trial populations varied across trials; between 47.3 and 62.3 years. Four trials included individuals with diabetes mellitus type 2 only. The mean treatment duration and follow-up of participants across trials was 4.8 years. We judged the risks of selection and performance bias to be low; risks of detection bias, attrition bias, and reporting bias were unclear. Reporting of adverse effects by included trials was very limited; that is why we used discontinuation of therapy due to adverse effects as a proxy for adverse effects. Patients treated with fibrates had a reduced risk for the combined primary outcome of CVD death, non-fatal myocardial infarction, or non-fatal stroke compared to patients on placebo (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.74 to 0.96; participants = 16,135; studies = 6; moderate-quality of evidence). For secondary outcomes we found RRs for fibrate therapy compared with placebo of 0.79 for combined coronary heart disease death or non-fatal myocardial infarction (95% CI 0.68 to 0.92; participants = 16,135; studies = 6; moderate-quality of evidence); 1.01 for overall mortality (95% CI 0.81 to 1.26; participants = 8471; studies = 5; low-quality of evidence); 1.01 for non-CVD mortality (95% CI 0.76 to 1.35; participants = 8471; studies = 5; low-quality of evidence); and 1.38 for discontinuation of therapy due to adverse effects (95% CI 0.71 to 2.68; participants = 4805; studies = 3; I2 = 74%; very low-quality of evidence). Data on quality of life were not available from any trial. Trials that evaluated fibrates in the background of statins (2 studies) showed no benefits in preventing cardiovascular events. Moderate-quality evidence suggests that fibrates lower the risk for cardiovascular and coronary events in primary prevention, but the absolute treatment effects in the primary prevention setting are modest (absolute risk reductions < 1%). There is low-quality evidence that fibrates have no effect on overall or non-CVD mortality. Very low-quality evidence suggests that fibrates are not associated with increased risk for adverse effects.

Primary Prevention of Cardiovascular Disease – What Happens in the Rest of the World?

Background: Risk management thresholds for medication commencement for primary prevention of cardiovascular disease (CVD) remains controversial. Recent guidelines released in the UK and the United States (e.g. UK NICE and ACC/AHA guidelines) have added to this. In anticipation of new contemporary equations being available specifically for New Zealanders and a need to update our own guidelines, a systematic review was conducted looking at current international guidance and practice for the medical management of CVD Risk. Methods: The review focussed on recent quality assured international guidelines and systematic reviews published since the Primary care Handbook update in 2012, which included CVD risk assessment and management. It was outside the remit and scope of the review to look at individual trials or studies. The focus was on the primary prevention of CVD events and management of risk factors. Results/Conclusions: Fourteen international quality assured guidelines and six systematic reviews were identified and reviewed. A full summary of the results will be presented including:•A variety of thresholds for considering or recommending whether to treat medically with some using CVD Risk, some using individual risk values and others using a combination-NZ's higher CVD Risk threshold for considering or recommending medications to treat at approximately double the risk of contemporary international guidelines-Most recommend tailoring medications to reach a target but some not-When treating to a target varying views on what those targets should be-Equivocal views on risk communication and medication adherence-Identification of mental health as a CVD risk factor

Vascular Protection in People with Diabetes

Vascular Protection in People with Diabetes

Is it important to measure or reduce C-reactive protein in people at risk of cardiovascular disease?

Systemic and local vascular inflammation is implicated in atherogenesis. High-sensitivity (hs) assays detecting low concentrations of C-reactive protein (CRP) in healthy individuals have delineated associations of this inflammation marker with cardiovascular events years later. A 160 309-person participant level meta-analysis of 54 prospective studies found the relationship between log-CRP concentration and cardiovascular disease (CVD) events to be linear, with a 2.5-fold risk difference in individuals at opposite extremes of the CRP distribution.1 In vitro studies and animal experiments point to potentially atherogenic actions of CRP,2 and statins lower both CRP and low-density lipoprotein cholesterol (LDL-C).3 The Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER),4 designed to ‘assess the effect of rosuvastatin on first ever cardiovascular events in apparently healthy men and women who do not qualify for statin therapy due to low levels of LDL-C, but who are at increased cardiovascular risk due to elevated levels of hs-CRP’, was halted because of ‘unequivocal evidence of a reduction in cardiovascular morbidity and mortality among patients who received CRESTOR (rosuvastatin) when compared to placebo’ (http://clinicaltrials.gov/ct2/show/[NCT00239681][1]). Consequently, the US Food and Drug Administration approved an amended license for rosuvastatin for the primary prevention of CVD events in men and women over 50 and 60 years, respectively, with one other risk factor and a CRP concentration of >2 mg/L. Even before the publication of this trial, the estimated 5 million ‘hs-CRP’ tests were being ordered annually in the USA,5 and updated Canadian guidance on CVD prevention6 now recommends the consideration of ‘hs-CRP’ measurement in those at intermediate risk. The 2010 American College of Cardiology Foundation/American Heart Association Guidelines stated that in ‘men 50 years of age or older and women 60 years of age or older with an LDL-C < 130 … [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00239681&atom=%2Fehj%2F33%2F18%2F2258.atom

Primary Prevention of Coronary Heart Disease With Statins

In the current issue of Circulation , Lazar et al report the results of their modeling of the cost-effectiveness of alternative statin treatment strategies for primary prevention using low-cost, lower-potency generic statins.1 Lazar's study informs clinical decisions and practice guidelines about the potential use of statin therapy in people at low to moderate risk for coronary heart disease. It also provides an opportunity to consider the appropriate use and potential misuse of decision models to inform and guide clinical practice, and it highlights research opportunities, challenges, and potential limitations of comparative effectiveness, as well. Patients and providers commonly express the desire to make medical decisions solely on the basis of anticipated clinical benefits, harms, and patient preferences and values, without considering the distorting effects of cost. With the widespread availability of generic forms of most US-licensed statins (as of November 2011, rosuvastatin will be the only Food and Drug Administration-approved patent-protected statin in the United States), the cost of statin therapy has dropped precipitously. All currently available generic statins, with the exception of simvastatin 80 mg, can be purchased for as little $0.11 to $0.13 a pill at 1 or more major national pharmacy chains. Article see p 146 At these acquisition costs, Lazar et al find that low/moderate potency statin therapy is cost saving for those without a prior cardiovascular event at a moderately high risk of experiencing a coronary heart disease (CHD) event (10% to 20% over 10 years; 2 Framingham Heart Study [FHS] risk factors and a low-density lipoprotein-cholesterol [LDL-C] >100 mg/dL), and those with 2 risk factors but a 130 mg/dL, as well. They further identify a cost-effective maximum impact strategy that comprises all people with 2 Framingham risk factors, regardless of 10-year FHS risk or LDL-C level, those …

Postmenopausal Hormone Replacement Therapy and the Primary Prevention of Cardiovascular Disease

To evaluate the value of hormone replacement therapy (HRT) in the primary prevention of cardiovascular disease (CVD) and coronary artery disease (CAD). MEDLINE and Cochrane databases were searched for all primary prevention studies reporting CVD or CAD incidence, mortality, or both in association with HRT; reference lists, letters, editorials, and reviews were also reviewed. All studies were reviewed, abstracted, and rated for quality. Only studies of good or fair quality, according to U.S. Preventive Services Task Force (USPSTF) criteria, were included in the detailed review and meta-analysis. The summary relative risk with any HRT use was 0.75 (95% credible interval [CrI], 0.42 to 1.23) for CVD mortality and 0.74 (CrI, 0.36 to 1.45) for CAD mortality. The summary relative risk with any use was 1.28 (CrI, 0.86 to 2.00) for CVD incidence and 0.87 (CrI, 0.62 to 1.21) for CAD incidence. Further analysis of studies adjusting for socioeconomic status, as well as other major CAD risk factors, showed a summary relative risk of 1.07 (CrI, 0.79 to 1.48) for CAD incidence associated with any HRT use. Similar results were found when the analysis was stratified by studies adjusting for alcohol consumption, exercise, or both, in addition to other major risk factors, suggesting confounding by these factors. This meta-analysis differs from previous meta-analyses by evaluating potential explanatory variables of the relationship between HRT, CVD, and CAD. The adjusted meta-analysis is consistent with recent randomized trials that have shown no benefit in the secondary or primary prevention of CVD events. A valid answer to the role of HRT in the primary prevention of CVD will best come from randomized, controlled trials.