Relative Risk Of Coronary Events Research Articles

Role of statins in primary prevention of cardiovascular disease

Cardiovascular disease continues to remain a global health challenge due to its increasing trend of prevalence. Almost, 6.2 million deaths were caused by cardiovascular diseases among patients of age range 30-70 years in 2019. The burden of cardiovascular diseases can only be reduced by implementation of effective preventive strategies. Primary prevention is of utmost importance since individuals at risk are treated beforehand thus reducing the chance of development of disease. Statins are lipid lowering agents and are used in primary prevention of cardiovascular disease. The purpose of this research is to review the available information about role of statins in primary prevention of cardiovascular disease. Generally, statins are considered as safe and effective medications to treat and reduce the morbidity of cardiovascular diseases. The relative risk of coronary events, cardiovascular disease mortality, non-fatal strokes, and all-cause mortality is decreased with statin therapy. Elderly population or individuals at risk of development of cardiovascular diseases can be efficiently managed by statin therapy. Some studies associate the occurrence of diabetes with the use of statins but most of the studies recommend the role of statins in prevention as benefits outweigh the risks. Literature also supports the role of statins in primary prevention although more clinical studies in future can yield better evidence-based results to support the use of statins especially in primary prevention.

Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease

BackgroundBoth genetic and lifestyle factors contribute to individual-level risk of coronary artery disease. The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown.MethodsUsing a polygenic score of DNA sequence polymorphisms, we quantified genetic risk for coronary artery disease in three prospective cohorts — 7814 participants in the Atherosclerosis Risk in Communities (ARIC) study, 21,222 in the Women’s Genome Health Study (WGHS), and 22,389 in the Malmö Diet and Cancer Study (MDCS) — and in 4260 participants in the cross-sectional BioImage Study for whom genotype and covariate data were available. We also determined adherence to a healthy lifestyle among the participants using a scoring system consisting of four factors: no current smoking, no obesity, regular physical activity, and a healthy diet.ResultsThe relative risk of incident coronary events was 91% higher among participants at high genetic risk (top quintile of polygenic scores) than among those at low genetic risk (bottom quintile of polygenic scores) (hazard ratio, 1.91; 95% confidence interval [CI], 1.75 to 2.09). A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor), regardless of the genetic risk category. Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle (hazard ratio, 0.54; 95% CI, 0.47 to 0.63). This finding corresponded to a reduction in the standardized 10-year incidence of coronary events from 10.7% for an unfavorable lifestyle to 5.1% for a favorable lifestyle in ARIC, from 4.6% to 2.0% in WGHS, and from 8.2% to 5.3% in MDCS. In the BioImage Study, a favorable lifestyle was associated with significantly less coronary-artery calcification within each genetic risk category.ConclusionsAcross four studies involving 55,685 participants, genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease. Among participants at high genetic risk, a favorable lifestyle was associated with a nearly 50% lower relative risk of coronary artery disease than was an unfavorable lifestyle. (Funded by the National Institutes of Health and others.)

Diet-heart disease hypothesis is unaffected by results of analysis of recovered data from Minnesota Coronary Experiment.

Commentary on: Ramsden CE, Zamora D, Majchrzak-Hong S, et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968–73). BMJ 2016;353:i1246[OpenUrl][1][Abstract/FREE Full Text][2]. Replacement of a proportion of saturated fat with polyunsaturated fats is a cornerstone of dietary recommendations for the prevention of coronary heart disease.1 Ramsden and colleagues have hypothesised that n-6 polyunsaturates may increase the risk of heart disease.2 The Minnesota Coronary Experiment (MCE) was one of a small number of randomised controlled trials conducted and published between the mid-1960s and early 1990s to test the effect of replacing dietary saturated fat with polyunsaturated fat on coronary heart disease.3 The relative risk of coronary events in the treatment group was 1.08 (95% CI 0.84 to 1.37) and this result, reported in the trial's original paper, has been included … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.i1246%26rft_id%253Dinfo%253Apmid%252F27071971%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=353/apr12_12/i1246&atom=%2Febmed%2F21%2F5%2F185.atom

The Homocysteine Paradox

There is little doubt that elevation of plasma total homocysteine is associated with increased cardiovascular risk. Over the past 2 decades, many large prospective studies have established that hyperhomocysteinemia predicts for an increased relative risk of coronary events, stroke, venous thromboembolism, and death.1,2 Hyperhomocysteinemia also has been shown to produce abnormalities of vascular structure and function in animal models.3 Paradoxically, however, several intervention trials have failed to demonstrate any clinical benefit from homocysteine-lowering therapy.4–8 What is the explanation for this paradox? See accompanying article on page 1158 One possibility is that hyperhomocysteinemia is a clinically important risk factor only when plasma total homocysteine is elevated to extremely high levels. The hypothesis that homocysteine is a cardiovascular risk factor first arose from clinical and pathological observations in children and young adults with hereditary homocystinuria.9 If untreated, these individuals develop severe hyperhomocysteinemia, with plasma total homocysteine levels greater than 100 μmol/L, and they have a high risk of developing pathological vascular lesions and thromboembolic events at a young age.10 When placed on homocysteine-lowering therapy (high doses of vitamin B6, vitamin B12, folic acid, or betaine, along with dietary methionine restriction), their risk of adverse vascular events decreases markedly.11 Improvement in vascular outcome occurs despite a moderate level of residual hyperhomocysteinemia. In contrast to the clear clinical benefit of homocysteine-lowering therapy in severe hyperhomocysteinemia, its potential role in mild hyperhomocysteinemia remains unproven. All of the recent intervention trials of homocysteine-lowering therapy have been performed in subjects with relatively mild hyperhomocysteinemia (plasma total homocysteine levels between 10 and 30 μmol/L). The negative …

Coronary Calcification Improves Cardiovascular Risk Prediction in the Elderly

Coronary calcification detected by electron beam tomography may improve cardiovascular risk prediction. The technique is particularly promising in the elderly because the predictive power of cardiovascular risk factors weakens with age. We investigated the prognostic value of coronary calcification for cardiovascular events and mortality in a general, asymptomatic population of elderly subjects. From 1997 to 2000, electron beam tomography scanning to assess coronary calcification was performed in subjects of the population-based Rotterdam Study. Risk factors were measured by standardized procedures. Coronary calcium scores were available for 1795 asymptomatic participants (mean age, 71 years; range, 62 to 85 years). During a mean follow-up of 3.3 years, 88 cardiovascular events, including 50 coronary events, occurred. The risk of coronary heart disease increased with increasing calcium score. The multivariate-adjusted relative risk of coronary events was 3.1 (95% CI, 1.2 to 7.9) for calcium scores of 101 to 400, 4.6 (95% CI, 1.8 to 11.8) for calcium scores of 401 to 1000, and 8.3 (95% CI, 3.3 to 21.1) for calcium scores >1000 compared with calcium scores of 0 to 100. The predictive value in subjects >70 years of age was similar. Risk prediction based on the cardiovascular risk factors improved when coronary calcification was added. Coronary calcification is a strong and independent predictor of coronary heart disease, also in the elderly. Coronary calcification improves prediction of coronary events based on cardiovascular risk factors. Risk stratification by assessment of coronary calcification may have an important role in the primary prevention of coronary heart disease events in the elderly.

Variations and increase in use of statins across Europe: data from administrative databases

Coronary heart disease remains a major cause of death in most European countries.1 Statins lower blood cholesterol concentration and reduce the relative risk of coronary events by about 30% in...

Treating lipids in cardiovascular disease: new directions

Aims To review the importance of lipid parameters beside low-density lipoprotein (LDL) levels as risk factors for cardiovascular disease, and their potential as therapeutic targets for lipid-lowering agents. Methods and Results Large numbers of studies have shown that, as well as high low-density lipoprotein (LDL) levels, low high-density lipoprotein (HDL) levels and a high LDL/HDL ratio are important cardiovascular disease risk factors. The new generation of statins, such as cerivastatin, demonstrates greater potency in getting more patients to their LDL-C targets, as recommended by the U.S. NCEP guidelines. Statins and also fibrates can increase HDL levels. In the VA-HIT study, for example, a 6% increase in HDL level using gemfibrozil was associated with a 22% reduction in the relative risk of coronary events compared with placebo. Statin treatment, by decreasing LDL and increasing HDL levels, produces strong reductions in the LDL/HDL ratio. In a cerivastatin study, the percentage of patients with LDL/HDL ratio <3 (low risk of coronary heart disease) increased from 32% (baseline) to 90% after 8 weeks of therapy. The density of LDL particles also affects cardiovascular disease risk. Studies have shown that small dense LDL particles have atherogenic properties, and that lipid-lowering therapy can alter the LDL density profile. The TRIGMA trial is investigating the effect of cerivastatin on LDL particle size and triglyceride levels in patients with type 2 diabetes. Conclusions Other lipid parameters, besides LDL levels, can provide new targets for lipid intervention therapy.

Primary prevention of coronary heart disease in women through diet and lifestyle.

Many lifestyle-related risk factors for coronary heart disease have been identified, but little is known about their effect on the risk of disease when they are considered together. We followed 84,129 women participating in the Nurses' Health Study who were free of diagnosed cardiovascular disease, cancer, and diabetes at base line in 1980. Information on diet and lifestyle was updated periodically. During 14 years of follow-up, we documented 1128 major coronary events (296 deaths from coronary heart disease and 832 nonfatal infarctions). We defined subjects at low risk as those who were not currently smoking, had a body-mass index (the weight in kilograms divided by the square of the height in meters) under 25, consumed an average of at least half a drink of an alcoholic beverage per day, engaged in moderate-to-vigorous physical activity (which could include brisk walking) for at least half an hour per day, on average, and scored in the highest 40 percent of the cohort for consumption of a diet high in cereal fiber, marine n-3 fatty acids, and folate, with a high ratio of polyunsaturated to saturated fat, and low in trans fat and glycemic load, which reflects the extent to which diet raises blood glucose levels. Many of the factors were correlated, but each independently and significantly predicted risk, even after further adjustment for age, family history, presence or absence of diagnosed hypertension or diagnosed high cholesterol level, and menopausal status. Women in the low-risk category (who made up 3 percent of the population) had a relative risk of coronary events of 0.17 (95 percent confidence interval, 0.07 to 0.41) as compared with all the other women. Eighty-two percent of coronary events in the study cohort (95 percent confidence interval, 58 to 93 percent) could be attributed to lack of adherence to this low-risk pattern. Among women, adherence to lifestyle guidelines involving diet, exercise, and abstinence from smoking is associated with a very low risk of coronary heart disease.

Coronary artery disease: the Scandinavian Simvastatin Survival Study Experience

Although hyperlipidemia is a known risk factor for coronary artery disease, lipid-lowering agents were not used widely until recently because evidence was lacking that they could prolong life. In 1987, a large clinical trial, the Scandinavian Simvastatin Survival Study (4S), was designed to test whether such therapy could decrease all-cause mortality in patients with documented coronary artery disease. The prospective, randomized, multicenter trial included 4,444 patients who had had angina pectoris or myocardial infarction (MI), serum total cholesterol of 213–310 mg/dL, and serum triglycerides ≤221 mg/dL. Patients received either simvastatin 20–40 mg/day or placebo and were followed for a median of 5.4 years. Therapy decreased total cholesterol an average of 25%; low-density lipoprotein (LDL) cholesterol, 35%; and triglyceride levels, 10%. Therapy increased high-density lipoprotein (HDL) cholesterol levels 8%. Although noncardiac death rates were similar among the groups, the relative risk of mortality (from any cause) was decreased 30%, and the relative risk of coronary mortality was decreased 42% in the simvastatin arm. The mortality risk reductions were profound in patients ≥60 years of age. Treatment also significantly decreased the relative risk of coronary events and the need for bypass surgery or coronary angioplasty. Patients with diabetes also benefited significantly from simvastatin therapy. The reductions in relative risk of major coronary events were achieved irrespective of such baseline risk factors as hypertension and smoking and such medication factors as aspirin, β-blocker, and calcium-antagonist use. Simvastatin therapy has been shown to be cost-effective, decreasing per-patient hospitalization costs by 31% or $3,872 in 1995 dollars.