Risk factors for primary prevention of cardiovascular disease and risk reduction by lipid control: the OMEGA study risk factor sub-analysis

The aim of this study was to determine the trends of cardiovascular risk factor prevalence between 1988/9 and 2008/9 in the 25–74-year-old population in an area of Southern Italy. We compared three cross-sectional studies conducted in random population samples, in 1988/9, 1998/9, and 2008/9 in Salerno, Italy. The methodology of data collection (lipid profile, systolic and diastolic blood pressure, glycaemia, and smoking) and conducting tests which the population underwent during the three phases was standardized and comparable. Prevalence of diabetes, hypertension, hypercholesterolemia, and smoking was calculated and standardized for age. A total of 3491 subjects were included. From 1988/9 to 2008/9, in males, the prevalence of all four risk factors was reduced. In women, there was a clear reduction of hypertension, a similar prevalence of hypercholesterolemia, and an increase of smoking and diabetes. In the area of Salerno, our data confirm that the global prevalence of the major risk factors is decreasing in men, but their absolute values are still far from optimization. In women, diabetes and smoking showed a negative trend, therefore requiring targeted interventions. These data are now used as a base for executive targeted programs to improve prevention of cardiovascular disease in our community.

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Update of Antiplatelet Therapy in Patients Without Known Cardiovascular Disease

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2017-0013 ◽

2018 ◽

Vol 19 (4) ◽

pp. 383-388

Author(s):

Miloje Tomasevic ◽

Srdjan Aleksandric ◽

Sinisa Stojkovic

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Primary Prevention ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Artery Disease ◽

Prevention Of Cardiovascular Disease

Abstract Platelet activation and aggregation play a critical role in thrombosis, a fundamental pathophysiologic event responsible for the acute clinical manifestations of atherothrombotic events such as acute coronary syndrome, myocardial infarction, ischemic stroke/transient ischemic attack and peripheral artery disease. Dual antiplatelet therapy (low-dose aspirin plus ADP-P2Y12 receptor blockers) has become the cornerstone of therapy for the management of acute and chronic coronary artery disease and the prevention of ischemic complications associated with percutaneous coronary intervention. However, dual antiplatelet therapy in primary prevention of cardiovascular disease in patients without known cardiovascular disease did not significantly reduce the risk of cardiovascular events, such as myocardial infarction, stroke or death, but significantly increased the rate of bleeding. Furthermore, despite multiple randomized controlled trials evaluating the efficacy and safety of aspirin use in patients without known cardiovascular disease, its role in primary prevention is still unclear, especially in patients with a higher risk of cardiovascular disease (non-diabetic individuals with >2 risk factors for coronary artery disease, elderly >60 years with additional risk factors, and patients with diabetes). Currently, there are four ongoing randomized controlled trials aiming to fill the missing gap in the efficacy and safety of aspirin therapy for primary prevention in these patients. The current European and United States Guidelines agree that primary prevention of cardiovascular disease is essential, but there are some substantial differences in risk estimation and treatment strategies among patients without known cardiovascular disease. This short review is focused on these differences and practical treatment approach to these patients based on present European and United States recommendations.

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Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews

BMJ Open ◽

10.1136/bmjopen-2018-023085 ◽

2019 ◽

Vol 9 (4) ◽

pp. e023085 ◽

Cited By ~ 21

Author(s):

Paula Byrne ◽

John Cullinan ◽

Amelia Smith ◽

Susan M Smith

Keyword(s):

Cardiovascular Disease ◽

Primary Prevention ◽

Risk Reduction ◽

Systematic Reviews ◽

Baseline Risk ◽

Risk Category ◽

All Cause Mortality ◽

Overview Of Systematic Reviews ◽

And Gender ◽

Prevention Of Cardiovascular Disease

ObjectiveTo synthesise evidence from exclusively primary prevention data on the effectiveness of statins for prevention of cardiovascular disease (CVD), including stroke, and outcomes stratified by baseline risk and gender.DesignOverview of systematic reviews (SRs) using Revised-AMSTAR approach to assess quality.Data sourcesCochrane Database of Systematic Reviews, MEDLINE, Embase, PubMed, Scopus and PROSPERO to June 2017.Eligibility criteria for selecting studiesSRs of randomised control trials (RCTs) or individual patient data (IPD) from RCTs, examining the effectiveness of statins versus placebo or no treatment on all-cause mortality, coronary heart disease, CVD (including stroke) and composite endpoints, with stratification by baseline risk and gender.Data extraction and synthesisTwo independent reviewers extracted data and assessed methodological quality. A narrative synthesis was conducted.ResultsThree SRs were included. Quality of included SRs was mixed, and none reported on the risk of bias of included trials.We found trends towards reduced all-cause mortality in all SRs (RR 0.91 [95% CI 0.85 to 0.97]), (RR 0.91 [95% CI 0.83 to 1.01]) and (RR 0.78 [95% CI 0.53 to 1.15]) though it was not statistically significant in two SRs. When stratified by baseline risk, the effect on all-cause mortality was no longer statistically significant except in one medium risk category. One review reported significant reductions (RR 0.85 [95% CI 0.77 to 0.95]) in vascular deaths and non-significant reductions in non-vascular deaths (RR 0.97 [95% CI 0.88 to 1.07]). There were significant reductions in composite outcomes overall, but mixed results were reported in these when stratified by baseline risk. These reviews included studies with participants considered risk equivalent to those with established CVD.ConclusionsThere is limited evidence on the effectiveness of statins for primary prevention with mixed findings from studies including participants with widely ranging baseline risks. Decision making for the use of statins should consider individual baseline risk, absolute risk reduction and whether risk reduction justifies potential harms and taking a daily medicine for life.Trial registration numberCRD42017064761.

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Primary prevention of cardiovascular disease: Cost-effectiveness comparison

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462307051598 ◽

2007 ◽

Vol 23 (1) ◽

pp. 71-79 ◽

Cited By ~ 30

Author(s):

Oscar H. Franco ◽

Arno J. der Kinderen ◽

Chris De Laet ◽

Anna Peeters ◽

Luc Bonneux

Keyword(s):

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Smoking Cessation ◽

Heart Disease ◽

Cost Effectiveness ◽

Primary Prevention ◽

Risk Reduction ◽

Cost Effective ◽

Life Years ◽

Prevention Of Cardiovascular Disease

Objectives: The aim of this study was to evaluate the cost-effectiveness of four risk-lowering interventions (smoking cessation, antihypertensives, aspirin, and statins) in primary prevention of cardiovascular disease.Methods: Using data from the Framingham Heart Study and the Framingham Offspring study, we built life tables to model the benefits of the selected interventions. Participants were classified by age and level of risk of coronary heart disease. The effects of risk reduction are obtained as numbers of death averted and life-years saved within a 10-year period. Estimates of risk reduction by the interventions were obtained from meta-analyses and costs from Dutch sources.Results: The most cost-effective is smoking cessation therapy, representing savings in all situations. Aspirin is the second most cost-effective (€2,263 to €16,949 per year of life saved) followed by antihypertensives. Statins are the least cost-effective (€73,971 to €190,276 per year of life saved).Conclusions: A cost-effective strategy should offer smoking cessation for smokers and aspirin for moderate and high levels of risk among men 45 years of age and older. Statin therapy is the most expensive option in primary prevention at levels of 10-year coronary heart disease risk below 30 percent and should not constitute the first choice of treatment in these populations.

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