Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy

Law, Malcolm; Wald, Nicholas; Morris, Joan K.

doi:10.3310/hta7310

Cited by 211 publications

(86 citation statements)

References 132 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The risk curve concept illustrated in Figure 1 is also useful for considering alternative treatment strategies that can shift the entire curve downward. For example, more aggressive blood pressure management reduces the absolute risk of a cardiovascular event by about 25% [ 6 ]. In contrast, lowering LDL-C from 100 mg/dL to 70 mg/dL, or 30%, could require adding two more drugs to maximal statin therapy, yet only reduce risk by an additional 15% (or less) due to the log-linear relationship between LDL-C and cardiovascular risk.…”

Section: Selection Of Patients For Aggressive Ldl-c Loweringmentioning

confidence: 91%

LDL reduction: How low should we go and is it safe?

Robinson

2008

Curr Cardiol Rep

View full text Add to dashboard Cite

High-dose statin therapy or combination statin treatment is necessary for most patients to achieve aggressive low-density lipoprotein cholesterol goals. Adding ezetimibe or bile acid sequestrants appears unlikely to increase the risk of myopathy. Although the combination of niacin or fenofibrate with moderate-dose statins appears to be reasonably safe, the safety of combination with high-dose statins has yet to be determined. To enhance patient outcomes, attention must be paid to characteristics that predict muscle and hepatic statin toxicity when considering using high-dose statin or combination statin therapy.

show abstract

Section: Selection Of Patients For Aggressive Ldl-c Loweringmentioning

confidence: 91%

LDL reduction: How low should we go and is it safe?

Robinson

2008

Curr Cardiol Rep

View full text Add to dashboard Cite

show abstract

“…At the same time, age as the strongest predictor of cardiovascular risk leads to an exponential rise in the incidence of cardiovascular events above the age of 60 years [32]. This applies even more to recurrent events in patients with existing cardiovascular disease [14]. Accordingly, the extent and consequence of medication underuse in older individuals is substantial.…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with Wald and Morris [11], a generalized linear model was used to predict mortality for ages >90 years, and the estimates were further corrected for the period effects, such as the known temporal decrease in incidence and reduction in case fatality in the UK [15,16]. Event rates for recurrent events can exceed event rates for first events up to tenfold [14]: this applies to patients eligible for the considered START criteria, where a meta-analytic baseline risk for primary prevention with statins [17] could be increased tenfold for secondary prevention in one study [18] and fourfold in another study [19]. Risk estimates ranging from factor 2.7 to 4.2 are also reported for patients eligible for antiplatelet treatment [20].…”

Section: Methodsmentioning

confidence: 99%

“…deaths from other causes) was calculated by subtraction of cardiovascular mortality from all-cause mortality. Stratified for gender, age-dependent event rates for myocardial infarction (MI) and stroke were retrieved from supplemental information on analyses conducted by Law et al [14]. In accordance with Wald and Morris [11], a generalized linear model was used to predict mortality for ages >90 years, and the estimates were further corrected for the period effects, such as the known temporal decrease in incidence and reduction in case fatality in the UK [15,16].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Age-Dependent Impact of Medication Underuse and Strategies for Improvement

Meid

Haefeli²

2016

Gerontology

View full text Add to dashboard Cite

Background: Medication underuse is common in aging populations and, because of the growing risk for competing deaths, the benefit of preventive medicines gradually vanishes with advancing age, thus limiting their success. Objective: To estimate the optimum time of initiation of the secondary prevention of cardiovascular events, we examined the impact of appropriate pharmacotherapy for different starting ages at which it is implemented. Methods: In the competing risk framework, we obtained the population's life course from life tables, combined it with effect estimates quantifying the real-world effectiveness of secondary prevention, and compared the outcome of patients not receiving appropriate treatment (underuse) with those receiving preventive medicines that have demonstrated a reduction in the transition to serious cardiovascular events (START criteria). Starting at the age of 55 years, the population proportions of the distinct states of the framework were calculated for each year of chronological age in subgroups of appropriate treatment and underuse. These proportions were used over a follow-up period to estimate measures of treatment effectiveness and risks of underuse. Results: Despite increasing relative effectiveness with advancing age, benefits measured by patient-relevant endpoints, such as life years gained (LYG) or gained quality-adjusted life years (QALYs), markedly dropped after the starting age of 75 years, but even at an initiation age of 85 years, QALYs gained exceeded 1 year. Conclusion: Interventions targeting medication underuse may achieve considerable benefits at any stage of later life, while the benefit is probably largest if appropriate treatment is started before 75 years.

show abstract

“…A reduction in LDL cholesterol levels of 12 mg/dl at 12 months would reduce ischemic heart disease-related events by 6 %, and by 21 % if this reduction is maintained for 6 years [23]. If diastolic blood pressure is reduced by 5 mmHg at 12 months, the risk of stroke is reduced by 34 %, and the risk for ischemic heart disease is reduced by 21 % [24].…”

Section: Effect Sizementioning

confidence: 98%

Reduction of coronary risk factors immediately and 1 year after inpatient rehabilitation in a highly motivated patient cohort

Schnöll

Laimer²,

Altenberger³

et al. 2015

Wien Med Wochenschr

View full text Add to dashboard Cite

Adherence to medical advice, driven by high patient motivation, could lead to a significant reduction in risk factors during cardiac rehabilitation.During a 1-year period, 9082 patients were admitted to six cardiac rehabilitation centres. A total of 1195 highly motivated subjects were selected based on their reliable completion of a survey regarding cardiac risk factors.Study subjects had lower risk factors at baseline compared with a contemporary Austrian database. At discharge from the rehabilitation programme subjects showed further reductions in median weight, low-density lipoprotein cholesterol, blood pressure and resting pulse rate (due to increased levels of daily exercise). Smoking also decreased. Most of these changes were still significant after 1 year.The risk factors in these highly motivated patients were low to begin with and were further reduced by an inpatient rehabilitation programme. The content and method of delivery of this programme seem to be effective. Efforts should focus on increasing motivation.

show abstract

Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy

Abstract: have an interest in a patent application for a medical formulation designed to reduce simultaneously four cardiovascular risk factors.

Cited by 211 publications

References 132 publications

LDL reduction: How low should we go and is it safe?

LDL reduction: How low should we go and is it safe?

Age-Dependent Impact of Medication Underuse and Strategies for Improvement

Reduction of coronary risk factors immediately and 1 year after inpatient rehabilitation in a highly motivated patient cohort

Contact Info

Product

Resources

About