http://www.mdlinx.com/internal-medicine/top-medical-news/article/2016/04/06/11
Simple
pharmacological solutions to prevent heart attacks and stroke worldwide
have been proven effective by an international team involving
researchers from the University of Leicester. The research team led by
the Population Health Research Institute (PHRI) of McMaster University
and Hamilton Health Sciences studied more than 12,000 patients from 21
countries to evaluate drugs that can prevent cardiovascular disease
(CVD). CVD leads to 18 million deaths and about 50 million heart attacks
and strokes globally every year. The research was hosted in the UK by
the University of Leicester and the NIHR Leicester Cardiovascular
Biomedical Research Unit, based at Glenfield Hospital, with Dr William
Toff and Professor Kamlesh Khunti serving as the UK National Leads.
Professor Khunti, Co–Director of the Leicester Diabetes Centre and
Director of NIHR CLAHRC East Midlands, commented: “This is a landmark
pragmatic study which recruited patients from general practice. The
results show that we can use simple methods to identify people who would
benefit in terms of primary prevention of cardiovascular disease using
commonly available drugs such as statins and antihypertensives.” Dr
Toff, Senior Lecturer in Cardiology, added: “The findings from this
landmark trial could have a significant impact on clinical practice and
the approach to preventing cardiovascular disease around the world.” The
treatments examined included two established forms of therapy, namely
statins, a group of cholesterol–lowering drugs, and antihypertensives, a
class of drugs used to treat high blood pressure. In addition, a
combination of statins and antihypertensives was assessed. Three reports
on the studies were published in the New England Journal of Medicine.
Under the name of HOPE–3, or Heart Outcomes Prevention Evaluation–3, the
studies involved 228 centres looking at the effects of the three
treatment options in people without clinical heart disease but at
intermediate risk of developing it. Statins were found to significantly
and safely reduce CVD events by 25 per cent in patients at intermediate
risk but without evident CVD. Antihypertensives did not reduce major CVD
events overall in the population studied but they did reduce such
events in the group of people with hypertension at entry to the study.
When combined, statins and antihypertensives reduced CVD events by 30
per cent—with a 40% benefit in those with hypertension, suggesting that
patients with hypertension should not only lower their BP but also
consider taking a statin. The HOPE–3 research reports were led by Dr
Salim Yusuf and Dr Eva Lonn, both professors of medicine at McMaster
University’s Michael G. DeGroote School of Medicine, and Jackie Bosch,
an associate professor of the University’s School of Rehabilitation
Science. “The HOPE–3 trial brings clarity in the management of blood
pressure and cholesterol, two of the most common cardiovascular risk
factors,” said Lonn. “Primary prevention can be greatly simplified and
made available to most intermediate–risk people worldwide.” Bosch added:
“Treatment with a statin was remarkably safe and beneficial in our
study, regardless of cholesterol or blood pressure levels, age, gender
or ethnicity. We are incredibly encouraged by the study’s results.” The
findings from HOPE–3 will have a major influence on primary care in
developed nations, where statins and antihypertensives are inexpensive,
Yusuf added. While still relatively inexpensive in developing nations,
the drugs are less affordable in relation to income. Still, Yusuf said
the study’s results hold promise everywhere as the price of these drugs
start to come down. “These simple methods can be used practically
everywhere in the world, and the drugs will become even cheaper as more
and more systems and people adopt these therapies,” he said. Yusuf, Lonn
and Bosch presented the HOPE–3 trials at the 2016 American College of
Cardiology (ACC) Scient
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