Abstract
Although pharmacological treatments of hypertension and dyslipidaemia are both associated with a reduction in cardiovascular risk, little is known about the degree of cardiovascular risk remaining in treated individuals, by assessing the levels of their risk factors achieved, that is their ‘residual cardiovascular risk’. We then used the data from the Prospective Epidemiological Study of Myocardial Infarction (PRIME), which involved 9649 men aged 50–59 years, from France and Northern Ireland with a 10-year follow-up, to test the presence of specific residual cardiovascular risks of coronary heart disease, stroke, total of fatal and non-fatal cardiovascular events and cardiovascular mortality, in patients treated with antihypertensive agents or lipid-lowering agents. In the whole cohort, a total of 796 patients developed a fatal or non-fatal cardiovascular event. Antihypertensive drug use at baseline was significantly associated (RR=1.50, 95% CI: 1.25–1.80) with total cardiovascular event risk, but not lipid-lowering drug use, after adjusting for classic risk factors (age, smoking, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure and diabetes). Similar results were obtained for coronary heart disease (RR=1.46, 95% CI: 1.18–1.80), stroke (RR=1.75, 95% CI: 1.14–2.70) and cardiovascular death (RR=1.62, 95% CI: 1.02–2.58), but neither for total death (RR=1.15, 95% CI: 0.89–1.48) nor for non-cardiovascular death (RR=1.00, 95% CI: 0.74–1.36). For any cardiovascular end point, residual risks did not globally differ according to the antihypertensive drug class prescribed at baseline. In conclusion, treatment with antihypertensive agents, but not with lipid-lowering agents, was associated with a sizeable residual cardiovascular risk, suggesting that more efficient risk reduction strategies in hypertension should be developed as a priority.
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Acknowledgements
We thank the following organizations that allowed the recruitment of the PRIME subjects: the Health screening Centres organized by the Social Security of Lille (Institut Pasteur), Strasbourg, Toulouse and Tourcoing; Occupational Medicine Services of Haute-Garonne, of the Urban Community of Strasbourg; the Association Interentreprises des Services Médicaux du Travail de Lille et environs; the Comité pour le Développement de la Médecine du Travail; the Mutuelle Générale des PTT du Bas-Rhin; the Laboratoire d'Analyses de l'Institut de Chimie Biologique de la Faculté de Médecine de Strasbourg; the Department of Health (NI) and the Northern Ireland Chest Heart and Stroke Association. We also thank the members of the event validation committees: Professor Louis Guize, Dr Caroline Morrison, Dr Marie-Thérèse Guillanneuf, Professor Maurice Giroud; and the Alliance Partnership Programme for its financial support. Pierre Ducimetière had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Appendix
Appendix
The PRIME Study Group
The PRIME Study is organized under an agreement between INSERM and the Merck Sharp and Dohme-Chibret Laboratory, with the following participating laboratories:
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The Strasbourg MONICA Project, Laboratoire d'Epidemiologie et de Sante Publique, EA1801, Strasbourg, F-67085, France; Universite Louis Pasteur, Faculte de Medecine, Strasbourg, F-67085, France (D Arveiler and B Haas).
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The Toulouse MONICA Project, INSERM U558, Departement d'Epidemiologie, Universite Paul Sabatier-Toulouse Purpan, Toulouse, France (J Ferrières and JB Ruidavets).
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The Lille MONICA Project, INSERM U744, Lille, France; Institut Pasteur de Lille, Lille, France; Université de Lille 2, Lille, France (P Amouyel and M Montaye).
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The Department of Epidemiology and Public Health, Queen's University Belfast, Belfast, Northern Ireland (A Evans, J Yarnell and F Kee).
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The Department of Atherosclerosis, INSERM U545, Lille, France; Institut Pasteur de Lille, Lille, France; Université de Lille 2, Lille, France (G Luc and JM Bard).
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The Laboratory of Haematology, INSERM U626, Marseille, Hôpital La Timone, Marseille, France (I Juhan-Vague and P Morange).
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The Laboratory of Endocrinology, INSERM U563, Toulouse, France (B Perret).
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The Vitamin Research Unit, The University of Bern, Bern, Switzerland (F Gey).
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The Nutrition and Metabolism Group, Centre for Clinical and Population Sciences, Queen's University Belfast, Belfast, Northern Ireland (J Woodside and I Young).
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The DNA Bank, INSERM U525, Paris, France (F Cambien).
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The Coordinating Center, INSERM U780, Villejuif, F-94807, France; University Paris-Sud, Faculty of Medicine, Villejuif, F-94807, France (P Ducimetiere and A Bingham).
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Blacher, J., Evans, A., Arveiler, D. et al. Residual cardiovascular risk in treated hypertension and hyperlipidaemia: the PRIME Study. J Hum Hypertens 24, 19–26 (2010). https://doi.org/10.1038/jhh.2009.34
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DOI: https://doi.org/10.1038/jhh.2009.34
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