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Can we dramatically reduce the incidence of coronary heart disease?

Nature Reviews Cardiology volume 8, pages 721–725 (2011)Cite this article

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Abstract

Thrombotic events caused by atherosclerosis are by far the most common cause of death in the world. Advances in treatment have prolonged the life of patients with atherosclerotic disease, but treating individuals with clinically manifest disease will not result in a cure, and will not prevent the majority of such events. This paper explores the possibility that early implementation of a drug-based approach to the prevention of atherosclerosis and atherothrombotic events could dramatically reduce the footprint of this disease. Specifically, we consider the potential impact on atherothrombotic events of a population-based, pharmacological approach to lowering serum LDL-cholesterol levels in asymptomatic adults aged 35–50 years. We also consider the feasibility and basic design considerations for a clinical trial to assess the validity of this public health and primary prevention approach.

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Figure 1: Reductions in CHD annual event rates achieved by decreased serum LDL-cholesterol levels in four major primary prevention trials of statin therapy.

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References

  1. Fuster, V., Kelly, B. B. & Vedanthan, R. Promoting global cardiovcascualr heath: moving forward. Circulation 123, 1671–1678 (2011).

    Article  Google Scholar 

  2. List of wars and anthropogenic disasters by death toll. Wikipedia [online] (2011).

  3. Heidenreich, P. A. et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 123, 933–944 (2011).

    Article  Google Scholar 

  4. O'Keefe. J. H. Jr, Cordain, L., Harris, W. H., Moe, R. M. & Vogel, R. Optimal low-density lipoprotein is 50 to 70 mg/dl: lower is better and physiologically normal. J. Am. Coll. Cardiol. 43, 2142–2146 (2004).

    Article  CAS  Google Scholar 

  5. Chen, Z. et al. Serum cholesterol concentration and coronary heart disease in populations with low cholesterol concentrations. BMJ 303, 276–282 (1991).

    Article  CAS  Google Scholar 

  6. Stamler, J., Wentworth, D. & Neaton, J. D. Is relationship between serum cholesterol and the risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MrFIT). JAMA 256, 2823–2828 (1986).

    Article  CAS  Google Scholar 

  7. Stamler, J. Population studies. In Nutrition, Lipids, and Coronary Heart Disease: A Global View (eds Levy, R. I. et al) 25–88 (Raven, New York, 1979).

    Google Scholar 

  8. Prospective Studies Collaboration et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths. Lancet 370, 1829–1839 (2007).

  9. Brown M. S. & Goldstein, J. L. Biomedicine. Lowering LDL—not only how low, but how long? Science 311, 1721–1723 (2006).

    Article  CAS  Google Scholar 

  10. Eaton, S. B., Konner, M. & Shostak, M. Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective. Am. J. Med. 84, 739–749 (1988).

    Article  CAS  Google Scholar 

  11. Vint, F. W. Post-mortem findings in the natives of Kenya. E. Afr. Med. J. 13, 332–340 (1937).

    Google Scholar 

  12. Ho, K. J., Biss, K., Mikkelson, B., Lewis, L. A. & Taylor, C. B. The Masai of East Africa: some unique biological characteristics. Arch. Pathol. 91, 387–410 (1971).

    CAS  PubMed  Google Scholar 

  13. Kato, H., Tillotson, J. Nichaman, M. Rhoads, G. G. & Hamilton, H. B. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California. Am. J. Epidemiol. 97, 372–385 (1973).

    Article  CAS  Google Scholar 

  14. Truswell, A. S. & Hansen, D. L. Medical research among the !Kung. In Kalahari hunter-gatherers: studies of the !Kung San and their neighbours (eds Lee, R. B. & DeVore, I.) 166–195 (Harvard University Press, Cambridge, 1976).

    Google Scholar 

  15. [No authors listed]. The Lipid Research Clinics Coronary Primary Prevention Trial Results I. Reduction in incidence of coronary heart disease. JAMA 251, 351–364 (1984).

  16. Frick, M. H. et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N. Engl. J. Med. 317, 1237–1245 (1987).

    Article  CAS  Google Scholar 

  17. Ford, I. et al. Long-term follow-up of the West of Scotland Coronary Prevention Study. N. Engl. J. Med. 357, 1477–1486 (2007).

    Article  CAS  Google Scholar 

  18. Downs, J. R. et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCaPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 279, 1615–1622 (1998).

    Article  CAS  Google Scholar 

  19. Sever, P. S. et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 361, 1149–1158 (2003).

    Article  CAS  Google Scholar 

  20. Ridker, P. M. et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N. Engl. J. Med. 359, 2195–2207 (2008).

    Article  CAS  Google Scholar 

  21. Hsia, J., MacFadyen, B., Monyak, J. & Ridker, P. Cardiovascular event reduction and adverse events among subjects attaining low-density lipotrotein cholesterol <50 mg/dl with rosuvastatin. The JUPITER trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin). J. Am. Coll. Cardiol. 57, 1666–1675 (2011).

    Article  CAS  Google Scholar 

  22. [No authors listed]. The Atherosclerosis Risk in Communities (ARIC) study: design and objectives. The ARIC investigators. Am. J. Epidemiol. 129, 687–702 (1989).

  23. Cohen, J. C., Boerwinkle, E., Mosley T. H. Jr & Hobbs, H. H. Sequence variations in PCSK9, low LDL, and protection against coronary heart disease. N. Engl. J. Med. 354, 1264–1272 (2006).

    Article  CAS  Google Scholar 

  24. Frontini, M. et al. Usefulness of childhood non-high density lipoprotein cholesterol levels versus other lipoprotein measures in predicting adult subclinical atherosclerosis: the Bogalusa Heart Study. Pediatrics 121, 924–929 (2008).

    Article  Google Scholar 

  25. Law, M. R., Wald, N. J. & Rubnicka, A. R. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ 326, 1423–1429 (2003).

    Article  CAS  Google Scholar 

  26. DeMaria, A. N. et al. Comparative efficacy of strategies for risk screening and prevention for cardiovascular disease. J. Am. Coll. Cardiol. 53, A220 (2009).

    Google Scholar 

  27. Diamond, G. A. & Kaul, S. The things to come of SHAPE: cost and effectiveness of cardiovascular prevention. Am. J. Cardiol. 99, 1013–1015 (2007).

    Article  Google Scholar 

  28. Kazmin, A., Garcia-Bournissen, F. Koren, G. Risks of statin use during pregnancy: a systematic review. J. Obstet. Gynaecol. Can. 29, 906–908 (2007).

    Article  Google Scholar 

  29. D'Agostino, R. B. Sr et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117, 743–753 (2008).

    Article  Google Scholar 

  30. Berry, J. D. et al. Remaining lifetime risks for cardiovascular disease by age and risk factor burden: the cardiovascular lifetime risk pooling project. N. Engl. J. Med (in press).

  31. Baigent, C. et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 366, 1267–1278 (2005).

    Article  CAS  Google Scholar 

  32. Cholesterol Treatment Trialists' (CTT) Collaborators et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 371, 117–125 (2008).

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Authors and Affiliations

  1. Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, 10029, NY, USA

    Michael Domanski & Valentin Fuster

  2. Northwestern University Feinberg School of Medicine, 251 East Huron Street, Galter Suite 3-150, Chicago, 60611, IL, USA

    Donald Lloyd-Jones

  3. University of Texas Southwestern Medical School at Dallas, 5323 Harry Hines Boulevard, Dallas, 75390, TX, USA

    Scott Grundy

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  1. Michael Domanski
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  4. Scott Grundy
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All authors contributed to researching data for the article, writing, discussions of the content and review or editing of the manuscript before submission.

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Correspondence to Valentin Fuster.

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The authors declare no competing financial interests.

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Domanski, M., Lloyd-Jones, D., Fuster, V. et al. Can we dramatically reduce the incidence of coronary heart disease?. Nat Rev Cardiol 8, 721–725 (2011). https://doi.org/10.1038/nrcardio.2011.158

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