American Heart Association 2001 Scientific Sessions
2001; Lippincott Williams & Wilkins; Volume: 104; Issue: 21 Linguagem: Inglês
10.1161/hc4601.102698
ISSN1524-4539
Autores Tópico(s)Lipoproteins and Cardiovascular Health
ResumoHomeCirculationVol. 104, No. 21American Heart Association 2001 Scientific Sessions Free AccessOtherDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherDownload EPUBAmerican Heart Association 2001 Scientific SessionsLate-Breaking Science Robin Fox, FRCP Robin FoxRobin Fox Originally published20 Nov 2001https://doi.org/10.1161/hc4601.102698Circulation. 2001;104:e9051–e9052Statins: The New Aspirin?No work presented at American Heart Association's 2001 Scientific Sessions is likely to have greater clinical impact than the Medical Research Council/British Heart Foundation Heart Protection Study, reported by Dr Rory Collins (Clinical Trial Service Unit of Oxford University, Oxford, UK). The latest guidelines from the National Cholesterol Education Program probably will have to be modified. Patients (n=20 536) were recruited in 69 UK hospitals, the entry criterion being high risk of coronary heart disease without a clear indication for cholesterol-lowering therapy. Specifically targeted were women, people >70 years of age, people with diabetes, those with noncoronary vascular disease, and those with average or below-average cholesterol levels. Patients were 40 to 80 years old (28% age ≥70 years) and one fourth were women. Two regimens were under investigation: simvastatin (40 mg daily), and a cocktail of antioxidant vitamins (vitamin E [600 mg], vitamin C [250 mg], β-carotene [20 mg daily]). Patients were randomized to 4 groups of ≈5000 each, receiving simvastatin alone, simvastatin plus vitamins, vitamins alone, or placebo. Average follow-up period was 5.5 years. In the vitamin part of the study, the results were entirely negative. No benefit or harm was evident in terms of vascular disease or any other disorders (including cancers). By contrast, striking benefits were seen with simvastatin. The primary end points for the comparison of simvastatin and placebo were all-cause mortality (12.9% versus 14.6%, respectively) and deaths from heart disease and related blood vessel disease (7.7% versus 9.2%, respectively). Secondary end points were stroke (4.4% versus 6.0%), major cardiovascular events (19.9% versus 25.4%), deaths unrelated to heart disease (5.2% versus 5.5%; not significant), and heart attack/stroke in diabetic patients without previous disease (13.9% versus 18.7%). Muscle damage was very rare and was no more common in the simvastatin group: creatine kinase >10 times the upper limit of normal, 0.09% (9 patients) versus 0.05% (5 patients); alanine aminotransferase >3 times upper limit of normal, 0.8% (77) versus 0.6% (65). Vascular events such as myocardial infarction, stroke, and arterial surgery were all reduced by about one fourth. When allowance is made for noncompliance and treatment changes during the trial, Collins concludes that simvastatin reduced these major vascular events by at least one third in a wide range of high-risk patients for whom the indication for cholesterol-lowering therapy had been uncertain—notably, women, people >70 years of age, and people with an LDL cholesterol level 50% or 25 mL/min per 1.73 m2, end-stage renal disease, or death). Surprisingly, although there was a 10 mm Hg separation in mean arterial pressure between the 2 antihypertensive regimens, the slopes for decline in GFR did not differ. With the ACE inhibitor ramipril, the rate of decline was 25% slower than with metoprolol and there were 22% fewer composite events. Progression of kidney disease was particularly rapid in patients with a urinary protein to creatinine ratio >0.22 (which corresponds roughly to the level of proteinuria detectable by dipstick). In this group, the risk of composite clinical events was 46% lower with ramipril than with amlodipine and 37% lower with metoprolol than with amlodipine. The amlodipine limb of this trial was discontinued when an excess of clinical end points was seen with this calcium channel blocker (JAMA. 2001; 285:2719–2728Google Scholar). The positive message is that an ACE inhibitor can be beneficial in this group of African-Americans. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Vogt E, Øksnes M, Suleiman F, Juma B, Thordarson H, Ommedal O and Søfteland E (2017) Assessment of diabetic polyneuropathy in Zanzibar: Comparison between traditional methods and an automated point-of-care nerve conduction device, Journal of Clinical & Translational Endocrinology, 10.1016/j.jcte.2017.09.001, 10, (9-14), Online publication date: 1-Dec-2017. Lathief S and Inzucchi S (2016) Approach to diabetes management in patients with CVD, Trends in Cardiovascular Medicine, 10.1016/j.tcm.2015.05.005, 26:2, (165-179), Online publication date: 1-Feb-2016. Laham R (2010) Percutaneous Treatment of Coronary Artery Disease Device Therapy in Heart Failure, 10.1007/978-1-59745-424-7_10, (263-286), . Shih C, Lin S, Su Y and Shih C (2005) Amorphous oxide—a platform for drug delivery, Journal of Controlled Release, 10.1016/j.jconrel.2004.10.031, 102:3, (539-549), Online publication date: 1-Feb-2005. Thierry B, Winnik F, Merhi Y, Silver J and Tabrizian M (2004) Radionuclides-hyaluronan-conjugate thromboresistant coatings to prevent in-stent restenosis, Biomaterials, 10.1016/j.biomaterials.2003.10.068, 25:17, (3895-3905), Online publication date: 1-Aug-2004. Lazar H (2004) Role of statin therapy in the coronary bypass patient, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2003.12.041, 78:2, (730-740), Online publication date: 1-Aug-2004. Chong P and Cheng J (2004) Early Experiences and Clinical Implications of Drug-Eluting Stents: Part 1, Annals of Pharmacotherapy, 10.1345/aph.1D256, 38:4, (661-669), Online publication date: 1-Apr-2004. Thierry B and Tabrizian M (2003) Biocompatibility and Biostability of Metallic Endovascular Implants: State of the Art and Perspectives , Journal of Endovascular Therapy, 10.1583/1545-1550(2003)010 2.0.CO;2, 10:4, (807-824), Online publication date: 1-Aug-2003. Thierry B and Tabrizian M (2016) Biocompatibility and Biostability of Metallic Endovascular Implants: State of the Art and Perspectives, Journal of Endovascular Therapy, 10.1177/152660280301000419, 10:4, (807-824), Online publication date: 1-Aug-2003. Bueno H (2002) Prevención y tratamiento de la cardiopatía isquémica en pacientes con diabetes mellitus, Revista Española de Cardiología, 10.1016/S0300-8932(02)76736-5, 55:9, (975-986), Online publication date: 1-Jan-2002. Burns P, Lima E and Bradbury A (2002) Second Best Medical Therapy, European Journal of Vascular and Endovascular Surgery, 10.1053/ejvs.2002.1737, 24:5, (400-404), Online publication date: 1-Nov-2002. Adams M (2002) Prevention of myocardial infarction, Internal Medicine Journal, 10.1046/j.1445-5994.2002.00301.x, 32:12, (595-600), Online publication date: 1-Dec-2002. MacIsaac R and Jerums G (2002) Treatment of Dyslipidaemia in the Elderly, Journal of Pharmacy Practice and Research, 10.1002/jppr2002323188, 32:3, (188-193), Online publication date: 1-Sep-2002. November 20, 2001Vol 104, Issue 21 Advertisement Article InformationMetrics https://doi.org/10.1161/hc4601.102698 Originally publishedNovember 20, 2001 Advertisement
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