EUROASPIRE reveals disappointing trends in CVD prevention
3 September 2007
MedWire News: Results from EUROASPIRE presented at the European Society of Cardiology in Vienna, Austria, reveal disappointing trends in preventive cardiology in Europe over the past 12 years.
The EUROASPIRE series of surveys was conducted to measure the extent to which coronary artery disease (CAD) patients are managed to control risk factors and receive appropriate medical therapy with respect to guidelines.
The first survey was conducted in nine countries in 1994, the second in 15 countries in 2000, and the third in 22 countries in 2006-2007.
David Wood (Imperial College London, UK) presented a comparison of data from the same centers in the same eight countries – Czech Republic, Finland, France, Germany, Hungary, Italy, The Netherlands, and Slovenia – that participated in all three surveys.
A total of 8547 CAD patients, who had undergone coronary artery bypass graft surgery or angioplasty, suffered a myocardial infarction, or ischemia, and were aged on average 61 years, were interviewed and examined over the 12-year period.
The results reveal worrying trends in lifestyle management.
The prevalence of smoking did not change overall, with around 20% of patients continuing to smoke in all three surveys. This hid a marked increase in the prevalence of smoking among younger patients under the age of 50 years and women, however, Wood noted.
Meanwhile, there was a “striking” increase in the prevalence of obesity, he observed, from 25.0% in the first survey to 32.6% in the second and 38.0% in the third. This corresponded to an increase in central obesity, from 42.2% to 53.0% and 54.9%, respectively.
The prevalence of hypertension, defined as blood pressure levels of 140/90 mmHg or above, or 130/80 mmHg or over in patients with diabetes, remained relatively constant, at around 60%.
Self-reported diabetes increased from 17.4% to 20.1% and 28.0% in the first, second, and third surveys, respectively. But Wood said that systematic screening revealed a further 15% of the rest of the patients had undetected diabetes, and some two-thirds had evidence of glycemia. Furthermore, less than 10% of patients with diabetes had their condition adequately controlled.
In marked contrast, there were striking improvements in lipid management according to recommended levels for total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). The prevalence of elevated TC and LDL-C dropped from 94.5% to 76.7% and 46.2%, and from 96.4% to 78.1% and 47.5%, respectively.
Similarly, there were “encouraging” increases in the use of antiplatelets, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers, Wood noted.
But, he pointed out, this begs the obvious question of why it was not reflected in terms of a cut in uncontrolled blood pressure and diabetes. Summing up the results, Wood said that the increase in obesity may be an important mitigating factor in the reduced blood pressure control and increase in prevalence of diabetes.
He noted that less than one third of CAD patients have access to structured preventive and rehabilitative care programs, and that the findings illustrate the pressing need for such preventive cardiology programs.
“We invest a huge amount of effort in rescuing patients with acute ischemic heart disease conditions, we should make the same effort in addressing the underlying causes of the disease,” Wood concluded.
European Society of Cardiology Annual Congress 2007; Vienna, Austria: 1-5 Sept
Showing posts with label Prevention. Show all posts
Showing posts with label Prevention. Show all posts
Monday, September 3, 2007
Wednesday, August 22, 2007
Lessons from hormone replacement therapy trials for primary prevention of cardiovascular disease.[Miscellaneous]
Author
Mohandas, Bhavna; Mehta, Jawahar L
Institution
Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Title
Lessons from hormone replacement therapy trials for primary prevention of cardiovascular disease.[Miscellaneous]
Source
Current Opinion in Cardiology. 22(5):434-442, September 2007.
Abstract
Purpose of review: Coronary heart disease in women is a common cause of morbidity and mortality, particularly after menopause. It was thought that estrogen and progesterone protected women from coronary heart disease. The recommendations of the recent Women's Health Initiative, however, are that hormone replacement therapy should not be used for primary prevention of coronary heart disease in women.
Here, we have made a comprehensive review of major studies and comment on the validity of this recommendation.
We have also analyzed the importance of dietary modification in primary prevention. In addition, we have delineated the important predictors of cardiovascular disease in women from prior observational and clinical studies.
Recent findings: Recent major studies, including the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS), studied the role of hormone replacement therapy in protecting women from coronary heart disease. These studies showed no significant reduction in coronary heart disease events. In addition, the dietary modification component of the Women's Health Initiative did not show any significant reduction in the incidence of coronary heart disease.
Summary: It can be summarized that hormone replacement is not generally recommended in postmenopausal women for primary prevention of coronary heart disease.
Although the dietary modification trials did not show any significant reduction in the incidence of coronary heart disease, it is currently recommended to continue using a heart-healthy diet.
Mohandas, Bhavna; Mehta, Jawahar L
Institution
Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Title
Lessons from hormone replacement therapy trials for primary prevention of cardiovascular disease.[Miscellaneous]
Source
Current Opinion in Cardiology. 22(5):434-442, September 2007.
Abstract
Purpose of review: Coronary heart disease in women is a common cause of morbidity and mortality, particularly after menopause. It was thought that estrogen and progesterone protected women from coronary heart disease. The recommendations of the recent Women's Health Initiative, however, are that hormone replacement therapy should not be used for primary prevention of coronary heart disease in women.
Here, we have made a comprehensive review of major studies and comment on the validity of this recommendation.
We have also analyzed the importance of dietary modification in primary prevention. In addition, we have delineated the important predictors of cardiovascular disease in women from prior observational and clinical studies.
Recent findings: Recent major studies, including the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS), studied the role of hormone replacement therapy in protecting women from coronary heart disease. These studies showed no significant reduction in coronary heart disease events. In addition, the dietary modification component of the Women's Health Initiative did not show any significant reduction in the incidence of coronary heart disease.
Summary: It can be summarized that hormone replacement is not generally recommended in postmenopausal women for primary prevention of coronary heart disease.
Although the dietary modification trials did not show any significant reduction in the incidence of coronary heart disease, it is currently recommended to continue using a heart-healthy diet.
Thursday, August 9, 2007
Five Preventive Steps Could Save 100,000 American Lives A Year, New Report
Five Preventive Steps Could Save 100,000 American Lives A Year, New Report
09 Aug 2007
A new study by the Partnership for Prevention suggests that over 100,000 lives could be saved every year in the US by increasing the use of five preventive health services. The biggest impact would be saving 45,000 lives by encouraging more adults to take a daily low dose of aspirin to prevent heart disease, said the report which was sponsored by the US Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation and the WellPoint Foundation.
Other measures that would save tens of thousands more American lives every year include more adults getting flu shots and increased use of cancer screening.
The report said there are serious shortcomings in the take up of preventive care across the US, particularly by racial and ethnic minorities.
Dr Eduardo Sanchez, Chair of the National Commission on Prevention Priorities, a panel set up by Partnership for Prevention to guide the study, said:
"A lot of Americans are not getting live-saving preventive services, particularly racial and ethnic minorities. As a result, too many people are dying prematurely or living with diseases that could have been prevented."
"We could get much better value for our health care dollar by focusing upstream on prevention," explained Sanchez.
The study suggested that over 100,000 lives could be saved each year by raising to 90 per cent the proportion of adults who took part in a number of preventive health services:
45,000 lives saved from more adults taking a daily low dose of aspirin (current take up rate is below 50 per cent).
42,000 more lives saved by offering smokers professional help to quit, including medication (current level is below 28 per cent).
14,000 more lives saved by more adults having regular screening (current level is below 50 per cent).
saved by more adults aged 50 or over having an annual flu shot (current level is below 37 per cent).
Nearly 4,000 more lives saved by increasing the number of women aged 40 or over who have been screened for breast cancer in the last two years (current level is 67 per cent).
The report also suggests that 30,000 cases of pelvic inflammatory disease would be prevented every year by taking up to 90 per cent the proportion of sexually active young women who have been screened in the past year for chlamydial infection (current take up rate is less than 40 per cent).
Director of the Centers for Disease Control and Prevention, Dr Julie Gerberding, said:
"This report illustrates that the health benefits would be great if more people took preventive actions."
"More illnesses would be avoided, fewer lives would be lost, and there would be more efficient use of our limited health care resources. It's important that all of us make a concerted attempt to focus our energies and efforts on preventing disease, not just treating it," she added.
The report also showed that minorities are at major risk. African Americans, Hispanic Americans and Asian Americans use preventive health services at a much lower rate than white, non-Hispanics.
For example, Hispanic smokers are 55 per cent less likely to seek professional help to quit compared with white smokers, and Asian Americans are the lowest users of the daily dose of aspirin method to prevent heart disease, and they are the lowest users of screening for breast, cervical and colorectal cancers.
President of Partnership for Prevention, John M. Clymer, said:
"The bottom line is that we need to strengthen the US health system by investing more in preventing disease."
"This new report makes it clear that following a few preventive steps may end up saving your life," he added.
09 Aug 2007
A new study by the Partnership for Prevention suggests that over 100,000 lives could be saved every year in the US by increasing the use of five preventive health services. The biggest impact would be saving 45,000 lives by encouraging more adults to take a daily low dose of aspirin to prevent heart disease, said the report which was sponsored by the US Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation and the WellPoint Foundation.
Other measures that would save tens of thousands more American lives every year include more adults getting flu shots and increased use of cancer screening.
The report said there are serious shortcomings in the take up of preventive care across the US, particularly by racial and ethnic minorities.
Dr Eduardo Sanchez, Chair of the National Commission on Prevention Priorities, a panel set up by Partnership for Prevention to guide the study, said:
"A lot of Americans are not getting live-saving preventive services, particularly racial and ethnic minorities. As a result, too many people are dying prematurely or living with diseases that could have been prevented."
"We could get much better value for our health care dollar by focusing upstream on prevention," explained Sanchez.
The study suggested that over 100,000 lives could be saved each year by raising to 90 per cent the proportion of adults who took part in a number of preventive health services:
45,000 lives saved from more adults taking a daily low dose of aspirin (current take up rate is below 50 per cent).
42,000 more lives saved by offering smokers professional help to quit, including medication (current level is below 28 per cent).
14,000 more lives saved by more adults having regular screening (current level is below 50 per cent).
saved by more adults aged 50 or over having an annual flu shot (current level is below 37 per cent).
Nearly 4,000 more lives saved by increasing the number of women aged 40 or over who have been screened for breast cancer in the last two years (current level is 67 per cent).
The report also suggests that 30,000 cases of pelvic inflammatory disease would be prevented every year by taking up to 90 per cent the proportion of sexually active young women who have been screened in the past year for chlamydial infection (current take up rate is less than 40 per cent).
Director of the Centers for Disease Control and Prevention, Dr Julie Gerberding, said:
"This report illustrates that the health benefits would be great if more people took preventive actions."
"More illnesses would be avoided, fewer lives would be lost, and there would be more efficient use of our limited health care resources. It's important that all of us make a concerted attempt to focus our energies and efforts on preventing disease, not just treating it," she added.
The report also showed that minorities are at major risk. African Americans, Hispanic Americans and Asian Americans use preventive health services at a much lower rate than white, non-Hispanics.
For example, Hispanic smokers are 55 per cent less likely to seek professional help to quit compared with white smokers, and Asian Americans are the lowest users of the daily dose of aspirin method to prevent heart disease, and they are the lowest users of screening for breast, cervical and colorectal cancers.
President of Partnership for Prevention, John M. Clymer, said:
"The bottom line is that we need to strengthen the US health system by investing more in preventing disease."
"This new report makes it clear that following a few preventive steps may end up saving your life," he added.
Tuesday, June 19, 2007
Lipitor or simvastatin? - Lipitor is not superior
Pfizer Backtracks on Lipitor’s Edge Over Rival
Posted by Jacob Goldstein
Earlier this year, Pfizer issued a press release trumpeting an analysis that suggested the company’s cholesterol-lowering drug Lipitor helped patients more than simvastatin, a cheaper generic competitor originally sold by Merck as Zocor.
Today Pfizer filed a two-paragraph statement with the SEC explaining that those results were wrong. By the study’s primary measure of cardiovascular risks, patients who took Lipitor didn’t fare significantly better than those who took simvastatin.
That’s quite a rowback by Pfizer, which is fighting in the medical trenches to keep Lipitor sales humming. The March press release by Pfizer quoted a study author as saying the “analysis is important for physicians, employers and formulary directors at managed care companies who are making real-world treatment decisions for patients” because it “further supports the cardiovascular benefits previously seen with Lipitor.” There was no corrective press release issued today.
Generic simvastatin has been stealing market share from Lipitor since it became available last year.
The flawed study analyzed data from about 80,000 members of a managed care organization who had taken either Lipitor or simvastatin. The primary analysis compared the rate of serious cardiovascular problems, such as heart attacks and strokes, in patients who had been taking either drug for at least three months. The study found that, after adjusting for differences in doses of the medicines, the risk of cardiovascular events was 14% lower in patients who took Lipitor.
But according to the SEC filing today, “a subsequent review by the Company” found that the difference was in fact only 10% — not enough to be considered statistically significant, the standard test of scientific validity, Pfizer said.
The mistake was due to a “programming error” and came to light after the manuscript was submitted for publication in a medical journal, Pfizer spokeswoman Vanessa Aristide told the Health Blog this afternoon. Initial results from the study were presented at an American Heart Association epidemiology and prevention conference in March.
A secondary analysis included in the study looked at the difference between patients on Lipitor and simvastatin starting on the first day they took the drugs. That analysis found that Lipitor reduced cardiovascular risk by 26% more than simvastatin. The revised findings issued today said that difference was also lower than originally reported, but at 22% it was still enough to be statistically significant.
Update: We just got Pfizer senior vice president Michael Berelowitz on the phone. He explained that the mistake occurred because the initial analysis incorrectly included some data from 2005. The study was supposed to be limited to data from between 2002 and 2004.
The error was discovered while researchers were re-analyzing the data at the request of an expert who was reviewing the manuscript, which had been submitted for publication in a journal. Berelowitz declined to name the publication.
So is Lipitor superior to simvastatin or not, we asked? “We have clinical trial data and real-world data that are intriguing, and I think it should be followed up on,” said Berelowitz, citing a previous study, called IDEAL, that directly compared the two drugs. But that study also narrowly failed to show that Lipitor was superior to simvastatin in reducing heart attacks and heart-related deaths among patients who have already had heart attacks.
He wouldn’t say whether Pfizer is funding additional head-to-head studies of the two drugs. But he encouraged those who control the preferred-drug lists known as formularies to make the comparison for themselves. “People who make formulary decisions should look at their data and see how it plays out in their world.”
LINK: http://blogs.wsj.com/health/
Posted by Jacob Goldstein
Earlier this year, Pfizer issued a press release trumpeting an analysis that suggested the company’s cholesterol-lowering drug Lipitor helped patients more than simvastatin, a cheaper generic competitor originally sold by Merck as Zocor.
Today Pfizer filed a two-paragraph statement with the SEC explaining that those results were wrong. By the study’s primary measure of cardiovascular risks, patients who took Lipitor didn’t fare significantly better than those who took simvastatin.
That’s quite a rowback by Pfizer, which is fighting in the medical trenches to keep Lipitor sales humming. The March press release by Pfizer quoted a study author as saying the “analysis is important for physicians, employers and formulary directors at managed care companies who are making real-world treatment decisions for patients” because it “further supports the cardiovascular benefits previously seen with Lipitor.” There was no corrective press release issued today.
Generic simvastatin has been stealing market share from Lipitor since it became available last year.
The flawed study analyzed data from about 80,000 members of a managed care organization who had taken either Lipitor or simvastatin. The primary analysis compared the rate of serious cardiovascular problems, such as heart attacks and strokes, in patients who had been taking either drug for at least three months. The study found that, after adjusting for differences in doses of the medicines, the risk of cardiovascular events was 14% lower in patients who took Lipitor.
But according to the SEC filing today, “a subsequent review by the Company” found that the difference was in fact only 10% — not enough to be considered statistically significant, the standard test of scientific validity, Pfizer said.
The mistake was due to a “programming error” and came to light after the manuscript was submitted for publication in a medical journal, Pfizer spokeswoman Vanessa Aristide told the Health Blog this afternoon. Initial results from the study were presented at an American Heart Association epidemiology and prevention conference in March.
A secondary analysis included in the study looked at the difference between patients on Lipitor and simvastatin starting on the first day they took the drugs. That analysis found that Lipitor reduced cardiovascular risk by 26% more than simvastatin. The revised findings issued today said that difference was also lower than originally reported, but at 22% it was still enough to be statistically significant.
Update: We just got Pfizer senior vice president Michael Berelowitz on the phone. He explained that the mistake occurred because the initial analysis incorrectly included some data from 2005. The study was supposed to be limited to data from between 2002 and 2004.
The error was discovered while researchers were re-analyzing the data at the request of an expert who was reviewing the manuscript, which had been submitted for publication in a journal. Berelowitz declined to name the publication.
So is Lipitor superior to simvastatin or not, we asked? “We have clinical trial data and real-world data that are intriguing, and I think it should be followed up on,” said Berelowitz, citing a previous study, called IDEAL, that directly compared the two drugs. But that study also narrowly failed to show that Lipitor was superior to simvastatin in reducing heart attacks and heart-related deaths among patients who have already had heart attacks.
He wouldn’t say whether Pfizer is funding additional head-to-head studies of the two drugs. But he encouraged those who control the preferred-drug lists known as formularies to make the comparison for themselves. “People who make formulary decisions should look at their data and see how it plays out in their world.”
LINK: http://blogs.wsj.com/health/
Tuesday, June 5, 2007
Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials
Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials
Thavendiranthan et al have undertaken a study to examine the role of statins in primary prevention of cardiovascular disease (1)
Cochrane Collaboration, and American College of Physicians Journal Club databases were searched for RCTs published between 1966 and June 2005. The authors included RCTs with follow-up of 1 year or longer, more than 100 major CV events, and 80% or more of the population without CV disease. From each trial, demographic data, lipid profile, CV outcomes, mortality, and adverse outcomes were recorded. Summary relative risk (RR) ratios with 95% confidence intervals (CIs) were calculated using a random effects model
seven trials with 42,848 patients were included. Note that the analysis also included primary prevention patients from the HPS trial (more than 80% were in secondary prevention) and the patients from the CARDS trial
mean follow-up was 4.3 years
statin therapy reduced the RR of major coronary events, major cerebrovascular events, and revascularizations by 29.2% (95% CI, 16.7%-39.8%) (P<.001), 14.4% (95% CI, 2.8%-24.6%) (P = 0.02), and 33.8% (95% CI, 19.6%-45.5%) (P<.001), respectively
statins produced a nonsignificant 22.6% RR reduction in coronary heart disease mortality (95% CI, 0.56-1.08) (P = 0.13)
no significant reduction in overall mortality (RR, 0.92 [95% CI, 0.84-1.01]) (P = .09) or increases in cancer or levels of liver enzymes or creatine kinase were observed
the authors affirm that statin therapy could reduce the absolute risk of coronary events during the next 4.3 years by 0.75% in low-risk patients (NNT= 133), by 1.63% (NNT=61) in moderate-risk patients and by 2.51% (NNT=40) in high-risk patients. They also conclude that it could be cost-effective in patients with an absolute risk over 20% of having a coronary event in the following 10 years. It would not be cost-effective in patients with a risk <10%, and its use would be controversial in the risk-group of 10-20%
the study authors concluded that, in patients without CV disease, statin therapy decreases the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality
Reference:
1. Thavendiranathan P et al. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Nov 27;166(21):2307-13.
Thavendiranthan et al have undertaken a study to examine the role of statins in primary prevention of cardiovascular disease (1)
Cochrane Collaboration, and American College of Physicians Journal Club databases were searched for RCTs published between 1966 and June 2005. The authors included RCTs with follow-up of 1 year or longer, more than 100 major CV events, and 80% or more of the population without CV disease. From each trial, demographic data, lipid profile, CV outcomes, mortality, and adverse outcomes were recorded. Summary relative risk (RR) ratios with 95% confidence intervals (CIs) were calculated using a random effects model
seven trials with 42,848 patients were included. Note that the analysis also included primary prevention patients from the HPS trial (more than 80% were in secondary prevention) and the patients from the CARDS trial
mean follow-up was 4.3 years
statin therapy reduced the RR of major coronary events, major cerebrovascular events, and revascularizations by 29.2% (95% CI, 16.7%-39.8%) (P<.001), 14.4% (95% CI, 2.8%-24.6%) (P = 0.02), and 33.8% (95% CI, 19.6%-45.5%) (P<.001), respectively
statins produced a nonsignificant 22.6% RR reduction in coronary heart disease mortality (95% CI, 0.56-1.08) (P = 0.13)
no significant reduction in overall mortality (RR, 0.92 [95% CI, 0.84-1.01]) (P = .09) or increases in cancer or levels of liver enzymes or creatine kinase were observed
the authors affirm that statin therapy could reduce the absolute risk of coronary events during the next 4.3 years by 0.75% in low-risk patients (NNT= 133), by 1.63% (NNT=61) in moderate-risk patients and by 2.51% (NNT=40) in high-risk patients. They also conclude that it could be cost-effective in patients with an absolute risk over 20% of having a coronary event in the following 10 years. It would not be cost-effective in patients with a risk <10%, and its use would be controversial in the risk-group of 10-20%
the study authors concluded that, in patients without CV disease, statin therapy decreases the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality
Reference:
1. Thavendiranathan P et al. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Nov 27;166(21):2307-13.
Friday, April 20, 2007
Low salt intake reduces risk of cardiovascular disease
Br Med J 2007; Advance online publication
MedWire News: People could reduce their long-term risk of cardiovascular events by reducing their dietary sodium intake, US researchers say.
"The observed reduction in cardiovascular risk associated with this sodium decrease was substantial and provides strong support for population-wide reduction in dietary sodium intake to prevent cardiovascular disease," the authors write in the British Medical Journal.
Nancy Cook (Harvard Medical School, Boston, Massachusetts) and colleagues followed-up 2415 participants in two randomized trials – the trial of hypertension prevention phase I (TOHP I) and phase II (TOHP II) – for cardiovascular disease and mortality over a period of 10-15 years.
Patients with prehypertension were randomly assigned to an active sodium-reduction intervention or usual care control for 18 months in the TOPH I, and 36-48 months in the TOPH II trial. Net sodium reductions in the intervention groups were 44 and 33 mmol/24 hours, respectively.
The primary outcome was cardiovascular disease, a composite of myocardial infarction, stroke, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, or cardiovascular death.
Patients in the sodium-reduction intervention group had a 25% lower risk of cardiovascular disease compared with those in the control group (relative risk [RR]=0.75, p=0.04), after adjustment for trial, clinic, age, ethnic background, and gender.
Further adjustments for baseline weight and sodium excretion revealed a 30% reduction of cardiovascular disease risk among patients in the sodium intervention group (RR=0.70, p=0.02), compared with controls.
Overall, 35 patients in the sodium group and 42 patients in the control group died, with 10 and 15 of the deaths, respectively, induced by cardiovascular disease. Results were similar for each trial.
Intention to treat analysis showed a mortality risk reduction of 20% among patients in the sodium reduction intervention, compared with those in the control group (RR=0.80, p=0.25).
Cook and co-workers conclude: "People with prehypertension assigned to a sodium reduction intervention experienced a 25-30% lower risk of cardiovascular outcomes in the 10 to 15 years after the trial.
"Sodium reduction, previously shown to lower blood pressure and prevent hypertension, also seems to prevent cardiovascular disease."
MedWire News: People could reduce their long-term risk of cardiovascular events by reducing their dietary sodium intake, US researchers say.
"The observed reduction in cardiovascular risk associated with this sodium decrease was substantial and provides strong support for population-wide reduction in dietary sodium intake to prevent cardiovascular disease," the authors write in the British Medical Journal.
Nancy Cook (Harvard Medical School, Boston, Massachusetts) and colleagues followed-up 2415 participants in two randomized trials – the trial of hypertension prevention phase I (TOHP I) and phase II (TOHP II) – for cardiovascular disease and mortality over a period of 10-15 years.
Patients with prehypertension were randomly assigned to an active sodium-reduction intervention or usual care control for 18 months in the TOPH I, and 36-48 months in the TOPH II trial. Net sodium reductions in the intervention groups were 44 and 33 mmol/24 hours, respectively.
The primary outcome was cardiovascular disease, a composite of myocardial infarction, stroke, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, or cardiovascular death.
Patients in the sodium-reduction intervention group had a 25% lower risk of cardiovascular disease compared with those in the control group (relative risk [RR]=0.75, p=0.04), after adjustment for trial, clinic, age, ethnic background, and gender.
Further adjustments for baseline weight and sodium excretion revealed a 30% reduction of cardiovascular disease risk among patients in the sodium intervention group (RR=0.70, p=0.02), compared with controls.
Overall, 35 patients in the sodium group and 42 patients in the control group died, with 10 and 15 of the deaths, respectively, induced by cardiovascular disease. Results were similar for each trial.
Intention to treat analysis showed a mortality risk reduction of 20% among patients in the sodium reduction intervention, compared with those in the control group (RR=0.80, p=0.25).
Cook and co-workers conclude: "People with prehypertension assigned to a sodium reduction intervention experienced a 25-30% lower risk of cardiovascular outcomes in the 10 to 15 years after the trial.
"Sodium reduction, previously shown to lower blood pressure and prevent hypertension, also seems to prevent cardiovascular disease."
Link: http://www.bmj.com/cgi/content/short/bmj.39147.604896.55v1
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