6 responses to “Cardiovascular outcomes and blood pressure, glucose, and cholesterol numbers”

  1. It will also be interesting to know if current treatment guidelines reduced and/or impact cost of healthcare i.e reduction in hospitalizations, surgeries, procedures, etc that are related to cardiovascular health and /or impact on quality of life.

  2. Interesting timing for Dr McCormack’s article, with the NIH press release this week saying that treating to a target of 120 systolic “reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg” . http://www.nhlbi.nih.gov/news/press-releases/2015/landmark-nih-study-shows-intensive-blood-pressure-management-may-save-lives
    It seems strange and questionable that NIH issued this press release before actually publishing the results in a peer-reviewed journal, so we all hear the big news but it will be months before it can be critically assessed.

  3. There have been criticisms of the studies on statins for some time, so this is not entirely new information, however it does fly in the face of current practice guidelines. I spend a lot of time in my patient encounters trying to encourage healthy lifestyle measures in conjunction with medications for prevention of cardiovascular disease. I do experience peer pressure from colleagues to start medication earlier and to give higher doses.

  4. I believe there was a recent article in NEMJ which recommended keeping systolic BP at or below 120.
    Did you see that article?
    What are your thoughts.
    I very much appreciated your literature review.

  5. The SPRINT trial (120 better than 140) just announced could be very useful but as mentioned we need to see the actual results before it impacts practice. Drives everyone mad when study results aren’t made available. We don’t need every data point but just the essentials of baseline risk absolute benefit, tolerability, QOL, etc. Use common sense – low starting doses, encourage healthy lifestyles, discussion of the benefits and harms with patient – there are lots of other peers who will also pressure you to do this as well – listen to them instead :)

  6. I’ve been asked by Steve Wong to comment on some trials that have come out since I wrote my article.

    1) EMPA-REG OUTCOME Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes – since UKPDS, this is the first trial of a ~ 8 large glucose lowering studies to show that a medication that lowers glucose may also lower clinically important outcomes – overall the primary outcome, a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke was reduced by 1.6% over 3 years (mortality and SAE were also individually reduced), genital infections were increased by 4.6% – you can find a synopsis of the results here http://is.gd/7414uu. But it is just one study and the results from a couple of other ongoing trials from drugs in this class should be released in the next few years and they will help inform us as to how convinced we should be that this class of medications has a clinically important impact.

    2) The SPRINT trial – see my previous post

    3) The IMPROVE-IT trial – ezetimibe for secondary prevention – doesn’t really apply to the issue of risk assessment and primary prevention

    4) The latest USPTF on ASA – they state “the updated review finds that aspirin reduces the relative risk of MI and stroke in both men and women by 15% and 18%, respectively”. This is not that dissimilar to what we suggest in our CVD calculator at cvdcalculator.com in which we use a 15% benefit for men and a 10% benefit for women based on Arch Intern Med 2012;172:209-16

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