Cardiovascular disease (CVD), which comprises heart attacks (myocardial infarction), angina and strokes, is ranked as the number one cause of mortality and is a major cause of morbidity world wide. High blood cholesterol is linked to CVD events and is an important risk factor. Reducing high blood cholesterol, is thus an important way to reduce the chances of suffering a CVD event. Statins - cholesterol lowering drugs - (e.g. simvastatin, pravastatin, atorvastatin) are the first-choice treatments. Since the early statin randomised controlled trials were reported in the 1990s, several reviews of the effects of statins have been published highlighting their benefits particularly in people with a past history of CVD. Benefits include a reduction in CVD events. Statins have also been shown to reduce the risk of a first event in otherwise healthy individuals at high risk of CVD (primary prevention) but information on possible hazards has not been reported fully. The aim of this updated systematic review is to assess the effects, both in terms of benefits and harms of statins, for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE until 2011. We found 18 randomised controlled trials with 19 trial arms (56,934 patients) dating from 1994 to 2008. All were randomised control trials comparing statins with usual care or placebo. The mean age of the participants was 57 years (range 28 - 97 years), 60.3% were men, and of the eight trials that reported on ethnicity, 85.9 % were Caucasian. Duration of treatment was a minimum one year and with follow-up of a minimum of six months. All-cause mortality and fatal and non-fatal CVD events were reduced with the use of statins as was the need for revascularisation (the restoration of an adequate blood supply to the heart) by means of surgery (coronary artery bypass graft ) or by angioplasty (PTCA). Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event which compares well with other treatments used for preventing cardiovascular disease. Taking statins did not increase the risk of serious adverse effects such as cancer. Statins are likely to be cost-effective in primary prevention.

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Statins for the primary prevention of cardiovascular disease.

Statins for the primary prevention of cardiovascular disease (Review)

Flavonoid intake and cardiovascular disease mortality in a prospective cohort of US adults

Habitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are associated with increased cardiovascular risk. Indeed, behind only smoking and obesity, excessive alcohol consumption is the third leading cause of premature death in the United States. Heavy alcohol use (1) is one of the most common causes of reversible hypertension, (2) accounts for about one-third of all cases of nonischemic dilated cardiomyopathy, (3) is a frequent cause of atrial fibrillation, and (4) markedly increases risks of stroke-both ischemic and hemorrhagic. The risk-to-benefit ratio of drinking appears higher in younger individuals, who also have higher rates of excessive or binge drinking and more frequently have adverse consequences of acute intoxication (for example, accidents, violence, and social strife). In fact, among males aged 15 to 59 years, alcohol abuse is the leading risk factor for premature death. Of the various drinking patterns, daily low- to moderate-dose alcohol intake, ideally red wine before or during the evening meal, is associated with the strongest reduction in adverse cardiovascular outcomes. Health care professionals should not recommend alcohol to nondrinkers because of the paucity of randomized outcome data and the potential for problem drinking even among individuals at apparently low risk. The findings in this review were based on a literature search of PubMed for the 15-year period 1997 through 2012 using the search terms alcohol, ethanol, cardiovascular disease, coronary artery disease, heart failure, hypertension, stroke, and mortality. Studies were considered if they were deemed to be of high quality, objective, and methodologically sound.

Alcohol and cardiovascular health: the dose makes the poison…or the remedy.

Inflammation is a coordinated cellular-humoral response to injury. A close interaction between resident cells (ie, endothelial cells, fibroblasts, and dendritic cells) and leukocytes regulates the initiation and resolution of the acute inflammatory response. Constitutive membrane and cytoplasmic receptors function as guardians that “signal the alarm” when activated by products of cell destruction or microbial invasion. This first-line innate immune response initiates a process of leukocyte mobilization from the bone marrow, recruitment to the “activated” endothelium, and migration to the site of tissue injury to prevent infection and to facilitate tissue repair. Although critical for many forms of repair, the inflammatory response may also become a mechanism for progressive injury, impaired healing, and disease.

Interleukin-1 (IL-1) is an apical proinflammatory mediator in acute and chronic inflammation and a powerful inducer of the innate immune response.1,2 The production and activity of IL-1 are finely regulated at multiple levels, and very small concentrations of exogenous IL-1 can induce a sepsis-like syndrome and shock.1,2 IL-1 induces the synthesis and expression of several hundreds of secondary inflammatory mediators.1,2 IL-1 also induces its own production and processing, and this step is key in the pathogenesis of many autoinflammatory diseases.1,3 Two related genes code for 2 different proteins (IL-1α and IL-1β) that bind the same receptor (type I). IL-1α is synthesized as a fully active peptide that remains membrane bound or may be released from the cytoplasm during cell death. IL-1α thereby participates more prominently in local response to injury and less in the systemic inflammatory response.1,2 IL-1β, the main form of circulating IL-1, is initially synthesized as a precursor (proIL-1β) that becomes activated by caspase-1 cleavage in the setting of a macromolecular structure known as the inflammasome.1,4 Caspase-1 …

Targeting Interleukin-1 in Heart Disease

Despite the fact that we possess highly effective tools for the primary and secondary prevention of myocardial infarction and other complications of atherosclerosis, coronary heart disease remains the most common cause of death in our society. Arterial inflammation and endothelial dysfunction play central roles in the pathogenesis of atherosclerosis and adverse cardiovascular (CV) events. Therapeutic lifestyle changes in conjunction with an aggressive multidrug regimen targeted toward the normalization of the major CV risk factors will neutralize the atherogenic milieu, reduce vascular inflammation, and markedly decrease the risk of adverse CV events and need for revascularization procedures. Specific CV risk factors and optimal therapies for primary and secondary prevention are discussed.

https://www.mayoclinicproceedings.org/article/S0025-6196(11)60525-9/pdf

Primary and Secondary Prevention of Cardiovascular Diseases: A Practical Evidence-Based Approach

Light-to-moderate alcohol consumption has been previously associated with a lower risk of acute myocardial infarction (AMI) and mortality. The association of changes in drinking behavior after an AMI with health status and long-term outcomes is unknown. Using a prospective cohort of patients with AMI evaluated with the World Health Organization's Alcohol Use Disorders Identification Test, we investigated changes in drinking patterns in 325 patients who reported moderate drinking at the time of their AMI. One-year alcohol consumption, disease-specific (angina pectoris and quality of life) and general (mental and physical) health status and rehospitalization outcomes, and 3-year mortality were assessed. Seattle Angina Questionnaire Angina Frequency and Quality of Life, Short Form-12 Mental and Physical Component Summary Scales were modeled using multivariable hierarchical linear models within site. Of the initial 325 moderate drinkers at baseline, 273 (84%) remained drinking and 52 (16%) quit. In fully adjusted models, Physical Component Scale scores (beta 6.47, 95% confidence interval 3.73 to 9.21, p

Comparison of outcomes among moderate alcohol drinkers before acute myocardial infarction to effect of continued versus discontinuing alcohol intake after the infarct.

In the recently published Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study, a large, randomized, placebo-controlled trial, rosuvastatin proved to be safe and remarkably effective in the setting of primary prevention. In patients without coronary heart disease or diabetes, with a baseline low-density lipoprotein cholesterol (LDL-C) level or = 2mg/L, a statin-induced LDL-C reduction of 50% reduced serious cardiac events by about 50%, including in women and the elderly, and also lowered all-cause mortality. The mean on-treatment LDL-C level (55 mg/dL) in the rosuvastatin arm of JUPITER was about in the mid-range of the physiologically normal levels. C-reactive protein screening should be considered, especially in patients without preexisting indications for statin therapy. In general, the CRP-lowering efficacy of statin therapy is directly and significantly correlated with its LDL-C-lowering activity. Simvastatin, at the 80-mg daily dose, is more toxic to muscles and liver than other statins at their highest dose, and thus should be used with caution.

The gravity of JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin).

Is red yeast rice a suitable alternative for statins

© 2009 Mayo Foundation for Medical Education and Research A paradigm shift, the seeds of which were planted decades ago, is now in full bloom and is drastically altering the way in which we diagnose and treat stable coronary heart disease (CHD). The traditional and intuitively logical plumbing paradigm hypothesized that the likelihood of major adverse cardiovascular (CV) events, such as myocardial infarction (MI) and CV death, were directly Despite the fact that we possess highly effective tools for the primary and secondary prevention of myocardial infarction and other complications of atherosclerosis, coronary heart disease remains the most common cause of death in our society. Arterial inflammation and endothelial dysfunction play central roles in the pathogenesis of atherosclerosis and adverse cardiovascular (CV) events. Therapeutic lifestyle changes in conjunction with an aggressive multidrug regimen targeted toward the normalization of the major CV risk factors will neutralize the atherogenic milieu, reduce vascular inflammation, and markedly decrease the risk of adverse CV events and need for revascularization procedures. Specific CV risk factors and optimal therapies for primary and secondary prevention are discussed.

Maia D. Carter

Papers

Primary and Secondary Prevention of Cardiovascular Diseases: A Practical Evidence-Based Approach

Comparison of outcomes among moderate alcohol drinkers before acute myocardial infarction to effect of continued versus discontinuing alcohol intake after the infarct.

The gravity of JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin).

Is red yeast rice a suitable alternative for statins

Primary and Secondary Prevention of Cardiovascular Diseases: A Practical Evidence-Based Approach SYMPOSIUM ON CARDIOVASCULAR DISEASES