Most cardiovascular diseases and mortality come down to 4 years of unhealthy habits (smoking, poor diet, obesity and sedentarism) and 3 major risk factors (cholesterol, hypertension, and diabetes). Ideal cardiovascular health, defined as absence or control of these 7 factors, is far less frequent than we might believe. It is estimated that 87% of the…
AHA 2020 | POLYPILL: One Pill Plus Aspirin to Treat Everything
Using only one compressed tablet or pill with a fixed combination of statins, angiotensin-converting enzyme inhibitors, beta-blockers, and diuretics significantly lowered cardiovascular risk in a large population without previous events (primary prevention). However, it presented an intermediate risk of cardiovascular disease onset. The TIPS-3 (The International Polycap Study 3) study had a 2-by-2-by-2 factorial design,…
The FDA Approves Ticagrelor for Primary Prevention in High Risk Patients
The FDA has approved the indication of ticagrelor as primary prevention in high risk CAD patients with no history of MI or stroke. The lab producing ticagrelor has informed the FDA has based this decision on the THEMIS study, which included nearly 20,000 patients with stable CAD and type 2 diabetes. This decision has come…
Statins in Primary Prevention: As Questioned as Aspirin?
This new review, recently published in BMJ, questions the benefit of statins in low-risk primary prevention patients. Authors argue that statins should be more cautiously indicated in primary prevention, considering that their absolute benefit is almost marginal in low-risk patients. Changes in the European guidelines have translated into a wide expansion of patients eligible for…
Primary Prevention Guidelines Published for the First Time: Are They Useful for All Patients?
The American College of Cardiology/American Heart Association (ACC/AHA) have recently published primary prevention cardiovascular disease guidelines. They were originally considered very useful for general practitioners who had no choice but to review separately expert consensus or clinical practice guidelines for hypertension, cholesterol, diabetes, etc. Now, everything is concentrated in a single reference document. But is…
Aspirin in Primary Prevention: Another “Trendy” Topic in Publications
Aspirin is the standard treatment when it comes to optimal medical treatment in the context of secondary prevention of coronary artery disease, in patients with diagnosed, established atherosclerosis. Even though bleeding risk is rather small in the short period an acute event takes place, it increases substantially over time. However, the evidence clearly supports the…
ACC 2019 | The New ACC/AHA Guidelines on Primary Prevention Focus on Life Style, Diet and Socioeconomic Factors.
These guidelines basically remind us that we should focus on life style changes to best prevent heart disease, heart failure and atrial fibrillation. These changes, of course, should be permanent. It is estimated that life style changes translate into 80% risk reduction of heart disease. These recommendations are based on 9 topics: risk estimation,…
ESC 2018 | ARRIVE: Aspirin in the Eye of the Storm of Primary Prevention
Aspirin failed to reach the primary endpoint in a population that was at risk of experiencing cardiovascular disease. However, something that a short time ago seemed obvious could not be proved by randomizing 12,000 patients. The ARRIVE trial, presented at the European Society of Cardiology (ESC) Congress 2018 and simultaneously published in The Lancet, joins the…
ESC 2018 | ASCEND: Aspirin for Primary Prevention in Diabetic Patients Fails the Cost-Benefit Analysis
The obvious risk of bleeding posed by aspirin was too clear in this work, casting a shadow of doubt over the indication of aspirin for primary prevention in diabetic patients. According to the ASCEND trial, presented at the European Society of Cardiology (ESC) 2018 Congress and simultaneously published in NEJM, aspirin reduces cardiovascular events as…