International Task Force for Prevention
of Coronary Heart Disease

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Scientific News
Literature Up-date since 2002

Observational Studies

Prediction of risk of coronary events in middle-aged men in the Prospective Cardiovascular Münster
Study (PROCAM), using neural networks.
Int J Epidemiol 2002;31:1253-1262

Intervention trials indicate that about one in three coronary events can be prevented by 5 years of lipid -lowering
treatment. This analysis suggests that use of the multi-layer perceptron to identify high-risk individuals as
candidates for drug treatment would allow prevention of 25% of coronary events in middle -aged men, compared
to 15% and 11% with logistic regression and the probabilistic neural networks, respectively.

Years of life lost due to obesity
JAMA 2003;289:187 -193

Obesity appears to lessen life expectancy markedly, especially among younger adults.

The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men
JAMA 2002;288: 2709 -2716
Cardiovascular disease and all-cause mortality are increased in men with the metabolic syndrome, even in the
absence of baseline cardiovascular disease and diabetes. Early identification, treatment, and prevention of the
metabolic syndrome present a major challenge for health care professionals facing an epidemic of overweight
and sedentary lifestyle.

Homocysteine and risk of ischemic heart disease and stroke. A meta-analysis.
JAMA 2002;288:2015-22

This meta-analysis of observational studies suggests that elevated homocysteine is at most a modest independent
predictor of ischemic heart disease (IHD) and stroke risk in healthy populations.

Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for
one million adults in 61 prospective studies
Lancet 2002;360:1903-1913

Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall)
mortality, without any evidence of a threshold down to at least 115/75 mm Hg.

Prediction of the risk of myocardial infarction from polymorphisms in candidate genes.
NEJM 2002;347:1916-1923

Determination of the genotypes of the connexin 37, plasminogen-activator inhibitor type 1, and stromelysin-1
genes may prove reliable in predicting the genetic risk of myocardial infarction and might thus contribute to the
primary prevention of this condition.

Clinical Studies – Pharmacological

Coronary angiographic changes in patients with cardiac events in the prospective randomised evaluation
of the vascular effects of Norvasc trial (PREVENT)
Am J Cardiol 2002;90:776-778

In patients with cardiac ischemic events in PREVENT, it was rare to identify a culprit lesion in segments that
were completely normal by core angiographic laboratory standards. Culprit lesions undergoing substantial
progression were found most often in segments with a 30% to 60% diameter stenosis at baseline.
Effects of atorvastatin on stroke in patients with unstable angina or non-Q-wave myocardial infarction. A
Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Substudy.
Circulation 2002;106:1690-1695
Intensive cholesterol lowering with atorvastatin over 16 weeks in patients with acute coronary syndromes
reduced the overall stroke rate by half and did not cause hemorrhagic stroke.

Ezetimibe coadministered with simvastatin in patients wi th primary hypercholesterolemia
J Am Coll Cardiol 2002;40:2125-2134

When coadministered with simvastatin, ezetimibe provided significant incremental reductions in LDL-
cholesterol and triglycerides, as well as increases in HDL-cholesterol. Coadministration of ezetimibe with
simvastatin was well tolerated and comparable to statin alone.

Major outcomes in high-risk hypertensive patients randomised to angiotensin-converting enzyme
inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-lowering Treatment to
Prevent Heart Attack Trial (ALLHAT)
JAMA 2002;288:2981-2997

Thizide-type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive.

Major outcomes in moderately hypercholesterolemic, hypertensive patients randomised to pravastatin vs
usual care. The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial
JAMA 2002;288:2998-3007

Pravastatin did not reduce either all-cause mortality or coronary heart disease significantly when compared with
usual care in older participants with well-controlled hypertension and moderately elevated LDL-cholesterol. The
results may be due to the modest differential in total cholesterol (9.6 %) and LDL-cholesterol (16.7 %) between
pravastatin and usual care compared with prior statin trials supporting cardiovascular disease prevention.
Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial
Lancet 2002;360:1623-30

Pravastatin given for 3 years reduced the risk of coronary disease in elderly individuals. PROSPER therefore
extends to elderly individuals the treatment strategy currently used in middle aged people.
German translation of abstract

Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial
infarction: the OPTIMAAL randomised trial.
Lancet 202;360:752-60
Since there was a non-significant difference in total mortality in favour of captopril, ACE inhibitors should remain first-choice treatment in patients after complicated acute myocardial infarction. Losartan cannot be generally recommended in this population. However, it was better tolerated than captopril, and was associated with significantly fewer discontinuations. Although the role of losartan in patients intolerant of ACE inhibition is not clearly defined, it can be considered in such patients. Abstract
Clinical Studies – Non-pharmacological (e.g. nutrition, physical activity)

Diet quality and major chronic disease risk in men and women: moving toward improved dietary

Am J Clin Nutr 2002 Dec;76(6):1261 -71

The Alternate Healthy Eating Index (AHEI) predicted chronic disease risk better than did the Recommended
Food Score (RFS) (or the Healthy Eating Index (HEI) in previous research) primarily because of a strong inverse
association with cardiovascular disease. Dietary guidelines can be improved by providing more specific and
comprehensive advice.

Systematic review of long term effects of advice to reduce dietary salt in adults
BMJ 2002;325:628-

Intensive interventions, unsuited to primary care or population prevention programmes, provide only small
reductions in blood pressure and sodium excretion, and effects on deaths and cardiovascular events are unclear.
Advice to reduce sodium intake may help people on antihypertensive drugs to stop their medication while
maintaining good blood pressure control.

The impact of dietary fat composition on serum leptin concentrations in healthy nonobese men and
J Clin Endocrinol Metab 2002;87:5008-5014

Both the olive oil and the sunflower oil diet did not affect serum leptin concentrations. Serum leptin levels were
affected by the high amount of α-linolenic acid in rapeseed oil - differently in men and women.

Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients
(Indo-Mediterranean Diet Heart Study): a randomised single-blind trial
Lancet 2002;360:1455-61

An Indo-Mediterranean diet that is rich in α-linolenic acid might be more effective in primary and secondary
prevention of CAD than the conventional step I NCEP prudent diet.
German translation of abstract

Walking compared with vigorous exercise for the prevention of cardiovascular events in women
NEJM 2002;347: 716 -725

These prospective data indicate that both walking and vigorous exercise are associated with substantial
reductions in the incidence of cardiovascular events among postmenopausal women, irrespective of race or
ethnic group, age, and body -mass index. Prolonged sitting predicts increased cardiovascular risk.
German translation of abstract
Clinical Studies – Cost-effectiveness

European comparison of costs and quality in the treatment of acute myocardial infarction (2000-2001)
Eur Heart J 2002;23:858-868

There was little variation in the process quality of care for treating acute myocardial infarction. Differences in
resource use may result from differences in the types of reimbursement and in the rates of diffusion of new

Costs associated with the primary prevention of type 2 diabetes mellitus in the Diabetes Prevention
Diabetes Care 2003;26:36-47

The metformin and lifestyle interventions are associated with modest incremental costs compared with the
placebo intervention. The evaluation of costs relative to health benefits will determine the value of these
interventions to health systems and society.


Expert Group on HDL Cholesterol
The role of High-Density Lipoprotein (HDL) Cholesterol in the prevention and treatment of coronary
heart disease: expert group recommendations
Am J Cardiol 2002;90:139-143

U.S. Preventive Services Task Force
Postmenopausal hormone replacement therapy for primary prevention of chronic conditions:
recommendations and rationale
Ann Intern Med 2002;137:834 -839

American Heart Association/Centers for Disease Control and Prevention
Markers of inflammation and cardiovascular disease. Application to clinical and public health practice. A
statement for healthcare professionals from the Centers for Disease Control and Prevention and the
American Heart Association.
Circulation 2003;107:499-511

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final
Circulation 2002;106:3143
Fulltext PDF-Format

American Heart Association
Fish consumption, fish oil, omega-3 fatty acids and cardiovascular disease
Circulation 2002;106:2747-2757

American College of Cardiology/American Heart Association
ACC/AHA guideline update for the management of patients with unstable angina and non-S T-segment
elevation myocardial infarction – 2002: Summary Article. A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the
Management of Patients with Unstable Angina)
Circulation 2002;106:1893-1900

American Heart Association
AHA Guidelines for primary prevention of cardiovascular disease and stroke: 2002 Update. Consensus
panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic
vascular diseases.
Circulation 2002;106:388-391

Working Group on Valvular Heart Disease
Recommendations on the management of the asymptomatic patient with valvular heart disease
Eur Heart J 2002;23:1253-1266

American College of Cardiology/American Heart Association
ACC/AHA 2002 guideline update for the management of patients with chronic stable angina – summary
article. A report of the American College of Cardiology/American Heart Association Task Force on
practice guidelines (Committee on the Management of Patients With Chronic Stable Angina).
J Am Coll Cardiol 2003;41:159 -168
National High Blood Pressure Education Program
Primary prevention of hypertension. Clinical and public health advisory from the National High Blood
Pressure Education Program
JAMA 2002;288:1882-1888


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