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Heart Protection Study Collaborative Group MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial Lancet 2002 Jul 6;360(9326):7 22 [PMID: 12114036] Keech A et al; FIELD study investigators Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial Lancet 2005 Nov 26;366(9500):1849 61 [PMID: 16310551] Khot UN et al Prevalence of conventional risk factors in patients with coronary heart disease JAMA 2003 Aug 20;290 (7):898 904 [PMID: 12928466] Larosa JC et al Intensive lipid lowering with atorvastatin in patients with stable coronary disease N Engl J Med 2005 Apr 7;352(14):1425 35 [PMID: 15755765] Lauer MS Clinical practice Aspirin for primary prevention of coronary events N Engl J Med 2002 May 9;346(19):1468 74 [PMID: 12000818] Lonn E et al; Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators Homocysteine lowering with folic acid and B vitamins in vascular disease N Engl J Med 2006 Apr 13;354 (15):1567 77 [PMID: 16531613] Nissen SE et al Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial JAMA 2004 Mar 3;291(9):1071 80 [PMID: 14996776] Pedersen TR et al; Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group Highdose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial JAMA 2005 Nov 16;294(19): 2437 45 [PMID: 16287954] Ridker PM et al A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women N Engl J Med 2005 Mar 31;352(13):1293 304 [PMID: 15753114] Rossouw JE et al Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause JAMA 2007 Apr 4;297(13):1465 77 [PMID: 17405972] Rossouw JE et al; Women s Health Initiative Investigators Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women s Health Initiative randomized controlled trial JAMA 2002 Jul 17;288(3):321 33 [PMID: 12117397] Smith SC et al AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute Circulation 2006 May 16;113(19):2363 72 [PMID: 16702489] van den Hoogen PC et al The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world Seven Countries Study Research Group N Engl J Med 2000 Jan 6;342(1):1 8 [PMID: 10620642]
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present While clopidogrel was found to be effective at preventing vascular events for 9 12 months after acute coronary syndromes, it was not found to be effective at preventing vascular events in the CHARISMA trial This large trial included patients with clinically evident stable atherothrombosis or with multiple risk factors; all were treated with aspirin and observed for a median of 28 months There may have been benefit for the group of patients with established vascular disease The previously mentioned GISSI Prevention Trial found a significant reduction in mortality with administration of omega-3 fatty acid (850 mg daily) which has an antiplatelet effect in addition to other purported mechanisms in postinfarction patients The effect of hormone replacement therapy in postmenopausal women has been clarified, and it is clear that neither combined estrogen progesterone nor estrogen alone therapy is protective In fact, both cause harm, although hormone replacement therapy for short-term management of menopausal symptoms appears to be relatively safe Control of BP has been shown to prevent infarctions Individuals who exercise for at least 30 minutes a week are at lower risk for subsequent coronary events, and 30 minutes of exercise five times a week reduces the risk of developing diabetes in half among patients at risk The HOPE and the EUROPA trials demonstrated that ACE inhibitors (ramipril 10 mg/d and perindopril 8 mg/d, respectively) reduce fatal and nonfatal vascular events (cardiovascular deaths, nonfatal myocardial infarctions, and nonfatal strokes) by 20 25% in patients at high risk, including diabetics with additional risk factors or patients with clinical coronary, cerebral, or peripheral arterial atherosclerotic disease The PEACE trial did not show benefit of the ACE inhibitor trandolapril in a lower-risk population of patients with coronary heart disease, most of whom had been treated aggressively with medical and revascularization therapies Therefore, while low-risk patients may not derive substantial benefits from ACE inhibitors, most patients with vascular disease, even in the absence of heart failure or LV dysfunction, should be treated with an ACE inhibitor
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Bhatt DL et al; CHARISMA Investigators Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events N Engl J Med 2006 Apr 20;354(16):1706 17 [PMID: 16531616] Bonaa KH et al; NORVIT Trial Investigators Homocysteine lowering and cardiovascular events after acute myocardial infarction N Engl J Med 2006 Apr 13;354(15):1578 88 [PMID: 16531614] Cannon CP et al Intensive versus moderate lipid lowering with statins after acute coronary syndromes N Engl J Med 2004 Apr 8;350(15):1495 504 [PMID: 15007110] Dagenais GR et al Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials Lancet 2006 Aug 12;368(9535):581 8 [PMID: 16905022] Grundy SM et al; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines Circulation 2004 Jul 13;110(2): 227 39 [PMID: 15249516]
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