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A combination concept for ‘dramatic’ lower risk

ESC Congress News 2016 - Rome, Italy

Hot Line Session Results

Risk Factors, Prevention, Rehabilitation, Sports Cardiology
Risk Factors and Prevention

Long-term exposure to the combination of even modestly lowered LDL cholesterol and systolic blood pressure (SBP) has the potential to deliver synergistic effects that dramatically reduce a person’s lifetime risk of CVD, according to a study in yesterday’s Hot Line.

‘The results demonstrate for the first time that LDL cholesterol and systolic blood pressure have independent, multiplicative and cumulative causal effects on the risk of CVD,’ said study presenter Brian Ference from Wayne State University School of Medicine, Detroit. ‘Our study confirms that CVD events are largely preventable.’

Previous studies have suggested that people with ideal risk factor profiles have very low lifetime risks of CVD, but the causal effects of combined lowering of LDL and SBP are unknown.

In this study investigators used genetic and cardiovascular risk factor data from 102,773 subjects of 14 prospective cohort or case-control studies. Genetic LDL and BP scores were used as instruments to ‘naturally randomise’ the subjects to lower LDL, lower SBP, both or neither, using a 2x2 factorial randomisation design.

Results showed that a total of 14,368 major vascular events (a composite of major vascular event, CHD death, MI stroke or coronary revascularisations) occurred during up to 32 years of follow-up. In comparison to the reference group (where neither were lowered), subjects in the lower LDL group had 54.2% lower risk of the primary outcome (OR 0.454), subjects in the lower SBP group had 44.7% lower risk (OR 0.553), and those in the combined lower LDL and SBP group had an 86.1% lower risk (OR 0.139).

‘Because their effects are multiplicative and cumulative, long-term exposure to the combination of modestly lower LDL and SBP has the potential to dramatically reduce the lifetime risk of cardiovascular events, even among persons with apparently normal cholesterol and blood pressure levels,’ said  Ference.

The prevention of CVD, he added, can be substantially improved and simplified by designing prevention programmes which focus on promoting long-term exposure to the combination of lower LDL levels and lower SBP beginning in early adulthood. Instead of using more pharmacotherapy, he said, it would be important to introduce lifestyle changes that included increased activity to lower blood pressure and cholesterol.


Click here to read other scientific highlights in the full edition of the Congress news.