Heart Attacks: Not Necessary, Completely Preventable?

Heart disease shouldn't kill anyone, researchers said today at the European Society of Cardiology’s ESC Congress 2016 in Rome, Italy.

The risk of having a major cardiovascular event, including dying, can theoretically be reduced by up to 90% by controlling blood pressure and cholesterol--as long as that process starts in early adulthood..

The research’s conclusion was in contrast to a puzzling finding at the most recent major US cardiology meeting, the American College of Cardiology’s April, 2016 conference in Chicago, Ill. There a study called HOPE3 found no added survival benefit in adding blood pressure treatment with cholesterol lowering drugs.

The study by Brian Ference, MD, of Wayne State University School of Medicine in Detroit, MI and colleagues, made a more intuitive finding: “LDL cholesterol a SBP have independent, multiplicative, and cumulative causal effects on the risk of cardiovascular disease.”

The strategy of reducing LDL cholesterol by one mmol/L and systolic blood pressure by 100 mmHG has the potential to “largely eliminate” the lifetime risk of cardiovascular disease, Ference said in a news conference.

But to achieve that reduction in risk, physicians and their patients would have to intervene as soon as possible, because the negative effects of higher levels are cumulative.

Still, that also means that the benefits of lowering these measures are multiplicative, Ference said.

The study looked at data from 102,773 individuals who had been subjects in 14 prospective cohort or case-controlled studies. There were 14,368 primary outcome events among the subjects. They then looked at which groups had more events.

The team used genetic LDL and BP scores as instruments to “naturally randomize’ the participants to lower LDL, lower BP or both.

The goal was to evaluate the unconfounded causal effect of random allocation to lower LDL, lower BP and combined exposure to both on the risk of cardiovascular events “in a manner analogous to a long-term randomized trial,” Ference said.

“Our study confirms that cardiovascular events are largely preventable,” the researchers concluded.

“A 90% reduction rate is spectacular,” said Diederick Grobbee, MD, a Utrecht, Netherlands Distinguished University Professor of International Health Sciences and Global Health and moderator of a research presentation at a news conference this morning.

He joked that the paper was a major step in the quest for eternal life.

When subjects had both lower LDL and BP, there were independent, multiplicative and cumulative causal effects on the risk of cardiovascular events.

That finding was consistent and found in both men and women, smokers and non-smokers, diabetics and non-diabetics.

Commenting on the study in an interview, Jeffrey Kuvin, MD, chief of cardiovascular medicine at Dartmouth Hitchcock in Lebanon, NH said the work represented “a new way of looking at data” and made a strong case for the benefits of prevention.

As for the findings in the HOPE3 study that BP medication did not appear to help reduce risk when added to a statin, he said it was a smaller study, did not cover as long a time period, and may have been skewed by the dramatic impact of statins on cardiovascular events.

“It’s hard to tease it out,” he said.