Solid Evidence Backs Heart Attack Prevention Initiative

By David Douglas

NEW YORK - An overview of systematic reviews shows that high-quality evidence underlies the choice of drugs in the Million Hearts Program for primary prevention of atherosclerotic cardiovascular disease, according to researchers.

As Dr. Mark D. Huffman explained in an email to Reuters Health, "The Centers for Disease Control and Prevention and Department of Health and Human Services created its Millions Hearts Program to prevent one million heart attacks and strokes by 2017."

The program, he added, "emphasizes ABCS, including Aspirin, Blood pressure lowering drugs, Cholesterol lowering drugs, and Smoking cessation to achieve this ambitious goal. Our paper uses a transparent method to summarize information from previous systematic reviews to evaluate the safety and efficacy of these commonly used drugs to prevent heart attacks and strokes."

In an April 27 online paper in JAMA Cardiology, Dr. Huffman, of Northwestern University Feinberg School of Medicine, Chicago, and colleagues noted that they settled on 35 systematic reviews of randomized clinical trials. Of these, 15 covered aspirin, four included blood pressure lowering therapy, 12 were on statins, and the remaining four reviewed tobacco-cessation drugs.

"We found high-quality evidence supporting the use of aspirin, statins, and blood pressure lowering drugs to prevent heart attacks and strokes and for tobacco-cessation drugs to nearly triple abstinence rates," Dr. Huffman said.

In particular, compared to placebo, the relative risk of atherosclerotic cardiovascular disease was 0.90 with aspirin and 0.75 with statins. With blood pressure lowering therapy, the relative risk for coronary heart disease was 0.84 and for stroke it was 0.64.

"Medications like aspirin carry an increased risk for side effects," Dr. Huffman continued, "including major bleeding, while statins are generally safe. Side effects have not been reported as clearly in systematic reviews of blood pressure lowering or tobacco-cessation drugs."

Commenting on the findings by email, Dr. Joseph Yeboah of Wake Forest Baptist Health, Winston-Salem, North Carolina, told Reuters Health, "Unfortunately risk-benefit ratios of these methods/approaches are not uniform across the spectrum of characteristics in the general asymptomatic community dwelling adult population."

Dr. Yeboah, who has conducted research in the field, added, "While the benefits of blood pressure lowering and smoking cessation may tip the risk-benefit ratio balance toward generalized application for primary prevention of atherosclerotic cardiovascular disease, caution should be exercised with aspirin and statin use due to very significant side effects that may grossly outweigh any benefits in segments of primary atherosclerotic cardiovascular disease prevention populations."

The Center for Medicare and Medicaid Innovation supported this research. Two coauthors reported disclosures.

SOURCE: https://bit.ly/1SNK5hb

JAMA Cardiol 2016.

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