While maximal weight loss occurred at 6 months, the maximal cardiovascular benefits lagged behind by 3 to 12 months for all measured variables. According to authors, this finding suggests that previous studies of obese subjects undergoing moderate weight loss-which typically involved smaller groups followed for a few months up to a year-may have failed to show cardiovascular benefit.
All participants underwent a medical history, physical exam, and cardiac and vascular ultrasound studies at baseline and at 3, 6, 12 and 24 months after the start of the intervention. Two years after starting the diet intervention, subjects regained over half of the weight that had been lost. Although the maximum benefits of weight loss were somewhat diminished with subsequent weight regain, there was still a significant improvement in heart function and blood vessel wall thickness at two years compared with baseline measures. Whether the present findings translate into improved clinical outcomes requires further investigation.
More Intensive Cholesterol-Lowering Drugs Appear to Outshine Standard or Moderate Statin Therapy in the Prevention of Recurrent Cardiovascular Disease in Certain Patients; Stronger Statins Prevent Not Just First Heart Problem, but Also Second and Third Heart Attack
Two studies in this issue find that use of higher strength statin medications prevent not just a first cardiac event, but also a second or third event as well - showing an even greater benefit of statin therapy than previously thought.
Data from over 14,000 patients from two large randomized lipid-lowering trials- the Pravastin or Atorvastatin Evaluation and Infection Therapy-Thrombosis in Myocardial Infarction 22 (PROVE IT-TIMI 22) and Incremental Decreases in End Points through Aggressive Lipid Lowering (IDEAL) trials were analyzed in a new way to count the total number of heart problems. Traditionally, trials are analyzed based on the time to first cardiovascular event and, as a result, statistical analyses did not include subsequent cardiovascular events. Results from the expanded analyses of the PROVE-IT and IDEAL data found intensive statin therapy to be more effective than standard or moderate statin therapy in preventing additional atherosclerotic development and future cardiovascular events. When additional events are considered, the total number of events prevented by more intensive lipid-lowering therapy was substantially greater.
As previously reported by PROVE-IT, first primary end point events (death, heart attack, stroke, UA requiring rehospitalization, or revascularization) were reduced by 16 percent with atorvastatin 80 mg (intensive lipid lowering) versus pravastatin 40 mg (moderate lipid lowering) (n = 464 vs. n = 537, respectively; p = 0.005). When reexamining the data to include recurrent cardiovascular events during the two-year follow up, authors found additional events were reduced by 19 percent with atorvastatin 80 mg versus pravastatin 40 mg (n = 275 vs. n = 340, respectively; p = 0.009), resulting in 138 fewer total primary events during follow-up. Based on this reanalysis which considers total events, the authors calculate that 14 patients need to be treated to prevent one event-a much smaller number than the 26 needed-to-treat to prevent the first occurrence of the primary end point.
A post-hoc analysis of the IDEAL trial provides new insights into the treatment of patients experiencing repeated occurrences of cardiovascular disease, and shows that high-dose statin therapy remains highly effective. In fact, compared with patients taking simvastatin 20 to 40 mg daily, patients receiving atorvastatin 80 mg daily had their relative risk of a first cardiovascular event reduced by 17 percent (p < 0.0001), of a second by 24 percent (p < 0.0001), of a third by 19 percent (p = 0.035), of a fourth by 24 percent (p = 0.058), and of a fifth by 28 percent (p = 0.117). There was a 17 percent overall reduction in risk across all five events.
Source: American College of Cardiology