atherosclerosis, cardiovascular disease, primary prevention
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2018 Jun 13. doi: 10.1056/NEJMoa1800389. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients The Use of
Mediterranean diet supplemented with extra-virgin olive oil, or with mixed nuts
As Prevention, Primary
Is better Than
simple advice to reduce dietary fat
To reduce cardiovascular events (myocardial infarction, stroke, or cardiovascular death): medit. diet plus olive oil 3.8% VS medit. diet plus nuts 3.4% VS control group 4.4%
JAMA. 2006 Feb 8;295(6):655-66 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
intensive dietary intervention to reduce fat intake and increased intakes of vegetables, fruits, and grains
As Prevention, Primary
Is equal Than
providing diet-related education materials
To reduce at 8 years coronary heart disease (0.64% both groups), stroke (0.27%), in spite of mild reductions in fat intake and blood lipids
Cochrane Database Syst Rev. 2012;5:CD002137 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
reduction of dietary saturated fat by partially replacing by unsaturatef fats
As Prevention, Primary
Is better Than
no modification of diet
To modestly reduce cardiovascular events (RR 0.86) but not to reduce total or cardiovascular mortality
Cochrane Database Syst Rev. 2013;1:CD004816 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
statins
As Prevention, Primary
Is better Than
placebo
To reduce all cause mortality (OR 0,86), and cardiovascilar death and events (OR 0,73 to 0,78), after at least 1 year of treatment
N Engl J Med. 2018 Aug 26. doi: 10.1056/NEJMoa1804988. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, diabetes mellitus, type 2 The Use of
aspirin, 100 mg daily
As Treatment, Chronic
Is better Than
placebo
To reduce at 7.4 years cardiovascular events (8.5% VS 9.5% placebo), but it increased major bleeding (4% aspirin VS 3% placebo), most of the excess being gastrointestinal bleeding and other extracranial bleeding.
BMJ. 2014;349(iss):g4379 Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol The Use of
drug treatments targeted to increase high density lipoprotein: niacin, fibrates, and cholesteryl ester transfer protein (CETP) inhibitors
As Prevention, Primary
Is equal Than
placebo or no treatment
To modify cardiovascular events (all cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke)
JAMA. 2014 Sep 17;312(11):1136-44 Systematic Review
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol, older patients The Use of
statins
As Prevention, Primary
Is undefined Than
no statin treatment
To reduce cardiovascular events. No RCT in patients older than 80 years was found
Lancet. 2002 Nov 23;360(9346):1623-30 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol, older patients The Use of
statins, pravastatin 40 mg/d
As Prevention, Primary
Is better Than
placebo
To to reduce at 3 years cardiovascular events: 14% pravastatine VS 16% placebo. Reduction was due to reduction in non-fatal myocardial infaction, no significant difference in stroke and death
J Am Coll Cardiol. 2013 Dec 3;62(22):2090-9 Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, older patients The Use of
statins
As Prevention, Primary
Is better Than
placebo
To reduce myocardial infarction (RR 0.60) and stroke (RR 0.76) but it did not reduced mortality (either total or cardiovascular)
N Engl J Med. 2016 May 26;374(21):2021-31 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, intermediate risk patients, normal or high cholesterol The Use of
statins, rosuvastatin 10 mg/day for > 5 years
As Prevention, Primary
Is better Than
placebo
To reduce cardiovascular events (cardiovascular death, nonfatal myocardial infarction or stroke) at 5.6 years: 3.7% rosuvastatin VS 4.8% placebo. No difference in mortality: 2.8-2.9% both. Muscle symptoms in 5.8% of patients on rosuvastatin.
JAMA Intern Med. 2017 Jul 01;177(7):955-965 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, low to moderate risk patients, older patients The Use of
statin, pravastatin, 40 mg/d
As Prevention, Primary
Is equal Than
usual care
To modify, after 6 years, mortality or coronary disease
N Engl J Med. 2008 Nov 20;359(21):2195-207 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, normal cholesterol, elevated C-reactive protein The Use of
statins, rosuvastatin
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of major cardiovascular events at 2 years: 0.77% per year statin VS 1.4% per year placebo.
Cochrane Database Syst Rev. 2018 07 18;7:CD003177 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention, secondary prevention The Use of
omega-3 fatty acids
As Treatment, Chronic
Is equal Than
placebo
To polyunsaturated fatty acids from oily fish had little or no effect on mortality or cardiovascular health (high-quality evidence). Alpha-linolenic acid from plants may slightly reduce CVD events and mortality (low-quality evidence)