How Low to Go With Glucose, Cholesterol, and Blood Pressure in Primary Prevention of CVD

Journal of the American College of Cardiology

Volumn 70, Issue 17, 2017, Pages 2171-2185

  Hong, Kimberly N ^a   Fuster, Valentin ^a   Rosenson, Robert S ^a   Rosendorff, Clive ^a   Bhatt, Deepak L ^b  

^a MOUNT SINAI HEALTH SYSTEM   (United States)

^b BRIGHAM AND WOMEN S HOSPITAL   (United States)

Author keywords

cardiovascular disease; diabetes; hyperlipidemia; hypertension; primary prevention

Indexed keywords

AMLODIPINE; ANTIDIABETIC AGENT; ANTIHYPERTENSIVE AGENT; ATORVASTATIN; CANDESARTAN; CHOLESTEROL; DIPEPTIDYL PEPTIDASE IV INHIBITOR; GLUCAGON LIKE PEPTIDE 1 RECEPTOR AGONIST; GLUCOSE; HEMOGLOBIN A1C; HYDROCHLOROTHIAZIDE; LOW DENSITY LIPOPROTEIN CHOLESTEROL; METFORMIN; ROSUVASTATIN; SULFONYLUREA; VALSARTAN; GLUCOSE BLOOD LEVEL;

BLOOD PRESSURE REGULATION; CARDIOVASCULAR DISEASE; CARDIOVASCULAR MORTALITY; CARDIOVASCULAR RISK; DIABETES MELLITUS; DISEASE COURSE; EVIDENCE BASED MEDICINE; FOLLOW UP; GLUCOSE BLOOD LEVEL; GLYCEMIC CONTROL; HIGH RISK POPULATION; HUMAN; HYPERLIPIDEMIA; HYPERTENSION; INCIDENCE; ISCHEMIC HEART DISEASE; LIFESTYLE MODIFICATION; LIPID ANALYSIS; MEDICATION COMPLIANCE; ONSET AGE; PRACTICE GUIDELINE; PREVENTIVE MEDICINE; PRIORITY JOURNAL; REVIEW; RISK ASSESSMENT; RISK FACTOR; RISK REDUCTION; TIME TO TREATMENT; TREATMENT INDICATION; TREATMENT OUTCOME; TREATMENT RESPONSE; AGED; ANALYSIS; BLOOD; BLOOD PRESSURE; CARDIOVASCULAR DISEASES; HYPERLIPIDEMIAS; MIDDLE AGED;

AGED; BLOOD GLUCOSE; BLOOD PRESSURE; CARDIOVASCULAR DISEASES; CHOLESTEROL; DIABETES MELLITUS; GUIDELINES AS TOPIC; HUMANS; HYPERLIPIDEMIAS; HYPERTENSION; MIDDLE AGED; RISK FACTORS;

EID: 85032165770     PISSN: 07351097     EISSN: 15583597     Source Type: Journal    
DOI: 10.1016/j.jacc.2017.09.001     Document Type: Review

References (97)

1. Mozaffarian, D., Benjamin, E.J., Go, A.S., et al. Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 133 (2016), 447–454.
2. Kones, R.R., Primary prevention of coronary heart disease: integration of new data, evolving views, revised goals, and role of rosuvastatin in management. A comprehensive survey. Drug Des Devel Ther 5 (2011), 325–380.
3. Kohli, P.P., Whelton, S.P., Hsu, S., et al. Clinician's guide to the updated ABCs of cardiovascular disease prevention. J Am Heart Assoc, 3, 2014, e001098.
4. Yusuf, S.S., Hawken, S., Ounpuu, S., et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364 (2004), 937–952.
5. Vaduganathan, M., Venkataramani, A.S., Bhatt, D.L., Moving toward global primordial prevention in cardiovascular disease: the heart of the matter. J Am Coll Cardiol 66 (2015), 1535–1537.
6. Labarthe, D.R., Dunbar, S.B., Global cardiovascular health promotion and disease prevention: 2011 and beyond. Circulation 125 (2012), 2667–2676.
7. Rose, G., Sick individuals and sick populations. Int J Epidemiol 14 (1985), 32–38.
8. Huang, R., Abdelmoneim, S.S., Nhola, L.F., Basu, R., Basu, A., Mulvagh, S.L., Relationship between glycosylated hemoglobin A1c and coronary flow reserve in patients with type 2 diabetes mellitus. Expert Rev Cardiovasc Ther 13 (2015), 445–453.
9. Sorop, O., Olver, T.D., van de Wouw, J., et al. The microcirculation: a key player in obesity-associated cardiovascular disease. Cardiovasc Res 113 (2017), 1035–1045.
10. Sucato, V., Novo, G., Evola, S., Novo, S., Coronary microvascular dysfunction in patients with diabetes, hypertension and metabolic syndrome. Int J Cardiol 186 (2015), 96–97.
11. Crea, F., Camici, P.G., Bairey Merz, C.N., Coronary microvascular dysfunction: an update. Eur Heart J 35 (2014), 1101–1111.
12. Rosenson, R.S., Fioretto, P., Dodson, P.M., Does microvascular disease predict macrovascular events in type 2 diabetes?. Atherosclerosis 218 (2011), 13–18.
13. Kawata, T., Daimon, M., Hasegawa, R., et al. Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Cardiovasc Diabetol, 12, 2013, 121.
14. Erdogan, D., Yildirim, I., Ciftci, O., et al. Effects of normal blood pressure, prehypertension, and hypertension on coronary microvascular function. Circulation 115 (2007), 593–599.
15. Fox, C.S., Golden, S.H., Anderson, C., et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 132 (2015), 691–718.
16. James, P.A., Oparil, S., Carter, B.L., et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311 (2014), 507–520.
17. American Heart Association. American Heart Association backs current BP treatments. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatment ofHighBloodPressure/American-Heart-Association-backs-current-BP-treatments_UCM_459129_Article.jsp#.WX_kDa2ZOt8. Accessed July 31, 2017.
18. Stone, N.J., Robinson, J.G., Lichtenstein, A.H., et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:Suppl B (2014), 2889–2934.
19. Goff, D.C., Lloyd-Jones, D.M., Bennett, G., et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:Suppl B (2014), 2935–2959.
20. Newsom, L.C., Primary prevention of atherosclerotic cardiovascular disease: controversies and clinical considerations. Ann Pharmacother 49 (2015), 484–493.
21. Piepoli, M., Hoes, A.W., Agewall, S., 2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur J Prev Cardiol 23 (2016), NP1–NP96.
22. Kones, R., Rumana, U., Current treatment of dyslipidemia: a new paradigm for statin drug use and the need for additional therapies. Drugs 75 (2015), 1187–1199.
23. Cook, N.R., Ridker, P.M., Further insight into the cardiovascular risk calculator: the roles of statins, revascularizations, and underascertainment in the Women's Health Study. JAMA Intern Med 174 (2014), 1964–1971.
24. Rana, J.S., Tabada, G.H., Solomon, M.D., et al. Accuracy of the atherosclerotic cardiovascular risk equation in a large contemporary, multiethnic population. J Am Coll Cardiol 67 (2016), 2118–2130.
25. Emdin, C.A., Khera, A.V., Natarajan, P., et al. Evaluation of the pooled cohort equations for prediction of cardiovascular risk in a contemporary prospective cohort. Am J Cardiol 119 (2017), 881–885.
26. Muntner, P., Colantonio, L.D., Cushman, M., Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations. JAMA 311 (2014), 1406–1415.
27. Verdoia, M., Schaffer, A., Cassetti, E., et al. Glycosylated hemoglobin and coronary artery disease in patients without diabetes mellitus. Am J Prev Med 47 (2014), 9–16.
28. Selvin, E., Steffes, M.W., Zhu, H., et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 362 (2010), 800–811.
29. Knowler, W.C., Barrett-Connor, E., Fowler, S.E., et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346 (2002), 393–403.
30. Knowler, W.C., Fowler, S.E., Hamman, R.F., et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 374 (2009), 1677–1686.
31. Gerstein, H.C., Bosch, J., Dagenais, G.R., et al., for the ORIGIN Trial Investigators. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 367 (2012), 319–328.
32. Hemmingsen, B., Sonne, D.P., Metzendorf, M.I., Richter, B., Insulin secretagogues for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus. Cochrane Database Syst Rev, 10, 2016, CD012151.
33. Hemmingsen, B., Sonne, D.P., Metzendorf, M.I., Richter, B., Dipeptidyl-peptidase (DPP)-4 inhibitors and glucagon-like peptide (GLP)-1 analogues for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk for the development of type 2 diabetes mellitus. Cochrane Database Syst Rev, 5, 2017, CD012204.
34. Cavender, M.A., Scirica, B.M., Raz, I., et al. Cardiovascular Outcomes of Patients in SAVOR-TIMI 53 by Baseline Hemoglobin A1c. Am J Med 129 (2016), 340.e1–340.e8.
35. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352 (1998), 837–853.
36. Nathan, D.M., Cleary, P.A., Backlund, J.Y., et al., for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353 (2005), 2643–2653.
37. Holman, R.R., Paul, S.K., Bethel, M.A., Matthews, D.R., Neil, H.A., 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359 (2008), 1577–1589.
38. Heller, S.R., A summary of the ADVANCE trial. Diabetes Care 32 (2009), S357–S361.
39. Bloomgarden, Z.T., Glycemic control in diabetes: a tale of three studies. Diabetes Care 31 (2008), 1913–1919.
40. Hayward, R.A., Reaven, P.D., Wiitala, W.L., et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med 372 (2015), 2197–2206.
41. Gerstein, H.C., Miller, M.E., Genuth, S., et al., for the ACCORD Study Group. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med 364 (2011), 818–828.
42. Seo, H.S., Choi, M.H., Cholesterol homeostasis in cardiovascular disease and recent advances in measuring cholesterol signatures. J Steroid Biochem Mol Biol 153 (2015), 72–79.
43. Grundy, S.S., Approach to lipoprotein management in 2001 National Cholesterol Guidelines. Am J Cardiol 90:Suppl 8A (2002), 11i–21i.
44. Pencina, M.J., Navar-Boggan, A.M., D'Agostino, R.B., et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med 370 (2014), 1422–1431.
45. Morris, P.P., Ballantyne, C.M., Birtcher, K.K., Dunn, S.P., Urbina, E.M., Review of clinical practice guidelines for the management of LDL-related risk. J Am Coll Cardiol 64 (2014), 196–206.
46. Berenson, G.S., Srinivasan, S.R., Bao, W., Newman, W.P., Tracy, R.E., Wattigney, W.A., Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 338 (1998), 1650–1656.
47. Frontini, M.G., Srinivasan, S.R., Xu, J., Tang, R., Bond, M.G., Berenson, G.S., Usefulness of childhood non-high density lipoprotein cholesterol levels versus other lipoprotein measures in predicting adult subclinical atherosclerosis: the Bogalusa Heart Study. Pediatrics 121 (2008), 924–929.
48. Pletcher, M.J., Bibbins-Domingo, K., Liu, K., et al. Nonoptimal lipids commonly present in young adults and coronary calcium later in life: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Ann Intern Med 153 (2010), 137–146.
49. Nakamura, H., Arakawa, K., Itakura, H., et al. Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial. Lancet 368 (2006), 1155–1163.
50. Ridker, P.P., Danielson, E., Fonseca, F.A., Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 359 (2008), 2195–2207.
51. Lonn, E., Bosch, J., Pogue, J., et al. Novel approaches in primary cardiovascular disease prevention: the HOPE-3 trial rationale, design, and participants' baseline characteristics. Can J Cardiol 32 (2016), 311–318.
52. Yusuf, S., Bosch, J., Dagenais, G., et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 374 (2016), 2021–2031.
53. Domanski, M.J., Fuster, V., Diaz-Mitoma, F., et al. Next steps in primary prevention of coronary heart disease: rationale for and design of the ECAD trial. J Am Coll Cardiol 66 (2015), 1828–1836.
54. Robinson, J.G., 2013 ACC/AHA cholesterol guideline for reducing cardiovascular risk: what is so controversial?. Curr Atheroscler Rep, 16, 2014, 413.
55. Collins, R., Reith, C., Emberson, J., Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 388 (2016), 2532–2561.
56. Bays, H., Cohen, D.E., Chalasani, N., Harrison, S.A., An assessment by the Statin Liver Safety Task Force: 2014 update. J Clin Lipidol 8:Suppl 3 (2014), S47–S57.
57. Banach, M., Rizzo, M., Nikolic, D., Howard, G., Howard, V., Mikhailidis, D., Intensive LDL-cholesterol lowering therapy and neurocognitive function. Pharmacol Ther 170 (2017), 181–191.
58. Cannon, C.P., Blazing, M.A., Giugliano, R.P., et al., for the IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 372 (2015), 2387–2397.
59. Sabatine, M.S., Giugliano, R.P., Keech, A.C., et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 376 (2017), 1713–1722.
60. Olsson, A.G., Angelin, B., Assmann, G., et al. Can LDL cholesterol be too low? Possible risks of extremely low levels. J Intern Med 281 (2017), 534–553.
61. Amgen. Extension (OLE) Study to Assess Safety and Efficacy of Evolocumab. Available at: https://clinicaltrials.gov/ct2/show/NCT02304484. Accessed August 17, 2017.
62. Fujita, H., Okada, T., Inami, I., et al. Low-density lipoprotein profile changes during the neonatal period. J Perinatol 28 (2008), 335–340.
63. Pac-Kozuchowska, E.E., Evaluation of lipids, lipoproteins and apolipoproteins concentrations in cord blood serum of newborns from rural and urban environments. Ann Agric Environ Med 14 (2007), 25–29.
64. Robinson, J.G., Rosenson, R.S., Farnier, M., Safety of very low low-density lipoprotein cholesterol levels with alirocumab: pooled data from randomized trials. J Am Coll Cardiol 69 (2017), 471–482.
65. Giugliano, R.P., Pedersen, T.R., Park, J.G., et al. Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial. Lancet, 2017 Aug 25 [E-pub ahead of print].
66. Giugliano, R.P., Mach, F., Zavitz, K., et al. Cognitive function in a randomized trial of evolocumab. N Engl J Med 377 (2017), 633–643.
67. Ridker, P.M., Revkin, J., Amarenco, P., et al. Cardiovascular efficacy and safety of bococizumab in high-risk patients. N Engl J Med 376 (2017), 1527–1539.
68. Baigent, C., Blackwell, L., Emberson, J., et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 376 (2010), 1670–1681.
69. Ference, B.A., Yoo, W., Alesh, I., et al. Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis. J Am Coll Cardiol 60 (2012), 2631–2639.
70. Ettehad, D., Emdin, C.A., Kiran, A., et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 387 (2016), 957–967.
71. Lewington, S., Clarke, R., Qizilbash, N., Peto, R., Collins, R., Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360 (2002), 1903–1913.
72. Vasan, R.S., Larson, M.G., Leip, E.P., et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 345 (2001), 1291–1297.
73. Gaddam, K.K., Ventura, H., Lavie, C.J., Antihypertensive therapy versus alternative therapeutic options for prehypertension: an evidence-based approach. Future Cardiol 8 (2012), 115–122.
74. Lüders, S., Schrader, J., Berger, J., et al. The PHARAO study: prevention of hypertension with the angiotensin-converting enzyme inhibitor ramipril in patients with high-normal blood pressure: a prospective, randomized, controlled prevention trial of the German Hypertension League. J Hypertens 26 (2008), 1487–1496.
75. Papadopoulos, D.P., Makris, T.K., Papademetriou, V., Is it time to treat prehypertension?. Hypertens Res 31 (2008), 1681–1686.
76. Lonn, E.M., Bosch, J., López-Jaramillo, P., Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 374 (2016), 2009–2020.
77. Vidal-Petiot, E., Ford, I., Greenlaw, N., et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet 388 (2016), 2142–2152.
78. McEvoy, J., Chen, Y., Rawlings, A., et al. Diastolic blood pressure, subclinical myocardial damage, and cardiac events: implications for blood pressure control. J Am Coll Cardiol 68 (2016), 1713–1722.
79. Bhatt, D.D., Troponin and the J-curve of diastolic blood pressure: when lower is not better. J Am Coll Cardiol 68 (2016), 1723–1726.
80. Böhm, M., Schumacher, H., Teo, K.K., et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Lancet 389 (2017), 2226–2237.
81. Kang, Y.Y., The J-curve phenomenon in hypertension. Pulse (Basel) 4 (2016), 49–60.
82. Vidal-Petiot, E.E., Ford, I., Greenlaw, N., et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet 388 (2016), 2142–2152.
83. Hansson, L.L., Zanchetti, A., Carruthers, S.G., et al., for the HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 351 (1998), 1755–1762.
84. Julius, S., Kjeldsen, S.E., Weber, M., et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 363 (2004), 2022–2031.
85. Kjeldsen, S.S., Berge, E., Bangalore, S., et al. No evidence for a J-shaped curve in treated hypertensive patients with increased cardiovascular risk: the VALUE trial. Blood Press 25 (2016), 83–92.
86. The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362 (2010), 1575–1585.
87. Wright, J.T. Jr., Williamson, J.D., Whelton, P.K., et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373 (2015), 2103–2116.
88. Thomopoulos, C., Parati, G., Zanchetti, A., Effects of blood pressure lowering treatment in hypertension: 8. Outcome reductions vs. discontinuations because of adverse drug events—meta-analyses of randomized trials. Hypertens 34 (2016), 1451–1463.
89. Kjeldsen, S.E., Lund-Johansen, P., Nilsson, P.M., Mancia, G., Unattended blood pressure measurements in the Systolic Blood Pressure Intervention Trial: implications for entry and achieved blood pressure values compared with other trials. Hypertension 67 (2016), 808–812.
90. Pires, A., Sena, C., Seiça, R., Dyslipidemia and cardiovascular changes in children. Curr Opin Cardiol 31 (2016), 95–100.
91. Nasir, K., Bittencourt, M.S., Blaha, M.J., et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association Cholesterol Management Guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 66 (2015), 1657–1668.
92. Mahabadi, A.A., Möhlenkamp, S., Lehmann, N., CAC Score improves coronary and CV risk assessment above statin indication by ESC and AHA/ACC Primary Prevention Guidelines. J Am Coll Cardiol Img 10 (2017), 143–153.
93. Baber, U., Mehran, R., Sartori, S., et al. Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. J Am Coll Cardiol 65 (2015), 1065–1074.
94. Fernández-Friera, L., Peñalvo, J.L., Fernández-Ortiz, A., et al. Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort: the PESA (Progression of Early Subclinical Atherosclerosis) study. Circulation 131 (2015), 2104–2113.
95. de Lemos, J.A., Ayers, C.R., Levine, B., et al. Multimodality strategy for cardiovascular risk assessment: performance in 2 population-based cohorts. Circulation 135 (2017), 2119–2132.
96. Khera, A.V., Emdin, C.A., Drake, I., et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med 375 (2016), 2349–2358.
97. Natarajan, P., Young, R., Stitziel, N.O., et al. Polygenic risk score identifies subgroup with higher burden of atherosclerosis and greater relative benefit from statin therapy in the primary prevention setting. Circulation 135 (2017), 2091–2101.