PREVENTIVE CARDIOLOGY

Question 1

This study was a groundbreaking longitudinal cohort study that identified major cardiovascular risk factors such as hypertension, high cholesterol levels, smoking, diabetes, and obesity. It provided crucial insights into the epidemiology of cardiovascular disease and laid the foundation for modern preventive cardiology.

Answer 1

Framingham Heart Study (1948)

Question 2

This study investigated the importance of various modifiable risk factors in the development of acute myocardial infarction (AMI) across different countries and ethnic groups. It highlighted the significance of nine modifiable risk factors, including smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits and vegetables, alcohol intake, regular physical activity, and regular consumption of fish, in the prevention of AMI.

Answer 2

INTERHEART (2004)

Question 3

This trial demonstrated the efficacy of a diet rich in fruits, vegetables, whole grains, and low-fat dairy products in lowering blood pressure. It provided evidence for dietary interventions as a non-pharmacological approach to preventing and managing hypertension.

Answer 3

Dietary Approaches to Stop Hypertension (DASH) (1997)

Question 4

This trial evaluated the effects of comprehensive lifestyle changes, including a low-fat vegetarian diet, exercise, stress management, and social support, on coronary artery disease (CAD) regression. It demonstrated that intensive lifestyle modifications could lead to significant improvements in angina symptoms and reversal of CAD.

Answer 4

Lifestyle Heart (1983)

Question 5

This study investigated the efficacy of statin therapy in individuals at high risk of cardiovascular events, regardless of their baseline cholesterol levels. It demonstrated that statin therapy significantly reduced the risk of major cardiovascular events, including myocardial infarction, stroke, and cardiovascular mortality, in high-risk individuals.

Answer 5

Heart Protection Study (HPS) (2002)

Question 6

This trial assessed the efficacy of rosuvastatin in primary prevention among individuals with elevated high-sensitivity C-reactive protein (hs-CRP) levels but normal LDL cholesterol levels. It showed that rosuvastatin significantly reduced the risk of major cardiovascular events in this population, emphasizing the role of inflammation in atherosclerosis and the potential benefits of statin therapy beyond lipid lowering.

Answer 6

Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) (2008)

Question 7

This trial investigated the effects of atorvastatin versus placebo in hypertensive patients with average cholesterol levels and without prior cardiovascular disease. It demonstrated that atorvastatin significantly reduced the risk of major cardiovascular events, leading to the inclusion of statin therapy in hypertensive patients, even with normal cholesterol levels.

Answer 7

Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA) (2003)

Question 8

This trial assessed the efficacy of ramipril, an ACE inhibitor, in individuals at high risk of cardiovascular events but without heart failure or left ventricular dysfunction. It demonstrated that ramipril significantly reduced the risk of myocardial infarction, stroke, and cardiovascular mortality, highlighting the importance of ACE inhibitors in high-risk populations.

Answer 8

Heart Outcomes Prevention Evaluation (HOPE) (2000)

Question 9

This trial compared the efficacy of amlodipine, enalapril, and placebo in patients with stable CAD. It showed that amlodipine significantly reduced the risk of major cardiovascular events compared to placebo, providing evidence for the use of calcium channel blockers in CAD management.

Answer 9

Comparison of Amlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) (2004)

Question 10

This trial compared the efficacy of different antihypertensive medications, including thiazide diuretics, ACE inhibitors, calcium channel blockers, and alpha-blockers, in reducing cardiovascular events and mortality in high-risk hypertensive patients. It found that thiazide diuretics were as effective as other antihypertensive agents in preventing cardiovascular events and were more cost-effective, supporting their use as first-line therapy for hypertension.

Answer 10

Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (2002)

Question 11

This trial evaluated the efficacy of pravastatin in secondary prevention among patients with a history of myocardial infarction or unstable angina. It demonstrated that pravastatin significantly reduced the risk of major cardiovascular events and mortality in this population, providing robust evidence for the benefits of statin therapy in secondary prevention.

Answer 11

Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) (1998)

Question 12

This study was one of the earliest prospective cohort studies that identified high serum cholesterol levels as a significant risk factor for coronary heart disease. It provided crucial epidemiological evidence linking cholesterol levels to cardiovascular risk and contributed to the recognition of hypercholesterolemia as a major modifiable risk factor for heart disease.

Answer 12

Copenhagen Male Study (1981)

Question 12

This trial assessed the efficacy of lovastatin in primary prevention among individuals with average cholesterol levels and without known cardiovascular disease. It showed that lovastatin significantly reduced the risk of major cardiovascular events, including myocardial infarction and stroke, in individuals with moderate hypercholesterolemia, supporting the use of statin therapy for primary prevention in selected populations.

Answer 12

Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) (1998)

Question 13

This study investigated the efficacy of irbesartan in preventing the progression of renal disease in patients with type 2 diabetes and microalbuminuria. It demonstrated that irbesartan significantly reduced the risk of renal outcomes, highlighting the importance of renin-angiotensin system blockade in preventing diabetic nephropathy.

Answer 13

Prevention of Renal and Vascular End-stage Disease Intervention Trial (PREVEND IT) (2010)

Question 14

This trial assessed the efficacy of a Mediterranean diet supplemented with either extra-virgin olive oil or nuts in primary prevention among individuals at high cardiovascular risk. It showed that a Mediterranean diet reduced the risk of major cardiovascular events, including myocardial infarction, stroke, and cardiovascular mortality, highlighting the cardiovascular benefits of dietary interventions rich in fruits, vegetables, legumes, nuts, olive oil, and fish.

Answer 14

Prevención con Dieta Mediterránea (PREDIMED) (2013)

Question 15

This study investigated the optimal blood pressure target in hypertensive patients at high cardiovascular risk but without diabetes. It demonstrated that targeting a systolic blood pressure of less than 120 mm Hg significantly reduced the risk of major cardiovascular events and mortality compared to a standard target of less than 140 mm Hg, leading to revisions in blood pressure treatment guidelines.

Answer 15

Systolic Blood Pressure Intervention Trial (SPRINT) (2015)

Question 15

This study evaluated the efficacy of pravastatin in primary prevention among men with hypercholesterolemia but without prior cardiovascular disease. It demonstrated that pravastatin significantly reduced the risk of major cardiovascular events, including myocardial infarction and coronary death, in individuals with elevated cholesterol levels, providing strong evidence for the use of statin therapy for primary prevention in high-risk populations.

Answer 15

West of Scotland Coronary Prevention Study (WOSCOPS) (1995)

Question 16

This study evaluated the efficacy of intensive lifestyle interventions and pharmacological treatments in reducing cardiovascular risk factors, including hypertension, hypercholesterolemia, and smoking, among middle-aged men at high risk of coronary heart disease. Although the trial did not demonstrate a significant reduction in cardiovascular mortality, it provided valuable insights into the complex interplay of multiple risk factors and the challenges of modifying lifestyle behaviors.

Answer 16

Multiple Risk Factor Intervention Trial (MRFIT) (1982)

Question 17

This trial investigated the efficacy of low-dose aspirin in primary prevention among healthy older adults. Contrary to previous evidence, this trial found that low-dose aspirin did not significantly reduce the risk of cardiovascular events and increased the risk of major bleeding in older adults, leading to reconsideration of aspirin use for primary prevention in this population.

Answer 17

Aspirin in Reducing Events in the Elderly (ASPREE) (2018)

Question 18

This trial evaluated the efficacy of aspirin in primary prevention among individuals with moderate cardiovascular risk but without known cardiovascular disease. This trial found that aspirin did not significantly reduce the risk of cardiovascular events but increased the risk of major bleeding, challenging the routine use of aspirin for primary prevention in low-risk populations.

Answer 18

Aspirin to Reduce Risk of Initial Vascular Events (ARRIVE) (2018)

Question 18

This trial evaluated the efficacy of aspirin in preventing cardiovascular events in patients with diabetes but without known cardiovascular disease. This trial found that aspirin reduced the risk of major cardiovascular events but increased the risk of major bleeding, suggesting a nuanced approach to aspirin use in diabetic patients without established CVD.

Answer 18

A Study of Cardiovascular Events in Diabetes (ASCEND) (2018)

Question 19

This trial compared the efficacy of high-dose atorvastatin versus low-dose atorvastatin in reducing cardiovascular events in patients with stable coronary heart disease.This demonstrated that intensive lipid-lowering therapy with high-dose atorvastatin significantly reduced the risk of major cardiovascular events compared to standard-dose therapy, providing evidence for aggressive LDL cholesterol lowering in secondary prevention.

Answer 19

Treating to New Targets (TNT) (2005)

Question 20

This trial investigated the efficacy of ezetimibe, a cholesterol absorption inhibitor, in combination with simvastatin compared to simvastatin alone in patients with acute coronary syndrome. IMPROVE-IT demonstrated that the addition of ezetimibe to statin therapy further reduced LDL cholesterol levels and the risk of major cardiovascular events, providing support for combination therapy in high-risk patients.

Answer 20

Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) (2015)

Question 20

This trial evaluated the efficacy of extended-release niacin in combination with statin therapy compared to statin therapy alone in patients with atherosclerotic cardiovascular disease and low HDL cholesterol levels. This trial found that the addition of niacin did not significantly reduce the risk of major cardiovascular events, leading to uncertainty regarding the benefits of niacin therapy in secondary prevention.

Answer 20

Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes (AIM-HIGH) (2011)

Question 21

This trial evaluated the efficacy of fenofibrate, a fibric acid derivative, in combination with simvastatin compared to simvastatin alone in patients with type 2 diabetes and dyslipidemia. They found that the addition of fenofibrate did not significantly reduce the risk of major cardiovascular events beyond statin therapy alone, leading to questions about the role of fibrates in diabetic dyslipidemia management.

Answer 21

Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid (2010)

Question 22

This trial investigated the efficacy of gemfibrozil, a fibric acid derivative, in raising high-density lipoprotein (HDL) cholesterol levels and reducing cardiovascular events in patients with coronary heart disease and low HDL cholesterol levels. This demonstrated that gemfibrozil significantly reduced the risk of major cardiovascular events in this population, providing evidence for the role of raising HDL cholesterol levels in secondary prevention.

Answer 22

Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) (2001)

Question 23

The _____ was a series of clinical trials that investigated the effects of intensive glucose control, blood pressure control, and lipid management on microvascular and macrovascular outcomes in patients with type 2 diabetes. This demonstrated that intensive glucose control reduced the risk of microvascular complications, while blood pressure control reduced the risk of macrovascular complications, providing key insights into the management of type 2 diabetes and its associated cardiovascular risks.

Answer 23

United Kingdom Prospective Diabetes Study (UKPDS) (1998)

Question 24

This trial assessed the effects of intensive glucose control with gliclazide and other medications, as well as blood pressure control with perindopril-indapamide, on cardiovascular outcomes in patients with type 2 diabetes. This demonstrated that intensive glucose control and blood pressure control significantly reduced the risk of macrovascular and microvascular events, providing further evidence for aggressive multifactorial intervention in diabetic patients.

Answer 24

Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) (2008)

Question 25

This trial assessed the effects of metformin therapy on cardiovascular risk factors in adolescents with obesity and type 2 diabetes. This trial demonstrated that metformin therapy improved insulin sensitivity, reduced weight gain, and improved cardiovascular risk factors in this population, highlighting the potential benefits of early intervention with metformin in obese adolescents with type 2 diabetes.

Answer 25

Reduction in Metformin and Obesity in Youth (REMOVAL) (2014)

Question 26

This trial investigated the effects of intensive glucose control with various medications, including insulin, as well as blood pressure control and lipid management, on cardiovascular outcomes in patients with type 2 diabetes at high risk of cardiovascular events. They found that intensive glucose control did not significantly reduce the risk of cardiovascular events and increased the risk of mortality, highlighting the importance of balancing glycemic control with the risk of hypoglycemia and other adverse effects.

Answer 26

Action to Control Cardiovascular Risk in Diabetes (ACCORD) (2008)