VIEWPOINT
The Forgotten Majority
Unfinished Business in Cardiovascular Risk Reduction
Peter Libby, MD*
Donald W. Reynolds Cardiovascular Clinical Research Center, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts.
Manuscript received February 4, 2005;
accepted February 16, 2005.
* Reprint requests and correspondence: Dr. Peter Libby, Brigham and Women’s Hospital, 77 Avenue Louis Pasteur, NRB 741, Boston, Massachusetts 02115. (Email: plibby{at}rics.bwh.harvard.edu).
Despite meaningful progress in the identification of risk factors and the development of highly effective clinical tools, deaths from cardiovascular disease continue to increase worldwide. Sparked by an obesity epidemic, the metabolic syndrome and the rising incidence of type 2 diabetes have led to an upsurge of cardiovascular risk. Although pharmacologic treatments with the statin class of drugs have reduced cholesterol levels and lowered mortality rates, several large controlled clinical trials, including the Scandinavian Simvastatin Survival Study, the Cholesterol and Recurrent Events trial, the Air Force/Texas Coronary Atherosclerosis Prevention studies, and Long-term Intervention with Pravastatin in Ischemic Disease study, have indicated that cardiovascular events continue to occur in two thirds of all patients. Follow-up studies, such as the Heart Protection Study and the Pravastatin or Atorvastatin Evaluation and Infection Therapy/Thrombolysis In Myocardial Infarction-22 trials, reinforced these earlier results. Although therapy with gemfibrozil, a fibric acid derivative, showed reduced occurrence of cardiovascular events in the Helsinki Heart Study and the Veterans Affairs HDL Intervention Trial, results of other studies, e.g., the Bezafibrate Intervention Program and the Diabetes Atherosclerosis Intervention study, showed less encouraging results. Although lifestyle modifications, such as improved diet and increased exercise levels, benefit general health and the metabolic syndrome and insulin resistance in particular, most people continue to resist changes in their daily routines. Thus, physicians must continue to educate their patients regarding an optimal balance of drug therapy and personal behavior.
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Abbreviations and Acronyms
| | HDL = high-density lipoprotein | | HMG-CoA = 3-hydroxy-3-methlyglutaryl coenzyme A | | LDL = low-density lipoprotein |
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