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July 12, 1985, Vol 254, No. 2 >
ARTICLE | July 12, 1985

Prevention of Coronary Heart Disease in Practice: Title and subTitle BreakImplications of the Results of Recent Clinical Trials FREE

Nemat O. Borhani, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Department of Community Health, School of Medicine, University of California at Davis, Davis, CA 95616 (Dr Borhani).


JAMA. 1985;254(2):257-262. doi:10.1001/jama.1985.03360020089031
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References

IDEALLY, coronary heart disease should be prevented before it becomes clinically manifest, but when primary prevention fails, prevention of death and recurrent myocardial infarction after the first event, or secondary prevention, is still a worthwhile and achievable goal. Therefore, a review of the results of recent clinical trials on both secondary and primary prevention of coronary heart disease, and of their implications for clinical practice, would seem to be timely and useful.

SECONDARY PREVENTION OF CORONARY HEART DISEASE  A previous history of myocardial infarction is a recognized risk factor for recurrent events, including sudden death. This review reports on recent clinical trials on the efficacy of platelet-active drugs, β-adrenergic blockers, and lowering blood cholesterol regimen in treatment of this high-risk group of patients. Only selected examples of large-scale clinical trials, both short and long term, are addressed.

Clinical Trials on the Protective Effect of Platelet-Active Drugs  Platelet-active drugs, such as

REFERENCES

1 +
Maseri A, Chierchia S, L'Abbate A:  Pathogenetic mechanisms underlying the clinical events associated with atherosclerotic heart disease . Circulation 1980;;62( (suppl V) ):V-3-V-13.
2 +
Moncada S, Vane JR:  Arachidonic acid metabolites and the interactions between platelets and blood vessel walls . N Engl J Med 1979;;300:1142-1147.
3 +
May GS, Eberlein KA, Furberg CD, et al:  Secondary prevention after myocardial infarction: A review of long term trials . Prog Cardiovasc Dis 1982;;24:331-352.
4 +
Aspirin Myocardial Infarction Study Research Group:  A randomized controlled trial of aspirin in persons recovered from myocardial infarction . JAMA 1980;;243:661-669.
5 +
Weksler BB, Pett SB, Alonso D, et al:  Differential inhibition by aspirin of vascular and platelet prostaglandin synthesis in atherosclerotic patients . N Engl J Med 1983;;308:800-805.
6 +
Persantine-Aspirin Reinfarction Study Research Group:  Persantine and aspirin in coronary heart disease . Circulation 1980;;62:449-461.
7 +
Klimt CR, Stamler J:  Secondary coronary prevention with Persantine and aspirin , abstracted. J Am Coll Cardiol 1985;;5:505.
8 +
Lewis HD Jr, Davis JW, Archibald DG, et al:  Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina . N Engl J Med 1983;;309:396-403.
9 +
Cairns J, Gent M, Suiger J, et al:  A study of aspirin and/or sulfinpyrazone in unstable angina , abstracted. Circulation 1984;;70( (suppl II) ):II-415.
10 +
Cutler JA:  A review of ongoing beta blockers in the secondary prevention of coronary heart disease . Circulation 1983;;67( (suppl I) ):I-62-1-65.
11 +
β-Blocker Heart Attack Trial Research Group:  A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results . JAMA 1982;;247:1707-1714.
12 +
Roberts R, Croft C, Gold H, et al:  Effect of propranolol on myocardial-infarct size in a randomized blinded multicenter trial . N Engl J Med 1984;;311:218-225.
13 +
Borhani NO:  Primary prevention of coronary heart disease: A critique . Am J Cardiol 1977;;40:251-259.
14 +
Coronary Drug Project Research Group:  Clofibrate and niacin in coronary heart disease . JAMA 1975;;231:360-381.
15 +
Canner PL:  Mortality in coronary drug project patients during a nine year post-treatment period , abstracted. J Am Coll Cardiol 1985;;5:442.
16 +
Hjermann I, Holme I, Byre KV, et al:  Effect of diet and smoking intervention on the incidence of coronary heart disease . Lancet 1982;;2:1303-1310.
17 +
World Health Organization (WHO) European Collaborative Group:  Multifactorial trial in the prevention of coronary heart disease: Incidence and mortality rates . Eur Heart J 1983;; 4:141-147.
18 +
Multiple Risk Factor Intervention Trial Research Group:  Multiple risk factor intervention trial: Risk factor changes and mortality results . JAMA 1982;;248:1465-1477.
19 +
MRFIT Research Group:  Baseline rest electrocardiographic abnormalities, antihypertensive treatment and mortality in the MRFIT . Am J Cardiol 1985;;55:1-15.
20 +
Hypertension Detection and Follow-up Program Cooperative Research Group:  The effect of antihypertensive drug treatment on mortality in the presence of resting electrocardiographic abnormalities at baseline: The HDFP experience . Circulation 1984;;70:996-1003.
21 +
Hypertension Detection and Follow-up Program Cooperative Group:  Five year findings of the Hypertension Detection and Follow-Up Program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA 1979;;242:2562-2571.
22 +
Lipid Research Clinics Program:  The Lipid Research Clinics Coronary Primary Prevention Trial Results: I. Reduction in incidence of coronary heart disease . JAMA 1984;;251:351-364.
23 +
Lipid Research Clinics Program:  The Lipid Research Clinics Coronary Primary Prevention Trial Results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA 1984;;251:365-374.
24 +
Hypertension Detection and Follow-up Program Cooperative Group:  The effect of treatment on mortality in 'mild' hypertension . N Engl J Med 1982;;307:976-989.
25 +
 The NIH Consensus Development Conference to Lower Blood Cholesterol for Prevention of Heart Disease . JAMA 1985;;253:2080-2086.
26 +
Kolata G:  Heart panel's conclusions questioned . Science 1985;;227:40-41.
27 +
Kronmal RA:  Commentary on the published results of the Lipid Research Clinics Coronary Primary Prevention Trial . JAMA 1985;; 253:2091-2093.
28 +
Hypertension Detection and Follow-up Program Cooperative Group:  Five-year findings of the Hypertension Detection and Follow-up Program: III. Reduction in stroke incidence among persons with high blood pressure . JAMA 1982;;247:633-638.
29 +
Hypertension Detection and Follow-up Program Cooperative Group:  Effect of stepped care treatment on the incidence of myocardial infarction and angina pectoris . Hypertension 1984;;6( (suppl I) ):I-198-I-206.
30 +
Report of the Management Committee:  The Australian Therapeutic Trial in Mild Hypertension . Lancet 1980;;1:1261-1267.
31 +
The Management Committee of the Australian National Blood Pressure Study:  Prognostic factors in the treatment of mild hypertension . Circulation 1984;;69:668-676.
32 +
Steinberg D:  Lipoprotein and atherosclerosis: A look back and a look ahead . Arteriosclerosis 1983;;3:283-301.
33 +
Health—United States and Prevention Profile 1983: Report of the National Center for Health Statistics , publication 84, 1232. US Dept of Health and Human Services, 1984;.

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1 +
Maseri A, Chierchia S, L'Abbate A:  Pathogenetic mechanisms underlying the clinical events associated with atherosclerotic heart disease . Circulation 1980;;62( (suppl V) ):V-3-V-13.
2 +
Moncada S, Vane JR:  Arachidonic acid metabolites and the interactions between platelets and blood vessel walls . N Engl J Med 1979;;300:1142-1147.
3 +
May GS, Eberlein KA, Furberg CD, et al:  Secondary prevention after myocardial infarction: A review of long term trials . Prog Cardiovasc Dis 1982;;24:331-352.
4 +
Aspirin Myocardial Infarction Study Research Group:  A randomized controlled trial of aspirin in persons recovered from myocardial infarction . JAMA 1980;;243:661-669.
5 +
Weksler BB, Pett SB, Alonso D, et al:  Differential inhibition by aspirin of vascular and platelet prostaglandin synthesis in atherosclerotic patients . N Engl J Med 1983;;308:800-805.
6 +
Persantine-Aspirin Reinfarction Study Research Group:  Persantine and aspirin in coronary heart disease . Circulation 1980;;62:449-461.
7 +
Klimt CR, Stamler J:  Secondary coronary prevention with Persantine and aspirin , abstracted. J Am Coll Cardiol 1985;;5:505.
8 +
Lewis HD Jr, Davis JW, Archibald DG, et al:  Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina . N Engl J Med 1983;;309:396-403.
9 +
Cairns J, Gent M, Suiger J, et al:  A study of aspirin and/or sulfinpyrazone in unstable angina , abstracted. Circulation 1984;;70( (suppl II) ):II-415.
10 +
Cutler JA:  A review of ongoing beta blockers in the secondary prevention of coronary heart disease . Circulation 1983;;67( (suppl I) ):I-62-1-65.
11 +
β-Blocker Heart Attack Trial Research Group:  A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results . JAMA 1982;;247:1707-1714.
12 +
Roberts R, Croft C, Gold H, et al:  Effect of propranolol on myocardial-infarct size in a randomized blinded multicenter trial . N Engl J Med 1984;;311:218-225.
13 +
Borhani NO:  Primary prevention of coronary heart disease: A critique . Am J Cardiol 1977;;40:251-259.
14 +
Coronary Drug Project Research Group:  Clofibrate and niacin in coronary heart disease . JAMA 1975;;231:360-381.
15 +
Canner PL:  Mortality in coronary drug project patients during a nine year post-treatment period , abstracted. J Am Coll Cardiol 1985;;5:442.
16 +
Hjermann I, Holme I, Byre KV, et al:  Effect of diet and smoking intervention on the incidence of coronary heart disease . Lancet 1982;;2:1303-1310.
17 +
World Health Organization (WHO) European Collaborative Group:  Multifactorial trial in the prevention of coronary heart disease: Incidence and mortality rates . Eur Heart J 1983;; 4:141-147.
18 +
Multiple Risk Factor Intervention Trial Research Group:  Multiple risk factor intervention trial: Risk factor changes and mortality results . JAMA 1982;;248:1465-1477.
19 +
MRFIT Research Group:  Baseline rest electrocardiographic abnormalities, antihypertensive treatment and mortality in the MRFIT . Am J Cardiol 1985;;55:1-15.
20 +
Hypertension Detection and Follow-up Program Cooperative Research Group:  The effect of antihypertensive drug treatment on mortality in the presence of resting electrocardiographic abnormalities at baseline: The HDFP experience . Circulation 1984;;70:996-1003.
21 +
Hypertension Detection and Follow-up Program Cooperative Group:  Five year findings of the Hypertension Detection and Follow-Up Program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA 1979;;242:2562-2571.
22 +
Lipid Research Clinics Program:  The Lipid Research Clinics Coronary Primary Prevention Trial Results: I. Reduction in incidence of coronary heart disease . JAMA 1984;;251:351-364.
23 +
Lipid Research Clinics Program:  The Lipid Research Clinics Coronary Primary Prevention Trial Results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA 1984;;251:365-374.
24 +
Hypertension Detection and Follow-up Program Cooperative Group:  The effect of treatment on mortality in 'mild' hypertension . N Engl J Med 1982;;307:976-989.
25 +
 The NIH Consensus Development Conference to Lower Blood Cholesterol for Prevention of Heart Disease . JAMA 1985;;253:2080-2086.
26 +
Kolata G:  Heart panel's conclusions questioned . Science 1985;;227:40-41.
27 +
Kronmal RA:  Commentary on the published results of the Lipid Research Clinics Coronary Primary Prevention Trial . JAMA 1985;; 253:2091-2093.
28 +
Hypertension Detection and Follow-up Program Cooperative Group:  Five-year findings of the Hypertension Detection and Follow-up Program: III. Reduction in stroke incidence among persons with high blood pressure . JAMA 1982;;247:633-638.
29 +
Hypertension Detection and Follow-up Program Cooperative Group:  Effect of stepped care treatment on the incidence of myocardial infarction and angina pectoris . Hypertension 1984;;6( (suppl I) ):I-198-I-206.
30 +
Report of the Management Committee:  The Australian Therapeutic Trial in Mild Hypertension . Lancet 1980;;1:1261-1267.
31 +
The Management Committee of the Australian National Blood Pressure Study:  Prognostic factors in the treatment of mild hypertension . Circulation 1984;;69:668-676.
32 +
Steinberg D:  Lipoprotein and atherosclerosis: A look back and a look ahead . Arteriosclerosis 1983;;3:283-301.
33 +
Health—United States and Prevention Profile 1983: Report of the National Center for Health Statistics , publication 84, 1232. US Dept of Health and Human Services, 1984;.

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