Joint societies CVD Prevention Guidelines launched in May 2012

The latest CVD Prevention Guidelines emphasize changing behaviour and give more weight to population studies.     

人群心血管病原发预防及效果评价

为了探讨在我国人群中进行心血管病防治的有效方法,我们在两所高等院校来用人群对照设计开展了心血管病原发预防。一年后的结果示:两组的血压、胆固醇水平改变及吸烟和饮食习惯改善情况,干预组优于常规组,但组间无统计学意义。分析原因可能有:研究人群的危险因素水平偏低;对干预组的干预强度尚不足;常规组人群本身对其危险因素现状敏感性提高和社会影响的作用。     

The Effectiveness of Community Health Workers for CVD Prevention in LMIC

Community health workers (CHW) may be effective in tackling the burden of cardiovascular diseases in low- and middle-income countries (LMIC). This review examines whether CHWs can improve the identification and control of cardiovascular risk factors in LMIC. We searched for studies that used CHW as a basis for cardiovascular risk factor management. Our search yielded 11 articles that targeted cardiovascular risk factor assessment, hypertension, diabetes, smoking, diet and physical activity. There were 4 randomized controlled trials, 3 quasi-experimental studies, 3 cross-sectional studies, and 1 retrospective analysis. Eight studies reported positive results with CHW being able to effectively screen for cardiovascular risk factors, decrease systolic blood pressure, decrease fasting blood glucose, increase quit rates of smoking, decrease weight, and improve diet and physical activity. Our review demonstrates that CHW may be effective in helping tackle the burden of cardiovascular disease in LMIC.     

Multiple Risk Factor Interventions for Primary Prevention of CVD in LMIC: A Cochrane Review

This study sought to determine the effectiveness of multiple risk factor interventions aimed at modifying major cardiovascular risk factors for the primary prevention of cardiovascular disease in low- and middle-income countries (LMIC). We searched electronic databases for randomized controlled trials of health promotion interventions to achieve behavior change. The pooled effect indicated a reduction in systolic blood pressure (−6.72 mm Hg; 95% confidence interval [CI]: −9.82 to −3.61; I² = 91%), diastolic blood pressure (−4.40 mm Hg; 95% CI: −6.47 to −2.34; I² = 92%), body mass index (−0.76 kg/m²; 95% CI: −1.29 to −0.22; I² = 80%), and waist circumference (−3.31 cm; 95% CI: −4.77 to −1.86; I² = 55%) in favor of multiple risk factor interventions. There is some evidence that multiple risk factor interventions may lower blood pressure levels and anthropometrics in populations in LMIC settings at high risk of hypertension and diabetes.     

CETP as a Target in HDL-raising Therapy:lessons from APOE*3-Leiden. CETP Transgenic Mice

Background Cardiovascular disease (CVD) is mainly caused by atherosclerosis,for which dyslipidemia (i.e. high (V)LDL-cholesterol (C),high triglycerides and low HDLC is a major risk factor. To reduce the risk to develop CVD,patients with dyslipidemia are usually treated with lipid-lowering drugs including statins and fibrates.     

Inhibition of CETP as a novel therapeutic strategy for reducing the risk of atherosclerotic disease.

Lowering low-density lipoprotein cholesterol (LDL-C) levels with statins is a proven strategy for reducing the risk of atherothrombotic cardiovascular disease (CVD). Yet, despite the success of statins in reducing cardiovascular event rates in at-risk patients, many will still experience further events. There is, therefore, a need to develop suitable therapies to reduce this residual risk. Low high-density lipoprotein cholesterol (HDL-C) levels are an important independent risk factor for CVD. Though fibrates, niacin, and statins have been shown to modestly raise HDL-C, there is increasing recognition of the need to develop therapies that can increase HDL-C more robustly. Such therapies may help supplement the LDL-C-lowering benefits of statins. Inhibition of cholesteryl ester transfer protein (CETP) has been identified as a possible strategy for substantially increasing HDL-C levels and CETP inhibitors have demonstrated clinical efficacy, in terms of increasing HDL-C, in preliminary clinical trials, and clinical trials based on outcomes are ongoing. Two CETP inhibitors, JTT-705 and torcetrapib, are now being evaluated more extensively.     

The hypertension peril: Lessons from CETP inhibitors

Pharmacologic inhibitors of the cholesteryl ester transfer protein (CETP) are capable of increasing HDL cholesterol by 50% to 100% in humans. Despite intriguing antiatherogenic effects of CETP inhibition in animal models of atherosclerosis, the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events trial investigators observed an excess of cardiovascular and noncardiovascular morbidity and mortality associated with the use of the CETP inhibitor torcetrapib. This review summarizes available clinical and experimental data about potential underlying mechanisms.     

Viewpoint: Stroke Prevention in Recent Guidelines for the Management of Patients with Atrial Fibrillation: An Appraisal

Formal guidelines play an important role in disseminating the best available evidence knowledge and are expected to provide simple and practical recommendations for the most optimal management of patients with various conditions. Such guidelines have important implications for many disease states, which thereby could be more professionally managed in everyday clinical practice by clinicians with divergent educational backgrounds, and also more easily implemented in wards or outpatient clinics, eliminating inequalities in health care management. In this brief Viewpoint we provide an appraisal on the recommendations pertinent to the prevention of atrial fibrillation–related stroke or systemic thromboembolism, as provided in recently published guidelines for the management of this arrhythmia.     

The role of CETP inhibition in dyslipidemia

Cholesteryl ester transfer protein (CETP) inhibitors are currently being investigated because of their ability to increase high-density lipoprotein cholesterol levels. In various metabolic settings, the relationship between CETP and lipoprotein metabolism is complex and may depend largely on the concentration of triglyceriderich lipoproteins. Two CETP inhibitors, JTT-705 and torcetrapib, are in an advanced phase of development. Following hopeful intermediate results, a large endpoint study using torcetrapib has just been discontinued due to increased mortality in torcetrapib-treated subjects. In this review we summarize clinical data on the use of CETP inhibitors.