Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: population based cohort study

The objective of this study was to determine if the use of statins or fibrates in an older population with no history of cardiovascular events affected the risk of coronary heart disease and stroke. The study used a random sample of 7484 individuals(63% female) aged 65 or older from three french cities.

The study found that those using either drug were at a decreased risk of stroke compared to those not using a lipid lowering drug, however no association was found between those using either drug and a decreased risk of coronary heart disease. The researchers analyzed the data based on age, sex, body mass index, and hypertension amongst other variables, and found that overall there was a 30% decrease in risk of stroke for those using a lipid lowering drug.

I think this study is important for understanding the use of statins and fibrates. With the data from this study, there appears to be a clear indication for the use of statins or fibrates for stroke prevention, however there doesn’t seem to be an indication for the use of either drug in prevention of coronary artery disease. With this knowledge, we can help prevent drug therapy problems and recommend that different drugs should be used to prevent coronary heart disease.

Link to study

Association of Fitness in Young Adulthood With Survival and Cardiovascular Risk

Evidence has shown the benefits of exercise to be prognostic factor for overall health and developmental changes to cardiovascular system for adults. Specifically, cardiorespiratory fitness (CRF) is one predictive indicator for older adults with cardiovascular disease but a study was conducted to examine the risk factor of CRF of young adults linked to cardiovascular disease (CVD). Patients underwent a treadmill exercise test at the beginning of the study and repeated the test 7 years later. They assessed obesity, left ventricular mass and strain, coronary artery calcification, and vital status, and incident CVD at different time points to grasp the progression of their cardiovascular health.

The results showed that individuals with longer exercise duration had lower risks of mortality (15%) and cardiovascular disease (12%). There was an association between cardiorespiratory fitness and myocardial phenotypes. Those with a higher CRF levels had a lower left ventricular mass index and a better global longitudinal strain. They did not find a correlation between fitness level and coronary artery calcification. This shows early detection of cardiovascular disease through cardiorespiratory fitness as a biomarker can be beneficial in young adults and can be an influential factor in changing the fitness lifestyle.

I believe this assessment reminds us that preventative measures can be taken at an early stage in adulthood that will lead to better health outcomes. Genetics will be anticipated but there are manageable variables that people can control. In the future, we could see applications of CRF to other health complications, such as diabetes and obesity.

Question: Could the cardiorespiratory fitness of teenagers prior to adulthood be an indicator for potential cardiovascular diseases later in life?

 

JAMA Intern Med. 2016;176(1):87-95.