Related Experiment Video
Updated: May 22, 2026
07:51
Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Cardiovascular primary prevention: how high should we set the bar?
Vinay Prasad1, Andrae Vandross
1Department of Medicine, Northwestern University, Chicago, IL 60611, USA. v-prasad@md.northwestern.edu
Archives of Internal Medicine
|April 25, 2012
Summary
New cardiovascular drug trials show extended-release niacin and fenofibrate offer no mortality benefit alongside statins. The high cost of these medications necessitates higher evidence standards for cardiovascular primary prevention. Future recommendations require demonstrated improvements in overall mortality.
Area of Science:
- Cardiovascular Medicine
- Clinical Trials
- Pharmacoeconomics
Background:
- Extended-release niacin and fenofibrate have been commonly used as add-on therapies to statins for cardiovascular primary prevention.
- Recent clinical trials have yielded results that contradict established clinical practice regarding these medications.
Purpose of the Study:
- To evaluate the efficacy of extended-release niacin and fenofibrate in improving mortality when used with statin therapy.
- To propose revised standards for the recommendation and use of novel agents in cardiovascular primary prevention based on recent trial outcomes.
Main Methods:
- Review of recent large-scale clinical trials investigating the impact of extended-release niacin and fenofibrate on mortality in patients receiving statin therapy.
- Analysis of the cost-effectiveness and established practice surrounding cardiovascular primary prevention medications.
Main Results:
- Extended-release niacin and fenofibrate failed to demonstrate a mortality benefit when added to statin therapy.
- Significant financial investment in cardiovascular primary prevention drugs like statins, ezetimibe, and fenofibrate has been noted.
Conclusions:
- The efficacy of extended-release niacin and fenofibrate as add-on therapies to statins for cardiovascular primary prevention is not supported by recent evidence.
- A higher bar, requiring demonstrated improvements in overall mortality from large studies, should be established before recommending and utilizing novel agents in cardiovascular primary prevention.
- The findings necessitate a re-evaluation of current practices and the economic implications of cardiovascular drug spending.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
01:26Atherosclerosis III: Management
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
01:26Levels of Health Promotion and Illness Prevention
Health promotion allows a person to control the determinants of health, resulting in an improved health status. It enhances the quality of life and reduces premature deaths. Health promotion and illness prevention programs help people make beneficial choices to reduce the risk of disease and disabilities. There are three health promotion and illness prevention levels: primary, secondary, and tertiary prevention.
In primary prevention, actions taken before disease onset prevent the disease from...
In primary prevention, actions taken before disease onset prevent the disease from...
01:30Preventive Healthcare Services
Preventive healthcare services keep people healthy via frequent check-ups, screening, and counseling. They primarily aid in disease prevention rather than treating an acute or chronic illness. Preventive treatment also keeps individuals productive and energetic, allowing them to work well into their retirement years. Examples of preventive care services include:
01:30Coronary Artery Disease I: Introduction
Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the patient.