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Multifactorial primary prevention of cardiovascular diseases in middle-aged men. Risk factor changes, incidence, and
Insights
This study investigated multifactorial primary prevention of vascular diseases. While stroke incidence decreased, coronary events were not prevented, possibly due to adverse drug effects.
Area of Science:
- Cardiovascular disease prevention
- Clinical trials
- Public health
Background:
- Vascular diseases, hyperlipidemias, hypertension, obesity, and abnormal glucose tolerance are significant health concerns.
- Primary prevention trials are crucial for managing cardiovascular risk factors.
- Multifactorial interventions aim to address multiple risk factors simultaneously.
Purpose of the Study:
- To evaluate the efficacy of a five-year multifactorial intervention program in preventing vascular diseases.
- To assess the impact of dietetic-hygienic measures and pharmacotherapy on cardiovascular risk.
- To determine the effects on coronary and stroke incidence in high-risk men.
Main Methods:
- A randomized controlled trial involving high-risk men (n=612) receiving intervention and matched controls (n=610).
- Intervention included dietetic-hygienic measures, hypolipidemic agents (probucol, clofibrate), and antihypertensive agents (diuretics, beta-blockers).
- A low-risk control group (n=593) was included for comparison.
Main Results:
- The intervention group showed improved risk factor status.
- Stroke incidence was significantly reduced in the intervention group (1.3% vs 0%).
- Coronary incidence tended to be higher in the intervention group (3.1% vs 1.5%), particularly in subgroups on beta-blockers or clofibrate.
Conclusions:
- The multifactorial intervention effectively reduced stroke development.
- The program did not prevent cardiac events and may have been offset by potential adverse drug effects.
- Further research is needed to clarify the role of specific agents and adverse effects in cardiovascular outcomes.
Abstract:
In a randomized five-year multifactorial primary prevention trial of vascular diseases, hyperlipidemias, hypertension, smoking, obesity, and abnormal glucose tolerance of the high-risk test group (n = 612 men) were treated with dietetic-hygienic measures and hypolipidemic (mainly probucol and clofibrate) and antihypertensive (mainly diuretics and beta-blockers) agents. A matched high-risk control group (n = 610) and a low-risk control group (n = 593) were not treated. The program markedly improved the risk factor status, yet the five-year coronary incidence tended to be higher in the intervention group than in the control group (3.1% vs 1.5%), while the stroke incidence was significantly reduced (1.3% vs 0%). The coronary events tended to be accumulated in subgroups treated with beta-blocking agents or clofibrate, but there were few in those receiving probucol or diuretics. Thus, the intervention program significantly reduced development of stroke, but the occurrence of cardiac events was not prevented. Possible adverse drug effects offsetting the probable benefit of improved risk profile are not excluded.