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New study findings hammer home ACC speakers’ message about the importance of prevention.
Bold statements regarding payment reform, population health and prevention of cardiovascular disease made by healthcare leaders and First Lady Michelle Obama at the April 2 opening of the 65th annual American College of Cardiology’s (ACC’s) Scientific Session and Expo were overshadowed by the release of a study that found wider use of statins could significantly reduce the risk of death, stroke or heart attack.
A team of Canadian researchers announced the findings of their Heart Outcomes Prevention Evaluation trial, known as HOPE 3. The study was funded by the Canadian Institutes of Health Research and AstraZeneca. It involved 12,705 participants in 21 countries (but not the U.S.) who received low doses of blood pressure-lowering drugs, AstraZeneca’s rosuvastatin, sold as Crestor, or placebos for a median length of 5.6 years.
Treatment with rosuvastatin resulted in a 24% risk reduction for cardiovascular events in participants considered at intermediate risk compared to those who received a placebo. The blood pressure-lowering drugs appeared to only benefit participants whose blood pressure reading was in the highest third. The results were released in three NEJM reports focusing on cholesterol, hypertension, and both.
The lead authors from the Population Health Research Institute of McMaster University in Hamilton, Ontario, presented the findings and took questions from an expert panel that included Donald Lloyd-Jones, MD, chair of the department of preventive medicine at the Northwestern University Feinberg School of Medicine.
The first outcome Lloyd-Jones asked about was how did they manage to get three NEJM papers out of one trial. “I need to learn about that,” he said.
Principal Investigator Salim Yusuf, MD, professor of medicine and clinical epidemiology and biostatistics at McMaster, said four papers were originally discussed.
At a news conference, Yusuf said the trial also served as the first formal testing of the concept of a “polypill,” designed to prevent the onset of cardiovascular problems. While it didn’t have universal benefit, it was important to find out for which individuals it did and didn’t work.
Another benefit was the low dose of the drugs administered didn’t require frequent doctor visits to refine and titrate doses per individual patients.
“We have to simplify prevention or it won’t be used widely,” Yusuf said.
Valentin Fuster, MD, editor of the Journal of the American College of Cardiology and physician-in-chief of Mount Sinai Medical Hospital in New York, agreed.
“The future of prevention is simplicity,” he said.
ACC immediate past president Patrick O’Gara, MD, director of clinical cardiology at Brigham and Women’s Hospital in Boston, said he wasn’t concerned that AstraZeneca’s participation compromised the trial in any way.
“A trial like this would not have been done without the availability of a drug of this nature,” O’Gara told Medical Economics, adding that the study’s construction and methodology made it clear that “this was an investigator-managed trial.”
The trial included participants in Canada, China, Russia and 18 other countries, and O’Gara said he was concerned “if perceived barriers” to clinical research could lead to excluding the U.S. from similar studies in the future.
Kicking off the ACC conference via a video message, Obama welcomed the group to her hometown of Chicago and praised the ACC for its “strategic focus on prevention” and connected it to her own initiative to motivate children to exercise, “Let’s Move,” which she launched in 2010.
Another Chicagoan, ACC President Kim Allan Williams, Sr., MD, followed by noting how cardiologists’ success in prolonging the lives of patients with heart disease wasn’t enough anymore.
“We must turn off the faucet instead of just mopping up the floor,” said Williams, chief of the division of cardiology at Rush University in Chicago. He added how it was critical that cardiologists take a bigger role in educating patients about how lifestyle changes can help prevent cardiovascular disease or events.
Williams also spoke out against high drug prices that force patients to spend half their salaries on basic medicines and declared that “buy or die” policies should not exist. He also warned ACC members that quality-reporting programs and value-based payments are “here to stay.”
These thoughts were echoed by David Nash, MD, MBA, founding dean of the Jefferson College of Public Health in Philadelphia, who said transparency and accountability are the only ways “to achieve true professionalism.”
“In God we trust,” Nash said. “Everyone else bring their outcome data.”