Background: Several new strategies for prevention of coronary artery disease have emerged. This review examines the various approaches to primary prevention, and some aspects of secondary prevention.
Methods and Results : The role of aspirin, beta-blockers, exercise, diets, fish intake, vitamin E, and folic acid are discussed. The potential role of chlamydia in atherosclerosis, the pro tective effect of alcohol consumption, and the benefits of female sex hormones are also examined. An update on lipid-lowering therapy, and a summary of the recent major clinical trials establishing the use of 3-hydroxy-3-methylgluataryl-coenzyme A reductase inhibitors in primary and secondary prevention of coronary artery disease, are provided.
Conclusions: An aggressive approach to medical management of coronary artery disease a substantial reduction in risk.
Falk E., Shah PK, Fuster V. Coronary plaque disruption.Circulation92:657,1995
2.
Shah PK, Falk E., Badimon JJ, Fernandez OA, Mailhac A., Villareal LG, Fallon JT, Regnstrom J., Fuster V.Human monocyte-derived macrophages induce collagen breakdown in fibrous caps of atherosclerotic plaques. Potential role of matrix-degrading metalloproteinases and implications for plaque rupture. Circulation92:1565, 1995
3.
Steering Committee of the Physician's Health Study Research Group.Final report on the aspirin component of the ongoing Physician's Health Study. N Engl J Med321:129, 1989
4.
Ridker PM, Cushman M., Stampfer MJ, Tracy RP, Hennekens CHInflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men [see comments]. N Engl J Med336:973,1997
5.
A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA247: 1707,1982
6.
Berglund G.Beta-blockers and diuretics. The HAPPHY and MAPHY studies. Clin Exp Hypertens11:1137,1989
7.
Wikstrand J. , Berglund G., Tuomilehto J.Beta-blockade in the primary prevention of coronary heart disease in hypertensive patients. Review of present evidence . Circulation84 (suppl I): V193, 1991
8.
Lakka TA, Venalainen JM, Rauramaa R., Salonen R., Tuomilehto J., Salonen JTRelation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction. N Engl J Med330:1549, 1994
9.
Ornish D., Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KLCan lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet336:129,1990
10.
Daviglus ML , Stamler J., Orencia AJ, Dyer AR, Liu K., Greenland P., Walsh MK, Morris D., Shekelle RBFish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med336:1046,1997
11.
Stephens NG , Parsons A., Schofield PM, Kelly F., Cheese-man K., Mitchinson MJRandomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS) . Lancet347:781, 1996
12.
Nygard O., Nordrehaug JE, Refsum H., Ueland PM, Farstad M., Vollset SEPlasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med337:230,1997
13.
Boushey CJ, Beresford SA, Omenn GS, Motulsky AGA quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA274:1049,1995
14.
Kuo CC, Grayston JT, Campbell LA, Goo YA, Wissler RW, Benditt EPChlamydia pneumoniae (TWAR) in coronary arteries of young adults (15-34 years old). Proc Natl Acad Sci USA92:6911,1995
15.
Saikku P., Leinonen M., Mattila K., Ekman MR, Nieminen MS, Makela PH, Huttunen JK, Valtonen V.Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet2:983, 1988
16.
Gupta S., Leatham EW, Carrington D., Mendall MA, Kaski JC, Camm AJElevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction. Circulation96: 404, 1997
17.
Criqui MH, Ringel BLDoes diet or alcohol explain the French paradox?Lancet344:1719, 1994
18.
Demrow HS, Slane PR, Folts JDAdministration of wine and grape juice inhibits in vivo platelet activity and thrombosis in stenosed canine coronary arteries. Circulation91:1182. 1995
19.
Klatsky ALArmstrong MA, Friedman GD. Red wine, white wine. liquor, beer, and risk for coronary artery disease hospitalization. Am J Cardiol80:416, 1997
20.
Rossouw JE, Finnegan LP, Harlan WR, Pinn VW, Clifford C., McGowan JAThe evolution of the Women's Health Initiative: perspectives from the NIH . J Am Med Womens Assoc50:50,1995
21.
Pitt B., Mancini GB, Ellis SG, Rosman HS, Park JS, McGovern MEPravastatin limitation of atherosclerosis in the coronary arteries (PLAC I): reduction in atherosclerosis progression and clinical events. PLAC I investigation . J Am Coll Cardiol26:1133,1995
22.
Jukema JW, Bruschke AV, van Boven AJ, Reiber JH, Bal ET, Zwinderman AH, Jansen H., Boerma GJ, van Rappard FMLie KIEffects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The Regression Growth Evaluation Statin Study (REGRESS) . Circulation91:2528,1995
23.
Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) [see comments]. Lancet344: 1383,1994
24.
Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JDCole TG, Brown L., Warnica JW, Arnold JM, Wun CCDavis BR, Braunwald E.The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med335: 1001,1996
Frick MH, Elo O., Haapa K., Heinonen OP, Heinsalmi P., Helo P., Huttunen JK, Kaitaniemi P., Koskinen P., Manninen V., Maenpaa H., Malkonen M., Manttari M., Norola S., Pasternack A., Pikkarainen J., Romo M., Sjoblom T., Nikkila EAHelsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med317:1237,1987
27.
Probstfield JL, Margitic SE, Byington RP, Espeland MA, Furberg CDResults of the primary outcome measure and clinical events from the Asymptomatic Carotid Artery Progression Study. Am J Cardiol76:47C, 1995
28.
Shepherd J. , Cobbe SM, Ford I., Isles CG, Lorimer AR, MacFarlane PW, McKillop JH, Packard CJPrevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group [see comments]. N Engl J Med333: 1301,1995
29.
Lacoste L., Lam JY, Hung J., Letchacovski G, Solymoss CB, Waters D. Hyperlipidemia and coronary disease. Correction of the increased thrombogenic potential with cholesterol reduction . Circulation92:3172,1995
30.
Egashira K. , Hirooka Y., Kai H., Sugimachi M., Suzuki S., Inou T., Takeshita A.Reduction in serum cholesterol with pravastatin improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia . Circulation89:2519, 1994
31.
Corsini A., Raiteri M., Soma MR, Bernini F., Fumagalli R., Paoletti R.Pathogenesis of atherosclerosis and the role of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Am J Cardiol76:21A, 1995
Kobashigawa JA, Katznelson S., Laks H., Johnson JA, Yeatman L., Wang XM, Chia D., Terasaki PI, Sabad A., Cogert GA, Trosian K., Hamilton MA, Moriguchi JD, Kawata N., Haje A., Drinkwater DC, Stevenson LWEffect of pravastatin on outcomes after cardiac transplantation. N Engl J Med333:621,1995
