'Simple' treatments to prevent heart attacks and strokes: McMaster study

Clinical studies of patients given preventative blood-pressure medications and cholesterol-lowering drugs could simplify treatments, researchers from McMaster and Hamilton Health Sciences say.

Three studies published today in the New England Journal of Medicine could have global impact

McMaster University researchers have found that cholesterol-lowering statins can cut the risk of heart disease 4:55

An international, seven-year study led by researchers at McMaster University could have significant impacts on prevention treatments for millions of people around the world at risk of developing heart disease.

Three studies under that umbrella were published on Saturday in the New England Journal of Medicine, after studying more than 12,000 patients from 21 countries, including 260 patients from Hamilton and Six Nations.

The studies involved testing two types of drugs: Statins, which lower cholesterol; and anti-hypertensives, which are used to treat high blood pressure; and a mix of both.

Patients who qualified to be studied had an intermediate risk of developing heart disease – a heart attack or a stroke. That meant they were men older than 55 or women over 60 with a factor like smoking, obesity or high blood pressure. But they hadn't been formally diagnosed with clinical heart disease.

The studies' findings: 

  • Giving the cholesterol-lowering statins significantly and safely reduced the number of incidents of cardiovascular disease by 25 per cent.
  • Giving the blood pressure meds, the anti-hypertensives, did not reduce major cardiovascular events overall in the population, but it did if the patients already had high blood pressure.
  • Giving both led to a 30 per cent drop in cardiovascular events. For those who had hypertension, the combination treatment resulted in an even bigger 40 per cent drop. (So patients with high blood pressure should not only lower their blood pressure but also consider taking a statin, the study suggests.)

"Clinicians' guidelines are fairly complex, with all kinds of different criteria," said Dr. Sonia Anand, a McMaster researcher and physician who directs the  Vascular Medicine Clinic at Hamilton Health Sciences.

The work of helping patients prevent heart attacks and strokes is made "much more simple based on these results," she said.

'Who not to treat'

The powerful effect of the statins across a broad range of patients was one of the most significant findings of the study, Anand said.

But another was how the study showed the anti-hypertensives, the blood-pressure medications, may not be right for all patients at risk of heart disease, namely those who don't have hypertension.

"That's really important," Anand said. "Who not to treat."

The team included researchers from McMaster's Population Health Science Research Institute and Hamilton Health Sciences.

The research reports, dubbed HOPE-3, were led by principal investigator Dr. Salim Yusuf and Dr. Eva Lonn, both professors of Medicine of McMaster's Michael G. DeGroote School of Medicine, and Jackie Bosch, an associate professor of the university's School of Rehabilitation Science.

At the study's launch in 2007, Yusuf was excited about the prospects. 

"HOPE-3 will test the concept of whether or not we can slow down, or better yet, reverse the process in most people before they develop cardiovascular disease," he said.

The researchers hope their findings will immediately influence primary care in countries like Canada where the drugs are inexpensive, but that their impact will have global reach.

"These simple methods can be used practically everywhere in the world, and the drugs will become even cheaper as more and more systems and people adopt these therapies," Yusuf said.

Yusuf and Lonn and Bosch present the results of the research this weekend at the American College of Cardiology conference in Chicago.

Yusuf, Lonn and Bosch are presenting the HOPE-3 trials at the 2016 American College of Cardiology (ACC) Scientific Session and Expo in Chicago this weekend.

The study was funded by Canadian Institutes of Health Research and AstraZeneca.


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