Document Detail


Reduction in cardiovascular risk using proactive multifactorial intervention versus usual care in younger (< 65 years) and older (≥ 65 years) patients in the CRUCIAL trial.
MedLine Citation:
PMID:  23448581     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the reduction in calculated Framingham 10 year coronary heart disease (CHD) risk after 52 weeks' intervention with a proactive multifactorial intervention (PMI) strategy (based on single-pill amlodipine/atorvastatin [SPAA]) versus continuing usual care (UC) (based on investigators' best clinical judgment) among younger (<65 years) and older (≥ 65 years) patients.
RESEARCH DESIGN AND METHODS: Sub-analysis of the Cluster Randomized Usual Care versus Caduet Investigation Assessing Long-term risk (CRUCIAL) trial. Eligible patients had hypertension and ≥ 3 cardiovascular risk factors.
MAIN OUTCOME MEASURE: Treatment-related reduction in calculated Framingham 10 year CHD risk between baseline and Week 52 in younger and older patients.
RESULTS: Nine hundred patients (63.5%) were <65 years (mean age 54.2 years, 57.4% men) and 517 patients (36.5%) were ≥ 65 years (mean age 70.5 years, 42.7% men). Younger patients had lower mean baseline CHD risk versus older patients (17.1% vs. 22.6%). A greater reduction in calculated CHD risk at Week 52 was observed in the PMI versus the UC arm in both younger (-33.2% vs. -2.9%, p < 0.001) and older (-32.7% vs. -5.7%, p < 0.001) patients. Least-squares mean treatment differences (PMI vs. UC) in percentage change from baseline in calculated CHD risk were similar in younger and older patients (-26.3% vs. -25.7%, age interaction p = 0.887). CHD risk reduction was slightly greater among younger men than younger women (-29.3 vs. -23.9, gender interaction p = 0.062). A low proportion of patients discontinued the PMI strategy due to adverse events in both age groups (5.8% vs. 6.1%, respectively). Study limitations included ad-hoc (not pre-specified) sub-group analysis and short duration of follow-up.
CONCLUSIONS: The PMI strategy based on the inclusion of SPAA in the treatment regimen is more effective than UC in reducing calculated CHD risk. This strategy may be considered as the treatment of choice in younger and older hypertensive patients with additional cardiovascular risk factors.
Authors:
Jae-Hyung Kim; José Zamorano; Serap Erdine; Abel Pavia; Ayman Al-Khadra; Santosh Sutradhar; Carla Yunis;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2013-04-03
Journal Detail:
Title:  Current medical research and opinion     Volume:  29     ISSN:  1473-4877     ISO Abbreviation:  Curr Med Res Opin     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-16     Completed Date:  2013-11-01     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  0351014     Medline TA:  Curr Med Res Opin     Country:  England    
Other Details:
Languages:  eng     Pagination:  453-63     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Amlodipine / administration & dosage*
Coronary Disease / drug therapy*,  epidemiology*
Drug Combinations
Female
Heptanoic Acids / administration & dosage*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
Male
Middle Aged
Prospective Studies
Pyrroles / administration & dosage*
Risk Factors
Sex Factors
Time Factors
Chemical
Reg. No./Substance:
0/Drug Combinations; 0/Heptanoic Acids; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Pyrroles; 0/amlodipine, atorvastatin drug combination; 1J444QC288/Amlodipine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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