Tag Archives: primary prevention

Introduction Compared with the general population, life-expectancy for people with intellectual disability (ID) is 13 years lower in men and 20 years lower in women.1 Cardiovascular diseases (CVDs) are the leading cause of mortality in ID patients, accounting for 21% of all adult deaths.2 The Dutch Healthy Ageing and Intellectual Disability (HA-ID) study found similar levels of CVD risk in ID patients over 50 years as age-matched controls.3 However, CVDs are significantly underdiagnosed and undermanaged in people with ID. In one study, only 15% of patients with ID who died from CVD had a documented CVD risk assessment.1,2 Assessment of CVD ri

Introduction The ASPirin in Reducing Events in the Elderly trial (ASPREE), published in 2018, was a landmark randomised-controlled trial (RCT) that contributed important knowledge about primary cardiovascular disease (CVD) prevention among healthy older adults.1 ASPREE found that daily low-dose aspirin (LDA) does not statistically prevent disability or CVD among adults aged over 70 years when compared with placebo, but does significantly increase risk of haemorrhage; findings that immediately influenced clinical practice guidelines.2 When used as a case study of large RCTs, ASPREE provides further, more existential, lessons for both researche

Introduction The implantable cardioverter defibrillator (ICD) implant rate within the UK remains significantly lower than that across Europe; furthermore, there is marked inequity in access to ICD implant between regions within the UK.1 The need for an ICD is self-evident in secondary prevention patients successfully resuscitated from ventricular tachycardia (VT) or ventricular fibrillation (VF). Intuitively, therefore, it would seem most likely that underperformance and inequity of access in the UK resides chiefly within the primary prevention patient group. A number of international randomised-controlled trials have identified patient subgr

The authors, led by Professor Kausik Ray (St George’s University of London) conclude that the modest benefits and the significant increase in risk of bleeding do not justify routine use of aspirin in primary prevention, but that aspirin may be considered in certain higher-risk groups. The recently published meta-analysis (Arch Intern Med 2012;172:209–16), included nine randomised placebo-controlled trials with a total of 100,000 participants. Results (table 1) showed that during a mean follow-up of six years, aspirin treatment reduced total cardiovascular events by 10%, driven primarily by a reduction in non-fatal myocardial infarction (M

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