Preventing heart attack, stroke and heart failure
This page is the starting point for the atlas's prevention material. For now it is built around blood pressure, because the first evidence recorded here is about medicines that lower blood pressure. Other parts of prevention are not covered yet.
Also called Cardiovascular prevention
- Care topic
- In this atlas
Overview
Technical summary
Scope page, not a clinical statement. The first evidence tied to it is an individual-participant meta-analysis of 48 randomised trials (BPLTTC, Lancet 2021). That paper defines a major cardiovascular event as a composite of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital. Blood pressure lowering medicine links to this topic through a claim that records the hazard ratios per 5 mm Hg systolic reduction.
Scope
Blood-pressure-related prevention first; other prevention areas are not covered yet. The sources read do not state an age group for this topic.
- Life stages
None stated
- Care setting
- Not reported
Claims and evidence
No claims are published for this care topic yet.
Clinical links
Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.
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Claim, not a settled fact Evaluated for this: Blood pressure lowering medicine
Applies to Recipient not specified- People randomised in 48 trials of blood-pressure-lowering medicines, analysed in two groups: those with and those without previous cardiovascular disease, defined as stroke, myocardial infarction or ischaemic heart disease before randomisation. Mean age at baseline was 65 years in both groups. The age range is not reported in the text read, which does not describe the participants as adults, and it does not say how pregnancy was handled.
- Randomised clinical trials of blood-pressure-lowering medicines. The settings of the individual trials are listed in the paper's appendix, which was not read.
- Not stated in the text read (the trial list is in the appendix, which was not read)
- Not stated in the text read; mean age 65 years at baseline, age range not reported
- Gestational age Not reported
- Postnatal age Not reported
In a pooled analysis of individual-participant data from 48 randomised trials of blood-pressure-lowering medicines (344,716 people, median follow-up 4.15 years), a 5 mm Hg lower systolic blood pressure from treatment was associated with a lower risk of a major cardiovascular event: a stroke, a heart attack or ischaemic heart disease, or heart failure that caused death or needed hospital admission. The hazard ratio was 0.91 (95% CI 0.89 to 0.94) in people without previous cardiovascular disease and 0.89 (95% CI 0.86 to 0.92) in people with it. The authors report no reliable evidence that this proportional effect differed between the two groups.Source problem. A cited source is corrected. Check the sources before relying on this claim.
Limitations. The pooled trials differ in design: placebo-controlled trials, comparisons of drug classes, and more-versus-less-intensive treatment. The hazard ratios are standardised to a 5 mm Hg systolic reduction, while the trials' average reduction between their groups, excluding the first 12 months, was 6.3 mm Hg. Previous cardiovascular disease means stroke, myocardial infarction or ischaemic heart disease before randomisation. Trials only in heart failure or acute settings, and people with known heart failure at baseline, are left out. The trials tested blood-pressure-lowering medicines in general, so the result is not specific to the first-line classes named in the WHO recommendations. The estimate is an average across trials. It says nothing about one drug or about benefit for one person. Each component outcome, stroke alone included, is shown in Figure 3 of the paper, an image that could not be read, so no component result is recorded here. The paper's Discussion also states a percentage reduction for each component, which comes from the same component results as Figure 3; those percentages are left unrecorded too, so this claim stays about the combined outcome. A two-stage sensitivity analysis gave similar estimates (0.89 with and 0.92 without previous cardiovascular disease). One erratum only updates the collaboration group list. The numbers are the authors' reported results, taken from the open-access PMC version rather than the publisher's version of record, and nobody has re-analysed them.
Record details
- Record id
cardio:cardiovascular-prevention- Content hash
4f2980bccc38feceed49595d2db2a3ed50420a051f55b1b2855c3f40ed3401e9