Coronary artery disease

Overview

Recognition

NHLBI notes that symptoms differ between people and that many learn of the disease only when chest pain, a heart attack or cardiac arrest occurs.

Burden

No burden claims are published.

Claims and evidence

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.

• Claim, not a settled fact Can cause a heart attack: Heart attack (myocardial infarction) (Associated with a higher risk of)

  Applies to Adult

  • Adults in general. The pages are written for the public and give no study population, age range or risk group for these statements.
  • General health information for the public; no care setting is stated
  • United States (pages of US government agencies; some figures on them are US statistics)
  • Adults. The NHLBI coronary page gives a prevalence for adults aged 20 and older.

  Follow-up Not applicable (descriptive statement)
  According to NHLBI, coronary artery disease is behind most heart attacks. MedlinePlus describes a heart attack as blood flow to the heart suddenly becoming blocked.

  Limitations. Patient-education pages from two US government sources. They give no study, no size of risk and no population, and they do not say how often coronary artery disease leads to a heart attack beyond the word most.

• Claim, not a settled fact Evaluated for this: Alirocumab (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients who had an acute coronary syndrome 1 to 12 months earlier, with LDL cholesterol of at least 70 mg/dL, non-HDL cholesterol of at least 100 mg/dL or apolipoprotein B of at least 80 mg/dL, receiving statin at a high-intensity dose or the maximum tolerated dose (abstract). The registry gives a minimum age of 40 years.
  • Multicentre trial (abstract); site list not read
  • Multinational: the study record lists every country the registry names
  • Adult, 40 years and older (registry minimum age)

  Follow-up Median follow-up 2.8 years (abstract).
  In ODYSSEY OUTCOMES, 18,924 patients who had an acute coronary syndrome 1 to 12 months earlier and were on high-intensity or maximum tolerated statin received alirocumab or placebo every 2 weeks. Over a median of 2.8 years, the primary composite end point occurred in 903 patients (9.5%) on alirocumab and 1052 (11.1%) on placebo (hazard ratio 0.85, 95% CI 0.78 to 0.93). Death occurred in 334 patients (3.5%) on alirocumab and 392 (4.1%) on placebo (hazard ratio 0.85, 95% CI 0.73 to 0.98). The abstract reports similar adverse events except local injection-site reactions (3.8% on alirocumab, 2.1% on placebo).

  Limitations. One randomised, double-blind trial funded by Sanofi and Regeneron according to the abstract. The abstract reports the death result as a secondary finding without saying how it was tested; this record does not claim a survival benefit beyond the numbers given. The abstract says the absolute benefit was greater in patients with baseline LDL cholesterol of 100 mg/dL or more. Abstract only.

• Claim, not a settled fact Evaluated for this: Colchicine (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients with chronic coronary disease; 5522 were randomised (abstract). The abstract does not give an age range. The trial is registered with the Australian New Zealand Clinical Trials Registry, which was not read.
  • Not stated in the source (abstract only)
  • Not stated in the source (abstract only)
  • Adult patients; no age range is stated in the abstract

  Follow-up Median follow-up 28.6 months (abstract).
  In LoDoCo2, 5522 patients with chronic coronary disease were randomised to colchicine 0.5 mg once daily (2762) or placebo (2760). Over a median of 28.6 months, the primary composite end point occurred in 187 patients (6.8%) on colchicine and 264 (9.6%) on placebo (2.5 against 3.6 events per 100 person-years; hazard ratio 0.69, 95% CI 0.57 to 0.83). The key secondary composite occurred in 115 (4.2%) and 157 (5.7%) (hazard ratio 0.72, 95% CI 0.57 to 0.92). Death from noncardiovascular causes was higher with colchicine (0.7 against 0.5 events per 100 person-years; hazard ratio 1.51, 95% CI 0.99 to 2.31).

  Limitations. One randomised, double-blind trial; the abstract names the National Health Medical Research Council of Australia and others as funders. The higher rate of noncardiovascular death is reported as given and its interval includes 1. This record covers LoDoCo2 only. A separate trial of colchicine after a recent heart attack is registered as COLCOT (NCT02551094); this atlas records its registry entry and not its results. Abstract only.

• Claim, not a settled fact Evaluated for this: Evolocumab (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients with atherosclerotic cardiovascular disease and LDL cholesterol of 70 mg per deciliter (1.8 mmol per liter) or higher who were receiving statin therapy (abstract). The registry gives ages 40 to 85 years and all sexes.
  • Multicentre outpatient trial (abstract); site list not read
  • Multinational: the study record lists every country the registry names
  • Adult, 40 to 85 years (registry)

  Follow-up Median follow-up 2.2 years (abstract).
  In FOURIER, 27,564 patients with atherosclerotic cardiovascular disease and LDL cholesterol of 70 mg/dL or higher on statin therapy received evolocumab or placebo by injection. At 48 weeks the LDL cholesterol was 59% lower with evolocumab than with placebo, to a median of 30 mg/dL. The primary composite end point occurred in 1344 patients (9.8%) on evolocumab and 1563 (11.3%) on placebo (hazard ratio 0.85, 95% CI 0.79 to 0.92). The key secondary composite occurred in 816 (5.9%) and 1013 (7.4%) (hazard ratio 0.80, 95% CI 0.73 to 0.88). The abstract reports no significant difference in adverse events except injection-site reactions, more common with evolocumab (2.1% against 1.6%).

  Limitations. One randomised, double-blind, placebo-controlled trial with a median follow-up of 2.2 years, funded by Amgen according to the abstract. The population is defined by atherosclerotic cardiovascular disease, which is wider than coronary artery disease. Abstract only.

• Claim, not a settled fact Evaluated for this: Ezetimibe (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients hospitalised for an acute coronary syndrome within the preceding 10 days, with LDL cholesterol 50 to 100 mg/dL if on lipid-lowering therapy or 50 to 125 mg/dL if not (abstract). The registry gives a minimum age of 18 years and all sexes.
  • Hospital-recruited patients followed in a multicentre trial (abstract). Site list not read.
  • Not stated in the source (abstract). The registry record lists no countries.
  • Adult, 18 years and older (registry minimum age)

  Follow-up Median follow-up 6 years (abstract). The registry gives up to approximately 9 years as the outcome time frame.
  In IMPROVE-IT, 18,144 patients hospitalised for an acute coronary syndrome in the previous 10 days received simvastatin 40 mg with ezetimibe 10 mg or simvastatin 40 mg with placebo. The median time-weighted LDL cholesterol was 53.7 mg/dL with ezetimibe added and 69.5 mg/dL with simvastatin alone. At 7 years the Kaplan-Meier rate of the primary composite end point was 32.7% with ezetimibe and 34.7% with simvastatin alone (absolute difference 2.0 percentage points; hazard ratio 0.936, 95% CI 0.89 to 0.99; P=0.016). The abstract says muscle, gallbladder and hepatic adverse effects and cancer were similar in the two groups.

  Limitations. One randomised trial, double-blind, funded by Merck according to the abstract. The benefit is modest in absolute terms (2.0 percentage points at 7 years). The population was people after an acute coronary syndrome who took simvastatin 40 mg; the result is for adding ezetimibe to that statin, not for ezetimibe alone. Abstract only; the registry record lists Organon and Co as its current lead sponsor.

• Claim, not a settled fact Evaluated for this: Percutaneous coronary intervention (stents) (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients with stable coronary disease and moderate or severe ischemia (abstract); 5179 were randomly assigned. The registry gives a minimum age of 21 years and all sexes.
  • Open-label strategy trial; the registry records masking as none. Site list not read.
  • Multinational: the study record lists every country the registry names
  • Adult, 21 years and older (registry minimum age)

  Follow-up Median follow-up 3.2 years (abstract).
  ISCHEMIA randomly assigned 5179 patients with stable coronary disease and moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible, plus medical therapy) or an initial conservative strategy of medical therapy alone. Over a median of 3.2 years, there were 318 primary outcome events in the invasive group and 352 in the conservative group. The cumulative event rate at 6 months was 5.3% against 3.4% (difference 1.9 percentage points, 95% CI 0.8 to 3.0), and at 5 years 16.4% against 18.2% (difference -1.8 percentage points, 95% CI -4.7 to 1.0). There were 145 deaths with the invasive strategy and 144 with the conservative strategy (hazard ratio 1.05, 95% CI 0.83 to 1.32). The authors report that they did not find evidence that an initial invasive strategy reduced the risk of ischemic cardiovascular events or death from any cause, and that the findings were sensitive to the definition of myocardial infarction.

  Limitations. This was a null result for the primary outcome. The invasive strategy was angiography with revascularization when feasible, which covers stents (PCI) and bypass surgery, so the result cannot be read as the effect of PCI alone. The trial was open-label (the registry records masking as none), and the conservative group could cross over to angiography if medical therapy failed. The population was stable coronary disease with moderate or severe ischemia, not people having a heart attack. Abstract only.

• Claim, not a settled fact Risk raised by: High LDL cholesterol (Associated with a higher risk of, seen from the other side)

  Applies to Adult

  • Adults in general. The pages are written for the public and give no study population, age range or risk group for these statements.
  • General health information for the public; no care setting is stated
  • United States (pages of US government agencies; some figures on them are US statistics)
  • Adults. The NHLBI coronary page gives a prevalence for adults aged 20 and older.

  Follow-up Not applicable (descriptive statement)
  MedlinePlus says that a high LDL level means too much LDL cholesterol in the blood, that this extra LDL forms plaque in the arteries, and that coronary artery disease is that plaque buildup in the arteries of the heart. NHLBI adds that plaque built up from high LDL cholesterol raises the risk of heart attack, stroke and other conditions.

  Limitations. Patient-education pages. They explain how the process works and give no study, no size of risk and no LDL threshold. They say high LDL raises the risk of coronary artery disease, not by how much.

Record details

Record id

cardio:coronary-artery-disease

Content hash

37fa3ff4d3cc27ef88059bfe969f2c74842abb572ff604132a595ba981081eab