ESC Congress 2016 - 22

clINIcAl TRIAl HIgHlIgHTs designed to encourage patients with ACS to adopt a heart-healthy lifestyle with current standard CR. The primary outcome parameter was the SCORE at 18 months after randomization. In addition to age and gender, the SCORE risk function contains 3 modifiable risk parameters (systolic blood pressure, total cholesterol, and smoking status). Secondary outcome parameters were quality of life, anxiety, and daily physical activity. Intention-to-treat (ITT) and per-protocol (PP) analyses (considered to include more motivated patients) were performed. The study comprised adult patients with a documented ACS. Patients with heart failure, ejection fraction < 40%, psychological or cognitive impairments, chronic obstructive pulmonary disease, and those in renal failure were not permitted to enroll. Eligible participants were randomly allocated to 1 of 3 treatment regimens: standard CR plus 3 faceto-face (F) physical activity counseling sessions and 3 group sessions (CR + F; n = 309) that included fitness training and lifestyle counseling; standard CR care plus 5 to 6 telephone (T) lifestyle counseling sessions (CR + T; n = 299); or standard CR care (CR only; n = 306). Participants were mean age 57 years; the majority were men. Between 75-81% of patients had a prior percutaneous coronary intervention at baseline and 42-45% were smokers prior to their ACS. The majority of patients were receiving optimal medical treatment (eg, 70% were receiving angiotensin-converting-enzyme inhibitors, 84% ß-blockers, and 97% statins). Almost all patients (97%) were taking aspirin and 86% were prescribed thienopyridines. SCORE risk function at 18 months did not differ significantly for the 3 treatment arms on either ITT or PP analysis. With respect to the individual modifiable factors of SCORE, CR+F significantly (P < .001) improved total cholesterol (ITT analysis) compared with CR only and CR + T. On the PP analyses: CR+F and CR+T significantly (P < .05) decreased smoking and total cholesterol (CR + F, P < .001; CR + T, P < .05), and improved quality of life (CR + F, P = .004; CR + T, P = .04) compared with CR only. The percentage of patients with 6 of 9 risk factors 'on target' at 18 months was significantly (P = .004) greater and anxiety levels were lower following CR+F treatment compared with CR-only (PP analysis). There were no differences in number of cardiac events among the treatment arms at 18 months. Neither of the extended CR programs added benefit over standard CR with respect to the SCORE risk function likely because most patients had reached the target levels for the modifiable SCORE risk factors by randomization, which was 6 weeks post ACS (ie, there was a ceiling effect). PP analyses of the data revealed benefits for both alternative protocols compared with standard CR only. 22 October 2016 Long-term Exposure to Even Modestly Lower LDL-C and SBP May Significantly Reduce the Lifetime Risk of CVD Written by Maria Vinall Brian A. Ference, MD, MPhil, MSc, Wayne State University, Cardiovascular Medicine, Detroit, Michigan, USA, reported data showing that interventions that modestly lower low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) have the potential to reduce the cardiovascular (CV) risk with long-term exposure. The aim of this study was to evaluate the causal effect of combined exposure to lower LDL-C and SBP associated with genetic polymorphisms on the risk of major vascular events (MVEs) using a 2x2 factorial Mendelian study design. A total of 102,773 men and women aged 27 to 100 years who were enrolled in 14 prospective cohort or case-control studies were included. The investigators constructed a genetic LDL-C score based on 46 polymorphisms to naturally randomize individuals to higher or lower cholesterol levels and a genetic SBP score based on 33 polymorphisms to naturally randomize individuals to higher or lower SBP levels. The Mendelian randomization resulted in 4 groups (Figure 1). Figure 1. 2x2 Factorial Mendelian Randomization LDL-C Score Naturally Randomize Above Median (reference) Below Median (Lower LDL-C) SBP Score SBP Score Naturally Randomize Naturally Randomize Above Median (reference) Below Median (Lower SBP) Above Median (reference) Below Median (Lower SBP) Reference Lower SBP Lower LDL-C Both Lower LDL-C & Lower SBP Lifetime risk of cardiovascular events LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure. Reproduced with permission from B Ference, MD, MPhil, MSc. medicom-publishers.com/mcr http://www.medicom-publishers.com/mcr

Table of Contents for the Digital Edition of ESC Congress 2016