Earlier treatment in adults with high lifetime risk of cardiovascular diseases: What prevention trials are feasible and could change clinical practice? Report of a National Heart, Lung, and Blood Institute (NHLBI) Workshop

Ann Marie Navar; Lawrence J. Fine; Walter T. Ambrosius; Arleen Brown; Pamela S. Douglas; Karen Johnson; Amit V. Khera; Donald Lloyd-Jones; Erin D. Michos; Mahasin Mujahid; Daniel Muñoz; Khurram Nasir; Nicole Redmond; Paul M Ridker; Jennifer Robinson; David Schopfer; Deborah F. Tate; Cora E. Lewis

doi:10.1016/j.ajpc.2022.100430

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Earlier treatment in adults with high lifetime risk of cardiovascular diseases: What prevention trials are feasible and could change clinical practice? Report of a National Heart, Lung, and Blood Institute (NHLBI) Workshop

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Earlier treatment in adults with high lifetime risk of cardiovascular diseases: What prevention trials are feasible and could change clinical practice? Report of a National Heart, Lung, and Blood Institute (NHLBI) Workshop

Ann Marie Navar, Lawrence J. Fine, Walter T. Ambrosius, Arleen Brown, Pamela S. Douglas, Karen Johnson, Amit V. Khera, Donald Lloyd-Jones, Erin D. Michos, Mahasin Mujahid, …

American journal of preventive cardiology, Vol.12, pp.100430-100430

12/2022

DOI: 10.1016/j.ajpc.2022.100430

PMCID: PMC9691440

PMID: 36439649

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Abstract

More than half of U.S. young adults have low ten-year but high lifetime risk of cardiovascular disease (CVD). Improving primary prevention in young adulthood may help reduce persistent CVD disparities and overall CVD morbidity and mortality. The National Heart, Lung, and Blood Institute (NHLBI) convened a workshop in 2021 to identify potential trial opportunities in CVD prevention in young adults. The workshop identified promising interventions that could be tested, including interventions that focus on a single cardiovascular risk factor (e.g., lipids or inflammation) to multiple risk factor interventions (e.g., multicomponent lifestyle interventions or fixed-low dose combination of medications). Given the sample size and duration for a trial with hard endpoints, more research is needed on the utility of intermediate endpoints identified noninvasively such as subclinical coronary atherosclerosis as a surrogate endpoint. For now, clinical outcomes trials with hard endpoints will more likely change clinical practice. Trial efficiency depends on accurate identification of high-risk young adults, which can potentially be done using traditional risk equations, coronary artery calcium screening, computerized tomography coronary angiography, and polygenic risk scores. Trials in young adults should include enhanced recruitment strategies with intense community engagement to enroll a trial population that is racially, ethnically, geographically, and socially diverse. Despite the challenges in conducting large prevention trials in young adults, recent advances including innovation in clinical trial conduct, new therapies and successful interventions in older populations, and an increasing recognition of a lifespan approach to risk assessment have made such trials more feasible than ever. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

Atherosclerotic cardiovascular disease

Cardiovascular Disease

Risk assessment

Young adults

Details

Title: Subtitle: Earlier treatment in adults with high lifetime risk of cardiovascular diseases: What prevention trials are feasible and could change clinical practice? Report of a National Heart, Lung, and Blood Institute (NHLBI) Workshop
Creators: Ann Marie Navar - The University of Texas Southwestern Medical Center
Lawrence J. Fine - National Heart Lung and Blood Institute
Walter T. Ambrosius - Wake Forest University
Arleen Brown - University of California at Los Angeles, USA
Pamela S. Douglas - Duke University
Karen Johnson - University of Tennessee at Knoxville
Amit V. Khera - Massachusetts General Hospital
Donald Lloyd-Jones - Northwestern University
Erin D. Michos - Johns Hopkins University School of Medicine
Mahasin Mujahid - University of California at Berkeley, USA
Daniel Muñoz - Vanderbilt University Medical Center
Khurram Nasir - Houston Methodist
Nicole Redmond - National Heart Lung and Blood Institute
Paul M Ridker - Brigham and Women's Hospital
Jennifer Robinson - University of Iowa
David Schopfer - National Heart Lung and Blood Institute
Deborah F. Tate - University of North Carolina at Chapel Hill
Cora E. Lewis - University of Alabama at Birmingham
Resource Type: Journal article
Publication Details: American journal of preventive cardiology, Vol.12, pp.100430-100430
DOI: 10.1016/j.ajpc.2022.100430
PMID: 36439649
PMCID: PMC9691440
NLM abbreviation: Am J Prev Cardiol
ISSN: 2666-6677
eISSN: 2666-6677
Publisher: Elsevier B.V
Language: English
Date published: 12/2022
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center
Record Identifier: 9984364542402771

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