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November 25, 2019

Cardiovascular Disease Prevention at a Crossroads:Precision Medicine or Polypill?

Author Affiliations
  • 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
  • 2Departments of Epidemiology and Biostatistics, Michigan State University, College of Human Medicine, East Lansing
  • 3Departments of Pediatrics and Human Development, Michigan State University, College of Human Medicine, East Lansing
JAMA. 2019;322(23):2281-2282. doi:10.1001/jama.2019.19026

The remarkable decline in mortality from cardiovascular disease (CVD) in the United States since the 1960s has been attributed to a combination of primary prevention measures (smoking cessation, healthful diet, increased exercise), management of elevated blood pressure and lipids, and treatment of CVD when it occurs (revascularization, heart failure drugs). But since 2016, CVD death rates have leveled off and may even be rising slightly, prompting consideration of the next phase of how to address CVD. Currently, prevention options are to advocate broadly for primary prevention and to test for conventional risk factors and assign an estimated risk as the basis for treatment (secondary prevention).

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    1 Comment for this article
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    Controlled Trial Should Have a True 'Usual Care' Arm
    Oliver Frank, MBBS PhD | Oakden Medical Centre and University of Adelaide, South Australia
    "The proposed trial should have 3 intervention groups: a polypill group, a precision medicine group, and a conventional risk factor modification group."

    In this proposed trial, as well as in other trials that have an arm in which placebo treatments are administered, there would be a benefit to including a true 'usual care' arm. This is because it is becoming evident that even the offering and use of a placebo medicine or other treatment can and often does have some effect. The need to obtain consent from participants might make it difficult or impossible to have a true
    'usual care' arm, but the exercise could still be worth doing.
    CONFLICT OF INTEREST: None Reported
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