title: Residual coronary risk in men aged 50-59 years treated for hypertension and hyperlipidaemia in the population: the PRIME study.
abstract: OBJECTIVE
  Since the proportion of subjects taking antihypertensive and lipid-lowering drugs is currently increasing in industrialized countries, it is important to evaluate, at the population level, coronary risk of treated individuals, while taking into account the achieved level of their risk factors (i.e. their 'residual coronary risk').
  
  
  METHODS
  We used the data from the Prospective Study of Myocardial Infarction (PRIME), which involved populations from France (three centres) and Northern Ireland (one centre) (in each centre, 2500 men, aged 50-59 years, free of coronary heart disease, with a 5-year follow-up), to analyse the relationships between cardiovascular drug use and subsequent coronary risk.
  
  
  RESULTS
  Antihypertensive drug use was significantly positively associated (relative risk = 1.60; 95% confidence interval, 1.18-2.16) with total coronary risk, but not lipid-lowering drug use (relative risk = 1.15; 95% confidence interval, 0.77-1.73), while adjusting on classical risk factor levels (age, smoking, total cholesterol, high-density lipoprotein-cholesterol and systolic blood pressure). Subgroup analysis showed that these results applied to beta-blockers and calcium channel antagonists, but not to diuretics and angiotensin-converting enzyme inhibitors, to both angina pectoris and hard coronary event risk, but in the French population only and not in Belfast. Although the PRIME study was not designed to test the ability of different drugs to prevent coronary heart disease, this analysis raises the hypothesis that antihypertensive drugs could be associated with a sizeable residual coronary risk in middle-aged men.
  
  
  CONCLUSIONS
  Treatment with antihypertensive agents, beta-blockers and calcium channel antagonists in particular, was associated with a sizeable residual coronary risk. It seems, therefore, important to consider antihypertensive treatment in the cardiovascular risk assessment of individuals.
authors.affiliation: INSERM U 258, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Blacher
authors.forename: Alun
authors.initials: A
authors.lastname: Evans
authors.forename: Dominique
authors.initials: D
authors.lastname: Arveiler
authors.forename: Philippe
authors.initials: P
authors.lastname: Amouyel
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.forename: Annie
authors.initials: A
authors.lastname: Bingham
authors.forename: John
authors.initials: J
authors.lastname: Yarnell
authors.forename: Bernadette
authors.initials: B
authors.lastname: Haas
authors.forename: Michèle
authors.initials: M
authors.lastname: Montaye
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
authors.forename: Pierre
authors.initials: P
authors.lastname: Ducimetière
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003327:Coronary Disease / Q000209:etiology*; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000188:drug therapy*; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009660:Northern Ireland; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D000960:Hypolipidemic Agents