title: Reduction in cardiovascular risk using proactive multifactorial intervention versus usual care in younger (< 65 years) and older (≥ 65 years) patients in the CRUCIAL trial.
abstract: OBJECTIVE
  To compare the reduction in calculated Framingham 10 year coronary heart disease (CHD) risk after 52 weeks' intervention with a proactive multifactorial intervention (PMI) strategy (based on single-pill amlodipine/atorvastatin [SPAA]) versus continuing usual care (UC) (based on investigators' best clinical judgment) among younger (<65 years) and older (≥ 65 years) patients.
  
  
  METHODS
  Sub-analysis of the Cluster Randomized Usual Care versus Caduet Investigation Assessing Long-term risk (CRUCIAL) trial. Eligible patients had hypertension and ≥ 3 cardiovascular risk factors.
  
  
  METHODS
  Treatment-related reduction in calculated Framingham 10 year CHD risk between baseline and Week 52 in younger and older patients.
  
  
  RESULTS
  Nine hundred patients (63.5%) were <65 years (mean age 54.2 years, 57.4% men) and 517 patients (36.5%) were ≥ 65 years (mean age 70.5 years, 42.7% men). Younger patients had lower mean baseline CHD risk versus older patients (17.1% vs. 22.6%). A greater reduction in calculated CHD risk at Week 52 was observed in the PMI versus the UC arm in both younger (-33.2% vs. -2.9%, p < 0.001) and older (-32.7% vs. -5.7%, p < 0.001) patients. Least-squares mean treatment differences (PMI vs. UC) in percentage change from baseline in calculated CHD risk were similar in younger and older patients (-26.3% vs. -25.7%, age interaction p = 0.887). CHD risk reduction was slightly greater among younger men than younger women (-29.3 vs. -23.9, gender interaction p = 0.062). A low proportion of patients discontinued the PMI strategy due to adverse events in both age groups (5.8% vs. 6.1%, respectively). Study limitations included ad-hoc (not pre-specified) sub-group analysis and short duration of follow-up.
  
  
  CONCLUSIONS
  The PMI strategy based on the inclusion of SPAA in the treatment regimen is more effective than UC in reducing calculated CHD risk. This strategy may be considered as the treatment of choice in younger and older hypertensive patients with additional cardiovascular risk factors.
authors: St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. jhkim480kr@yahoo.co.kr
authors: Jae-Hyung
authors: JH
authors: Kim
authors: José
authors: J
authors: Zamorano
authors: Serap
authors: S
authors: Erdine
authors: Abel
authors: A
authors: Pavia
authors: Ayman
authors: A
authors: Al-Khadra
authors: Santosh
authors: S
authors: Sutradhar
authors: Carla
authors: C
authors: Yunis
mesh_terms: D000367:Age Factors; D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage*; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology*; D004338:Drug Combinations; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
chemical_list: D004338:Drug Combinations; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; C487936:amlodipine, atorvastatin drug combination; D017311:Amlodipine