Implications of Recent Results of Long Term Multifactorial Primary Prevention of Cardiovascular Diseases

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Abstract
Multifactorial primary prevention trials for reduction of cardiovascular diseases have engendered disappointing results because beneficial in-trial prevention has not been obtained consistently even when risk factor levels have been significantly improved. In addition, long term follow up studies, including post-trial periods, have revealed diminished or disappeared differences in risk factor levels between treated and control groups; total and coronary mortality differences have also been reduced or the death rates have even been increased during the post-trial period of treated group over those of control subjects in a study with a consistent coronary risk reduction during the intervention period. Reasons for this enhanced coronary mortality cannot be pointed out but drug treatment, especially beta-blocking agents in mild hypertension, should be studied more carefully. Despite this discouraging mortality finding multifactorial prevention with simultaneous reduction of several coronary risk factors sounds useful provided that pharmacological prevention could be selected to give more benefit than harm.