Healthy Behavior, Risk Factor Control, and Survival in the COURAGE Trial
Why the study?
Individual risk factor control improves survival in stable ischemic heart disease, but it was uncertain if multiple risk factor control further extends survival.
Study Design
Type
Cohort (n=2,102)
PICO
P
Population
2,102 patients with stable ischemic heart disease, followed for a mean of 6.8 years to assess the impact of comprehensive risk factor control on survival.
E
Exposure / Comparator
6 risk factors at goal vs 0 to 1 risk factor at goal
O
Primary Outcome
Mortality — HR 0.27 (0.09-0.79), p=<0.001
Main Result
Hazard Ratio: 0.27 (95% CI 0.09–0.79)
p-value: p=<0.001
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This should emphasize what most of us already believe, which is that controlling the factors that contribute to atherosclerosis reduces death. And yet, it is somewhat alarming how poorly we control risk factors. The most surprising part of this analysis was that most of the effect was in the lifestyle risk factors, and we're not very good as a profession at motivating and guiding patients to make lifestyle changes. So I think that this hopefully will be a call to action to pay attention to the nonglamorous and frankly nonprescription interventions that we should be making for patients with coronary artery disease.”
LMLaxmi MehtaCardiologist, Ohio State University Wexner Medical Center
“patients with stable CAD who feel some symptom relief after PCI need to understand that stent is not a cure, nor is it the end of their journey.”
Abstract
BACKGROUND Individual risk factor control improves survival in patients with stable ischemic heart disease (SIHD). It is uncertain if multiple risk factor control further extends survival. OBJECTIVES This study determined whether a greater number of risk factors at goal predicted improved survival in SIHD patients. METHODS Of 2,287 participants in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, 2,102 (92%) had complete ascertainment of 6 pre-specified risk factors: systolic blood pressure, low-density lipoprotein cholesterol, smoking, physical activity, diet, and body mass index. Participants received interventions to control these risk factors. The outcome measure was mortality. RESULTS During a mean follow-up of 6.8 years, 473 (22.5%) subjects died. In univariate analysis, the greater the number of risk factors controlled, the higher the probability of survival (unadjusted log rank: p < 0.001). In multivariate analysis, the strongest predictors at 1 year of improved survival were being a nonsmoker, regular physical activity, having a systolic blood pressure <130 mm Hg, and following the American Heart Association Step 2 diet. Baseline risk factor values and evidence-based medications did not independently predict survival once risk factor control at 1 year was included in the model. Having 4 to 6 risk factors compared with 0 to 1 risk factor at goal predicted lower mortality (hazard ratios for 4 and 6 controlled risk factors: 0.64; 95% confidence interval: 0.41 to 0.98, and 0.27; 95% confidence interval: 0.09 to 0.79, respectively). CONCLUSIONS The greater the number of risk factors in control, the higher the probability of survival in patients with SIHD. More effective strategies are needed to achieve comprehensive risk factor control, including healthy behaviors. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]; NCT00007657).
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Maron et al. (2018) conducted a cohort in Stable ischemic heart disease (n=2,102). 6 risk factors at goal vs. 0 to 1 risk factor at goal was evaluated on Mortality (HR 0.27, 95% CI 0.09-0.79, p=<0.001).