The Triggered Acute Risk Prevention Study

Lead Researchers: Prof Geoff Tofler and A/Prof Thomas Buckley

Increasing evidence shows that heart attacks in some instances can be triggered by external factors such as heavy physical exertion, acute emotional stress, heavy fatty meals, and respiratory infection.  For instance, the group published findings that respiratory infection acutely increases the relative risk of heart attack up to 16-fold.   However, it is uncertain how to use this information on stressors for disease prevention.

Professor Tofler’s team determined, in a randomised, controlled trial whether it is feasible for individuals with cardiac risk factors or known cardiovascular disease to take targeted medication using customised packaging for specific stressors.  The team also investigated whether the treatment had an impact on inflammatory markers, lipids, perceived control and quality of life.

Subjects initially recorded episodes of heavy physical exertion, anger and anxiety, heavy meals and respiratory infection over 2 weeks.  After baseline measures and questionnaires were obtained subjects were randomised to control (usual therapy) or a treatment strategy for 4 months, during which they were additionally instructed to take either aspirin 100mg and propranolol (10mg) (for episodes of significant physical and emotional stress) or aspirin alone (for respiratory infection and heavy meal). Triggers were recorded for a further 2 weeks at the study end for the controls, and throughout the 4 months for the treatment group.

56 subjects were enrolled in the study. Participants in the study reported that it was indeed feasible to identify potential triggers of heart attack and take the TARP medication.  Comments included that the study provided more insight into health, provided a way to stop anxiety symptoms, and may mean reduction of medication in the future.  Trends to greater perceived control were observed among the treatment subjects, with a greater sense of control over things that happen.

The findings from this randomised controlled study, provide encouragement to proceed to the next step of a multicentre trial to evaluate this approach for prevention of heart attack and stroke.  Professor Tofler has initiated discussion regarding planning a large multicentre trial, the results of which could potentially provide new insights into the prevention of heart disease.