Highlights of AHA meeting
About a third of all heart attacks and strokes could be prevented if more people took a statin drugand that includes many people with normal cholesterol levels. This was one of the more provocative conclusions reported at the annual meeting of the American Heart Association, held in Anaheim, Calif., last month.
"Statins are the new aspirin," claimed principal investigator Rory Collins, M.D., of Oxford University in England, who reported the results from a large Heart Protection Study sponsored by the Medical Research Council and the British Heart Foundation. In comparing statins to aspirin, he said, he was referring to the finding more than 20 years ago that aspirin could help prevent heart attacks.
The new study involved 20,536 people ranging in age from 40 to 80 years who were considered at high risk for cardiovascular disease, even though many had normal cholesterol levels. Many findings showed that cholesterol-lowering with statin treatment not only reduced the incidence of heart attacks and strokes by almost a third but also reduced the need for angioplasty, arterial surgery, and amputations in the group randomized to 40 mg/d simvastatin (Zocor, Merck) as compared with those randomized to placebo.
Half of each group was also randomly selected to receive 600 mg vitamin E, 250 mg vitamin C, and 20 mg beta carotene, which turned out to have no effect on cardiovascular events. Collins said that other statins would probably have a similar effect to Zocor, although the other drugs were not studied.
Valsartan (Diovan, Novartis), an angiotensin II receptor blocker, has been shown in a trial of more than 5,000 patients to prevent not only the time to first hospitalization for heart failure but also the time to subsequent hospitalizations, according to a report by Jay Cohn, M.D., of the University of Minnesota. Novartis has received an "approvable" letter from the Food & Drug Administration for valsartan for the treatment of heart failure in patients who are not on ACE inhibitors, in addition to its previous approval as first-line treatment for hypertension.
The new study reported at the AHA meeting showed that valsartan reduced the number of hospitalizations for heart failure by 22.3% as compared with placebo, according to lead investigator Cohn. Previous studies showed that valsartan reduced time to first hospitalization by 27% and that it reduced heart failure morbidity by 13.2%.
In addition, researchers reported a study that found that valsartan reduced brain natriuretic peptide (BNP), a neurohormone that has been shown to correlate with the severity of heart failure.
The Type II diabetes oral drug rosiglitazone (Avandia, GlaxoSmithKline) was shown to reduce two markers associated with heart disease, a common killer of individuals with diabetes. These are the inflammatory C-reactive protein (CRP) and matrix metalloproteinase (MMP-9), which makes arterial plaques more likely to rupture.
Steve Haffner, M.D., lead investigator and professor of internal medicine at the University of Texas, San Antonio, noted that both atherosclerosis and diabetes might share a common causeinsulin resistance, which is associated with inflammation.
The study in 350 patients showed that those patients on 4 mg/d or 8 mg/d of the drug experienced drops in C-reactive protein of 40.7% and 35.6%, respectively, while those on placebo had a nonsignificant drop of 13.9%. For matrix metalloproteinase, the placebo group showed a rise of 1.9% over the 26-week period of the study, while the rosiglitazone groups showed drops from 10.3% to 21.1%. Haffner said these findings indicate that the diabetes drug may be helpful in preventing cardiac complications in people with Type II diabetes.
In another study, an analysis by investigators at Hôpital Pitie-Salpetriere in Paris showed that the use of abciximab (ReoPro, Lilly) in diabetic patients after angioplasty and stenting resulted in no deaths for those on abciximab, compared with a 16.7% death rate in the six months following the procedure for those who did not receive the drug.
The patients treated with abciximab also fared better overall, in terms of the combined endpoints of death, heart attack recurrence, or any urgent need to open the coronary arteries again (20.7% versus 50%).
Jean Mccann. Major study says statins may be 'new aspirin' for the heart.