Heart drug effective in saving lives – study

More and more people are suffering from heart attacks — and they are getting younger. Recent news of a famous young musician having a heart attack should properly warn people that heart disease does not only affect the elderly anymore.

Heart disease is the leading cause of death in the country. Department of Health data show that in 2003 alone, nearly 70,000 Filipino men and women died of heart disease.

Heart disease is a manifestation of a complex of diseases now wreaking havoc all over the world — atherothrombosis, which also covers such potentially deadly diseases as stroke and peripheral artery disease.

Atherothrombosis involves the formation of clots inside blood vessels. If the clots appear or get lodged in any of the arteries leading to the heart, it could result in a heart attack.

One particularly dangerous kind of heart attack is called by cardiologists as STEMI (ST-elevation myocardial infarction), which may lead to serious damage to heart muscles. This particular type of heart attack results from the complete blockage of an artery leading to the heart.

STEMI is so serious that it could result in heart failure, or even death. In other words, the longer the heart is deprived of blood and oxygen, the higher is the chance of a patient succumbing to heart failure or death. STEMI, like any form of heart attack, is considered an emergency and must be brought to the attention of a cardiologist immediately.

Depending on the seriousness of the condition and how soon the patient is brought to a doctor, STEMI is managed through either of the following ways: by the insertion of a "balloon" or a wire mesh into the blocked artery to allow blood to move freely, or by giving blood-thinning agents to dissolve the blockage.

Traditionally, aspirin is the blood-thinning agent of choice in such an emergency. But with the unveiling of the results of large-scale scientific studies, combining aspirin with the landmark blood-thinning agent clopidogrel has been shown to give patients a better chance at survival and lower risk of complications.

This is why the Bureau of Food and Drugs recently approved the use of clopidogrel for the management of patients who experience STEMI.

In a recent symposium organized by Sanofi-Aventis, two respected cardiologists spoke about the latest scientific evidence backing up the effectiveness and safety of clopidogrel in managing STEMI.

Dr. Dante Morales, a noted cardiologist who also serves as medical director of the Manila Doctors Hospital, said that in a study of STEMI patients 75 years or younger, giving clopidogrel with aspirin could prevent as much as 20 percent of all possible complications (including another heart attack, oxygen deprivation, and death) over a period of 30 days, compared with giving aspirin only.

Furthermore, giving the combination of clopidogrel and aspirin did not increase the risk for major bleeding, including bleeding from the brain.

In another study, heart attack patients who were given clopidogrel early had significant reduction of the risk for death and other complications both before and after stenting without a significant increase in major or minor bleeding.

Dr. Donato Marañon, another noted cardiologist from the Medical City and Philippine General Hospital, interpreted the study this way: giving patients clopidogrel and aspirin before angioplasty or stenting could prevent two people from suffering a heart attack, compared with giving aspirin alone.

Giving them the two drugs after the procedure could prevent two more heart attacks and one death, compared with giving aspirin alone.

Balloon angioplasty involves the insertion of a small "balloon" into a blocked artery with the help of a catheter. When the target blockage is reached, the balloon is inflated to open up the blood vessel and allow blood to flow freely.

Stenting, meanwhile, involves the insertion of a tiny metal cylinder into the blocked blood vessel. Once put in place, it is made to expand, thus propping open the blocked blood vessel.

Clopidogrel is an important drug used in the management of atherothrombosis. It is marketed in the Philippines by Sanofi-Aventis, one of the leading research-based pharmaceutical companies in the world.