Early cholesterol therapy and heart bypass offer dramatic benefits to heart disease sufferers
December 14, 2001 | 12:00am
A landmark study on treatment strategies for patients with heart disease suggests that a combination of early therapy with the cholesterol-lowering dug statin and revascularization, or coronary heart bypass, significantly improves the chances of survival from the disease.
The study, presented during the XXII Annual Congress of the European Society of Cardiology in Amsterdam, Netherlands, was based on data from the Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA) which included more that 22,000 patients. The RIKS-HIA study suggests that the combination of statin therapy given before discharge from the hospital, and coronary heart bypass before 14 days, showed a dramatic 64% reduction in mortality at one year.
This significant reduction was the combined effect of a 34% reduction in death at one year seen with statin therapy, and 36% reduction from an early invasive strategy with coronary artery bypass grafting within 14 days. Because of the results of the Scandinavian Simvastatin Study (4S), the majority of the patients on the registry were taking simvastatin.
"This is a strong support, and a strong message to the cardiologist," said Dr. Lars Wallentin of the University Hospital, Uppsala, Sweden, who presented the study. According to Wallentin, conventional treatment today with aspirin, beta-blockers and ACE-inhibitors are effective but stressed that "early start of statin treatment, and consideration of early revascularization will have a major impact on survival."
Dr. Wallentin's observation comes at a time when other trials of early cholesterol lowering therapy are currently ongoing. More notable among these are the MIRACL and the A to Z trials. The MIRACL trial, however, excludes patients requiring a revascularization procedure. The results were presented at the American Heart Association meeting in November while the A to Z trial is still ongoing and will not be completed for another one or two years.
He pointed out, however, that these studies do not conflict with his study, citing that what is critical about the RIKS-HIA study is the statin treatment before discharge from the hospital. He emphasizes that, "If a physician starts a treatment before leaving the hospital, there will be a higher proportion of patients treated."
The various treatment strategies for patients with heart disease have been argued by the medical community for some time. The RIKS-HIA study revealed the broadness of the range of use of these strategies. Data from the study showed that prescription of statin before discharge from the hospital ranged from 7% to 60% while a heart bypass within 14 days ranged from 1% to 37%. "This variation in strategies is seen across databases, including those in the United States," according to Wallentin.
Dr. Klas Malmberg of the Karolinska Institute in Stockholm, who chaired the meeting, supported the RIKS-HIA findings noting that if patients make it back to their primary physician without a prescription for statin , the doctor may mistakenly believe that their patient does not need one. "You can say that in many countries, the guidelines have been rather conservative," said Malmberg. "They had advocated that you should wait and see what happened with diet and lifestyle changes, and probably we have lost a lot of lives because of that."
Simvastatin, belonging to the class of drugs known as "statins," is locally available in the Philippines as Zocor. It is one of the most widely used cholesterol lowering drug and has a proven long-term safety profile with more than 10 years if experience in clinical practice. For best treatment option in cholesterol therapy, consult a medical specialist.
The study, presented during the XXII Annual Congress of the European Society of Cardiology in Amsterdam, Netherlands, was based on data from the Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA) which included more that 22,000 patients. The RIKS-HIA study suggests that the combination of statin therapy given before discharge from the hospital, and coronary heart bypass before 14 days, showed a dramatic 64% reduction in mortality at one year.
This significant reduction was the combined effect of a 34% reduction in death at one year seen with statin therapy, and 36% reduction from an early invasive strategy with coronary artery bypass grafting within 14 days. Because of the results of the Scandinavian Simvastatin Study (4S), the majority of the patients on the registry were taking simvastatin.
"This is a strong support, and a strong message to the cardiologist," said Dr. Lars Wallentin of the University Hospital, Uppsala, Sweden, who presented the study. According to Wallentin, conventional treatment today with aspirin, beta-blockers and ACE-inhibitors are effective but stressed that "early start of statin treatment, and consideration of early revascularization will have a major impact on survival."
Dr. Wallentin's observation comes at a time when other trials of early cholesterol lowering therapy are currently ongoing. More notable among these are the MIRACL and the A to Z trials. The MIRACL trial, however, excludes patients requiring a revascularization procedure. The results were presented at the American Heart Association meeting in November while the A to Z trial is still ongoing and will not be completed for another one or two years.
He pointed out, however, that these studies do not conflict with his study, citing that what is critical about the RIKS-HIA study is the statin treatment before discharge from the hospital. He emphasizes that, "If a physician starts a treatment before leaving the hospital, there will be a higher proportion of patients treated."
The various treatment strategies for patients with heart disease have been argued by the medical community for some time. The RIKS-HIA study revealed the broadness of the range of use of these strategies. Data from the study showed that prescription of statin before discharge from the hospital ranged from 7% to 60% while a heart bypass within 14 days ranged from 1% to 37%. "This variation in strategies is seen across databases, including those in the United States," according to Wallentin.
Dr. Klas Malmberg of the Karolinska Institute in Stockholm, who chaired the meeting, supported the RIKS-HIA findings noting that if patients make it back to their primary physician without a prescription for statin , the doctor may mistakenly believe that their patient does not need one. "You can say that in many countries, the guidelines have been rather conservative," said Malmberg. "They had advocated that you should wait and see what happened with diet and lifestyle changes, and probably we have lost a lot of lives because of that."
Simvastatin, belonging to the class of drugs known as "statins," is locally available in the Philippines as Zocor. It is one of the most widely used cholesterol lowering drug and has a proven long-term safety profile with more than 10 years if experience in clinical practice. For best treatment option in cholesterol therapy, consult a medical specialist.
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