Cardiologists gathered in their last major international cardiology meeting of the year in Anaheim, Calif., at the recently concluded American Heart Association Scientific Sessions (Nov. 11-14, 2001). While overall attendance was down, enthusiasm was clearly up for new drugs, devices, therapies and research in the effort to treat the world’s leading cause of death.
The big highlight of the meeting was the report from the largest randomized trial of cholesterol lowering drugs (statins) for high-risk patients. The Heart Protection Study (HPS), sponsored by the British Heart Foundation, evaluated 20,000+ patients for more than five years, with a particular focus on patients not considered obvious candidates for cholesterol lowering drugs.
“In this trial, ten-thousand people were on a statin. If now, an extra 10 million high-risk people worldwide go onto statin treatment, this would save about 50,000 lives a year — that’s a thousand a week,” says Professor Rory Collins, lead researcher of the study.
A significant finding was a reduction in risk for patients with so-called normal cholesterol levels, indicating that there are real cardiovascular benefits to be gained from cholesterol reduction. This applies specifically to high-risk patients with normal levels.
Professor Collins put it bluntly into perspective: “These results are at least as important as previous findings for aspirin’s effects on heart attack and stroke. In fact, statins are the new aspirin.” If you want more details, visit www.hpsinfo.org.
So, we have an important trial that appears definitive — doctors can quickly evaluate their patients for consideration of this new and more aggressive therapy towards cholesterol reduction. But will patients gain the benefits from these drugs? This was the subject of the REACH trial (Reinforcing Education About Cholesterol and Hypertension for Patients with Coronary Artery Disease). The study was based on the simple fact that 80 percent of heart disease patients have not reached their recommended goals for cholesterol or blood pressure. Previous research has demonstrated that over one-third of patients that are prescribed statins stop taking the drug within six months. So can education alone help change this situation?
Harlan Krumholz, M.D., of Yale University reported the disappointing results that aggressive educational intervention failed to increase the proportion of patients who reached their target LDL cholesterol levels. While patients demonstrated more knowledge of their target level, their knowledge did not translate into ongoing effort to achieve this level via drugs, diet or life-style modification therapies. If only they put Madison Ave. marketing types onto this problem, we might find some solutions to changing consumer behavior — how about free prizes under the lids of the drug bottles? “Sorry, try again.” Seriously, if you’ve been given a target cholesterol or blood pressure level, make it your business to get there — we know it’s your choice, so why not make the choice to do it.
On the interventional side
In a quick recap of notable news from the interventional cardiology side of this meeting, drug-eluding stents for treatment of coronary artery disease are clearly the hottest topic in the field. Following closely on its heels, but not widely discussed, are the flat-panel digital x-ray systems that help move cath labs into the 21st century. These panels represent the first fundamental change in the x-ray imaging chain during the last 30 years, and the systems should only get better over time. IVUS systems continue to improve and win converts on a weekly basis, but many cardiologists remain unconvinced of the need for routine use. Pressure and flow measurement tools also are pushing forward into the market, providing physiological information on the effect of diffuse or local blockages, but also face the same challenge as intravascular ultrasound — broad clinical adoption.
Overall, this was an excellent meeting on many fronts, with a renewed emphasis clearly emerging to find cardiovascular disease treatments that work. The success of this meeting does not come from the numbers of attendees, but from the dedication of everyone (companies, researchers and clinicians) in finding new diagnostic and treatment tools that work in today’s society.
Doug Orr, president of J&M Group (Ridgefield, Conn.), consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to [email protected].
