Reports from the Field
News from the American College of Cardiology
The following studies were presented at the recent 50th Annual Scientific Sessions of the American College of Cardiology in Orlando.
Drug lowers death rate for women
A follow-up analysis of the landmark Long-term Intervention With Pravastatin in Ischemic Disease (LIPID) study provides new evidence regarding the benefits of cholesterol-lowering treatment with pravastatin for women with a prior history of coronary heart disease (CHD).
Researchers found that women with a prior history of CHD and average cholesterol levels who were placed on pravastatin had a 31% reduction in CHD deaths compared to women in the study who initially received a placebo. In absolute terms, CHD deaths were reduced from 9.9% in women on placebo to 6.7% for those given pravastatin.
The LIPID study originally was designed as a six-year, double-blind, controlled study, consisting of 9,014 men and women with a history of either heart attack or unstable angina. Half of these patients were placed on pravastatin and half received placebo. At the conclusion of the study, researchers conducted an additional two-year follow-up analysis of patients in the original study.
In the follow-up study, 85% of patients in each of the original groups were placed on pravastatin therapy. Researchers found that in addition to reductions in coronary heart disease deaths, women who had been assigned initial pravastatin also had a 29% reduction in deaths from cardiovascular disease.
COX-2 inhibitors battle head-to-head
A head-to-head safety comparison of elderly hypertensive osteoarthritis patients taking either of the COX-2 specific inhibitors, Vioxx or Celebrex, found that patients taking Vioxx experienced a statistically significant increase in mean systolic blood pressure compared with those taking Celebrex, who experienced no increase in mean systolic blood pressure.
"This study helps us gain a better assessment of some of the potential differences between Celebrex and Vioxx at the most commonly used doses in clinical practice," observes William B. White, MD, professor of medicine and chief, section of hypertension and clinical pharmacology, at the University of Connecticut School of Medicine in Farmington. "The data also show a higher proportion of patients, 17% compared to 11%, lost their hypertension control on Vioxx [vs.] Celebrex."
The six-week, multi-center, randomized, double-blind, parallel trial included more than 800 hypertensive osteoarthritis patients — all of whom were being treated with anti-hypertensive medication. Patient assessments were conducted at baseline and then at weeks one, two, and six to examine key measures of cardiorenal safety such as edema and systolic blood pressure.
In addition to loss of hypertension control, 9.5% of Vioxx-treated patients experienced clinically significant increases in edema compared to 4.9% of Celebrex-treated patients.
Low-weight heparin continues to outshine older drug
An analysis of more than 6,000 patients treated for acute coronary syndromes indicates that those who received the low-weight heparin blood thinner Lovenox (enoxaparin sodium) Injection prior to undergoing percutaneous coronary intervention (PCI) fared better than patients given unfractionated heparin.
Researchers analyzed 6,068 patients from the ESSENCE (Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events) and TIMI 11B (Thrombolysis In Myocardial Infarction) trials for death and heart attack at 43 days. Findings include:
• 7.1% of patients treated with unfractionated heparin experienced death or heart attack following the procedure, compared to 4.3% of enoxaparin-treated patients.
• There was a 17% risk reduction in all death and heart attack for enoxaparin-treated patients who did not undergo PCI.
Beta blocker reduces risk of second heart attack
Long-term treatment with the beta-blocking agent carvedilol following a heart attack reduces the risk of patients having a second heart attack by 41% and their risk of dying by 23%, according to Scottish researchers.
The study enrolled more than 1,900 patients and was conducted in more than 160 sites in 17 countries. Patients were randomized to receive either long-term treatment with carvedilol or placebo following a proven acute myocardial infarction (MI) and a left ventricular ejection fraction of less than or equal to 40%. All patients in the trial were receiving ACE inhibitors. Patients were followed for a mean of 15 months.
Treatment with carvedilol was shown to reduce the risk of death for any reason from 15% to 12%. This represents a 23% relative reduction in mortality and was associated with a 41% reduction in risk of recurrent nonfatal heart attack, and a 29% reduction in the risk of all-cause mortality or nonfatal heart attack.
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