Hamilton research suggests giving healthy seniors a pill to stop heart disease before it starts

News Apr 04, 2016 by Joanna Frketich The Hamilton Spectator

A trio of Hamilton studies found heart disease could potentially be stopped before it starts by giving healthy seniors a pill to lower cholesterol.

Statins reduced the risk of heart events by 24 per cent in people who don't have cardiovascular disease, high cholesterol, hypertension or diabetes, found the Heart Outcomes Prevention Evaluation (HOPE) — 3 trials.

Making the studies further stand out is that 80 per cent of the 12,705 participants are nonwhite and half are women.

The results have the "potential to substantially reduce the rates of premature cardiovascular events globally," concludes the research by the Population Health Research Institute at McMaster University and Hamilton Health Sciences.

The studies — funded in part by the drug company that makes the medication — found rosuvastatin significantly lowered the risk of heart attack, stroke and hospitalization for heart issues in men aged 55 and older and women aged 60 and older.

The participants from 21 countries were considered to be at intermediate risk because they had at least one cardiovascular risk factor such as smoking, family history of heart disease or a high waist-to-hip ratio.

"Eighty per cent of people over that age have a risk so it's very widely applicable," said Dr. Salim Yusuf, director of the institute and an author on all of the studies. "It makes prevention easier … The message is very clear."

Put together with other trials, the research provides "an extensive body of evidence of a significant clinical benefit," states the studies published in the New England Journal of Medicine and presented at the American College of Cardiology annual scientific session and expo running April 2-4 in Chicago.

The studies also provide evidence that has been lacking up until now that statin therapy is safe and effective for Hispanic as well as Chinese and other Asian populations.

"Although 80 per cent of the global burden of cardiovascular disease occurs in low-and-middle-income countries, the majority of the trials have been conducted in North America or Europe and involve mainly white persons," states the research.

The researchers encourage family doctors to use statins because the fixed dose in the study doesn't require routine blood tests or frequent clinic visits.

"Look at your risk factors," Hamilton researcher Jackie Bosch suggests to patients. "The lay person can walk into their doctor's office and say, 'Should I be on a statin?"

But not all doctors are convinced the studies show enough benefit for more widespread use of the drugs.

While the research found statins to be safe, it excluded patients with initial unacceptable adverse events, points out Dr. Brian Timmons, Canada research chair in child health and exercise medicine at McMaster.

"If you give the medication to 100 people who are fairly healthy to begin with, about one will benefit from it, 99 will not and about three of them could experience an unacceptable adverse event," he said. "Not sure if that makes the most sense for population health. An alternate, nonpharmaceutical approach is exercise, which also does a really good job at protecting people from cardiovascular events."

It's significant considering cardiovascular disease causes 18 million deaths a year globally with an equal number of non-fatal events.

"The HOPE-3 trial provides evidence to reinforce some current guideline recommendations and to influence future guidelines," concludes an accompanying editorial by Dr. William Cushman of the Veterans Affairs Medical Centre in Memphis and David Goff Jr. of the University of Colorado.

There was hope the studies would have the same results for medication to lower blood pressure, paving the way for what is known as a "polypill" which combines several medications. But candesartan and hydrochlorothiazide did not provide the same protection.

"The statins were highly effective," said Bosch who is an author on all three papers. "Statins reduced the risk of cardiovascular disease, the blood pressuring lowering however did not."

The researchers aren't giving up on the polypill. They are starting a new study of 5,000 patients to see if it works on those at higher risk.

"What it did is indicate the polypill isn't for everybody," said Bosch.

Patients were recruited between April 2007 and November 2010 and followed for an average of 5.6 years.

It was funded by the Canadian Institutes of Health Research and AtraZeneca. The drug maker provided the trial drug and had a single voting member on the 24-person steering committee. The studies state AstraZeneca "had no other role in the trial."

"An independent data and safety monitoring board reviewed the accumulating data."

jfrketich@thespec.com

905-526-3349 | @Jfrketich

Hamilton research suggests giving healthy seniors a pill to stop heart disease before it starts

News Apr 04, 2016 by Joanna Frketich The Hamilton Spectator

A trio of Hamilton studies found heart disease could potentially be stopped before it starts by giving healthy seniors a pill to lower cholesterol.

Statins reduced the risk of heart events by 24 per cent in people who don't have cardiovascular disease, high cholesterol, hypertension or diabetes, found the Heart Outcomes Prevention Evaluation (HOPE) — 3 trials.

Making the studies further stand out is that 80 per cent of the 12,705 participants are nonwhite and half are women.

The results have the "potential to substantially reduce the rates of premature cardiovascular events globally," concludes the research by the Population Health Research Institute at McMaster University and Hamilton Health Sciences.

The studies — funded in part by the drug company that makes the medication — found rosuvastatin significantly lowered the risk of heart attack, stroke and hospitalization for heart issues in men aged 55 and older and women aged 60 and older.

The participants from 21 countries were considered to be at intermediate risk because they had at least one cardiovascular risk factor such as smoking, family history of heart disease or a high waist-to-hip ratio.

"Eighty per cent of people over that age have a risk so it's very widely applicable," said Dr. Salim Yusuf, director of the institute and an author on all of the studies. "It makes prevention easier … The message is very clear."

Put together with other trials, the research provides "an extensive body of evidence of a significant clinical benefit," states the studies published in the New England Journal of Medicine and presented at the American College of Cardiology annual scientific session and expo running April 2-4 in Chicago.

The studies also provide evidence that has been lacking up until now that statin therapy is safe and effective for Hispanic as well as Chinese and other Asian populations.

"Although 80 per cent of the global burden of cardiovascular disease occurs in low-and-middle-income countries, the majority of the trials have been conducted in North America or Europe and involve mainly white persons," states the research.

The researchers encourage family doctors to use statins because the fixed dose in the study doesn't require routine blood tests or frequent clinic visits.

"Look at your risk factors," Hamilton researcher Jackie Bosch suggests to patients. "The lay person can walk into their doctor's office and say, 'Should I be on a statin?"

But not all doctors are convinced the studies show enough benefit for more widespread use of the drugs.

While the research found statins to be safe, it excluded patients with initial unacceptable adverse events, points out Dr. Brian Timmons, Canada research chair in child health and exercise medicine at McMaster.

"If you give the medication to 100 people who are fairly healthy to begin with, about one will benefit from it, 99 will not and about three of them could experience an unacceptable adverse event," he said. "Not sure if that makes the most sense for population health. An alternate, nonpharmaceutical approach is exercise, which also does a really good job at protecting people from cardiovascular events."

It's significant considering cardiovascular disease causes 18 million deaths a year globally with an equal number of non-fatal events.

"The HOPE-3 trial provides evidence to reinforce some current guideline recommendations and to influence future guidelines," concludes an accompanying editorial by Dr. William Cushman of the Veterans Affairs Medical Centre in Memphis and David Goff Jr. of the University of Colorado.

There was hope the studies would have the same results for medication to lower blood pressure, paving the way for what is known as a "polypill" which combines several medications. But candesartan and hydrochlorothiazide did not provide the same protection.

"The statins were highly effective," said Bosch who is an author on all three papers. "Statins reduced the risk of cardiovascular disease, the blood pressuring lowering however did not."

The researchers aren't giving up on the polypill. They are starting a new study of 5,000 patients to see if it works on those at higher risk.

"What it did is indicate the polypill isn't for everybody," said Bosch.

Patients were recruited between April 2007 and November 2010 and followed for an average of 5.6 years.

It was funded by the Canadian Institutes of Health Research and AtraZeneca. The drug maker provided the trial drug and had a single voting member on the 24-person steering committee. The studies state AstraZeneca "had no other role in the trial."

"An independent data and safety monitoring board reviewed the accumulating data."

jfrketich@thespec.com

905-526-3349 | @Jfrketich

Hamilton research suggests giving healthy seniors a pill to stop heart disease before it starts

News Apr 04, 2016 by Joanna Frketich The Hamilton Spectator

A trio of Hamilton studies found heart disease could potentially be stopped before it starts by giving healthy seniors a pill to lower cholesterol.

Statins reduced the risk of heart events by 24 per cent in people who don't have cardiovascular disease, high cholesterol, hypertension or diabetes, found the Heart Outcomes Prevention Evaluation (HOPE) — 3 trials.

Making the studies further stand out is that 80 per cent of the 12,705 participants are nonwhite and half are women.

The results have the "potential to substantially reduce the rates of premature cardiovascular events globally," concludes the research by the Population Health Research Institute at McMaster University and Hamilton Health Sciences.

The studies — funded in part by the drug company that makes the medication — found rosuvastatin significantly lowered the risk of heart attack, stroke and hospitalization for heart issues in men aged 55 and older and women aged 60 and older.

The participants from 21 countries were considered to be at intermediate risk because they had at least one cardiovascular risk factor such as smoking, family history of heart disease or a high waist-to-hip ratio.

"Eighty per cent of people over that age have a risk so it's very widely applicable," said Dr. Salim Yusuf, director of the institute and an author on all of the studies. "It makes prevention easier … The message is very clear."

Put together with other trials, the research provides "an extensive body of evidence of a significant clinical benefit," states the studies published in the New England Journal of Medicine and presented at the American College of Cardiology annual scientific session and expo running April 2-4 in Chicago.

The studies also provide evidence that has been lacking up until now that statin therapy is safe and effective for Hispanic as well as Chinese and other Asian populations.

"Although 80 per cent of the global burden of cardiovascular disease occurs in low-and-middle-income countries, the majority of the trials have been conducted in North America or Europe and involve mainly white persons," states the research.

The researchers encourage family doctors to use statins because the fixed dose in the study doesn't require routine blood tests or frequent clinic visits.

"Look at your risk factors," Hamilton researcher Jackie Bosch suggests to patients. "The lay person can walk into their doctor's office and say, 'Should I be on a statin?"

But not all doctors are convinced the studies show enough benefit for more widespread use of the drugs.

While the research found statins to be safe, it excluded patients with initial unacceptable adverse events, points out Dr. Brian Timmons, Canada research chair in child health and exercise medicine at McMaster.

"If you give the medication to 100 people who are fairly healthy to begin with, about one will benefit from it, 99 will not and about three of them could experience an unacceptable adverse event," he said. "Not sure if that makes the most sense for population health. An alternate, nonpharmaceutical approach is exercise, which also does a really good job at protecting people from cardiovascular events."

It's significant considering cardiovascular disease causes 18 million deaths a year globally with an equal number of non-fatal events.

"The HOPE-3 trial provides evidence to reinforce some current guideline recommendations and to influence future guidelines," concludes an accompanying editorial by Dr. William Cushman of the Veterans Affairs Medical Centre in Memphis and David Goff Jr. of the University of Colorado.

There was hope the studies would have the same results for medication to lower blood pressure, paving the way for what is known as a "polypill" which combines several medications. But candesartan and hydrochlorothiazide did not provide the same protection.

"The statins were highly effective," said Bosch who is an author on all three papers. "Statins reduced the risk of cardiovascular disease, the blood pressuring lowering however did not."

The researchers aren't giving up on the polypill. They are starting a new study of 5,000 patients to see if it works on those at higher risk.

"What it did is indicate the polypill isn't for everybody," said Bosch.

Patients were recruited between April 2007 and November 2010 and followed for an average of 5.6 years.

It was funded by the Canadian Institutes of Health Research and AtraZeneca. The drug maker provided the trial drug and had a single voting member on the 24-person steering committee. The studies state AstraZeneca "had no other role in the trial."

"An independent data and safety monitoring board reviewed the accumulating data."

jfrketich@thespec.com

905-526-3349 | @Jfrketich