New studies are changing the way that physicians and researchers look at heart disease — the No 1 killer in the Western world. And fewer people are dying of it than ever before.
The reason is clinical studies.
Advances in heart disease treatment and research are the topic of today's Deseret Morning News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Dr. Joseph "Brent" Muhlestein, director of cardiac research at LDS Hospital, and Heidi Thomas, cardiac research coordinator, will take called-in questions on the topic. All calls are confidential.
"Studies are exciting because they're the only way we know to find out things," said Muhlestein. "We learn more about heart disease. And once we come up with an idea that might help somebody, we don't know if it works until we do a study to find out. People get better on their own lots of times so we can never really tell for sure unless we do a study."
Doctors know more about treating heart disease than they do about many disease processes. The reason is simple: There are a lot of heart-related studies going on.
"When someone comes into the hospital, I'm not guessing what to do with them. That's only because patients before them enrolled in a trial. While they understand there's some risk, a patient is monitored much more carefully when in a trial than when he just comes to the clinic. Some studies have shown that people who enroll in a trial do better than people with the same disease who get normal care," even if they're given the placebo instead of the treatment being tested, he said. The difference is likely that extra care.
Patients in trials are also never kept from getting known effective therapy. Instead, a clinical trial is usually an "add-on" to standard treatment, Muhlestein said.
One study questions whether controlling lipid factors like cholesterol and triglyceride levels could prevent the nearly inevitable development of heart disease in people with diabetes. Thomas said that people with diabetes are up to four times as likely to develop heart disease as others. The main predictor is abnormal lipid values.
LDS Hospital is also sponsoring a trial testing the antiplatelet drug clopidogrel in combination with aspirin to block platelet activity.
Clopidogrel has proven effective in preventing clotting in stents, Muhlestein said. Another study has shown it reduces the risk of having a future heart attack after unstable angina.
Aspirin clearly benefits people with heart disease, and researchers want to know if a combination of the two will be even better.
"It turns out when platelets are activated, it triggers an inflammatory response, and that reactivates the platelets for more inflammation," he said. Even low-dose aspirin lowers the markers for inflammation, especially C-reactive protein levels.
"If you have stable coronary heart disease and added clopidogrel, would it lower your C-reactive protein level?"
Participants must have heart disease that's stable and no heart attack or angina in the past three months. They also may not be in severe heart failure.
The National Institutes of Health is sponsoring a multi-center study that looks at whether exercise can improve outcomes for those with heart failure.
"We think patients do better if they exercise and get in shape," Muhlestein said. "A body more in shape is able to more efficiently use cardiac output. We know a person who exercises can increase tolerance and feel better. We think we can probably improve longevity if they get on an exercise program, but right now, none of the funding agencies like Medicare pays for supervised cardiac rehab after heart failure."
Participants are randomly assigned to receive the standard treatment or that plus rehabilitation, training and supervision. Those who are randomized for training will receive a treadmill to use at home, information about appropriate exercise and how much, then followed for some time.
Another study is a phase 3 trial of a medication that may help coronary artery disease.
The medication is similar to a potent antioxidant that was taken off the market because of side effects. The pharmaceutical industry has been trying to come up with a drug that has the same positive effects, without the negatives. It's been through smaller safety tests successfully, appears to lower cholesterol and has potent antioxidant and antiinflammatory properties, Muhlestein said.
This study needs patients who are not extremely stable — anyone admitted to the hospital with a heart attack or angina in the past year. It's a three-year study.
E-mail: lois@desnews.com