Heart trial points to less invasive procedures
One of the most awaited clinical trials of the decade will potentially see a shift in the number of patients undergoing angioplasty or surgery for heart disease in favour of tablet medication.
At present, more than 130,000 people undergo invasive heart procedures to open up or bypass blocked arteries in the UK every year but the -ISCHEMIA trial found that tablets proved equally effective in preventing major heart events, including death and heart attacks, in patients who had stable ischemic heart disease.
The seven year trial involved more than 5,000 patients worldwide with Northwick Park’s Cardiac Research Charity co-ordinating the UK’s involvement as well as recruiting the second largest number of patients.
Professor Senior, Consultant Cardiologist at the Royal Brompton Hospital, London and Northwick Park Hospital, Harrow who led the trial in UK said: “It’s a game changer on several levels. Coronary Heart disease is one of the biggest killers in the UK. Any invasive procedure carries an inherent risk with many patients understandably anxious about undergoing an invasive procedure.
“In this group of patients with stable symptoms, we now know that it is safe initially to treat them with tablets reserving invasive procedures for those with continued chest pain - a huge reassurance to patients and a potential for substantial cost saving for the health service.”
At present, patients have two interventional options to restore bloodflow throughout the heart. One is an open bypass such as where a vein is harvested from the leg or an artery from the chest and used to bypass a blocked or a very narrow artery in the heart. The second is the insertion of a small wire mesh called a stent which forces the artery back open.
Professor Senior who is also the Director of Cardiac Research Charity at Northwick Park Hospital added: “The main cause of coronary heart disease is the build-up of plaque in the artery walls which may severely limit blood flow to heart muscle giving rise to chest pain or may even suddenly block the artery by breakdown of the plaque which leads to heart attack and death.
“The tablets like statins and newer counterparts diminish the build-up of plaque, reduce progression of the already formed plaque and reduce the tendency to rupture. Their development and refinement over the past 10 years has been quite extraordinary.
“We aren’t taking about the fabled pill to cure all ills but it is never-the- less an impressive conclusion to a very comprehensive study. Some of the tablets such as aspirin and betablockers have been used for many years, but we now have more treatment options for risk factors such as a high cholesterol.
"We also recognise the importance of making sure blood pressure is closely monitored and controlled and total avoidance of smoking along with exercise and high quality diet."
The Cardiac Research Charity’s work includes finding new treatments for heart disease and it takes part in large international trials, with many local patients volunteering to participate in research projects.
More than 200 Londoners from Northwick Park Hospital took part in the latest trial which was the second largest group of volunteers in the world after India.