Results of study on heart drug disclosed

The risk of life-threatening heart problems and stroke can be significantly reduced by 20 percent with an anti-platelet medicine called clopidogrel.

This was revealed in a report on the international clinical trial called CURE (Cloridogrel in Unstable Angina to Prevent Recurrent Ischemic Events) which was published in the Aug. 16 issue of the New England Journal of Medicine.

The highly respected journal, owned and published by the Massachusetts Medical Society, presented the results of the research which showed that a daily intake of clopidogrel, combined with aspirin and other standard therapies, could prevent major heart attacks, strokes or other cardiovascular deaths.

Dr. Salim Yusuf, CURE’s lead clinical investigator, pointed out that the results of the study "mark a major advance in both the immediate and long-term management of patients with Acute Coronary Syndromes (ACS)."

Yusuf, a multi-awarded cardiovascular medicine researcher, is a professor of medicine and the director of the Division of Cardiology of the McMaster University in Hamilton, Ontario, Canada.

According to Yusuf, "There is synergy between clopidogrel and aspirin as these two anti-platelet therapies work on different pathways within the platelets."

The CURE study, considered the largest ever done on people with unstable angina and mild heart attack, was a randomized, double-blind trial conducted on 12,562 patients in 482 hospitals in 28 countries.

Clopidogrel, sold worldwide as Plavix, was found to provide added protection from ischemic events. The benefit of the drug was seen in patients within two hours of treatment and continuously increased over the entire study duration of 12 months.

The country’s cardiovascular experts have expressed clear satisfaction over the results of the study which is believed to be one of the most important breakthroughs in the field of cardiovascular medicine.

Dr. Ma. Teresa Abola, chairperson of the Council on Stroke and Peripheral Vascular Diseases of the Philippine Heart Association and a well-respected cardiologist affiliated with Manila’s leading hospitals, said that "the CURE trial is the largest randomized controlled trial of a drug that could improve the outcome of patients with ACS, or those with impending mild heart attack."

"Clopidogrel has been proven to improve survival by preventing another heart attack, stroke or cardiovascular death, over and above the standard treatment being given by doctors," Abola said.

Dr. Cesar Recto, a member of the board of directors of the Philippine Heart Association, said the results of the CURE clinical trial present a major advance in the treatment of ACS.

"Clopidogrel is an important addition to the drug treatment of ACS," he said.

Acute Coronary Syndrome, which includes unstable angina and Non-Q-Wave Myocardial Infarction, is a classic example of atherothrombosis (blood clot resulting from atherosclerotic plaque rupture), the leading cause of heart attack, ischemic stroke and peripheral arterial disease.

Unstable angina is characterized by frequent and severe chest pain lasting more than 20 minutes at rest or during exercise.

There are a number of factors that put a person at increased risk of developing ACS, including age, genetic factors and smoking.

All these factors can cause hardening of the arteries (atherosclerosis) where there is an accumulation of fat in the artery wall. These fatty deposits can lead to insufficient blood flow to the heart, which causes pain of angina. If left untreated, this can cause unstable angina, non-Q-wave-MI and possibly, lead to death.

According to the Department of Health, the two most common causes of death in the country since 1995 have been diseases of the heart and the vascular system, comprising 39.6 percent of deaths attributed to the 10 leading causes in the Philippines.

The CURE study was organized by an independent group of investigators and was coordinated by the Canadian Cardiovascular Collaboration at McMaster University, Hamilton, Canada.