QUALITY USE OF CARDIOVASCULAR MEDICATION

1
QUALITY USE OF CARDIOVASCULAR MEDICATION

• Dr Mark Abelson

2
Prescription Drugs and Drug Trials

• Drug development
• - basic science research in a laboratory
• - chemical patented (20 years)
• - laboratory testing
• - Phase 1 trials tested for safety and
  efficacy in animals
• - Phase 2 trials tested for safety in normal
  humans
• - Phase 3 trials show effective (better than
  placebo or current standard treatment) and safe
  in many thousands of patients around the world
  (double blind

3

• Drug launched (5 years patent remaining)
• - post marketing surveillance
• 100 million
• Register with FDA / MCC (years)

4
Alternative Drugs

• Vitamins
• Minerals
• Cholesterol vaporises
• Tissue salts
• NO RESEARCH
• NO EVIDENCE OF EFFICACY
• NO PRODUCTION CONTROL
• NO REGISTRATION PROCESS
• Trials done consistently show NO benefit eg.
  Folate, anti-oxidant vitamins

5
Conspiracy Theory

• Doctors and Universities bribed / kick backs
  from pharmaceutical companies?
• Lack of patient trust?
• Only want natural treatment ( death?)

6
Commonly Used Drugs

• Statins -reduce cholesterol
• - Zocor, Simvastatin, Lipitor, Aspavor, Crestor,
  Prava, Lescol
• primary prevention (at risk but currently
  asymptomatic)
• benefit in high risk persons
• or
• - secondary prevention (known with coronary
  artery disease)
• 30 reduction in future heart attack and stroke
• Aspirin - reduces blood stickiness
• primary (little benefit) or secondary
  prevention (25 )
• ACE-I / ARB lower BP, improve heart failure
• - Prexum, Coversyl, Lisinopril, Zetomax,
  Pharmapres, Enalapril, Cozaar, Zartan, Diovan

7
Commonly Used Drugs

• Beta Blockers reduce heart rate (angina) and
  BP, heart failure
• - Concor, Bilocor, Bisocor, Carloc, Dilatrend
• Calcium Channel blockers reduce heart rate and
  BP
• - Verahexal, Calcicard, Ravamil, Amloc, Norvasc,
  Zildem

8
New Comers

• Coralin reduces heart rate without decreasing
  BP and no BB side effects (lethargy, impotence)
• - angina and heart failure
• Dabigatran thins blood like Warfarin but no INR
  (blood) testing needed
• - atrial fibrillation

9
Guideline recommendations for BP goals

• lt140/90mmHg for essential hypertension
• lt130/80mmHg for hypertensive patients with
  diabetes
• Most patients with hypertension will require two
  or more antihypertensive agents to achieve BP goal

ESH/ESC European Society of Hypertension/Europea
n Society of Cardiology JNC 7 Joint National
Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure, seventh
report
Guidelines Committee. J Hypertens 2003 21
1011-53. Chobanian AV, et al. JAMA 2003 289
2560-72.
10
Combination therapy needed to achieve target SBP
goals
INVEST data on file. ALLHAT Collaborative
Research Group. JAMA 2002 288 2981-97. Brenner
BM, et al. N Engl J Med 2001 345 861-9. Lewis
EJ, et al. N Engl J Med 2001 345
851-60. Adapted from Bakris GL, et al. Am J
Kidney Dis 2000 36 646-61.
11
Hypertension a risk factor forcardiovascular
morbidity and mortality
Risk ratio 2.0 2.2 3.8 2.5 2.0 3.7 4.0 3.0 Excess
risk 22.7 11.6 9.1 3.8 4.9 5.3 10.4 4.2
Kannel WB. JAMA 1996 275 1571-6.
12
MRFIT association of systolic BP and diabetes
with cardiovascular risk
Stamler J, et al. Diabetes Care 1993 16 434-44.
13
Early morning BP surge coincides with peak
incidences of stroke and myocardial infarction
Time of day
McInnes G. J Am Soc Hypertens 20082S1622.
14
(No Transcript)