It was recognized that medical professionals and the health care system are in an ideal position to help patients with CVDs. They play a crucial role in linking pharmacological and non-pharmacological methods for secondary prevention. It is now clearly evident that lifestyle changes such as smoking cessation; healthy dietary practices, weight control and regular moderate physical activity can have a major impact on the development of and their recurrence.
Coronary arteries are blood vessels that carry oxygen and nutrients to the heart. Coronary artery bypass surgery is an operation to improve the flow of blood to the heart muscle when your coronary arteries are severely narrowed or blocked by plaque. Plaque is a buildup of fats, cholesterol, and other substances on the inside walls of the arteries.
In the heart, stabilizing the blood vessel linings would make plaques less likely to rupture, thereby reducing the chance of a heart attack. Statins also help relax blood vessels, lowering blood pressure. In addition, statins have blood-thinning effects, reducing the risk of blood clots. For these reasons, doctors are now beginning to prescribe statins before and after coronary artery bypass surgery or angioplasty, and following certain types of strokes.
There is now overwhelming evidence to show that daily use of low-dose aspirin helps to reduce the risk of stroke, myocardial infarction or vascular death by one quarter (absolute risk reduction). This effect remains for as long as aspirin is taken.
Not only do women receive inferior diagnostic care, but they are less likely to be treated aggressively once coronary disease is detected. Fewer woman than men get clot busting drugs, bypass surgery or balloon angioplasty - the three main techniques for restoring blood flow to ailing hearts. The fact that the average woman tends to be older and frailer by the time she develops heart disease is a major factor behind this disparity.
Since angioplasty has been proven to improve symptoms in patients with angina and to prolong life in patients treated early after a heart attack. A new study, however, found that angioplasty performed several days after a heart attack provides no benefit in patients with a total blockage and no or mild symptoms. "Patients should know whether a procedure is being performed to treat symptoms or whether there is evidence that they will live longer or have a lower likelihood of heart attack or heart failure. Moreover a new study has determined that a sibling's heart disease increases heart disease risk by nearly half (45%) for white middle-aged adults. This risk is even more pronounced than if a parent had heart disease at a younger age.
Interventions for secondary prevention of cardiovascular and cerebrovascular disorders include modification of risk behaviors (smoking cessation, promotion of healthy diet and of physical activity) and the use of medications which have been proven to be cost-effective. Examples are the latter are: aspirin, beta-blockers, angiotensin converting enzyme inhibitors, lipid lowering drugs and antihypertensives. Systematic reviews and large CVDs have also found that lowering cholesterol in people at high risk of ischemic coronary events substantially reduces the risk of mortality and morbidity.
Already shown to be effective in lowering cholesterol, statins may have other potential benefits researchers are finding. But doctors are far from knowing everything about statins. The cholesterol-lowering effects of statins are well documented. Research shows that these drugs block a substance in your liver needed to make cholesterol. Statins also help your body reabsorb cholesterol that has accumulated on your artery walls. Together, these effects significantly reduce the risk of heart attacks and strokes.
Giving patients a cholesterol-lowering drug called atorvastatin for a week before heart surgery lowers the risk of developing a heart rhythm problem called atrial fibrillation after the procedures and reduces the time the patients spend in the hospital. Doctors have noticed that patients undergoing coronary artery bypass surgery who were taking the cholesterol-lowering drugs called statins before the operation were less likely to develop atrial fibrillation after it.
Prematurely stopping or skipping statin cholesterol-lowering medications can significantly increase the risk of heart attack, according to a new Dutch study. It found that after two years, half of new statin users had stopped taking the drug. Researchers estimated that, as a result, 7,000 American statin users have had heart attacks that are avoidable. On the other hand, for those who took statin medications as directed, hospital admissions for heart attack fell by 30%.
A study hints that taking a statin or other cholesterol-lowering drug before heart bypass surgery may boost survival. However, investigators caution that the improvement may be more directly associated with factors other than cholesterol-lowering medication.
Dr. Brian D. Powell of the Mayo Clinic in Rochester, Minnesota, and colleagues analyzed the outcome of 4,739 patients undergoing bypass surgery for the first-time between 1995 and 2001.
There were 2,334 patients who were on lipid-lowering therapy during the 30-day period prior to surgery and 2,405 patients who were not.
Powell and colleagues found that cholesterol-lowering therapy was associated a 36 percent decrease in the risk of dying in the hospital after heart bypass surgery.
But the team says that "patient risk factors and other cardio-protective medication use associated with the use of preoperative lipid-lowering therapy appear to explain the association with improved survival."
For example, patients on statins and other cholesterol-lowering agents tended to be younger, with an average age of 66 years compared with 68 years for the other group. Thirty-one percent of patients on cholesterol-lowering therapy had diabetes compared with 28 percent of those who were not. Other heart drugs called beta-blockers were taken by 70 percent of those taking cholesterol-lowering therapy compared with 77 percent of those who were not.
Despite the relatively large sample size, "we were unable to show that lipid-lowering therapy is independently associated with lower postoperative mortality...however, patients on statins had a lower risk profile," Powell's team writes in the American Journal of Cardiology.
"After adjustment for other risk factors, statin use was not associated with a significant decrease in mortality," they report.
Powell tells Reuters Health that "it is still important" for patients having heart bypass surgery to take lipid-lowering therapy "because there are long-term survival benefits in patients with coronary artery disease."
Cholesterol levels are dropping in older Americans as a result of increased statin use. Between 1960 and 2002, average cholesterol in Americans age 60 to 74 fell from 232 to 204 in men (a 12 percent decline) and from 263 to 223 in women (down 15 percent). However, triglyceride levels as well as obesity rates have increased, especially among younger people. As a result, their cholesterol decline is less significant than in older Americans. Experts acknowledge the value of statins, but warn these drugs are no replacement for lifestyle changes to reduce heart disease risk.
Statins are the world's top-selling drugs and have been proved highly effective at cutting the risk of cardiovascular disease such as heart attacks and strokes. They have made fortunes for drug companies like Pfizer Inc, which sells the market leader Lipitor, although they are now increasingly available as cheap generics.
Statins- cholesterol-fighting drugs -- should be considered as standard therapy for all diabetics, apart from children and pregnant women; a group of British and Australian researchers found recently (January, 2008); published in the Lancet medical journal. This largest (nearly 19,000 patients) study reassured a clear benefit in taking statins for irrespective of whether they have type 1 or type 2 (diabetes) or whether they are male or female. The latest research should encourage doctors to use them more widely still and also needed to stress the important of lifestyle changes, such as quitting smoking, healthy diet and regular exercise; they concluded.
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