Drumming up More Business
..."millions of Canadians with no outward signs of heart disease can soon expect to be prescribed a shelf-load of pills, including statins, diuretics and ACE inhibitors, to safeguard their hearts."...
Amazingly, lowering of homocysteine levels and long tern effects of heart drugs is not even an issue here. Suppose the low cost and effective vitamin therapies was just an oversight by these so called experts? Who needs nutrients - clearly we must all be drug deficient!
..."In the past we looked at a lot of patients as kind of being in the grey zone and decided, 'Well, maybe we'll try diet for another year,' " says Dr. Ruth McPherson, director of the lipid clinic at the University of Ottawa Heart Institute. "Now we're being a little more categorical that these people definitely will benefit from treatment."...What Benefit? See graph. There is only downside to these drugs ( ie loss of CQ10, muscle weakness etc but that's OK as it really strengthens the bank book right?) .
..."The upshot is that people who three years ago could be told they were reasonably healthy will now be informed they are ticking cardiac time bombs. Researchers have been fighting for years over the best ways to predict and ward off heart disease."...
They sure up the anti for the cash flow. Ah now that sure is a benefit!
Chris Gupta
Heart doctors redefine 'normal' Lower cholesterol, lower blood pressure now expected
Brad Evenson National Post
Thursday, October 30, 2003
To all Canadians who plan to get a medical exam soon: Brace yourselves for bad news.That beer belly is no longer a source of humour. Your borderline blood pressure has crossed the border. And those cholesterol levels that last week seemed normal, are now the dark precursors of a heart attack. Guidelines for what is "normal" cardiovascular health have fallen. The new normal is lower, lower, lower.
As a result, millions of Canadians with no outward signs of heart disease can soon expect to be prescribed a shelf-load of pills, including statins, diuretics and ACE inhibitors, to safeguard their hearts.
"In the past we looked at a lot of patients as kind of being in the grey zone and decided, 'Well, maybe we'll try diet for another year,' " says Dr. Ruth McPherson, director of the lipid clinic at the University of Ottawa Heart Institute. "Now we're being a little more categorical that these people definitely will benefit from treatment."
This week, the Canadian Medical Association Journal published a summary of new guidelines for blood fats. Among the most stringent in the world, they shift focus from so-called bad (LDL) cholesterol toward the lack of good (HDL) cholesterol levels. They also cast a suspicious eye on big waistlines and insulin levels.
The shift follows changes in May to blood pressure guidelines, which replaced the category "high normal" with the worrisome-sounding label "pre-hypertensive."
"Definitely more people are now candidates for [drug] treatment," says Dr. McPherson, part of the working group that drafted the new cholesterol guidelines.
"And some people are concerned about that. But the truth is that the safety of these medications is well established."
The upshot is that people who three years ago could be told they were reasonably healthy will now be informed they are ticking cardiac time bombs. Researchers have been fighting for years over the best ways to predict and ward off heart disease.
In recent years, such studies as the MIRACL trial and the Heart Protection Study have shown if you have a family history of heart disease, are overweight, diabetic or hypertensive, then treatment with lipid-lowering statins such as Lipitor or Zocor can save your life. "Even if you have a rock-bottom cholesterol level, if you have heart disease, going on statins definitely decreases your risk of having heart attacks and dying of heart disease," says Dr. McPherson. "That risk is decreased, in different studies, anywhere from 25% to 50%."
Now that they know it's possible to prevent cardiovascular disease, doctors are now inclined to be stickier about details. For example, research shows artery damage can start at blood pressure levels as low as 115/75 and doubles for each 20/10 millimetres of mercury. Previously, such levels were considered satisfactory. At least four million Canadians have hypertension, sometimes known as the silent killer. Up to 30% of victims do not realize they have it. Controlling blood pressure can reduce the incidence of stroke by 40%, reduce heart attacks by 25% and lower the rate of heart failure by 50%. So hypertension guidelines have fallen. Previously, systolic pressure of 130 to 139 and diastolic pressure of 85 to 89 were deemed "high normal." (Systolic is the pressure on blood vessels when the heart muscle is contracting, and diastolic is the pressure when the heart is pausing between beats.) Now this pressure is called pre-hypertensive, a name meant to evoke concern. Patients in this category may be told to lose weight, quit smoking and reduce salt consumption, or in some cases may be prescribed such drugs as diuretics -- "water pills" -- and ACE inhibitors. Many doctors find these new guidelines a headache. "The goal is to keep blood pressure below 140/90," said a Vancouver family physician who asked not to be named. "But it's incredibly difficult. You need to use huge doses of drugs to get there. Patients have to be really committed. And let's face it, [high] blood pressure has no symptoms. So a lot of patients don't take it seriously." The new cholesterol guidelines may be equally troublesome.
They recommend doctors use a ratio of total cholesterol to HDL cholesterol, an index shown to be a very good predictor of heart disease. The goal for most Canadians is to have a ratio of lower than 5.0. But even in people at low risk for heart disease, a ratio of 6 or higher would prompt a doctor to prescribe drugs.
That has raised serious concerns.
Last month, a controversy erupted when researchers from the University of British Columbia questioned the wisdom of giving statins to patients with high cholesterol but no evidence of hardened arteries. "The best estimate of the treatment benefit is a 1.4% reduction in heart attacks and strokes," Jim Wright, a UBC professor of pharmacology, wrote in a letter to the National Post.
Not only is this potential benefit small, Dr. Wright said he is not confident that long-term treatment with statin drugs is as safe as many researchers believe. An editorial this week in the British medical journal The Lancet raised similar concerns, saying not enough research had been done to support the safety and efficacy claims made by AstraZeneca for Crestor, its statin drug.
Many researchers dispute Dr. Wright's concerns, but concede the potential benefit of treating patients at low risk for heart disease is probably quite small.
Others say drug therapy is not the only answer. For example, earlier this year, University of Toronto researchers showed that eating an "ape" diet, similar to what humans consumed five million years ago, cuts down cholesterol as effectively as pharmaceutical drugs. The nutrition study, published in the Journal of the American Medical Association, said a diet rich in nuts, fibrous grains and vegetable proteins -- what our primate cousins eat every day -- can prevent heart disease.
Finally, the new normal guidelines put a clear definition on an increasingly common woe known as the metabolic syndrome. When three risk factors occur in one patient, the danger of heart disease skyrockets. The new guidelines say if a patient has a waist circumference of greater than 102 centimetres (88 cm for women), high triglycerides, fasting glucose of 6.2 to 7.0, low HDL cholesterol and blood pressure higher than 130/85, then the patient is at substantial risk of heart disease.
posted by Chris Gupta on Saturday November 1 2003
updated on Saturday September 24 2005URL of this article:
http://www.newmediaexplorer.org/chris/2003/11/01/drumming_up_more_business.htm
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