WellMan Clinic Putting
Men's Health First
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The British Regional Heart Study¹ 7735 men, aged 40-59 at entry (1978-80), were selected from 24 British towns and their history of heart disease was followed through to 1996. This is the largest study of its kind ever undertaken in the UK. It unequivocally showed that, although the death rate from heart disease fell by 4% over the period, the incidence of heart disease itself remained the same. Treatment of acute heart disease, i.e. heart attacks, has improved therefore, but, despite the increased availability of anti-cholesterol drugs, the causes of coronary heart disease are being under-treated. This has much to do with the reluctance of GP's to prescribe expensive, budget-draining statins, but it also highlights the fact that middle-aged men ignore the simple safe-guards: we are all too often overweight, we still smoke and drink too much, we tend to eat grossly unhealthy food, and, above all, we fail to take the modest amount of necessary exercise - just half an hour of walking a day. We can take control of our life-styles but what can we do about prescription only medicines? Lipid lowering drugs are most certainly effective, but they are not cheap and one can sympathise with cash-strapped GP's. There is, of course, a solution - pay for private prescriptions - they will cost at most £500 a year. The Heart Protection Study² Statins Could Save 25,000 British Lives A Year So the British Regional Heart Study showed that high cholesterol levels are being under-treated. Two months later "the world's largest cholesterol-lowering trial revealed massive benefits for high-risk patients". The British Heart Foundation funded research showed that "around a third of all heart attacks and strokes can be avoided in people at risk of vascular disease by using statin drugs to lower blood cholesterol levels - irrespective of the person's age or sex, and even if their cholesterol levels do not seem high". 20,000 volunteers aged 40-80 years were studied for five years. High risk people are classified as those who have previously had a heart attack or a stroke or evidence of narrowed arteries, have diabetes or angina. "The study's size, and the wide range of high-risk patients included, means that doctors now have evidence that is uniquely clear and reliable." Earlier this year Dutch researchers showed that aggressive reduction of the "bad" LDL cholesterol with the statin drug atorvastatin (Lipitor) was accompanied by regression of the thickness of the intima, the lining of the carotid arteries³. In other words, adequate treatment of familial hypercholesterolaemia with Lipitor not only reduces cholesterol levels but also thins the fatty plaques which will have previously accumulated - unlike any other statin. Obviously it is important to be aware that the newer statin Lipitor is more effective than earlier ones such as simvastatin (Zocor) and pravastatin (Lipostat). 1 Heart 2001; 86: 499-505 |
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