Too Few Heart Patients Getting Good Results From Medicines Alone
A rigorous, new international study finds that, despite doctors' best efforts, many heart patients given standard drugs aren't meeting goals to lower their cholesterol and blood pressure levels.
The study involved nearly 4,000 patients, averaging 64 years of age, treated at centers around the world.
The researchers found that, one year into treatment, nearly half (48%) of patients had failed to wrestle their blood levels of LDL "bad" cholesterol down to the target set by doctors.
And one-quarter of the patients failed to get their systolic blood pressure (the top number in a reading) down to the target level of below 140 mmHg, according to a team led by Dr. Jonathan Newman, of the New York University School of Medicine, in New York City.
A big gender divide emerged, too: Female patients were one-third less likely to achieve those one-year treatment goals than their male peers, the findings showed.
The study was funded by the U.S. National Institutes of Health and published online Nov. 13 in Circulation: Cardiovascular Quality and Outcomes.
One heart specialist called the long-awaited findings a wake-up call for physicians.
"This is an eye-opening study which reinforces the need for improvement in our approach for higher-risk patients with coronary artery disease," said Dr. Guy Mintz. He directs cardiovascular health at Northwell Health's Sandra Atlas Bass Heart Hospital, in Manhasset, N.Y.
The patients in the new study were representative of the general population of heart disease patients -- 41% were diabetic, 73% had high blood pressure, and most were on antihypertensive meds or statins. About one in every five of the patients had already experienced a heart attack or stroke, and about one-quarter had undergone procedures such as angioplasty or bypass.
Still, despite being placed on an average of four medications, success in reaching goals was relatively low, noted Mintz, who wasn't involved in the study.
"We have the knowledge and the tools to do better, but we are not," he said. "We need to be more vigilant and take the lessons learned from this study to our practices every day; be cognizant of the groups less likely to succeed in goal achievement, devote more resources through education to these groups."
Those lessons are especially crucial when it comes to treating women with heart disease, Mintz added.
"We need to acknowledge that women are not getting the same level of cardiovascular risk reduction as men. There is no excuse for this," he said.
Part of the solution may lie in better patient-doctor communication, Mintz believes.
"There should always be a clinician-patient engagement to review cardiovascular risk, explain therapies, goals, side effects of medications and cost. We need better-informed clinicians and patients," he said.
There's more on medications for heart disease at the American Heart Association.
SOURCES: Guy Mintz, M.D., director, cardiovascular health & lipidology, Northwell Health's Sandra Atlas Bass Heart Hospital, Manhasset, N.Y.; Nov. 13, 2019, Circulation: Cardiovascular Quality and Outcomes, online
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