second heart attack
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A clinical trial of a new anti-cholesterol drug has generated promising results in reducing the chances of a second heart attack, unstable angina, or death from coronary heart disease.

Acute coronary syndrome is a life-threatening health condition associated with sudden and reduced blood flow to the heart. The resulting under-supply of oxygen to the heart can lead to various heart diseases including chest discomfort, chest pain, shortness of breath, and heart attack. According to the Canadian Institute for Health Information, there were over 100,000 hospitalizations due to an acute coronary syndrome in Canada annually. As the proportion of Canadian seniors has been steadily growing, the number of Canadians suffering from acute coronary syndrome is expected to continue increasing.

Risk for second heart attack

Acute coronary syndrome, like heart attack, angina, and stroke, is common in people with high blood pressure, high blood cholesterol, smoking, unhealthy diet, lack of physical activity, and a family history of chest pain, heart disease or stroke. The survival rate of acute coronary syndrome has increased substantially over the past few decades, mainly due to improved management strategies. However, patients who have had an acute coronary syndrome remain at high risk for second heart attack.

New anti-cholesterol drug to prevent second heart attack

In a recent study published in The New England Journal of Medicine, a group of researchers from the University of Colorado Anschutz Medical Campus and scientists around the world, conducted a clinical trial to evaluate the effectiveness of a new anti-cholesterol drug in reducing the chance of having additional heart problems or second heart attack.

The new drug, Alirocumab, recently approved by the Food and Drug Administration, is a new class of cholesterol-lowering drug that inactivates a protein in the liver called PCSK9.To study the effectiveness of using Alirocumab in preventing second heart attack, the research team conducted a randomized, double-blind, placebo-controlled trial in different medical centers between November 2012 and November 2015.

A total of18,924 patients aged at least 40 who had an acute coronary syndrome 1 to 12 months earlier, were randomly divided into two groups. They either received alirocumab by self-injection under the skin every two weeks or placebo injections.

Clinical trial shows promising results

The researchers found that Alirocumab can increase receptors on the liver that attract particles of bad cholesterol from the blood and break it down. The researchers followed the patients for an average of nearly three years. They observed that the bad cholesterol level of the patients who received Alirocumab treatment was decreased by almost 50%. More excitingly, the chances of getting another heart attack, unstable angina, or death from coronary heart disease were decreased by 15%.

In this trial study, alirocumab was shown to be safe, effective, and generally well-tolerated. The common side effects with alirocumab were itching, redness, and swelling at the injection site. The researchers will continue to track patient outcomes for up to 10 years to determine the outcomes after stop using the drug.

Statin drugs have long been the main cholesterol-lowering drugs in the past three decades. This exciting study opens new doors to improve the outcomes of patients after a heart attack by adding alirocumab to statins.

Written by Man-tikChoy, Ph.D.

Reference: Schwartz, G.G. et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. The New England Journal of Medicine,November 7, 2018. DOI: 10.1056/NEJMoa1801174.

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