From the annual scientific session of the American College of Cardiology in Orlando
The people who put together the program for this year’s ACC meeting must be pleased by the juxtaposition their scheduling produced during the latebreaker session on the afternoon of March 30. Intended or not, two substantially different approaches to blood pressure reduction appeared side by side.
First came a report on pairing the low-salt, fruit-, vegetable-, and dairy-heavy DASH (Dietary Approaches to Stop Hypertension) diet with a weight-loss and exercise program. Over 16 weeks in a study with 49 people, this lifestyle regimen led to an average drop in systolic blood pressure of about 12 mm Hg. As one cardiologist on the session’s panel noted, that’s about what can be produced by treatment with one or two antihypertensive drugs at usual dosages. Cardiovascular disease expert Dr. Sidney C. Smith, Jr. from the University of North Carolina observed, “these were remarkable changes” produced through lifestyle steps alone.
Next were results from the first test of a new approach to lowering cardiovascular disease risk factors on a global scale, the polypill, which combined three antihypertensive drugs at low doses, a statin, and aspirin into a single capsule taken daily. In the first test of this approach’s safety and efficacy the polypill produced an average 7 mm Hg fall in systolic blood pressure during 12 weeks of treatment. The polypill also reduced serum lipid levels and other markers of cardiovascular risk.
The overall effects could probably cut recipients’ risk for cardiovascular events in half if maintained, said the study’s leader, Dr. Salim Yusuf from McMaster University in Canada. The polypill concept is to eventually give the treatment to millions, perhaps even eveyone over age 50.
“There is nothing more effective [for cardiovascular disease risk reduction] than modifying lifestyle, but people may tend to dismiss that concept if they believe that this pill will reduce their risk by 50%,” commented Dr. Clyde Yancy, from the Baylor Heart and Vascular Institute in Dallas.
But in an era of rampant risk, others were willing to accept anything that works.
“Not everyone will follow diet and exercise. Reserve polypharmacy for the people you can’t get to respond to lifestyle measures,” said Dr. Steven E. Nissen of the Cleveland Clinic.
—Mitchel Zoler @mitchelzoler
photo: Mitchel Zoler