Another Drug For Cardiovascular Disease

A report on the effectiveness of another drug for cardiovascular disease is found here.  I would like to see more on lifestyle (e.g., diet and exercise) however.  Abstract:

Background Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. Methods We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. Results During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. Conclusions Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .).

Diet Vs. Drugs

In general, I believe that, when and where appropriate, lifestyle changes should be tried first before taking drugs to deal with certain common types of chronic metabolic disorders (but of course always consult with your physician, as "in general" does not apply to every specific case). The experts agree with my opinion:

Many Americans, when faced with a serious health risk like high cholesterol, opt to take a pill rather than adopt healthier living habits.

A middle-aged woman I know is typifies this attitude. Thrilled with how well medication has controlled her rising cholesterol level, she continues to indulge in foods rich in cholesterol-raising saturated fats. She also carries around more body fat, especially risky abdominal fat, than is considered healthful.

I met people like that. For example, some people with Type II Diabetes believe that taking medication gives them green light to load up with cookies, cakes, and doughnuts.

Dr. Philip Greenland, a cardiologist and epidemiologist at Northwestern University Feinberg School of Medicine, said, “People should be following a heart-healthy diet, keeping their weight under control and exercising regularly. This would be a highly preferable approach. Unfortunately, it’s not the direction we’re going in.”

Admittedly, swallowing a little pill every day is simpler than changing one’s behaviors — and especially one’s eating habits. Yet experts like Dr. Greenland say that even when taking a statin or some other cholesterol-lowering drug, changes in diet and exercise habits are needed to maximize the drug’s benefits. He and others insist that drugs should be a last resort, after lifestyle changes fail to lower serum cholesterol adequately.

I agree. Unfortunately, Dr. Greenland is correct that this is not the direction we are going on. Everything and everyone needs to be medicated, it seems. I recently read a suggestion stating that drugs for treating the consequences of obesity are needed, since it is unrealistic to think people are going to lose weight. In other words, eat excessively, be obese, and then take a pill to try and evade the consequences. Of course, all of these drugs have side effects.  Wouldn’t it be easier to attack the problem rather than its consequences?  Lifestyle changes involving diet and exercise may help the underlying problem, and do so without expensive medications and their side-effects.

Noting that “every food a person might eat either fights or contributes to disease,” Dr. Kopecky said his clinic “tries to get everyone on a Mediterranean diet,” the traditional eating habits of people living in Greece and southern Italy. In addition to its heart benefits, studies suggest the Mediterranean diet may “reduce the risk of Alzheimer’s disease, cancer, Parkinson’s disease, diabetes, arthritis and the metabolic syndrome”… “people in Greece eat an average of nine servings a day of antioxidant-rich fruits and vegetables,” and the booklet outlines a long list of potentially healthful foods. Some examples include prunes, blueberries, red grapes, oranges, strawberries, kale, spinach, brussels sprouts, broccoli, beets, red bell peppers, corn and eggplant.

At a minimum, Americans should strive to consume two or more servings of vegetables and two to three or more servings of fresh fruit each day. If “fresh” is not available, “fresh frozen” is the next best option.

Living near the sea, Mediterraneans eat lots of seafood, often daily, and the Mayo diet recommends three or more servings a week of fish or shellfish. One or more servings should be a fatty fish rich in protective fish oils, like salmon, tuna, bluefish, sardines, mackerel and trout.

The white meat of chicken or turkey, eaten without the skin, is the land animal protein of choice, the Mayo Clinic says, with a serving size limited to 3 ounces of cooked meat, about the size of a deck of cards.

Unlike many Americans, people living along the Mediterranean also consume lots of foods with vegetable protein: legumes like split peas, lentils and peanuts, and beans like lima, black, red, kidney and navy…Whole grain breads and cereals are part of the recommended diet, but note that a serving of bread is one slice. Breads should be eaten plain or dipped in olive oil, the Mayo booklet says.

Which brings us back to fats. Olive oil, especially extra-virgin and virgin, the least processed forms, or canola oil should be used in place of butter or margarine…Eggs are back in fashion, consumed in moderation. That means a limit of three to four egg yolks a week, though no limit on egg whites. A good trick when preparing an omelet or scrambled eggs is to use two egg whites for every one yolk…However, red and processed meats should be limited to one three-ounce serving a week. And those cherished treats and desserts — pastries, cakes, doughnuts, cookies, pudding, French fries, potato chips and all sweetened and diet carbonated soft drinks — are best avoided altogether…Likewise, avoid high-fat dairy products…

Of course, what you eat is only half of the health-saving story. Regular physical exercise is a critical ingredient, even if it doesn’t result in weight loss. “Fitness trumps fatness,” Dr. Kopecky said, adding that being fit even while remaining fat markedly reduces cardiovascular risk. He urges parents to establish heart-healthy habits early in their children’s lives. “Patterns for physical activity are set by ages 6 to 9, and healthy eating habits by ages 9 to 12; together, they can result in a much lower risk for developing heart disease as adults,” he said.

This is all sound advice. If radical changes are considered too difficult at first, then go slowly. Reduce rather than eliminate the more unhealthy foods and continue to reduce their intake over time, until they are eliminated or are taken at a reasonable and acceptable frequency. Gradually increase your intake of fruits, vegetables, and whole grains. Increasingly incorporate physical activity into your daily regimen. Over time, you will have reached the required goals and objectives.