New drug combination for heart disease and diabetes

A NEW ground breaking study by ASCOT study, has found a new drug combination, for stroke, heart disease and diabetes and was presented at the recently held annual congress of the European Society of Cardiology in Stockholm, Sweden.

According to a report of this study sent to us by a Sri Lankan doctor who attended the meeting, the new drug combination Amlodipine and Coversyl used in the new treatment trial replacing B-blocker/Diuretic combination has reduced.

* Cardiovascular deaths by 24 per cent
* Stroke deaths by 23 per cent
* Diabetes deaths by 30 per cent
* Total coronary events by 13 per cent

Compared with the currently used B-blocker/diuretic combination.

The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) looks set to be one of the most influential clinical trials of recent years following its presentation at the European Society of Cardiology (ESC) Annual Congress and simulations publication on line in the Lancet.

The ground braking study shows the significantly better performance of the amlodipine and Coversyl (perindopril) treatment strategy versus a B-blocker/diuretic combination in reducing the risk of mortality, stroke, new-onset diabetes, and coronary events.

In a typical Western country with a population of 50 million people, about eight million receive treatment for high blood pressure; B-blockers and diuretics are among the treatments most frequently prescribed. The ASCOT results will have huge implications for these patients.

The ASCOT results predict that, if the amlodpine and perindopril combination were prescribed in only half of the patients currently receiving a B-blocker/diuretic combination for the treatment of high blood pressure, over a 5 1/2 year period there would be nearly 100,000 fewer cardiovascular events and procedures, nearly 40,000 fewer strokes and 35,000 fewer deaths from cardiovascular disease. There would also be over 90,000 fewer patients who develop type 2 diabetes.

These huge figures could still underestimate the potential impact, and could even be doubled again, as they do not take into account the further eight million patients with high blood pressure who are currently undiagnosed and not receiving treatment.

"High blood pressure is a major health problem," commented Professor Peter Sever, a principal investigator of ASCOT and Professor of Clinical Pharmacology and Therapeutics at the International Centre for Circulatory Health, Imperial College, London.

The ASCOT study used a simple and effective combination of treatments. The results demonstrated both control of blood pressure and reduction in risk of strokes, heart attacks and other related diseases, such as diabetes. This is very important news for patients and their physicians."

ASCOT is a major multi-national trial involving over 19,000 hypertensive patients that compared the effectiveness of two different treatment strategies at reducing cardiovascular events.

The newer treatment strategy (the calcium channel blocker, amlodipine and the agniotensin-converting enzyme (ACE) inhibitor, perindopril) offered such significant advantages over the older treatment strategy (the B-blocker, atenolol and the thiazide diuretic, bendroflumethiazide), that the trial was stopped early by the Data Safety Monitoring Board in December 2004.

The ESC presentation revealed that the perindopril/amlodipine treatment combination significantly reduced the risk of death by any cause (by 11 per cent) cardiovascular death (by 24 per cent), stroke (by 23 percent), total coronary events (by 13 per cent) and new-onset diabetes (by 30 per cent) compared with the atenolol/bendroflumethiazide combination.

"It is welcome indeed that the landmark ASCOT study has now been presented in full," commented Dr. Adrian Brady, consultant cardiologist at Glasgow Royal Infirmary, UK and member of the Executive committee of the British Hypertension Society.

"The results of ASCOT are substantial and important. We must consider whether the much-used regimen of B-blockers followed by thiazides is the automatic choice for our patients.

These drugs are no longer likely to be seen as first-line treatment for all patients with hypertension. Many thousands of individuals will likely benefit from the treatment changes implemented as a result of ASCOT."

Hypertension is a major risk factor for coronary heart disease (CHD) and stoke, and Coversyl has already amassed significant evidence in patients previously diagnosed with these conditions.

In the EUROPA study involving 12,000 patients with low-risk stable coronary artery disease, perindopril brought a significant 20 per cent relative risk reduction in the combined end point of cardiovascular death, non-fatal MI and resuscitated cardiac arrest. These results were consistent over patients already receiving lipid-lowering therapy or B-blockers.

The PROGRESS study in 6,000 post-stroke patients, showed that 1 out of 10 patients given a therapy based on perindopril (with or without a indapamide) avoided either death, myocardial infraction (MI) or further stroke over four years of treatment.

A EUROPA substudy called PERTINENT went on to show that perindopril has direct vascular and anti-atherosclerotic effects, thus improving the function of the endothelium.

###################

At WHO Regional Meeting in Colombo:

Prime Minister emphasises need for tsunami early warning system

PRIME MINISTER Mahinda Rajapakse on Sunday emphasised the importance of having an early warning system for natural disasters like the tsunamis, for the South-East Asian region.

He was inaugurating the WHO-SEARO 23 Health Ministers and the 58 Regional Committee Meeting held at Ceylon Continental Hotel in Colombo.

Prime Minister was the chief guest and Health, Nutrition and Uwa Wellassa Development Minister Nimal Siripala de Silva was the guest of honour at this event.

The Prime Minister while thanking the World Health Organisation (WHO) and other UN Agencies for their advice and support for Sri Lanka in meeting the problems created by the catastrophic tsunami, said that meetings of this nature would provide a strong platform to unite and share our knowledge in the field of health and other related issues.

Speaking of the high performance of health sector in Sri Lanka, Prime Minister Rajapakse said that the country had been able to provide health care of technically acceptable quality, free of user charges, while maintaining reasonable equity.

These achievements were due to the wide coverage by the health services, education of mothers and the social sector policies adopted over five decades.

Dr. Samlee Plianbangchang, Regional Director for WHO South-East Asia commended the remarkable progress in national health development made by Sri Lanka.

He noted that infectious diseases cause a large proportion of morbidity and mortality in the region, and that these challenges need to be urgently addressed.

He observed that the Commission on Macroeconomics and Health provided evidence that increased investment in health leads to economic growth and poverty reduction.

Dr. Samlee said the Millennium Development Goals were a comprehensive expression of Governments around the world for achieving the well-being of their people.

The MDGs identify a set of inter-related targets for addressing extreme poverty and its many related dimensions, with health being placed at the centre.

Health Minister Nimal Siripala de Silva welcomed WHO's role in strengthening its capabilities to meet global epidemics and disasters.

Recounting key milestones in health development in Sri Lanka, Mr. de Silva said that the country has established a National Macroeconomics and Health Commission and succeeded in obtaining an increase in the health budget as a worthwhile investment, critical for sustained socio-economic development.

Other achievements included the formulation of a National Medicinal Drugs Policy; expansion and up gradation of nursing and other paramedical education, and revision of the Mental Health Policy.

The eleven Member States of the WHO South-East Asia Region participating in the meeting are Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.

##################

Cultural medical practices on public health

BY DR. LORI Alvord MD

Western medical profession is now accepting that cultural medical practices, of people in all parts of the world have an important role to play in advancement of health of the people.

At a recently held medical symposium of the American Family Physicians Association AAFP in the Kansas city USA, Dr. Lori Alvord MD, Associate Dean of Minority and Student Affairs at Dartmouth Medical School delivering Stephen J. Jackson MD Memorial lecture has gone to the extent of saying "It is ironic that the so-called primitive cultures are the ones which are making medical breakthrough now".

An article published in the FP Report Vol.9, the journal of the American Family Physician, on Dr. Alvords lecture runs thus:

J. Michzel Brodie writes in FP Report

A young Navajo woman comes to the Gallup Indian Medical Center in Gallup, N.M., looking for Lori Alvord, M.D., the surgeon.

"My sisters won't eat my fry bread," the woman tells the surgeon. The woman has breast cancer, which in her community is something to be feared. She is shunned by the members of her tribe, by her own family.

But soon after her visit to the surgeon's office, the woman will take part in a night chant in which the tribal yei'ii, or dancers, don traditional grab - that of the talking god, the clown and the hunchback.

Through their sure-footed steps and rhythmic chants, the dancers celebrate the beauty of earth and sky and call for the gifts of good health and nature's bounty.

The ceremony is important to the young woman. It clears her mind of all thoughts. It readies her for cancer surgery. It also readies Alvord for her role in that procedure.

"It matters that your environment is pure," said Alvord, who delivered the Stephen J. Jackson, M.D., Memorial Lecture at the AAFP National Conference of Family Practice Residents and Medical Students Aug. 8 in Kansas City, Mo. "The ceremony is a way to heal the healer as well. Words have an extraordinary power.

"One thing was certain after the surgery: No one would be afraid to eat Carolyn Yazi's fry bread anymore."

Alvord is the first Navajo woman to become a surgeon. She grew up on a Navajo reservation in New Mexico where she attended public schools that were 95 percent Navajo.

One of the few students in her graduating class to attend college, she enrolled at Dartmouth College in Hanover, N.H., later earning her medical degree from Stanford University in Stanford, Calif.

"I was raised with tribal people, and I didn't know what to expect from college," Alvord said, "I had to try to reconcile two cultures."

Her book, the Scalpel and the Silver Bear, describes the healing practices of the Navajo people and the challenges Alvord faced on entering the realm of Western medicine.

Her book comes at a time when alternative medicine is garnering attention, and many patients are turning from Western medicine - with its pills, costly equipment and modern procedures - to other forms of healing.

Thought and spirit are integral parts of the Navajo healing process, as is an appreciation of the beauty inherent in all things.Illness, Alvord explained, results from being out of balance or harmony in any area of life.

It is the healer's task to restore that harmony. "I became a surgeon because I love the beauty of the human body," she said," and I wanted to restore the beauty of that body."