Good News Outweighs Bad in Study of Heart Disease, Diabetes

A new study involving about 9,000 people with heart disease or diabetes has found no evidence to support the popular practice of taking vitamin E to prevent worsening disease, but it did show that a common blood pressure medication has vast untapped potential to prevent heart attacks, strokes and even new cases of diabetes.

Both findings are expected to give cardiologists and their patients food for thought, perhaps influencing how heart disease is routinely treated. But the good news appears to outweigh the bad, experts said.

Some doctors said they were so impressed by the positive drug results that they plan to give the medication to many more of their heart patients, including those whose blood pressure is just fine. The drug is a type of ACE inhibitor called Altace. ACE inhibitors block a cellular enzyme that, among other things, helps control the dilating of blood vessels, thus affecting blood pressure.

The study involved 9,297 patients in 19 countries in Europe, North America and South America and a network of hundreds of physician-researchers.

Patients who received the drug were 22% less likely to have fatal and nonfatal heart attacks, worsening coronary artery disease, strokes and diabetes-related ailments than those who received a placebo. Also, the drug group had 30% fewer new cases of diabetes and 14% fewer coronary artery bypass operations to restore heart function.

“It’s a spectacular finding that will aid a lot of people,” said Dr. Vincent De Quattro, a cardiologist at the USC School of Medicine who has done research on other ACE inhibitor drugs.

Some of the findings were presented Wednesday at an American Heart Assn. meeting in Atlanta. At the same time, a paper describing some of the results was released two months before its scheduled publication in the New England Journal of Medicine.

The study is the first large clinical trial supporting the use of such a drug in patients with a broad range of heart disease symptoms and diabetes. Previous work has hinted at such broad benefits. Indeed, a recent summary of the medical literature suggested such positive effects, but researchers disputed the analysis as based on too few data.

Led by medical epidemiologist Salim Yusuf of McMaster University in Hamilton, Canada, the study’s authors estimated that 70 patients would be spared 150 instances of heart attack, stroke or diabetes for every 1,000 patients who took the drug. That could add up to a million lives saved worldwide, Yusuf said in a statement.

Significantly, many of the research subjects were also taking other drugs as part of their treatment, such as beta-blockers and aspirin. But the researchers were encouraged that other drugs did not interfere with the benefits of Altace, generically known as ramipril.

Whether other ACE inhibitor drugs--and there are several on the market--have the same benefits documented in this Altace study remains an open question. But academic cardiologists said in interviews that, despite the subtle differences among the drugs, they have generally been found to have similar effects.

The patients in the study were over 55 and had either documented heart disease or diabetes with at least one risk factor for heart disease, such as high blood-cholesterol levels. They were divided into several groups, depending on the treatment: Altace alone; vitamin E; Altace and vitamin E together; or a placebo.

Over more than four years, 653 people, or 14% of those taking Altace, suffered a heart attack or stroke or died of cardiovascular causes, whether or not they also received vitamin E. By comparison, 824 people, or 18% of those getting dummy pills, had such an outcome.

The drug’s main side effect is a cough, which is common with ACE inhibitors.

Dr. Jeffrey Goodman, a cardiologist at Cedars-Sinai Medical Center, said many up-to-date physicians already use ACE inhibitor drugs to treat heart disorders such as cardiac muscle dysfunction and valve problems as well as to reduce complications of diabetes. The new data, he said, are “confirmatory” of previous, smaller studies.

But others were buoyant because the study so resoundingly supported the practice. “We now have another very solid treatment that should be available to all patients who are at high risk of heart disease and over the age of 55,” said Dr. Thomas Ashton, a cardiologist at Penticton Regional Hospital in British Columbia who contributed to the study.