ATLANTA – People taking the blood thinner Plavix on top of aspirin to try to prevent heart attacks, as many doctors recommend, now have good reason to stop.
The drug combination not only didn’t help most people in a newly released study, but it unexpectedly almost doubled the risk of death, heart attack or stroke for those with no clogged arteries but with worrisome conditions such as high blood pressure and high cholesterol.
| B vitamin no help with heart attacks
Contrary to a widely promoted theory, B vitamins do not cut the risk for heart attacks or strokes, according to two large new studies released Sunday by The New England Journal of Medicine. The studies were conducted by McMaster University in Canada and the University of Tomsa in Norway. The new studies confirm the results of another large study that was published in 2004 in the Journal of the American Medical Association. The Washington Post |
“They actually were harmed,” said Dr. Eric Topol. “This was a trial to determine the boundaries of benefit, and it did. You don’t use this drug for patients without coronary artery disease.”
Drs. Eric Topol and Deepak Bhatt of the Cleveland Clinic led the study, which involved 15,603 people in 32 countries. Topol has since left the clinic and is at Case Western Reserve University in Cleveland. Results were reported Sunday at an American College of Cardiology conference.
Aspirin’s ability to prevent heart attacks in men is legendary but it does little for their risk of stroke. In women, aspirin wards off strokes but only reduces heart attack risk in those 65 or older. Adding Plavix to aspirin for people being treated for a heart attack cuts their risk of a second one or death.
For these reasons, doctors thought the drug combination might prevent “heart attacks waiting to happen” in people with very clogged arteries or lots of risk factors like heavy smoking, diabetes and high cholesterol.
They gave everyone in the study low daily doses of aspirin plus Plavix or a dummy pill and looked at how they fared more than two years later.
Adding Plavix made little difference for the group as a whole except for slightly reducing hospitalizations. But for the 20 percent with no signs of heart disease, the drug combination proved dangerous. Heart-related deaths almost doubled, from 2.2 percent of those taking only aspirin to 3.9 percent of those who added Plavix.
The only people even modestly helped by adding Plavix were those with established heart disease. Their risk of heart attack, stroke or death was about 7 percent versus 8 percent for those taking aspirin alone.
Specialists said this was not enough to justify recommending the drug in light of the overall findings of no benefit.
The cost and risks of Plavix don’t justify expanding its use for prevention, Dr. Marc Pfeffer of Brigham and Women’s Hospital in Boston and Dr. John Jarcho of the New England Journal of Medicine write in an editorial in the journal, which will be published along with the study results in the April 20 issue.
“Plavix should not be used for prevention,” said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute. “Aspirin alone is sufficient.”
The study was paid for by Sanofi and Bristol-Myers Squibb, which sell Plavix in the United States for about $4 a pill. Outside the U.S. the drug is sold as Iscover. Many of the researchers have ties to the companies or others that make heart drugs.
Talk to us
> Give us your news tips.
> Send us a letter to the editor.
> More Herald contact information.
