Tick tock: keep your heart healthy, with or without the new 'wonder' drug
Cardiovascular disease continues to be the world’s biggest killer, accounting for one in three of all deaths; so little wonder a new drug - billed as the biggest breakthrough since statins - has been hailed as heralding a new dawn in heart treatment, this week.
In Britain, 200,000 people will suffer a heart attack every year, but until now, cholesterol-lowering statins or blood-thinning drugs have been the only medicinal avenue available - even though half of heart attacks occur in people who do not have high cholesterol at all, and a quarter go on to suffer a second attack within the next five years, despite treatment.
Now, after a landmark four year-trial involving 10,000 high-risk patients and 1000 doctors in 39 countries, scientists claim an anti-inflammatory drug called canakinumab, injected every three months, has the potential to cut the risk of fatal repeat heart attacks and strokes by 24 per cent (nine per cent over and above the impact of statins).
Presented at the European Society of Cardiology Congress in Barcelona on Sunday, and published in the New England Journal of Medicine, the drug has made waves in the medical world because it marks a new approach to heart attack prevention. Unlike statins, its purpose is not to combat high cholesterol, but rather to reduce inflammation, which researchers have long suspected of playing a role in cardiovascular disease, cancer, and a whole host of other pathological problems from rheumatoid arthritis and chronic fatigue syndrome to depression.
Inflammation
is one of the body’s natural healing responses to infection or injury -
but while acute inflammation (such as the scabbing over of a cut, or a
sore throat during a cold) resolves quickly, chronic inflammation is
pervasive and ongoing, as the biochemicals that should repair your body
do the opposite, destroying tissue and cause cells to malfunction.
Canakinumabis
is an antibody that works by blocking the number of inflammatory
molecules in the bloodstream, which in high levels damage the lining of
the heart arteries and play a major role in causing heart attacks and
strokes. As well as cutting the risk of a heart attack by a quarter, it
is also claimed to have the potential to halve the chances of patients
dying from lung cancer, and prevent arthritis and gout.
Presenting his findings, Professor Paul Ridker of Harvard Medical School, said: “In my lifetime, I’ve gotten to see three broad eras of preventative cardiology. In the first, we recognised the importance of diet, exercise and smoking cessation. In the second, we saw the tremendous value of lipid-lowering drugs such as statins. Now, we’re cracking the door open on the third era.”
Presenting his findings, Professor Paul Ridker of Harvard Medical School, said: “In my lifetime, I’ve gotten to see three broad eras of preventative cardiology. In the first, we recognised the importance of diet, exercise and smoking cessation. In the second, we saw the tremendous value of lipid-lowering drugs such as statins. Now, we’re cracking the door open on the third era.”
Even
if canakinumab lives up to its blockbuster hype, however, there are two
flies in the ointment. First, it currently costs a prohibitive £40,000
per patient, per year to administer (compared with generic statins at
£20 a year). Second, it comes with potentially fatal side effects.
Because canakinumab works by suppressing part of the immune system, a
rise in infections killed one in every 1000 patients in the trial -
although this was offset by the reduction in deaths from cancer and
fewer heart bypasses needed.
Drugs
giant Novartis, which makes canakinumab, said it would immediately
apply for a medical licence to use the drug for heart disease and trials
of cheaper drugs are being looked at. Cardiology experts seem broadly
united - and excited - in believing that the move towards treating
inflammation rather than high cholesterol, marks an important shift in
our approach to heart disease.
Professor
Stephen Westaby, a heart surgeon at John Radcliffe Hospital believes
inflammation is at the root of “all sorts of pathological processes,
which include myocardial infarction [commonly known as a heart attack]
and of course cancer. Being able to modulate inflammation is potentially
important in all sorts of areas that you would never even think about.”
According to Dr Malhotra, following a relatively high fat Mediterranean diet is one of the chief ways to improve heart health by reducing inflammation. “Polyphenols - plant based compounds - and omega 3 fatty acids, which can be found in certain foods help reduce inflammation,” he says. Cutting out sugar is also key, as too much glucose in the bloodstream makes your body resistant to insulin, “which in turn increases inflammation.”
Nutritionist Jane Clarke says introducing long chain fatty acids into your diet, in the form of walnuts, olive oil and oily fish can help reduce “free radical damage, which exacerbates inflammation in the body.” Then there are ingredients like turmeric, which has been hailed as the ‘golden spice’ for its anti-inflammatory effects. Although not easily absorbed by the body, pairing it with black pepper is thought to increase its bioavailability. “A lot of my patients find that curcumen, which is the most active form of turmeric, can be a very useful way to bring down inflammation in the body,” says Clarke.
Stop smoking
Dr Malhotra explains that smoking “increases inflammatory molecules in the bloodstream, which in excess, over a sustained period of time will damage the heart arteries. That’s why the reduction in smoking has caused a reduction in heart attack deaths, because smoking is pro-inflammatory.”
So,
while we wait for researchers to trial more affordable drugs, what can
we do today, to start combatting inflammation? Every week, another new
headline contradicts the last in demonising caffeine, sugar, fat, salt
or alcohol. But Dr Aseem Malhotra, the award-winning NHS cardiologist
who has long advocated lifestyle changes over drugs in the fight against
heart disease in this country, says it is possible to keep inflammation
under control, holistically.
“Targeting cholesterol has been in many ways a failed experiment to curb the global pandemic of heart disease,” he tells me. “We know that the development of coronary heart disease is a chronic inflammatory process. There is clearly a recognition that drug therapies need to target inflammation, not cholesterol. However, we actually have much more simple solutions for patients at a population level, that don’t involve drugs, and which could be even more effective.”
“Targeting cholesterol has been in many ways a failed experiment to curb the global pandemic of heart disease,” he tells me. “We know that the development of coronary heart disease is a chronic inflammatory process. There is clearly a recognition that drug therapies need to target inflammation, not cholesterol. However, we actually have much more simple solutions for patients at a population level, that don’t involve drugs, and which could be even more effective.”
How to help keep inflammation under control
Eat a Mediterranean dietAccording to Dr Malhotra, following a relatively high fat Mediterranean diet is one of the chief ways to improve heart health by reducing inflammation. “Polyphenols - plant based compounds - and omega 3 fatty acids, which can be found in certain foods help reduce inflammation,” he says. Cutting out sugar is also key, as too much glucose in the bloodstream makes your body resistant to insulin, “which in turn increases inflammation.”
Nutritionist Jane Clarke says introducing long chain fatty acids into your diet, in the form of walnuts, olive oil and oily fish can help reduce “free radical damage, which exacerbates inflammation in the body.” Then there are ingredients like turmeric, which has been hailed as the ‘golden spice’ for its anti-inflammatory effects. Although not easily absorbed by the body, pairing it with black pepper is thought to increase its bioavailability. “A lot of my patients find that curcumen, which is the most active form of turmeric, can be a very useful way to bring down inflammation in the body,” says Clarke.
Stop smoking
Dr Malhotra explains that smoking “increases inflammatory molecules in the bloodstream, which in excess, over a sustained period of time will damage the heart arteries. That’s why the reduction in smoking has caused a reduction in heart attack deaths, because smoking is pro-inflammatory.”
Get more sleep (and exercise)
If you’re not getting seven hours of sleep a night, levels of cortisol and blood glucose in the bloodstream increase, reducing your body’s ability to deal with stress. Chronic stress increases the impact of inflammation on the bloodstream even further. Regular exercise doesn’t just help to combat stress and improve the quality of your sleep, but reduces the body’s resistance to insulin, which indirectly affects inflammation, too.
Watch for gum disease
If your gums bleed when you brush or floss, you most likely have oral inflammation. Make an appointment to see your dentist for a check-up, and step up your oral hygiene. Gum disease has been linked to an increased cancer risk, particularly in older women.
If you’re not getting seven hours of sleep a night, levels of cortisol and blood glucose in the bloodstream increase, reducing your body’s ability to deal with stress. Chronic stress increases the impact of inflammation on the bloodstream even further. Regular exercise doesn’t just help to combat stress and improve the quality of your sleep, but reduces the body’s resistance to insulin, which indirectly affects inflammation, too.
Watch for gum disease
If your gums bleed when you brush or floss, you most likely have oral inflammation. Make an appointment to see your dentist for a check-up, and step up your oral hygiene. Gum disease has been linked to an increased cancer risk, particularly in older women.
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