Artery Disease Poses Immediate Risks
Tuesday, March 20, 2007; 12:00 AM
TUESDAY, March 20 (HealthDay News) -- People with artery blockages suffered a surprisingly high incidence of major problems, including death, in the course of a single year, a large international study found.
The finding is a clear sign that patients and their doctors aren't being aggressive enough in dealing with the condition, experts say.
"A year ago, we published baseline data showing a fair amount of underutilized information in these patients," said Dr. Deepak Bhatt, associate director of the Cleveland Clinic's cardiovascular coordinating center, and one of the study's authors. "What we find now in the one-year results is that, in outpatients with risk factors, we observe a high rate of ischemic events, such as heart attack and stroke and of hospitalization. About one in seven of these patients had one of these events in the course of the year."
Bhatt is a member of the board of physicians running the study, which is following more than 60,000 people in 44 countries who have either established artery disease or at least three risk factors such as obesity, high blood pressure and diabetes. Such people are known to be at risk of serious, even fatal, problems.
But the study indicates that that risk is often not taken seriously enough if the person appears to be in stable condition, Bhatt said.
"If the patient comes in with a heart attack or stroke, the health-care system rapidly mobilizes," he said. "The problem is that in the stable phase, it is easy to be lulled into a sense of complacency. There is reluctance on the part of the doctor or patient to add medication or to add to the dose of a medication."
For example, an increase of 10 or more points in blood pressure might not bring a corresponding increase in the drugs taken to keep the pressure within safe bounds, Bhatt said.
The study looked at patients with atherosclerosis -- artery disease -- in three parts of the body: the legs, heart and brain. It found the same increased risk of major problems over the one-year period for all locations.
Over the year, 4.24 percent of the study participants suffered death, heart attack or stroke, ranging from 2.15 percent of patients with multiple risk factors only to 6.47 percent of those with disease in arteries supplying the brain.
The study findings are published in the March 21 issue of theJournal of the American Medical Association.
"It's not clear why these patients are not being optimally managed," said Dr. Mary McGrae McDermott, associate professor of medicine at Northwestern University's Feinberg School of Medicine, who wrote an accompanying editorial in the journal.
"I deal with prevention, and it doesn't seem that we are making as much progress in that direction as would be ideal," she said. "And once the disease is established, we're not doing as well as we could. Both are important."
Economics might play a role, McDermott said. "What this study does not tell us anything about is patients with limited access to health care," she said. "They get even worse therapy, because they can't afford it."
But Bhatt disagreed with that conclusion. Indeed, a striking observation is that the statistics were the same "across all the geographically diverse regions we studied," he said. "It was even true in countries like Canada, where everyone has health insurance. The study tells us we should not let up on the degree of intensity in treating risk factors."
Bhatt is working with Dr. Peter W. Wilson, professor of medicine at Emory University in Atlanta and also a member of the study's governing council, on a risk-factor predictor for patients, using data from the study.
"Blood pressure generally is being treated well," Wilson said. "We're not doing so well with cholesterol medications and other risk factors. If your doctor is not being aggressive with you, you should ask why not. We can prevent an awful lot of heart disease."
The American Heart Association has more on risk factors for coronary heart disease.
SOURCES: Deepak Bhatt, M.D., associate director, Cleveland Clinic cardiovascular coordinating center; Mary McGrae McDermott, M.D., associate professor of medicine, Northwestern University Feinberg School of Medicine, Chicago; Peter W. Wilson, M.D., professor of medicine, Emory University, Atlanta; March 21, 2007,Journal of the American Medical Association