An experimental heart drug has reduced deaths from repeat heart attacks by a dramatic one-third and should be widely used as soon as possible, according to a set of highly enthusiastic reports published today.
The drug is sulfinpyrazone, or Anthurane, and it apparently cuts heart attacks either by inhibiting production of platelets -- blood cells that pile up to form blood clots -- or by making heart muscle more resistant to abnormal rhythms.
The drug was tried on 775 patients who had just recovered from heart attacks at 26 hospitals in the United States and Canada. The hospitals included some of the largest univeristy centers and several community hospitals, including Prince George's General Hospital in Cheverly.
Another 783 patients were given only a placebo, dummy pills of no effectiveness -- a measure that is ehtical only when doctors have no solid evidence that an experimental drug is really effective.
In the first seven months after their heart attacks, there were 35 deaths from further heart attacks in the placebo group, but only 17 among those who took Anturane four times a day, according to the lead article in today's New England Journal of Medicine.
After two years, there were still 32 percent fewer deaths in the anturane group, due primarily to the drug's reduction in the number of fatal new attacks in the early months.
On this basis, says Dr. Sol Sherry of Temple University, the study's chairman, the drug can be termed "a substantial benefit in preventing sudden cardiac deaths" during the period of highest risk -- the months immediately after a heart attack.
Dr. Eugene Braunwald of Harvard Medical School says in an accompanying editorial that, "unless future studies are non-confirmatory," this drug's "striking" success seems to warrant giving it to many heart attack patients, "at least from the second to the seventh month" after their attacks.
"Therefore," he adds, "despite the great desirability of learning more" about the drug, "the information should be approved for use after infarction -- heart attack -- and made available to the American public at the earliest possible time."
Braunwald is cheif of medicine at Boston's Peter Bent Brigham Hospital, one of the nation's most highly regarded hospitals.
Anturane is already in fairly wide use in hospitals that have an "investigational new drug" permit for testing it in heart disease, and it is already on the general market for use in gout. But only the Food and Drug Administration can declare it safe and effective enough for all doctors to use after heart attacks.
The results of the 26-hospital study have already been presented to an FDA cardiac care advisory committee which recommended the drug's approval, it was learned yesterday.
"We are reviewing all the data and we expect a decision within a few months," said Wayne Pines, FDA associate director for public affairs.
Dr. Sherry said there were no reports among any Anturane patients of serious ill effects associated with the drug, the sort that might block FDA approval.
The huge number of heart attack victims -- and the grim fact that as many as 15 percent die of a second attack within six months -- make it imperative to seek better treatment, Sherry and Braunwald emphasized.
"We are dealing," Braunwald wrote, "with approximtely seven million post-infarction patients in the United States alone," and "an annual addition -- and attrition -- of about a million."
Heart attacks occur in many degrees, all patients must be assessed and treated individually, and neither Anturane nor any other drug will be right for every patient, he added.
Drugs called beta-blockers -- which affect so-called beta receptors on the walls of the heart and blood vessels -- are also being used after heart attacks.
There have been several reports, and more studies are underway, on the use of common aspirin to prevent repeat attacks. Aspirin also inhibits blood platelet formation and clotting. Some reports show a favorable result of aspirin, some do not.
When aspirin or beta-blockers are given as soon as Anturane -- it was started about 25 to 35 days after heart attacks -- and just the right doses are determined, "I think both of these drugs will also be proved highly effective," Braunwald said in an interview. "But aspirin has a greater potential for side effects," he added, "so the whole story of aspirin and heart attacks hasn't yet been written."