ESC Congress 2004: New insights from the ACTION study
The proper use of drugs to treat heart disease reduces the need for hospital interventions
Regular attacks of chest pain induced by exercise (angina pectoris) is a common condition caused by blockages of the blood vessels that supply the heart (coronary heart disease). This condition may develop without warning but often occurs in patients who have had a heart attack. One of the most commonly prescribed drugs to reduce attacks of chest pain is nifedipine, a calcium channel blocker. Because this drug also reduces blood pressure, it is frequently prescribed to people whose blood pressure is too high. Dr. Curt Furberg created a considerable commotion at the European Society of Cardiology Congress in 1995 by suggesting that short-acting nifedipine in particular and other drugs from the same class are unsafe and should not be used in patients with coronary heart disease or elevated blood pressure.
Directly after Dr. Furberg's 1995 presentation, SOCAR Research (an independent research institute that has large experience in clinical studies with nifedipine and other compounds in cardiac patients) proposed to Bayer (the manufacturer of nifedipine) to respond in a scientifically convincing manner by mounting the first-ever clinical trial in patients with stable angina pectoris that is large enough to assess the effect of nifedipine on important clinical events such as death, heart attacks, stroke and heart failure. The proposed trial became known as the ACTION study and compared the long-acting GITS (gastrointestinal therapeutic system) formulation of nifedipine with placebo. This is important because Dr. Furberg's data came from studies using the less optimal, short-acting formulation.
With the support of Bayer, the ACTION study has now been completed by SOCAR Research in collaboration with an international group of robustly independent experts chaired by Professor Philip A. Poole-Wilson from Imperial College, London, UK. Professor Poole-Wilson will present the main results of ACTION today at 11:00 am in the Hot Line I session.
Nine years after Dr. Furberg's presentation, and after studying just under 8,000 patients for a maximum of 6 years – half of whom were treated with nifedipine GITS and half with placebo – the place of this medication in the treatment of patients with stable angina can now be defined reliably as follows:
1. The addition of nifedipine GITS to other medications regularly prescribed for stable angina (such as beta blockers to prevent chest pain attacks, nitrates to treat attacks, cholesterol and blood pressure lowering drugs to prevent heart attacks and strokes) is safe. In patients who have both angina and elevated blood pressure, the available data from ACTION and other studies show that nifedipine GITS also prevents heart attacks and strokes.
2. Most importantly for medical practice, nifedipine GITS reduces the need for hospital procedures in patients with stable angina. In ACTION, the number of patients who needed a hospital procedure to either diagnose or treat blockages of blood vessels that supply the heart, the brain or the legs was reduced by 13%.
3. A new finding that has not been reported before is that nifedipine GITS reduces the need for hospitalisation for heart failure in patients with stable angina.
In conclusion, the ACTION study showed that the proper use of drugs to treat heart disease can reduce the need for costly hospital interventions in patients with stable angina.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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