Tag Archives: Attack

Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Hospitals attack ‘barking mad’ NHS target to manage winter crisis

Health service chiefs have been declared “barking mad” for ordering hospitals to ensure no patient is treated in a corridor or languishes on a trolley for hours when this year’s winter crisis hits.

NHS England’s instructions, intended to avoid a repeat of hospitals’ descent into the sort of meltdown seen last year, also say that patients should not have to wait more than 15 minutes in the back of an ambulance outside an A&E unit as they wait to be handed over to hospital staff.

Critics have described the plans, outlined in a four-page letter sent to hospital chiefs as “la-la land”, “totally unrealistic” and an attempt “to create Narnia”. Hospital bosses say they regularly have to use all the three tactics which the NHS wants to ban in order to help them cope with the influx of patients created by winter weather and seasonal infections.

“We all aspire to avoiding doing any of those things. But trying to flog a dead horse, or to create Narnia, through a new set of executive instructions isn’t going to help us,” said Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors.

“Our urgent and emergency care system is under extreme stress going into winter. Given that hospitals are underbedded and underfunded, and emergency departments are understaffed, trying to deliver performance in that climate is nigh-on impossible. We have to define reality rather than delude ourselves about the scale of this problem of caring safely for patients during winter.”

One NHS trust chief executive, who spoke on condition of anonymity, said: “They are barking mad. Patients are waiting on corridors already. This will only get worse as we progress through winter. Twelve-hour trolley breaches in some hospitals are no longer unusual, and for some no longer cause distress or outrage as they are viewed as inevitable. The demands are not realistic.”

Disclosure of NHS England’s attempt to impose a detailed series of duties on hospitals comes amid claims by senior insiders that its leadership is in a state of panic over winter.

Theresa May has told Simon Stevens, the organisation’s chief executive, that he is “personally responsible” for how the NHS performs during what most expect to be a very tough winter, with a flu outbreak feared. Some NHS bosses believe that the prime minister’s move is intended to protect Jeremy Hunt, the health secretary, who they blame for underfunding it and presiding over huge staffing problems.

The regulator NHS Improvement warned last week that the service was already under such pressure, with hospital wards too full after the failure of a £1bn exercise to free up 2,000-3,000 beds, that it was in an “extremely challenging” position.

NHS England’s plans are laid out in a letter sent to all 233 NHS trusts and 209 clinical commissioning groups on 7 June by Pauline Philip, its national director of urgent and emergency care, headed “Winter briefing one: operational management of winter – expectations and communication”. Philip sets out actions “to consistently ensure that safety is maintained during times of significant pressure”. They include an edict that “clinical escalation will need to ensure that patients are not cared for on hospital corridors; 12-hour trolley waits in the emergency department never happen; [and] patients do not wait more than 15 minutes in ambulances before being handed over to the hospital”.

But hospital bosses claim their struggle to keep up with the sheer demand for care over winter, while maintaining patient safety, forces them to deploy the three practices Philip wants to end. Another chief executive said: “This is totally la-la land thinking. The pressure is mounting now. I don’t think any of the areas ‘to be avoided’ will be. Many chairs and non-executive directors of trusts are in complete disbelief about NHS England’s tone and approach.” Serious doubts have been raised about the ability of hospitals to do what Philip has asked. For instance, 1,597 patients had to wait at least 12 hours in an A&E unit to be admitted into the hospital itself in January to March this year, when cold weather caused a spike in illness that led to the NHS experiencing its most pressurised winter ever. So many hospitals struggled so much last January that the British Red Cross called the situation “a humanitarian crisis”.

NHS England, working alongside NHS Improvement and Public Health England, have made unprecedented joint efforts to ensure the health service can withstand this winter’s rigours. For example, NHSE has put £237m into a campaign to offer free flu jabs to a record 21m people including expanded numbers of primary schoolchildren and, for the first time, care home staff.

Chris Hopson, chief executive of NHS Providers, which represents trusts, said hospitals would do everything they could to avoid trolley waits or patients being treated on corridors, and minimise patient handover times between ambulance and A&E staff. But he added: “The indications are that flu may cause more problems than we have seen in recent years. And a prolonged cold spell – often linked to falls and respiratory problems – could make matters worse. So we need to be realistic and honest.

“Trusts cannot guarantee that these problems will not happen. What they can do – and are doing – is to have strong and well developed plans in place to identify when they are struggling to cope, so they can call on support to ensure patients get the best care possible.”

Hospitals attack ‘barking mad’ NHS target to manage winter crisis

Health service chiefs have been declared “barking mad” for ordering hospitals to ensure no patient is treated in a corridor or languishes on a trolley for hours when this year’s winter crisis hits.

NHS England’s instructions, intended to avoid a repeat of hospitals’ descent into the sort of meltdown seen last year, also say that patients should not have to wait more than 15 minutes in the back of an ambulance outside an A&E unit as they wait to be handed over to hospital staff.

Critics have described the plans, outlined in a four-page letter sent to hospital chiefs as “la-la land”, “totally unrealistic” and an attempt “to create Narnia”. Hospital bosses say they regularly have to use all the three tactics which the NHS wants to ban in order to help them cope with the influx of patients created by winter weather and seasonal infections.

“We all aspire to avoiding doing any of those things. But trying to flog a dead horse, or to create Narnia, through a new set of executive instructions isn’t going to help us,” said Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors.

“Our urgent and emergency care system is under extreme stress going into winter. Given that hospitals are underbedded and underfunded, and emergency departments are understaffed, trying to deliver performance in that climate is nigh-on impossible. We have to define reality rather than delude ourselves about the scale of this problem of caring safely for patients during winter.”

One NHS trust chief executive, who spoke on condition of anonymity, said: “They are barking mad. Patients are waiting on corridors already. This will only get worse as we progress through winter. Twelve-hour trolley breaches in some hospitals are no longer unusual, and for some no longer cause distress or outrage as they are viewed as inevitable. The demands are not realistic.”

Disclosure of NHS England’s attempt to impose a detailed series of duties on hospitals comes amid claims by senior insiders that its leadership is in a state of panic over winter.

Theresa May has told Simon Stevens, the organisation’s chief executive, that he is “personally responsible” for how the NHS performs during what most expect to be a very tough winter, with a flu outbreak feared. Some NHS bosses believe that the prime minister’s move is intended to protect Jeremy Hunt, the health secretary, who they blame for underfunding it and presiding over huge staffing problems.

The regulator NHS Improvement warned last week that the service was already under such pressure, with hospital wards too full after the failure of a £1bn exercise to free up 2,000-3,000 beds, that it was in an “extremely challenging” position.

NHS England’s plans are laid out in a letter sent to all 233 NHS trusts and 209 clinical commissioning groups on 7 June by Pauline Philip, its national director of urgent and emergency care, headed “Winter briefing one: operational management of winter – expectations and communication”. Philip sets out actions “to consistently ensure that safety is maintained during times of significant pressure”. They include an edict that “clinical escalation will need to ensure that patients are not cared for on hospital corridors; 12-hour trolley waits in the emergency department never happen; [and] patients do not wait more than 15 minutes in ambulances before being handed over to the hospital”.

But hospital bosses claim their struggle to keep up with the sheer demand for care over winter, while maintaining patient safety, forces them to deploy the three practices Philip wants to end. Another chief executive said: “This is totally la-la land thinking. The pressure is mounting now. I don’t think any of the areas ‘to be avoided’ will be. Many chairs and non-executive directors of trusts are in complete disbelief about NHS England’s tone and approach.” Serious doubts have been raised about the ability of hospitals to do what Philip has asked. For instance, 1,597 patients had to wait at least 12 hours in an A&E unit to be admitted into the hospital itself in January to March this year, when cold weather caused a spike in illness that led to the NHS experiencing its most pressurised winter ever. So many hospitals struggled so much last January that the British Red Cross called the situation “a humanitarian crisis”.

NHS England, working alongside NHS Improvement and Public Health England, have made unprecedented joint efforts to ensure the health service can withstand this winter’s rigours. For example, NHSE has put £237m into a campaign to offer free flu jabs to a record 21m people including expanded numbers of primary schoolchildren and, for the first time, care home staff.

Chris Hopson, chief executive of NHS Providers, which represents trusts, said hospitals would do everything they could to avoid trolley waits or patients being treated on corridors, and minimise patient handover times between ambulance and A&E staff. But he added: “The indications are that flu may cause more problems than we have seen in recent years. And a prolonged cold spell – often linked to falls and respiratory problems – could make matters worse. So we need to be realistic and honest.

“Trusts cannot guarantee that these problems will not happen. What they can do – and are doing – is to have strong and well developed plans in place to identify when they are struggling to cope, so they can call on support to ensure patients get the best care possible.”

Hospitals attack ‘barking mad’ NHS target to manage winter crisis

Health service chiefs have been declared “barking mad” for ordering hospitals to ensure no patient is treated in a corridor or languishes on a trolley for hours when this year’s winter crisis hits.

NHS England’s instructions, intended to avoid a repeat of hospitals’ descent into the sort of meltdown seen last year, also say that patients should not have to wait more than 15 minutes in the back of an ambulance outside an A&E unit as they wait to be handed over to hospital staff.

Critics have described the plans, outlined in a four-page letter sent to hospital chiefs as “la-la land”, “totally unrealistic” and an attempt “to create Narnia”. Hospital bosses say they regularly have to use all the three tactics which the NHS wants to ban in order to help them cope with the influx of patients created by winter weather and seasonal infections.

“We all aspire to avoiding doing any of those things. But trying to flog a dead horse, or to create Narnia, through a new set of executive instructions isn’t going to help us,” said Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors.

“Our urgent and emergency care system is under extreme stress going into winter. Given that hospitals are underbedded and underfunded, and emergency departments are understaffed, trying to deliver performance in that climate is nigh-on impossible. We have to define reality rather than delude ourselves about the scale of this problem of caring safely for patients during winter.”

One NHS trust chief executive, who spoke on condition of anonymity, said: “They are barking mad. Patients are waiting on corridors already. This will only get worse as we progress through winter. Twelve-hour trolley breaches in some hospitals are no longer unusual, and for some no longer cause distress or outrage as they are viewed as inevitable. The demands are not realistic.”

Disclosure of NHS England’s attempt to impose a detailed series of duties on hospitals comes amid claims by senior insiders that its leadership is in a state of panic over winter.

Theresa May has told Simon Stevens, the organisation’s chief executive, that he is “personally responsible” for how the NHS performs during what most expect to be a very tough winter, with a flu outbreak feared. Some NHS bosses believe that the prime minister’s move is intended to protect Jeremy Hunt, the health secretary, who they blame for underfunding it and presiding over huge staffing problems.

The regulator NHS Improvement warned last week that the service was already under such pressure, with hospital wards too full after the failure of a £1bn exercise to free up 2,000-3,000 beds, that it was in an “extremely challenging” position.

NHS England’s plans are laid out in a letter sent to all 233 NHS trusts and 209 clinical commissioning groups on 7 June by Pauline Philip, its national director of urgent and emergency care, headed “Winter briefing one: operational management of winter – expectations and communication”. Philip sets out actions “to consistently ensure that safety is maintained during times of significant pressure”. They include an edict that “clinical escalation will need to ensure that patients are not cared for on hospital corridors; 12-hour trolley waits in the emergency department never happen; [and] patients do not wait more than 15 minutes in ambulances before being handed over to the hospital”.

But hospital bosses claim their struggle to keep up with the sheer demand for care over winter, while maintaining patient safety, forces them to deploy the three practices Philip wants to end. Another chief executive said: “This is totally la-la land thinking. The pressure is mounting now. I don’t think any of the areas ‘to be avoided’ will be. Many chairs and non-executive directors of trusts are in complete disbelief about NHS England’s tone and approach.” Serious doubts have been raised about the ability of hospitals to do what Philip has asked. For instance, 1,597 patients had to wait at least 12 hours in an A&E unit to be admitted into the hospital itself in January to March this year, when cold weather caused a spike in illness that led to the NHS experiencing its most pressurised winter ever. So many hospitals struggled so much last January that the British Red Cross called the situation “a humanitarian crisis”.

NHS England, working alongside NHS Improvement and Public Health England, have made unprecedented joint efforts to ensure the health service can withstand this winter’s rigours. For example, NHSE has put £237m into a campaign to offer free flu jabs to a record 21m people including expanded numbers of primary schoolchildren and, for the first time, care home staff.

Chris Hopson, chief executive of NHS Providers, which represents trusts, said hospitals would do everything they could to avoid trolley waits or patients being treated on corridors, and minimise patient handover times between ambulance and A&E staff. But he added: “The indications are that flu may cause more problems than we have seen in recent years. And a prolonged cold spell – often linked to falls and respiratory problems – could make matters worse. So we need to be realistic and honest.

“Trusts cannot guarantee that these problems will not happen. What they can do – and are doing – is to have strong and well developed plans in place to identify when they are struggling to cope, so they can call on support to ensure patients get the best care possible.”

E-cigarettes containing nicotine linked to raised heart attack risk

E-cigarettes containing nicotine could increase the risk of heart attacks and strokes, researchers have found.

A study discovered that vaping devices containing the stimulant could cause a stiffening of the arteries, as well as an increased heart rate and blood pressure.

Swedish scientists recruited 15 healthy volunteers to take part in the experiment, none of whom had used e-cigarettes before.

The tests found in the 30 minutes after smoking the e-cigarettes containing nicotine, there was a significant increase in blood pressure, heart rate and arterial stiffness.

There was no such effect in the volunteers who smoked the e-cigarettes without nicotine.

Dr Magnus Lundback of the Karolinska Institute, a medical university in Stockholm, said: “The number of e-cigarette users has increased dramatically in the last few years. E-cigarettes are regarded by the general public as almost harmless.

“The industry markets their product as a way to reduce harm and to help people to stop smoking tobacco cigarettes. However, the safety of e-cigarettes is debated, and a growing body of evidence is suggesting several adverse health effects.

“The results are preliminary, but in this study we found there was a significant increase in heart rate and blood pressure in the volunteers who were exposed to e-cigarettes containing nicotine. Arterial stiffness increased around three-fold in those who were exposed to nicotine-containing e-cigarettes compared with the nicotine-free group.”

While the effects seen in the tests were temporary, Lundback said that chronic exposure to e-cigarettes with nicotine could have permanent effects.

E-cigarettes containing nicotine linked to raised heart attack risk

E-cigarettes containing nicotine could increase the risk of heart attacks and strokes, researchers have found.

A study discovered that vaping devices containing the stimulant could cause a stiffening of the arteries, as well as an increased heart rate and blood pressure.

Swedish scientists recruited 15 healthy volunteers to take part in the experiment, none of whom had used e-cigarettes before.

The tests found in the 30 minutes after smoking the e-cigarettes containing nicotine, there was a significant increase in blood pressure, heart rate and arterial stiffness.

There was no such effect in the volunteers who smoked the e-cigarettes without nicotine.

Dr Magnus Lundback of the Karolinska Institute, a medical university in Stockholm, said: “The number of e-cigarette users has increased dramatically in the last few years. E-cigarettes are regarded by the general public as almost harmless.

“The industry markets their product as a way to reduce harm and to help people to stop smoking tobacco cigarettes. However, the safety of e-cigarettes is debated, and a growing body of evidence is suggesting several adverse health effects.

“The results are preliminary, but in this study we found there was a significant increase in heart rate and blood pressure in the volunteers who were exposed to e-cigarettes containing nicotine. Arterial stiffness increased around three-fold in those who were exposed to nicotine-containing e-cigarettes compared with the nicotine-free group.”

While the effects seen in the tests were temporary, Lundback said that chronic exposure to e-cigarettes with nicotine could have permanent effects.

Anti-inflammatory drugs may lower heart attack risk, study finds

Anti-inflammatory injections could lower the risk of heart attacks and may slow the progression of cancer, a study has found, in what researchers say is the biggest breakthrough since the discovery of statins.

Heart attack survivors given injections of a targeted anti-inflammatory drug called canakinumab had fewer attacks in the future, scientists found. Cancer deaths were also halved in those treated with the drug, which is normally used only for rare inflammatory conditions.

Statins are the mainstay drugs for heart attack prevention and work primarily by lowering cholesterol levels. But a quarter of people who have one heart attack will suffer another within five years despite taking statins regularly. It is believed this is because of unchecked inflammation within the heart’s arteries.

The research team, led from Brigham and Women’s Hhospital in Boston, tested whether targeting the inflammation with a potent anti-inflammatory agent would provide an extra benefit over statin treatment.

The researchers enrolled more than 10,000 patients who had had a heart attack and had a positive blood test for inflammation into the trial, known as the Cantos study. All patients received high doses of statins as well as either canakinumab or a placebo, both administered by injection every three months. The trial lasted for four years.

For patients who received the canakinumab injections the team reported a 15% reduction in the risk of a cardiovascular event, including fatal and non-fatal heart attacks and strokes. Also, the need for expensive interventional procedures, such as bypass surgery and inserting stents, was cut by more than 30%. There was no overall difference in death rates between patients on canakinumab and those given placebo injections, and the drug did not change cholesterol levels.

Dr Paul Ridker, who led the research team, said the study “usher in a new era of therapeutics”.

“For the first time, we’ve been able to definitively show that lowering inflammation independent of cholesterol reduces cardiovascular risk,” he said.

“This has far-reaching implications. It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to significantly improve outcomes for certain very high-risk populations.”

The hospital said the reductions in risk were “above and beyond” those seen in patients who only took statins.

Ridker said the study showed that the use of anti-inflammatories was the next big breakthrough following the linkage of lifestyle issues and then statins.

“In my lifetime, I’ve gotten to see three broad eras of preventative cardiology,” he said. “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. This is very exciting.”

But there were some downsides to the treatment. The researchers reported an increase in the chances of dying from a severe infection of about one for every 1,000 people treated, although this was offset by an unexpected halving of cancer deaths across all cancer types. In particular, the odds of succumbing to lung cancer were cut by over 75%, for reasons the team do not yet understand. The researchers are planning further trials to investigate canakinumab’s potentially protective effect against cancer.

Dr Paul Ridker, who led the study, which was published in the New England Journal of Medicine, said it had far-reaching implications.

“It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to improve outcomes for certain very high-risk populations,” he said.

Prof Martin Bennett, a cardiologist from Cambridge who was not involved in the study, said the trial results were an important advance in understanding why heart attacks happen. But, he said, he had concerns about the side effects, the high cost of the drug and the fact that death rates were not better in those given the drug.

“Treatment of UK patients is unlikely to change very much as a result of this trial, but the results do support investigation of other drugs that inhibit inflammation for cardiovascular disease, and the use of this drug in cancer,” he said.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, was optimistic about the trial opening the door to new types of treatment for heart attacks.

“Nearly 200,000 people are hospitalised due to heart attacks every year in the UK,” Pearson said. “Cholesterol-lowering drugs like statins are given to these people to reduce their risk of another heart attack and this undoubtedly saves lives. But we know that lowering cholesterol alone is not always enough.

“These exciting and long-awaited trial results finally confirm that ongoing inflammation contributes to risk of heart disease, and [lowering it] could help save lives.”

Anti-inflammatory drugs may lower heart attack risk, study finds

Anti-inflammatory injections could lower the risk of heart attacks and may slow the progression of cancer, a study has found, in what researchers say is the biggest breakthrough since the discovery of statins.

Heart attack survivors given injections of a targeted anti-inflammatory drug called canakinumab had fewer attacks in the future, scientists found. Cancer deaths were also halved in those treated with the drug, which is normally used only for rare inflammatory conditions.

Statins are the mainstay drugs for heart attack prevention and work primarily by lowering cholesterol levels. But a quarter of people who have one heart attack will suffer another within five years despite taking statins regularly. It is believed this is because of unchecked inflammation within the heart’s arteries.

The research team, led from Brigham and Women’s Hhospital in Boston, tested whether targeting the inflammation with a potent anti-inflammatory agent would provide an extra benefit over statin treatment.

The researchers enrolled more than 10,000 patients who had had a heart attack and had a positive blood test for inflammation into the trial, known as the Cantos study. All patients received high doses of statins as well as either canakinumab or a placebo, both administered by injection every three months. The trial lasted for four years.

For patients who received the canakinumab injections the team reported a 15% reduction in the risk of a cardiovascular event, including fatal and non-fatal heart attacks and strokes. Also, the need for expensive interventional procedures, such as bypass surgery and inserting stents, was cut by more than 30%. There was no overall difference in death rates between patients on canakinumab and those given placebo injections, and the drug did not change cholesterol levels.

Dr Paul Ridker, who led the research team, said the study “usher in a new era of therapeutics”.

“For the first time, we’ve been able to definitively show that lowering inflammation independent of cholesterol reduces cardiovascular risk,” he said.

“This has far-reaching implications. It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to significantly improve outcomes for certain very high-risk populations.”

The hospital said the reductions in risk were “above and beyond” those seen in patients who only took statins.

Ridker said the study showed that the use of anti-inflammatories was the next big breakthrough following the linkage of lifestyle issues and then statins.

“In my lifetime, I’ve gotten to see three broad eras of preventative cardiology,” he said. “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. This is very exciting.”

But there were some downsides to the treatment. The researchers reported an increase in the chances of dying from a severe infection of about one for every 1,000 people treated, although this was offset by an unexpected halving of cancer deaths across all cancer types. In particular, the odds of succumbing to lung cancer were cut by over 75%, for reasons the team do not yet understand. The researchers are planning further trials to investigate canakinumab’s potentially protective effect against cancer.

Dr Paul Ridker, who led the study, which was published in the New England Journal of Medicine, said it had far-reaching implications.

“It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to improve outcomes for certain very high-risk populations,” he said.

Prof Martin Bennett, a cardiologist from Cambridge who was not involved in the study, said the trial results were an important advance in understanding why heart attacks happen. But, he said, he had concerns about the side effects, the high cost of the drug and the fact that death rates were not better in those given the drug.

“Treatment of UK patients is unlikely to change very much as a result of this trial, but the results do support investigation of other drugs that inhibit inflammation for cardiovascular disease, and the use of this drug in cancer,” he said.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, was optimistic about the trial opening the door to new types of treatment for heart attacks.

“Nearly 200,000 people are hospitalised due to heart attacks every year in the UK,” Pearson said. “Cholesterol-lowering drugs like statins are given to these people to reduce their risk of another heart attack and this undoubtedly saves lives. But we know that lowering cholesterol alone is not always enough.

“These exciting and long-awaited trial results finally confirm that ongoing inflammation contributes to risk of heart disease, and [lowering it] could help save lives.”

Anti-inflammatory drugs may lower heart attack risk, study finds

Anti-inflammatory injections could lower the risk of heart attacks and may slow the progression of cancer, a study has found.

Heart attack survivors given injections of a targeted anti-inflammatory drug called canakinumab had fewer attacks in the future, scientists found. Cancer deaths were also halved in those treated with the drug, which is normally used only for rare inflammatory conditions.

Statins are the mainstay drugs for heart attack prevention and work primarily by lowering cholesterol levels. But a quarter of people who have one heart attack will suffer another within five years despite taking statins regularly. It is believed this is because of unchecked inflammation within the heart’s arteries.

The research team, led from Brigham and Women’s hospital in Boston, tested whether targeting this inflammation with a potent anti-inflammatory agent would provide an extra benefit over statin treatment.

They enrolled more than 10,000 patients who had had a heart attack and had a positive blood test for inflammation into the trial, known as the Cantos study. All patients received high doses of statins as well as either canakinumab or a placebo, both administered by injection every three months. The trial lasted for four years.

For patients who received the canakinumab injections the team reported a 15% reduction in the risk of a cardiovascular event, including fatal and non-fatal heart attacks and strokes. Also, the need for expensive interventional procedures, such as bypass surgery and inserting stents, was cut by more than 30%. There was no overall difference in death rates between patients on canakinumab and those given placebo injections, and the drug did not change cholesterol levels.

But there were some downsides to the treatment. The researchers reported an increase in the chances of dying from a severe infection of about one for every 1,000 people treated, although this was offset by an unexpected halving of cancer deaths across all cancer types. In particular, the odds of succumbing to lung cancer were cut by over 75%, for reasons the team do not yet understand. The researchers are planning further trials to investigate canakinumab’s potentially protective effect against cancer.

Dr Paul Ridker, who led the study, which was published in the New England Journal of Medicine, said it had far-reaching implications.

“It tells us that by leveraging an entirely new way to treat patients – targeting inflammation – we may be able to improve outcomes for certain very high-risk populations,” he said.

Prof Martin Bennett, a cardiologist from Cambridge who was not involved in the study, said the trial results were an important advance in understanding why heart attacks happen. But, he said, he had concerns about the side effects, the high cost of the drug and the fact that death rates were not better in those given the drug.

“Treatment of UK patients is unlikely to change very much as a result of this trial, but the results do support investigation of other drugs that inhibit inflammation for cardiovascular disease, and the use of this drug in cancer,” he said.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, was optimistic about the trial opening the door to new types of treatment for heart attacks.

“Nearly 200,000 people are hospitalised due to heart attacks every year in the UK,” Pearson said. “Cholesterol-lowering drugs like statins are given to these people to reduce their risk of another heart attack and this undoubtedly saves lives. But we know that lowering cholesterol alone is not always enough.

“These exciting and long-awaited trial results finally confirm that ongoing inflammation contributes to risk of heart disease, and [lowering it] could help save lives.”