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[The best of clinical pharmacology in 2002]
M Andréjak1, J L Gayet, P Ambrosi
1Service de pharmacologie clinique, CHU, hôpital Sud, 80054 Amiens.
Insights
In 2002, cardiovascular trials showed losartan benefits stroke prevention, while statins proved effective for secondary prevention regardless of LDL-cholesterol levels. New drugs like ezetimibe and nesiritide showed promise for heart conditions.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- 2002 saw significant cardiovascular trial results impacting treatment strategies.
- Focus on morbidity, mortality, and specific drug efficacy in various cardiovascular conditions.
Purpose of the Study:
- To summarize key findings from major cardiovascular therapeutic trials reported in 2002.
- To highlight advancements in drug therapy, interventional cardiology, and preventative strategies.
Main Methods:
- Review of published results from large-scale clinical trials (LIFE, OPTIMAAL, IONA, HPS, LIPS, RAVEL, WHI).
- Analysis of drug efficacy for conditions including hypertension, post-myocardial infarction, angina, and heart failure.
- Evaluation of interventional procedures (drug-eluting stents) and novel drug classes (ezetimibe, nesiritide, levosimendan).
Main Results:
- Losartan superior to atenolol for cardiovascular prevention (LIFE), but disappointing post-MI (OPTIMAAL).
- Nicorandil showed benefits in angina and mortality (IONA); statins effective in secondary prevention (HPS) and post-angioplasty (LIPS).
- Drug-eluting stents showed promise; ezetimibe, nesiritide, and levosimendan demonstrated potential; omapatrilate did not outperform ACE inhibitors.
Conclusions:
- 2002 marked progress in cardiovascular disease management through pharmacotherapy and interventional techniques.
- Statins and specific antihypertensives offer significant benefits, while novel agents require further study.
- Hormonal substitution therapy's cardiovascular risks were re-evaluated.
Abstract:
The results of several large therapeutic cardiovascular trials were reported in 2002. The LIFE study concluded that losartan is superior compared to atenolol in terms of prevention of cardiovascular morbidity and mortality, the benefit being for CVA without changing the incidence of myocardial infarction. The OPTIMAAL study stated the disappointing results of post-infarct losartan. The IONA study represents a first demonstration with nicorandil of benefit not only in angina crises but equally on cardiac morbidity and mortality. The HPS study confirms the benefit of a statin in secondary prevention but for the first time, no matter what the initial level of LDL-cholesterol. Finally in the LIPS study, it is reported that statins reduce major cardiovascular events after coronary angioplasty. The year 2002 was marked elsewhere by imagination after the publication of the RAVEL study on coated stents delivering anti-proliferative drugs in order to avoid coronary restenosis. Three drugs were the subject of work confirming their potential significance in cardiovascular pathology: a) ezetimibe, representing a new class of cholesterol lowering drugs with which the association with statins seems especially synergic, b) nesiritide recombinant type B natriuretic peptide, whose significance was confirmed in acute cardiac insufficiency. c) levosimendan (calcium sensitisor) which moreover can be a significant treatment in cardiac decompensation as suggested by the LIDO study with a follow up of 180 days. By contrast, omapatrilate did not confirm its potential superiority over ACE inhibitors in the treatment of cardiac insufficiency. Some encouraging data were reported in 2002 in the field of therapeutic angiogenesis as much at the myocardial level as in lower limb arteritis. Finally, 2002 was marked by the publication of the WHI study which intensified suspicions regarding hormonal substitution treatment, confirming the advantage of not only secondary but perhaps primary cardiovascular prevention.