Newswise — Listen -- do you want to know a secret? Do you promise not to tell? The Fab Four are back, and they're heading straight for the hearts of millions. It's enough to make you want to "Twist and Shout" !
No, it's not the Beatles. This Fab Four is a combination of four kinds of medicines that can protect the heart — and maybe save the life — of almost anyone who has ever had a heart attack or chest pain.
Although each one of them is great as a solo artist, the Fab Four are even better in concert as a group, say University of Michigan doctors. They "Come Together" to lower cholesterol and blood pressure, slow the heartbeat and keep blood flowing.
This makes it possible for the heart to be "Getting Better All the Time" and reduces the chances of problems in the future, down the "Long and Winding Road." And best of all, the drugs don't have to cost a lot of "Money."
In fact, the Fab Four offer just the kind of "Help!" that millions of people with heart trouble and high heart disease risk could use. But many of those who could benefit from this drug combo haven't heard the news.
That's why a U-M Cardiovascular Center leader is working "Eight Days a Week" to spread the word about the Fab Four.
Kim Eagle, M.D., hopes that anyone old enough to remember the Beatles will pay attention to the news about the Fab Four. That's because people in their 40s, 50s and 60s have a serious and growing risk of a first heart attack, or a first attack of a kind of chest pain called unstable angina, which is a warning sign for heart problems.
Eagle and his colleagues recently published a study showing that heart attack and unstable angina patients who took all the Fab Four drugs after they got home from the hospital were much less likely to die than people who didn't take any of the four.
"Our estimates are that it could be as much as a 90 percent reduction in their risk of having another event, such as another heart attack or sudden cardiac death," says Eagle, the clinical director of the U-M Cardiovascular Center. "If we look at the potential benefit of these classes of medications, we truly see a multiplied effect."
Just who are the Fab Four, anyway? Well, the group's members have names that aren't quite as catchy as John, Paul, George and Ringo. Instead, they go by the names of aspirin, beta blockers, ACE inhibitors and cholesterol-lowering drugs.
Think of aspirin as the low-key guitar player of the group. It's inexpensive and capable of making the blood's platelets less likely to stick together and clog the blood vessels. And it's available for pennies a pill at drugstores everywhere.
Beta blockers are like the cool drum player who keeps the beat steady, slowing down a heart that's trying to race or beat with an irregular tempo because of too much adrenaline. Beta blockers also help keep blood pressure down. There are many kinds of beta blockers available, and all of them are available in an inexpensive generic form.
ACE inhibitors are the laid-back bass players of the group, keeping the blood pressure low, low, low. They do this by relaxing the walls of the blood vessels, letting more blood flow through and reducing the risk that the flow will get cut off and cause angina or a heart attack. Just like beta blockers, there are several kinds of ACE inhibitors available, all as inexpensive generics.
Cholesterol-lowering drugs are the flamboyant lead singers of the group. They get all the attention because of the flashy advertising that drug companies put out about them. But don't get them wrong: These drugs, mainly the kind called statins, are very good at what they do. By reducing the level of "bad" cholesterol in the blood, they prevent new plaque from building up inside blood vessels and reduce the risk that the plaque will clog the blood flow.
Nearly 8 million Americans alive today have survived a heart attack, and almost 7 million have had angina. Nearly all of them should be saying "Got to Get You Into My Life" about the Fab Four.
"The burden of cardiovascular disease in our society is astonishing," says Eagle. "It's responsible for 40 to 50 percent of the deaths in this state and the nation. That means 35,000 Michiganians will die this year of cardiovascular disease, which translates into about 80 to 100 deaths a day. And this doesn't even begin to include stroke and other vascular disorders affecting, for example, the lower extremities. It's an incredibly common problem."
These days, doctors can do more than they could do "Yesterday" to save the lives of the million or so people who make it to a hospital each year after suffering a heart attack, and the million or so who visit a hospital for chest pain. "More than a million coronary angioplasties are done per year, and three-quarters of a million coronary bypass operations," says Eagle.
As a result, more people are living through heart attacks — and going home with a cloud of risk over their heads, because those who have had one heart attack or chest pain episode are most likely to have another. The Fab Four can help reduce that risk, says Eagle. If someone starts taking all four drugs when they go home from the hospital after a heart attack or angina episode, "It Won't Be Long" before they dramatically reduce their chance of another heart-related crisis.
How much does this drug combo help heart patients? Eagle and his colleagues began their study thinking that the benefit would be about the same as if you added up the known benefit of each of the types of drugs. But the effect, they found, is even greater — as if the drugs multiplied each others' effect. Eagle and his colleagues saw a 90 percent reduction in risk of another heart attack or death within 6 months of the patients' departure from the hospital. It's as if the four drugs were singing "With a Little Help From My Friends" in harmony.
Of course, not everyone can take all of the Fab Four drugs, whether due to another medical condition or side effects. But a bigger issue is the fact that many people never get all four because doctors and hospitals forget or neglect to prescribe them.
"Study after study shows that nationally we are underachieving in getting each of these possibly therapeutic drugs to our patients," says Eagle.
That's why it's important for patients to know about the Fab Four, and to ask their doctors if they should be taking one drug from each of the four classes. And it's why the U-M research on the Fab Four is so important — it's spreading the word among doctors and hospitals about how beneficial these drugs can be when taken together.
Eagle and his colleagues have also found ways to make sure that every patient going home from the hospital after a heart attack or angina attack gets as many of the Fab Four drugs as he or she qualifies for. "By using guidelines that are embedded in the way we deliver care, and other tools, we're seeing a steady increase in the number of eligible patients getting the right medications. It's going to have a big impact," he predicts.
And paying for the Fab Four won't send patients too far down "Penny Lane," because three of the four drug classes have medicines available as inexpensive generics.
So, heart attack survivors and angina sufferers, don't be a "Nowhere Man" (or woman) and just "Let it Be." Talk to your doctor today about whether the Fab Four could be a good combo for you " or about getting a prescription for any of the members of this quartet you don't already have. Even if you haven't had a heart attack, you may be a good Fab Four candidate if your cholesterol and blood pressure are high, and you have a family history of heart problems.
And in the end, as the Beatles might have said, the effort you make could be equal to the benefit you'll take.
Facts about the Fab Four and heart disease:
The "Fab Four" of heart medications include one drug from each of the four following classes of medicines: aspirins or anti-platelet agents, beta blockers, ACE inhibitors and cholesterol-lowering agents.
There are many medicines in each category, but three of the categories have many options for generic drugs that are very inexpensive. The exception is the cholesterol-lowering drugs, which are mainly available as name brands.
The Fab Four are most appropriate for people who have already had a heart attack or an episode of heart-related chest pain called angina. But people with a high risk of suffering a heart attack, such as those with high blood pressure and cholesterol and a family history of heart disease, may also benefit.
A University of Michigan study showed that the risk of dying or having a heart attack within 6 months of leaving the hospital was 90 percent lower for heart attack and angina patients who took all four Fab Four drugs than for those who took none.Many doctors and hospitals still aren't making sure that patients get prescriptions for the Fab Four, although efforts are under way to improve that. In the meantime, patients should ask their doctors if the Fab Four is right for them.
For more information, visit these web sites or call these numbers: U-M Cardiovascular Center: http://www.med.umich.edu/cvc
Fab Four study summary: http://www.med.umich.edu/opm/newspage/2004/fourdrugcombo.htm
NHLBI Reducing Heart Attack Risk: http://www.nhlbi.nih.gov/actintime/rhar/rhar.htm
Written by Kara Gavin
RSS