The £2-a-day heart pill that could save thousands of lives a year (?)

A bit of understandable but quite excessive enthusiasm about some very limited findings. The journal article is "Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms". The study was not of a normal population but of people who already had heart disease and who were taking the pill in conjunction with other heart medications. The pill reduced deaths or hospitalizations from 25.9% to 18.3% in the patients concerned. A worthy start but not a lot to write home about for the man in the street.

It's also a pity that the study was terminated early. That was ethically cautious but not very scientific. Trends observed over a short time period often do not persist over a longer period. See one rather spectacular example of that here

Note also that the hazard ratio (.76) was well below what is acceptable as indicating causation (2.0). Even at this stage then, the finding is a weak basis for public or private policy.

A heart disease pill costing just £2 a day could save tens of thousands of lives a year, scientists claim. The drug promises to revolutionise the treatment of Britain’s biggest killer and prevent many people being admitted to hospital. Eplerenone apparently reduces the risk of death by almost 40 per cent. Patients are also far less likely to need long-term care or need surgery such as bypass operations.

Researchers say their findings have ‘huge public health implications’ and could potentially cut millions from the NHS bill for treatment. Currently, doctors give patients the pill, also known Inspra, only if the standard medications do not work.

Heart disease patients are normally prescribed treatments including aspirin and anticoagulants to prevent the blood clotting, statins to lower cholesterol and beta blockers for high blood pressure.

However, the researchers say that if all heart disease patients were also prescribed the drug it would save millions every year through cost of treatment and loss of earnings.

The daily pill costs between £1.50 and £2 a day. It works by reducing the effects of the potentially harmful hormones cortisol and aldosterone, which are produced excessively in those with heart disease.

The University of Glasgow researchers – in collaboration with doctors from France, the U.S., Sweden and the Netherlands – compared the effects of the drug on almost 3,000 patients over four years. Their study, published in the New England Journal of Medicine, showed that those who took the drug were 37 per cent less likely to die or need hospital treatment.

Researcher Professor John McMurray, from the Institute of Cardiovascular and Medical Sciences at the University of Glasgow, said: ‘This trial will change the way we manage our patients. ‘Everyone with heart failure should be considered for treatment with a drug of this type – it will make patients feel better, stay out of hospital and live longer. ‘Eplerenone is not expensive and there is a related, generic drug, spironolactone, with similar properties, which is likely to have similar effects. ‘This type of treatment should be available and affordable across the globe. ‘Our trial has huge public health implications.’


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