Trial gives hope for less invasive heart procedures

Tablets are as effective as invasive heart procedures in preventing some major heart problems, a study supported by the NIHR has found.

Researchers believe the study, called ISCHEMIA, will lead to a shift in the number of patients undergoing surgery for heart disease in favour of tablet medication.

Major heart events such as death and heart attacks could be prevented in patients with stable ischemic heart disease, which is caused by narrowed heart arteries.

More than 5,000 patients took part in the global trial, led in the UK by the NIHR Clinical Research Network (CRN) North West London.

Northwick Park and Hammersmith hospitals delivered the trial in North West London. Northwick Park became the second largest global recruiter with over 200 patients.

Over 130,000 people undergo invasive heart procedures to open up or bypass blocked arteries in the UK every year.

Professor Senior, Consultant Cardiologist at the Royal Brompton Hospital, London and Northwick Park Hospital, Harrow, said: “It’s a game changer on several levels. Coronary Heart disease is one of the biggest killers in the UK. Any invasive procedure carries an inherent risk with many patients understandably anxious about undergoing an invasive procedure.

“In this group of patients with stable symptoms, we now know that it is safe initially to treat them with tablets reserving invasive procedures for those with continued chest pain - a huge reassurance to patients and a potential for substantial cost saving for the health service.”

At present, patients have two interventional options to restore blood flow throughout the heart. One is an open bypass such as where a vein is harvested from the leg or an artery from the chest and used to bypass a blocked or a very narrow artery in the heart. The second is the insertion of a small wire mesh called a stent which forces the artery back open.

Professor Senior added: “The main cause of coronary heart disease is the build-up of plaque in the artery walls which may severely limit blood flow to heart muscle giving rise to chest pain or may even suddenly block the artery by breakdown of the plaque which leads to heart attack and death.

“The tablets like statins and newer counterparts diminish the build-up of plaque, reduce progression of the already formed plaque and reduce the tendency to rupture. Their development and refinement over the past 10 years has been quite extraordinary.

“We aren’t talking about the fabled pill to cure all ills but it is never-the-less an impressive conclusion to a very comprehensive study. Some of the tablets such as aspirin and beta blockers have been used for many years, but we now have more treatment options for risk factors such as a high cholesterol.

"We also recognise the importance of making sure blood pressure is closely monitored and controlled and total avoidance of smoking along with exercise and high quality diet."

Thank you to the Communications Team at London North West University Healthcare NHS Trust for conducting the interview with Professor Roxy Senior, which was published in the original article on their website.