The long-awaited IMPROVE-IT trial was presented last month at the American Heart Association Scientific Sessions. Here are the presentation slides:
IMPROVE-IT was a trial that tested the ability of ezetimibe (Zetia) to lower the risk of heart attacks and strokes when added to simvastatin. See Larry Husten’s background post here, and if you type “ezetimibe” in the search box on this blog or on the Gooznews blog, you will find some previous posts of mine relating to ezetimibe. I admit I was a bit surprised that the trial was positive. I was expecting it to be negative, based on the negative results of the ENHANCE trial. Still, the benefit was small, a 6.4% reduction in risk of the primary endpoint (composed of cardiovascular death, heart attack, unstable angina requiring hospitalization, coronary revascularization, and stroke). In the high-risk trial participants — all patients who had been hospitalized for acute coronary syndrome within the 10 days before randomization — this translated to a 2% absolute benefit over 7 years. Of note, there was no reduction in all-cause or cardiovascular mortality.
I only want to make a few comments now, but I intend to write more when the trial is published. First, a 6.4% reduction is risk is a very small benefit, and many people would only consider that reduction in risk meaningful in a high risk population. Second, it is regrettable that we had to wait 12 years after the drug’s approval to find out whether it improves outcomes.
Here are great summaries by Larry Husten and Matt Herper. And here is a video of Harlan Krumholz giving his take on the results.
Addendum, May 5, 2015: Unfortunately, the GoozNews blog is no longer up on the web. I asked Merrill Goozner what happened and he said he decided to stop paying the annual fee for the website. So the posts I wrote on ezetimibe for GoozNews are no longer up.
Heart and Stroke Foundation “make death wait” campaign: effective advocacy or unnecessary scare tactics?
I would be interested to know what my readers think of the two Heart and Stroke Foundation of Canada (HSF) ads shown below. The ads are part of HSF’s “Make death wait” awareness and fundraising campaign that’s been going on for the last few months. In the first ad, shown in this You Tube video, several different women are shown as a male voice, meant to personify death, intones “I love women. I love older women, professional women, stay-at-home moms. I love how women put their family first. I love how you’re so concerned that I’ll get to your husband.” In the last scene a woman in a bathing suit looks apprehensively over her shoulder as the voice warns, “You have no idea that I’m coming after you.” Eileen Melnick McCarthy, director of communications for the foundation, told a reporter that the intent of the campaign is to “wake up Canadians to the threat of heart disease and stroke.”
In addition, the print ad that appears below has appeared in a Canadian magazine. The copy, in case you can’t make it out, reads as follows:
Death loves menopause. He loves that menopause makes women more vulnerable to heart disease and stroke. And that women are far more likely to die of a heart attack. Most of all, he loves that heart disease and stroke is the #1 killer of women. Please donate, and make death wait.
Is this a legitimate way to “wake up” people to the threat of cardiovascular disease? Or unnecessary and counterproductive scare tactics? I lean toward the latter.
Review of CNN special “The Last Heart Attack”
I have a guest post up on Gary Schwitzer’s blog critiquing Sanjay Gupta’s promotion of calcium scans and overhyping of extreme diets.