Regular pill popping decreases heart risks
Daily
placebo works better than taking an active drug irregularly. When it comes to heart disease,
it may not be what pill you take, but how regularly you take it that is
important. The finding controversially implies that so long as patients
stick to a daily regime, they would do just as well with a placebo. Bradi Granger of Duke
University in Durham, North Carolina, and her colleagues re-analysed the
results of a clinical trial involving nearly 7,600 heart-failure patients
who were testing an experimental angiotensin receptor blocker (ARB), which
relaxes blood vessels and lowers blood pressure. Patients who took their pills
every day halved their risk of dying by the end of the study, compared
with those who skipped pills, Granger's team found, regardless of whether
they took the drug or a placebo. Those who stuck to their pills were also
less likely to spend time in hospital, she revealed this week at the
American Heart Association meeting in New Orleans. Experts suspect that those who
stick to their medicine are also more likely to stick to other
heart-healthy activities such as regular exercise, good diet and not
smoking or drinking. These behaviours alone probably outweigh the
physiological effect of the drug. If doctors could identify those
patients who are unlikely to take their drugs regularly, Granger believes
that they could be targeted with education or social support that would
encourage them to follow a healthier lifestyle. "It is a direction people
are taking," agrees Hayden Bosworth who studies patient motivation at
Durham Veterans Affairs Medical Center in North Carolina. Some
researchers, for example, are examining whether there are biochemical
tests that would reliably show whether people are taking their drugs
regularly. Place
for placebos The drug in the recent study is
called candesartan cilexetil and is marketed in the US by AstraZeneca as
Atacand; it and many other drugs in its class are routinely used to treat
high blood pressure. Cardiovascular disease, including high blood
pressure, heart attacks and strokes, accounts for nearly 30% of total
deaths in the world. Two other earlier
investigations have also shown that patients with heart disease get
benefits from taking a regular placebo that almost match those provided by
beta-blockers or lipid-lowering drugs. But researchers have struggled to
explain exactly what is different about those who follow their doctor's
instructions compared with those who flout them. Another, more controversial,
implication of the new results is that those people who are diligent about
taking their drugs and following a healthy lifestyle might reap the same
benefit if they cut their dose or switched from active drugs to a cheaper
placebo. "It's definitely worth a study," Granger says. A separate study published last
week in The
Lancet
questioned the effectiveness of another widely used
blood-pressure-lowering drug, a beta-blocker called atenolol. In an
analysis of nine earlier studies, the drug was found to be less effective
than other drugs and no better than a placebo at reducing deaths from
heart attacks. 按时服药降低心脏病发作 Helen
Pearson （海伦 皮尔森） 按时服用安慰剂比无规律服药更有效 对于心脏病人来说，重要的不是你服什么药，而是你是否按时服药。研究发现表明，只要病人严格按照要求服药，就是服用安慰剂效果也是一样的。 北卡罗来纳州德哈姆市Duke大学的
Bradi Granger 和她的同事对7600位心衰病人服用扩张血管和降血压药物angiotensin
receptor blocker（血管紧张素受体拮抗剂）后的临床实验结果重新作了分析。 Granger小组的研究发现，每天服药的病人，不管他们是服用药物还是安慰剂，他们的死亡机率比那些漏服药物的病人降低了一半。本周，Granger在新奥尔良召开的美国心脏病协会会议上指出，那些按时服药的病人住院的时间相对更短。 专家们对那些能按时服药，同时又参加对心脏健康有益的活动，如定期锻炼、注意饮食、不抽烟和喝酒的这部分病人提出了质疑，因为这些习惯本身可能比药物更有效。 Granger认为，如果医生能确定哪些病人不按时服药，那么应该对这些人进行教育或得到必要的社会支持，以鼓励他们采取健康的生活方式。 研究病人行为动机的北卡罗来纳州德哈姆退伍军人医疗中心的Hayden
Bosworth对此表示赞同，他说：“人们正在接受这种指导。”一些研究者也正在探索是否有生化指标能可靠地知道病人是否按时服药。 替代安慰剂 AstraZeneca
as Atacand公司生产的新药candesartan
cilexetil现正在美国市场上销售，它和其它同类的药物一样通常是用来治疗高血压的。高血压、心脏病和中风等心血管疾病占世界死亡率的近30%。 其它两项早期调查也表明，心脏病病人按时服用安慰剂是有益处的，因为安慰剂与ß阻断剂或降脂药物几乎是一类的。但是研究人员也曾对那些按医嘱服药的和那些没有按照医嘱服药的到底存在哪些不同作过解释。 此外更有争议的是，那些按时服药又采取健康生活方式的人即使他们减少药物剂量或者服用较廉价的安慰剂来取代药物也可能会获得同样的疗效，Granger说：“这确实值得进一步研究。” 上周发表在The
Lancet（柳叶刀）上的另一项独立研究对另一种广泛使用药物atenolol
ß阻断剂的降血压疗效提出了质疑，九项初步研究表明，该药物在降低心脏病死亡方面比其它药物更差，也不比安慰剂好。 朱函亭译自www.nature.com
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