Puffe 1

Kelsey Puffe

Current Issues in Nutrition

Ellen Johnson

Coronary Heart Disease and the Effects of Simvastatin-Treated Patients

21 November 2007

One of the priorities in the national service framework for coronary heart disease summarized by saying “improved use of effective medicines after a heart attack especially aspirin, beta blockers, and statins; so that 80-90% of people discharged from hospital after a heart attack will be prescribed these drugs” (Mostyn, 2000). This is a recommendation which taken at face value implies that all three drugs should be prescribed before a patients leave the hospital after having a heart attack. This paper will talk about coronary heart disease in Scandinavian countries. It goes on to share a study about diabetes and another study explaining the effects of simvastatin on coronary heart disease patients. The paper ends with a positive outlook on the future of coronary heart disease in Scandinavian countries.

The Medical Boards of Norway, Sweden, and Finland have presented their conclusions in a release in Oslo, Stockholm, and Helsinki on May 3, 1968.In the twentieth century the board reviewed and changed some dietary standard, like the effects of the serum cholesterol level of dietary fat and cholesterol, and that relationship to atherosclerosis.The board’s statement read: “If we want to prevent the disease by means of a special diet, it should be introduced at an early stage and the change of diet should apply to the whole population” (Keys, 1968). The prevention of illness resulting from over-eating or faulty consumer dietswhich call for some changes in their eating habits.

To prevent coronary heart disease the population needs to decrease the consumption of foods that contain a large quantity of fats and/or sugar. This would leave room for a higher consumption of foods rich in protein, mineral substances, and vitamins. Right now the total consumption of fat is 40%; this should be reduced to between 25-35% of the total calories (Keys, 1968). To reduce fat, instead of eating foods that have saturated fat, eat foods that contain polyunsaturated fats. Also reduce the consumption of sugar and products containing sugar. Increase the consumption of vegetables, fruits, potatoes, skimmed milk, fish, lean meat, and cereal products. “From the medical and nutritional standpoint the importance of taking regular exercise from an early age for all those who have mainly sedentary occupations should be emphasized”(Keys, 1968). If the population follows some of these guidelines the Scandinavian countries will have a greater chance of reducing coronary heart disease.

The Medical Boards of the Scandinavian countries have responsibilities for medical education, licensure, and the national medical services, in addition to the functions corresponding to those of the Surgeon General of the U.S. Public Health Service, with these services the Scandinavian countries act with deliberate care.Here in the United States many experts are increasingly insistent that such advice, as now issued officially in Scandinavia, should be urged on the general public here. But our government agencies have stood isolated and our medical and health organizations have compromised by making it a responsibility of the individual physician to decide upon dietary prescription for the individual patient. With a substantial fraction of the adult population at risk of premature coronary heart disease, this condition essentially prevents any effective public health action.

Simvastatin is an inhibitor of hydroxyl-methylglutaryl coenzymes A reductase, which reduced LDL cholesterol to a greater extent than that achieved in previous diet and drug intervention trials (Pedersen, 1994). Patients were recruited at 94 clinical centers in the Scandinavian countries. A committee made up of cardiologists, lipidologists, and epidemiologists had scientific responsibility for the study and all the reports of the results in the study. The study was designed to evaluate the effect of cholesterol lowering with simvastatin on mortality and morbidity in patients with coronary heart disease. The number of patients with angina pectorisor previous myocardial infarction was 4,444 and their serum cholesterol was 5.5-8.0 mmol/L and on a lipid lowering diet; they were randomized to a double blind treatment study, where they would either receive simvastatin or a placebo (Pedersen, 1994).

In this study 256 patients (12%) in the placebo group died, compared with 182 (8%) in the simvastatin group (Pedersen, 1994). The relative risk of death in the simvastatin group was 95%. Over 6 years the probabilities of survival in the placebo and simvastatin groups were 87.6% and 91.3%. There were 189 coronary deaths in the placebo group and 111 in the simvastatin group, while non-cardiovascular causes accounted for 46 to 49 of the deaths.622 patients (28%) in the placebo group and 431 (19%) in the simvastatin group had one or more major coronary events (Pedersen, 1994). The risk was also significantly reduced in subgroups consisting of women and patients of both sexes ages 60 or older. Other benefits of treatment included a 37% reduction in the risk of undergoing myocardial revascularization procedures. This study shows that long term treatment with simvastatin is safe and improves survival in coronary heart disease patients.

Type two diabetes mellitus is associated with a two fold increased risk of coronary heart disease. In a previous report from the Scandinavian Simvastatin Survival Study, simvastatin treated patients had significantly fewer coronary heart disease events compared with placebo treated control subjects. Using 1997 American Diabetes Association diagnostic criteria, they assessed the effect of simvastatin therapy post hoc for an average of 5.4 yearsin theScandinavian Simvastatin Survival Study patients with normal fasting glucose, impaired fasting glucose and diabetes mellitus (Haffner, Alexander, Cook, Boccuzzi, Musliner, Pedersen, 1999). Simvastatin treated patients with diabetes mellitus had significantly reduced numbers of major coronary events and revascularizations. Total coronary mortality was also reduced in diabetes mellitus, but not significantly, because of the sample size. In impaired fasting glucose subjects, simvastatin use significantly reduced the number of coronary events revascularizations and total and coronary mortality (Haffner et al., 1999). Results confirmed the benefit of cholesterol lowering with simvastatin treatment of coronary heart disease events. A significant decrease in total mortality, major coronary events, and revascularizations were observed in simvastatin treated patients with impaired fasting glucose levels. These results strongly support the concept that cholesterol lowering with simvastatin therapy improves the prognosis of patients with elevated fasting glucose levels or diabetes mellitus and known coronary heart disease.

When using aspirin, beta blockers, or statins they found didn’t work for coronary heart disease patient. The patients should not give up hope, knowing that these two Scandinavian Simvastatin Survival studies do work, and it should help reassure the patient that coronary heart disease can be reduced, giving the patient a longer life to live.

References

Haffner, S., Alexander C., Cook T., Boccuzzi S., Musliner T., Pedersen T., et al. (March, 1999) Reduced Coronary Events in Simvastatin-Treated Patients with Coronary Heart Disease and Diabetes or Impaired Fasting Glucose Levels. American Medical Association, 159.

Keys, Ancel. (1968). Prevention of Coronary Heart Disease Official Recommendations from Scandinavia. Journal of the American Heart Association, Circulation; 38; 227-228.

Mostyn, Roger Lloyd. (September, 2000). National service framework for coronary heart disease. British Medical Journal; 321 (7261): 634.

Pedersen, Terje. (November, 1994). Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Atherosclerosis Supplement, 344(5), 81-87.