Ransdell Pierson

(Reuters) - Patients with hypertension and moderate risk of heart disease slashed their long-term risk of heart attack and stroke 40 percent by taking a blood pressure medication as well as a statin cholesterol fighter, according to a large global study that could change medical practice.

Results from the trial, called HOPE-3, could prod far more doctors to add a statin to antihypertensive therapy for such patients who have no prior history of heart attack or stroke, researchers said.

The data was presented on Saturday at the annual scientific session of the American College of Cardiology in Chicago.

To enroll in the trial, patients had to have at least one risk factor for heart disease such as obesity or smoking, in addition to being over 60 for women and over 55 for men.

"Intermediate-risk people with hypertension had a clear benefit when taking both a statin and an agent that lowers blood pressure," Dr. Salim Yusuf, a professor of cardiology at McMaster University in Ontario, Canada who headed the 12,000-patient global study, said in an interview.

Patients with systolic blood pressure of 140 and higher were deemed in the study to have high blood pressure. They experienced a 40 percent reduced risk of heart attack and stroke over a six-year period when taking AstraZeneca Plc's statin Crestor (rosuvastatin) as well as a combination tablet containing blood pressure treatment candesartan and the diuretic hydrochlorothiazide.

Patients with normal or low systolic pressure had the same approximate 25 percent reduction in cardiovascular events as seen among patients in one arm of the study who took only statins.

Yusuf said the trial underscores that if a patient at moderate heart risk has high blood pressure, defined as 140 or higher, "give them both a statin and a blood pressure medication as a matter of course." He said statins are not automatically given now to patients with hypertension that are at only moderate risk of heart attack or stroke.

Yusuf's trial included research centers in China, India, Latin America, Africa and Canada, but not the United States because of far greater research costs there. The trial was funded by the Canadian Institutes of Health Research and AstraZeneca.

A separate study published in November found that lowering blood pressure to below 120 dramatically reduced heart failure and risk of death in adults aged 50 and older. But the five-year U.S. government-sponsored study of more than 9,300 patients showed a higher rate of adverse side effects, including kidney damage, in the aggressively treated patients.

(Reuters) - Patients with hypertension and moderate risk of heart disease slashed their long-term risk of heart attack and stroke 40 percent by taking a blood pressure medication as well as a statin cholesterol fighter, according to a large global study that could change medical practice.

Results from the trial, called HOPE-3, could prod far more doctors to add a statin to antihypertensive therapy for such patients who have no prior history of heart attack or stroke, researchers said.

The data was presented on Saturday at the annual scientific session of the American College of Cardiology in Chicago.

To enroll in the trial, patients had to have at least one risk factor for heart disease such as obesity or smoking, in addition to being over 60 for women and over 55 for men.

"Intermediate-risk people with hypertension had a clear benefit when taking both a statin and an agent that lowers blood pressure," Dr. Salim Yusuf, a professor of cardiology at McMaster University in Ontario, Canada who headed the 12,000-patient global study, said in an interview.

Patients with systolic blood pressure of 140 and higher were deemed in the study to have high blood pressure. They experienced a 40 percent reduced risk of heart attack and stroke over a six-year period when taking AstraZeneca Plc's statin Crestor (rosuvastatin) as well as a combination tablet containing blood pressure treatment candesartan and the diuretic hydrochlorothiazide.

Patients with normal or low systolic pressure had the same approximate 25 percent reduction in cardiovascular events as seen among patients in one arm of the study who took only statins.

Yusuf said the trial underscores that if a patient at moderate heart risk has high blood pressure, defined as 140 or higher, "give them both a statin and a blood pressure medication as a matter of course." He said statins are not automatically given now to patients with hypertension that are at only moderate risk of heart attack or stroke.

Yusuf's trial included research centers in China, India, Latin America, Africa and Canada, but not the United States because of far greater research costs there. The trial was funded by the Canadian Institutes of Health Research and AstraZeneca.

A separate study published in November found that lowering blood pressure to below 120 dramatically reduced heart failure and risk of death in adults aged 50 and older. But the five-year U.S. government-sponsored study of more than 9,300 patients showed a higher rate of adverse side effects, including kidney damage, in the aggressively treated patients.

(Reuters) - Patients with hypertension and moderate risk of heart disease slashed their long-term risk of heart attack and stroke 40 percent by taking a blood pressure medication as well as a statin cholesterol fighter, according to a large global study that could change medical practice.

Results from the trial, called HOPE-3, could prod far more doctors to add a statin to antihypertensive therapy for such patients who have no prior history of heart attack or stroke, researchers said.

The data was presented on Saturday at the annual scientific session of the American College of Cardiology in Chicago.

To enroll in the trial, patients had to have at least one risk factor for heart disease such as obesity or smoking, in addition to being over 60 for women and over 55 for men.

"Intermediate-risk people with hypertension had a clear benefit when taking both a statin and an agent that lowers blood pressure," Dr. Salim Yusuf, a professor of cardiology at McMaster University in Ontario, Canada who headed the 12,000-patient global study, said in an interview.

Patients with systolic blood pressure of 140 and higher were deemed in the study to have high blood pressure. They experienced a 40 percent reduced risk of heart attack and stroke over a six-year period when taking AstraZeneca Plc's statin Crestor (rosuvastatin) as well as a combination tablet containing blood pressure treatment candesartan and the diuretic hydrochlorothiazide.

Patients with normal or low systolic pressure had the same approximate 25 percent reduction in cardiovascular events as seen among patients in one arm of the study who took only statins.

Yusuf said the trial underscores that if a patient at moderate heart risk has high blood pressure, defined as 140 or higher, "give them both a statin and a blood pressure medication as a matter of course." He said statins are not automatically given now to patients with hypertension that are at only moderate risk of heart attack or stroke.

Yusuf's trial included research centers in China, India, Latin America, Africa and Canada, but not the United States because of far greater research costs there. The trial was funded by the Canadian Institutes of Health Research and AstraZeneca.

A separate study published in November found that lowering blood pressure to below 120 dramatically reduced heart failure and risk of death in adults aged 50 and older. But the five-year U.S. government-sponsored study of more than 9,300 patients showed a higher rate of adverse side effects, including kidney damage, in the aggressively treated patients.

(Reuters) - New ways of controlling cholesterol, including possibly directly injecting "good" HDL cholesterol into patients, need to be studied following the failure of promising treatments from Eli Lilly, Pfizer Inc and Roche Holding AG, according to top heart researchers.

Lilly in October halted a 12,000-patient study of its experimental drug evacetrapib, an oral medication that in smaller earlier studies slashed "bad" LDL cholesterol and doubled levels of HDL.

But improved cholesterol levels did not prevent heart attacks and strokes, diminishing hopes for the approach to treating heart disease - by raising HDL through blockage of a protein called CETP.

Roche in 2012 scrapped its own CETP inhibitor after it also failed to help patients. Pfizer's similar drug was discontinued in 2006 after being linked to deaths in trials.

Although Merck & Co continues to develop its own CETP inhibitor in a 30,000-patient study expected to be completed next year, researchers on Sunday said the failures of the Lilly, Roche and Pfizer drugs bode poorly for it.

"Merck's drug is the fourth shot on goal for CETP inhibitors, but with disappointment or lack of success for the other agents you have to be increasingly pessimistic" about the class of drugs, said Dr. Stephen Nicholls, deputy director of the South Australian Health and Medical Research Institute in Adelaide, Australia. He was a lead investigator for the failed trial of Lilly's drug.

Nicholls and Dr. Steve Nissen, the head of cardiology for the Cleveland Clinic, who co-lead the evacetrapib study, on Sunday reviewed the baffling evacetrapib data in a presentation at the annual scientific sessions of the American College of Cardiology in Chicago.

"This drug lowered LDL by 37 percent and raised HDL by 130 percent and had absolutely no effect" on preventing deaths and heart attacks, Nissen said in an interview.

Although other ways of raising HDL cholesterol might eventually prove protective, Nissen said all attempts so far have been fruitless.

Nicholls said he remains hopeful of future HDL therapies and is testing whether artificial HDL can be made in the laboratory and injected directly into high-risk heart patients. "There is enthusiasm it may be able to shrink plaque" in heart arteries, he said.

He said he is studying variations of that approach with French drugmaker Cerenis Therapeutics and the Medicines Company. Nicholls said another possible approach would be to instruct the liver to make more HDL.

(Reuters) - New ways of controlling cholesterol, including possibly directly injecting "good" HDL cholesterol into patients, need to be studied following the failure of promising treatments from Eli Lilly, Pfizer Inc and Roche Holding AG, according to top heart researchers.

Lilly in October halted a 12,000-patient study of its experimental drug evacetrapib, an oral medication that in smaller earlier studies slashed "bad" LDL cholesterol and doubled levels of HDL.

But improved cholesterol levels did not prevent heart attacks and strokes, diminishing hopes for the approach to treating heart disease - by raising HDL through blockage of a protein called CETP.

Roche in 2012 scrapped its own CETP inhibitor after it also failed to help patients. Pfizer's similar drug was discontinued in 2006 after being linked to deaths in trials.

Although Merck & Co continues to develop its own CETP inhibitor in a 30,000-patient study expected to be completed next year, researchers on Sunday said the failures of the Lilly, Roche and Pfizer drugs bode poorly for it.

"Merck's drug is the fourth shot on goal for CETP inhibitors, but with disappointment or lack of success for the other agents you have to be increasingly pessimistic" about the class of drugs, said Dr. Stephen Nicholls, deputy director of the South Australian Health and Medical Research Institute in Adelaide, Australia. He was a lead investigator for the failed trial of Lilly's drug.

Nicholls and Dr. Steve Nissen, the head of cardiology for the Cleveland Clinic, who co-lead the evacetrapib study, on Sunday reviewed the baffling evacetrapib data in a presentation at the annual scientific sessions of the American College of Cardiology in Chicago.

"This drug lowered LDL by 37 percent and raised HDL by 130 percent and had absolutely no effect" on preventing deaths and heart attacks, Nissen said in an interview.

Although other ways of raising HDL cholesterol might eventually prove protective, Nissen said all attempts so far have been fruitless.

Nicholls said he remains hopeful of future HDL therapies and is testing whether artificial HDL can be made in the laboratory and injected directly into high-risk heart patients. "There is enthusiasm it may be able to shrink plaque" in heart arteries, he said.

He said he is studying variations of that approach with French drugmaker Cerenis Therapeutics and the Medicines Company. Nicholls said another possible approach would be to instruct the liver to make more HDL.

(Reuters) - New ways of controlling cholesterol, including possibly directly injecting "good" HDL cholesterol into patients, need to be studied following the failure of promising treatments from Eli Lilly, Pfizer Inc and Roche Holding AG, according to top heart researchers.

Lilly in October halted a 12,000-patient study of its experimental drug evacetrapib, an oral medication that in smaller earlier studies slashed "bad" LDL cholesterol and doubled levels of HDL.

But improved cholesterol levels did not prevent heart attacks and strokes, diminishing hopes for the approach to treating heart disease - by raising HDL through blockage of a protein called CETP.

Roche in 2012 scrapped its own CETP inhibitor after it also failed to help patients. Pfizer's similar drug was discontinued in 2006 after being linked to deaths in trials.

Although Merck & Co continues to develop its own CETP inhibitor in a 30,000-patient study expected to be completed next year, researchers on Sunday said the failures of the Lilly, Roche and Pfizer drugs bode poorly for it.

"Merck's drug is the fourth shot on goal for CETP inhibitors, but with disappointment or lack of success for the other agents you have to be increasingly pessimistic" about the class of drugs, said Dr. Stephen Nicholls, deputy director of the South Australian Health and Medical Research Institute in Adelaide, Australia. He was a lead investigator for the failed trial of Lilly's drug.

Nicholls and Dr. Steve Nissen, the head of cardiology for the Cleveland Clinic, who co-lead the evacetrapib study, on Sunday reviewed the baffling evacetrapib data in a presentation at the annual scientific sessions of the American College of Cardiology in Chicago.

"This drug lowered LDL by 37 percent and raised HDL by 130 percent and had absolutely no effect" on preventing deaths and heart attacks, Nissen said in an interview.

Although other ways of raising HDL cholesterol might eventually prove protective, Nissen said all attempts so far have been fruitless.

Nicholls said he remains hopeful of future HDL therapies and is testing whether artificial HDL can be made in the laboratory and injected directly into high-risk heart patients. "There is enthusiasm it may be able to shrink plaque" in heart arteries, he said.

He said he is studying variations of that approach with French drugmaker Cerenis Therapeutics and the Medicines Company. Nicholls said another possible approach would be to instruct the liver to make more HDL.

(Reuters) - Addressing a growing "epidemic" of opioid overdoses and abuse of the prescribed painkillers in the United States, the Centers for Disease Control and Prevention on Tuesday released voluntary guidelines that instruct primary care doctors to sharply deter use of the medicines for chronic pain.

"Overprescribing opioids, largely for chronic pain, is a key driver of America's drug-overdose epidemic," said CDC Director Tom Frieden. Sales of the prescription therapies have quadrupled since 1999, causing 165,000 fatal overdoses over the same period and now growing at more than 40 per day, according to the agency.

Primary care doctors who treat adults for chronic pain in outpatient settings account for nearly half of all opioid prescriptions, the CDC said. It defined chronic pain as lasting longer than three months, or past the typical time it takes for normal tissue healing.

The new guidelines recommend non-opioids, including acetaminophen and ibuprofen, as preferred therapy for chronic pain unless patients have active cancer or are receiving palliative or end-of-life care.

When opioids are used, the lowest possible dose should be prescribed to reduce risks of opioid abuse and overdose and patients should then be closely monitored, according to the CDC guidelines. The drugs should also be combined with non-drug approaches to controlling pain, like physical therapy and exercise, the agency said.

Moreover, when starting opioid therapy for chronic pain, doctors should prescribe immediate-release formulations instead of long-acting versions, the guidelines say. They recommend doctors avoid prescribing opioids with sedatives called benzodiazepines.

When prescribed for acute, or short-term pain, doctors should prescribe the lowest effective dose of immediate release opioids.

"Three days or less will often be sufficient; more than seven days will rarely be needed," the guidelines say.

Some studies suggest only 5 percent of patients prescribed opioids receive them for chronic pain, but they account for 70 percent of overall opioid prescriptions and the majority of overdoses.

For the vast majority of patients taking opioids for chronic pain, risks from the drugs will outweigh benefits, Frieden said. "The prescription overdose epidemic is doctor-driven," Frieden said, adding it can be reversed if doctors rein in their prescriptions of the painkillers.

The American College of Physicians on Tuesday said the new guidelines provide important guidance "at a time when many communities are being devastated by the adverse impact of opioid misuse."

The most widely used opioids include hydrocodone, which is the main active ingredient of Vicodin, and oxycodone, an active ingredient of OxyContin and Percocet. They are synthetic narcotics which work by binding to opioid receptors in the brain and are mostly available in pill form.

Nearly two million Americans aged 12 or older either abused or were dependent on prescription opioids in 2014, the CDC said.

Opioids also include heroin, an illegal injectable drug which has become a far cheaper alternative to oral opioids on the streets of many U.S. communities, causing many overdoses.

Other U.S. health officials on Tuesday said first responders should have wider access to naloxone, a drug that can reverse opioid overdoses.

SHM offers a safe opioid prescribing implementation guideline. The Implementation Toolkit, Reducing Adverse Drug Events related to Opioids, or RADEO, provides step-by step instructions for hospitals to implement a successful QI program to make opioid prescribing safer, with fewer adverse events, and much less likely to result in dangerous sedation, respiratory depression and death. Its scope is for hospitalized patients.

(Reuters) - Addressing a growing "epidemic" of opioid overdoses and abuse of the prescribed painkillers in the United States, the Centers for Disease Control and Prevention on Tuesday released voluntary guidelines that instruct primary care doctors to sharply deter use of the medicines for chronic pain.

"Overprescribing opioids, largely for chronic pain, is a key driver of America's drug-overdose epidemic," said CDC Director Tom Frieden. Sales of the prescription therapies have quadrupled since 1999, causing 165,000 fatal overdoses over the same period and now growing at more than 40 per day, according to the agency.

Primary care doctors who treat adults for chronic pain in outpatient settings account for nearly half of all opioid prescriptions, the CDC said. It defined chronic pain as lasting longer than three months, or past the typical time it takes for normal tissue healing.

The new guidelines recommend non-opioids, including acetaminophen and ibuprofen, as preferred therapy for chronic pain unless patients have active cancer or are receiving palliative or end-of-life care.

When opioids are used, the lowest possible dose should be prescribed to reduce risks of opioid abuse and overdose and patients should then be closely monitored, according to the CDC guidelines. The drugs should also be combined with non-drug approaches to controlling pain, like physical therapy and exercise, the agency said.

Moreover, when starting opioid therapy for chronic pain, doctors should prescribe immediate-release formulations instead of long-acting versions, the guidelines say. They recommend doctors avoid prescribing opioids with sedatives called benzodiazepines.

When prescribed for acute, or short-term pain, doctors should prescribe the lowest effective dose of immediate release opioids.

"Three days or less will often be sufficient; more than seven days will rarely be needed," the guidelines say.

Some studies suggest only 5 percent of patients prescribed opioids receive them for chronic pain, but they account for 70 percent of overall opioid prescriptions and the majority of overdoses.

For the vast majority of patients taking opioids for chronic pain, risks from the drugs will outweigh benefits, Frieden said. "The prescription overdose epidemic is doctor-driven," Frieden said, adding it can be reversed if doctors rein in their prescriptions of the painkillers.

The American College of Physicians on Tuesday said the new guidelines provide important guidance "at a time when many communities are being devastated by the adverse impact of opioid misuse."

The most widely used opioids include hydrocodone, which is the main active ingredient of Vicodin, and oxycodone, an active ingredient of OxyContin and Percocet. They are synthetic narcotics which work by binding to opioid receptors in the brain and are mostly available in pill form.

Nearly two million Americans aged 12 or older either abused or were dependent on prescription opioids in 2014, the CDC said.

Opioids also include heroin, an illegal injectable drug which has become a far cheaper alternative to oral opioids on the streets of many U.S. communities, causing many overdoses.

Other U.S. health officials on Tuesday said first responders should have wider access to naloxone, a drug that can reverse opioid overdoses.

SHM offers a safe opioid prescribing implementation guideline. The Implementation Toolkit, Reducing Adverse Drug Events related to Opioids, or RADEO, provides step-by step instructions for hospitals to implement a successful QI program to make opioid prescribing safer, with fewer adverse events, and much less likely to result in dangerous sedation, respiratory depression and death. Its scope is for hospitalized patients.

(Reuters) - Addressing a growing "epidemic" of opioid overdoses and abuse of the prescribed painkillers in the United States, the Centers for Disease Control and Prevention on Tuesday released voluntary guidelines that instruct primary care doctors to sharply deter use of the medicines for chronic pain.

"Overprescribing opioids, largely for chronic pain, is a key driver of America's drug-overdose epidemic," said CDC Director Tom Frieden. Sales of the prescription therapies have quadrupled since 1999, causing 165,000 fatal overdoses over the same period and now growing at more than 40 per day, according to the agency.

Primary care doctors who treat adults for chronic pain in outpatient settings account for nearly half of all opioid prescriptions, the CDC said. It defined chronic pain as lasting longer than three months, or past the typical time it takes for normal tissue healing.

The new guidelines recommend non-opioids, including acetaminophen and ibuprofen, as preferred therapy for chronic pain unless patients have active cancer or are receiving palliative or end-of-life care.

When opioids are used, the lowest possible dose should be prescribed to reduce risks of opioid abuse and overdose and patients should then be closely monitored, according to the CDC guidelines. The drugs should also be combined with non-drug approaches to controlling pain, like physical therapy and exercise, the agency said.

Moreover, when starting opioid therapy for chronic pain, doctors should prescribe immediate-release formulations instead of long-acting versions, the guidelines say. They recommend doctors avoid prescribing opioids with sedatives called benzodiazepines.

When prescribed for acute, or short-term pain, doctors should prescribe the lowest effective dose of immediate release opioids.

"Three days or less will often be sufficient; more than seven days will rarely be needed," the guidelines say.

Some studies suggest only 5 percent of patients prescribed opioids receive them for chronic pain, but they account for 70 percent of overall opioid prescriptions and the majority of overdoses.

For the vast majority of patients taking opioids for chronic pain, risks from the drugs will outweigh benefits, Frieden said. "The prescription overdose epidemic is doctor-driven," Frieden said, adding it can be reversed if doctors rein in their prescriptions of the painkillers.

The American College of Physicians on Tuesday said the new guidelines provide important guidance "at a time when many communities are being devastated by the adverse impact of opioid misuse."

The most widely used opioids include hydrocodone, which is the main active ingredient of Vicodin, and oxycodone, an active ingredient of OxyContin and Percocet. They are synthetic narcotics which work by binding to opioid receptors in the brain and are mostly available in pill form.

Nearly two million Americans aged 12 or older either abused or were dependent on prescription opioids in 2014, the CDC said.

Opioids also include heroin, an illegal injectable drug which has become a far cheaper alternative to oral opioids on the streets of many U.S. communities, causing many overdoses.

Other U.S. health officials on Tuesday said first responders should have wider access to naloxone, a drug that can reverse opioid overdoses.

SHM offers a safe opioid prescribing implementation guideline. The Implementation Toolkit, Reducing Adverse Drug Events related to Opioids, or RADEO, provides step-by step instructions for hospitals to implement a successful QI program to make opioid prescribing safer, with fewer adverse events, and much less likely to result in dangerous sedation, respiratory depression and death. Its scope is for hospitalized patients.