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Posted 12 months ago
BLOCK THAT BLOCKER?
Beta-blockers are absolutely necessary for some patients, said Dr. Sripal Bangalore, a cardiologist at New York University, but are probably prescribed too widely and for too long a period of time. Examining three distinct patient groups from a data registry of 44,000 patients, he said the drug did not reduce the risk of heart attack, stroke or death after 3.5 years.
Yet the American Heart Association (AHA) and American College of Cardiology guidelines recommend heart attack survivors take beta-blockers for at least three years. Those recommendations, several doctors noted, are based on data collected two decades ago. "We don't know if they are providing benefit for one year or three years," Bangalore said.
Today, blocked arteries are cleared right away with angioplasty, and the patient is typically put on a statin to keep harmful cholesterol from building up in the artery walls. For those whose hearts are not badly damaged, beta-blockers do not help.
Then there are blood thinners, like Warfarin, commonly used to treat some types of heart disease by preventing clots. Dr. Robert Harrington, a cardiologist at the Stanford School of Medicine, said patients were at risk of bleeding when they were on more than one. "We've had recent trials where we've gone from one to two to three agents," he said. "There's got to be a way to start peeling away, and maybe it's over a period of time, or as the clinical status changes."
MARKET SIDE EFFECTS
Clinical trials that have called into question the drugs' benefits have affected sales. Combined sales of AbbVie's TriCor and Trilipix were $1.4 billion in 2012, down from $1.7 billion in 2011. Sales of Niaspan were $911 million in 2012, down from $976 million in 2011.
Cowen and Co estimates the 13 main classes of drugs used to treat various types of cardiovascular disease had U.S. sales of almost $75 billion in 2011. The brokerage expects sales to shrink to about $59 billion in 2016 because of recent and looming patent expirations on branded products.
Even if doctors aggressively cut back the number of heart medicines they prescribe, however, it would have only a limited impact on drugmaker revenue because many would be the generic older drugs that are far cheaper, according to analyst Barbara Ryan, of Barbara Ryan Advisors.
Dr. Richard Stein, a professor of medicine at New York University and spokesperson for the AHA, estimated the average patient with heart disease truly needs to take from seven to nine pills each day in order to control the various risk factors, including cholesterol, high blood pressure and diabetes. Beyond that, he said, it makes sense to be restrictive.
"Doctors should look for combination pills if they can, and exclude pills that don't critically help patient care," he said. "To live your life taking that many pills, the danger is you'll stop taking the critical ones, because how many pills can you take several times a day?"