Twice-a-day pill slashes risk of second heart attack
PATIENTS at high risk of a fatal heart attack could see their odds of death slashed thanks to a twice-a-day pill now recommended for NHS use.
Anti-clotting treatment ticagrelor was given alongside daily aspirin to thousands of patients who had already suffered a first attack and was found to reduce deaths from a subsequent cardiovascular (CV) event by 23 per cent compared to a dummy pill.
While ticagrelor and aspirin is already offered in the first 12 months after a heart attack, one in five deaths occurs in the subsequent years, and the trial sought to determine whether the treatment could be effective in this group.
Following the trial, prescribing watchdogs the National Institute for Health and Care Excellence is advising patients to take the drug for four years after a first heart attack, also known as a myocardial infarction (MI).
About 50,000 men and 32,000 women suffer an MI each year in England alone, and one in five survivors suffers a second episode within the following 12 months. Of those who are eventfree during the first year, about one in five experiences another event in the following years.
It happened to rock guitarist Rick Parfitt, 67, of Status Quo, who had his first heart attack in 2011 and another this year.
Heart attacks happen when the supply of blood is suddenly blocked, usually by a clot forming in the arteries that supply the heart muscle.
According to Robert Storey, professor of cardiology at the University of Sheffield, ticagrelor, which has the brand name Brilique, works by targeting a receptor in the platelets in the blood, which stops them clumping together to form clots. He said: ‘Studies show that taking ticagrelor and aspirin together prevents further heart attack or stroke, including fatal ones, without increasing death due to bleeding, despite more bleeding episodes.’
A 90mg dose of ticagrelor with aspirin is already recommended as a treatment for the first 12 months after a heart attack in patients with acute coronary syndrome (ACS) – an umbrella term for heart problems where blood supply has been blocked by a clot.
The new recommendation follows results from a landmark study involving 21,000 patients, which demonstrated that ticagrelor, at a slightly lower dose of 60mg and taken for up to three more years, reduced the relative risk of further heart attack, stroke or CV death by up to 23 per cent.
Aspirin and ticagrelor both prevent clotting and there are studies going on looking at using ticagrelor alone, but so far it seems to work best in combination with aspirin.
One patient already benefiting is Simon Cooper, 53, an electrician from Bedfordshire, who had his first heart attack in January 2014.
‘I just thought I’d strained myself,’ he says. ‘A few days later, I had the feeling again.
‘Two weeks later, I developed a terrible pain across my arms. This time we called an ambulance. Tests showed I’d had a major heart attack. The others had been heart attacks too, but the damage was too mild to show up on an ECG.’
Simon had a stent fitted and was put on ticagrelor for a year. In March 2015, a month after he stopped taking it, he had another heart attack.
He was put back on the drug and, in December 2015, had heart bypass surgery.
‘Life is virtually back to normal now,’ he says.
Prof Storey wants ticagrelor used as a continued therapy in patients for whom cardiologists feel it’s appropriate.
He said: ‘The new recommendation is a step forward in further reducing patients’ long-term risk. It’s very good news. But the risk of further events doesn’t go away after four years.’