Filipinos vulnerable to heart disease

The majority of patients with cardiovascular disease (CVD) leading to heart attack and stroke do not receive appropriate treatment for various reasons.

This was the alarm sounded by Professor Liu Lisheng, President of the World Hypertension League during the recently concluded 19th Great Wall – International Cardiology Congress (GW-ICC) in Beijing, China.

“Worldwide, cardiovascular disease accounts for 31.5 percent of all deaths among women and 26.8 percent of all deaths among men,” said Professor Liu. Local statistics also show that CVD is the leading cause of deaths in the Philippines.

Professor Liu explained that common reasons for inadequate treatment include inappropriate lifestyle, low disease awareness and intolerance to proven medications such as angiotensin converting enzyme (ACE) inhibitors. It is an established fact that ACE inhibitors are highly cardio-protective in high-risk patients, but Asians cannot tolerate to take it for prolonged periods of time due to ACE-related coughing or severe itchiness of the throat.

Doctors from the region welcomed the sub-group analysis in the landmark Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET). The thorough sub-group analysis of the results shows that in high-risk Asian patients, telmisartan 80mg is as effective as, and significantly better tolerated than, ramipril 10mg in reducing the risk of cardiovascular death, heart attack, stroke and hospitalization for congestive heart failure.

Telmisartan and ramipril were shown to be equally protective both in Asian and non-Asian subjects enrolled in the study. However, there were more who attained the full dose with the angiotensin receptor blocker (ARB) telmisartan than the ACE inhibitor ramipril because of better tolerability, according to Dr. Antonio Miguel Dans, OnTarget coordinator for the Philippines.

“The new OnTarget data are very important for treatment of Asian patients at risk of cardiovascular disease,” said Dr. Dans added that long-term efficacy and tolerability of treatment in these patients is of prime importance to ensure that they remain on their medication and are well protected. “Telmisartan is shown to be a very good treatment option for these high-risk patients,” said Dr. Dans.

Professor Liu, who was also China’s national coordinator for the ONTARGET trial, explained the reasons why the investigators selected telmisartan in the largest head-to-head trial between an ARB and an ACE inhibitor. These reasons include its long half-life and duration of action among ARBs, such that its effects are maintained over 24 hours with a single dose, and its excellent tolerability.

Supporting Professor Lisheng Liu’s discussion on the beneficial properties of telmisartan was Dr. Jeffrey Probstfield, a professor from the University of Washington in the United States. “Telmisartan is similar in effectiveness to ramipril in reducing major vascular events in high-risk patients without heart failure and is better tolerated, and it can be used in high-risk patients without heart failure intolerant to ACE inhibitors,” he said.

Other clinical studies on telmisartan have shown that 96.8 percent of 19,870 patients have rated the drug’s tolerability as either good or very good in a post-marketing surveillance study. Professor Probstfield said it is also well-tolerated by young patients who may have a need for long-term antihypertensive treatments, as well as patients who are more at risk, such as the elderly and those with varying degrees of renal impairment.

Considered one of the most significant landmark trials of the decade, ONTARGET trial involved over 25,620 patients worldwide, including more than 3,000 patients from 79 centers across the Asia-Pacific region. The Philippines was actively involved in the trial. Other centers included China, Hong Kong, Malaysia, Singapore, South Korea, Taiwan, and Thailand.

Patients enrolled in the study were already receiving standard care such as statins, anti-platelet therapy and also betablockers and other anti-hypertensive treatment. Although both telmisartan and ramipril are anti-hypertensive medications, the ONTARGET was not about its blood-pressure lowering efficacy but about the two drugs’ ability to lower CVD risk.

Dr. Dans pointed out that a higher proportion of Asians achieved the full-dose treatment of telmisartan and ramipril, contrary to popular misconception that Asians should only receive smaller doses of drugs due to some tolerability issues. The ONTARGET has proven this to be untrue. Based on the results, 87.6 percent of Asians in the telmisartan group achieved the full dose, while 77.9 percent achieved the full dose of ramipril. “However, more attained the full dose of telmisartan than ramipril,” said Dr. Dans.