If you like easy answers, today was not so good

I’m sorry.

The news was really bad today. I wished it were better. (Well, maybe I don’t.)

The easy-answer people were denied again. Punched in the gut, were they.

The notion that a pill can do what exercise does remains a fantasy.

Another member of the group of drugs that boost HDL, called CETP inhibitors, was abandoned. As reported today on theHeart.org, Roche pharmaceuticals terminated development of its once promising HDL-booster, dalcetrapib.

Why? Because it did not work. Though the drug lowered inflammation in carotid arteries, improved levels of bio-markers and modestly raised HDL, an interim analysis of a study showed it had no effect on outcomes. Smart people say the drug lacked efficacy. At least it performed better than its predecessor, torcetrapib—another HDL-boosting CETP inhibitor that was abruptly pulled from the market in 2006 because it increased stroke and death rates.

The shape we are all in, I can see why drug companies desire a pill that could raise HDL (the good cholesterol) and reduce the risk of heart attacks. That’s one heck of a promising profit stream.

But…Come on. Thus far, the only safe and proven effective way to increase HDL and decrease heart events is something along these lines. (Fancy German computer not required.)

A half hour spin through the park

When I am finally wrong about pills doing what (normal) life should do, I’ll admit it. For now, we aren’t there yet.

That’s not to say companies like Lilly and Merck are throwing in the towel. Merck has pinned its hopes on anacetrapib—a pacman-like pill that some have likened to liquid plumber. (Warning: This link goes to a 2010 post of mine–that was before I knew about things like action verbs and not using the passive voice.) Even this pill skeptic has to admit that anacetrapib looks remarkable: it moves HDL up dramatically and it does not seem to make people worse. Anacetrapib is currently being studied in a major phase III clinical trial called REVEAL.

We shall see. As a heart doctor, I root for better therapies. But part of me (secretly) hopes the swallowing-pill thesis fails. A sad day it would be indeed, if word gets out there that heart health can be had with a pill.

Of course, even if anacetrapib proves better than its two predecessors, which would not be that hard, we can criticize REVEAL investigators for leaving out the most important comparison group: those who exercised each day and ate a plant-intensive low-calorie diet.

Stay tuned. But in the meantime, stay on your bike or in your running shoes, or even..in your Speedo?

JMM

10 comments

  1. Exercise doesn’t have to only be by biking – or running … Ballroom (and other forms) of dancing are equally enjoyable activities that may accomplish similar goals.

    BOTTOM LINE: The AFib Doctor has it right! No pill will ever do what simple, regular exercise will do – and the exercise of one’s choice is so much more fun! But then it is “preaching to the choir” to post on this web site …

  2. Are there are you would recommend? I am a 40yr old triathlete, I’ve also had triplets, and can’t seem to lose 15 lbs. I am counting calories and working out daily for Olympic distance tris. I really don’t want to resort to a pill, but I’m not seeing any results.

  3. I hate exercise. Wasn’t allowed to do it as a kid. I was born with an ASD and fortunately, I did ok until I needed open-heart at age 25. By that time cardiac care had progressed from the milk pump, beer hose heart lung machine that was used when I was diagnosed. Time had also proven that teflon patches were not reliable. Two months after my surgery my doc told me to get a membership to a gym. I’ve been going ever since.
    I’ve learned the hard way. Life is precious. I had a second open-heart some time back and I now have over $40,000 worth of stuff in my chest keeping me alive. (Installation extra.) My husband also died at 43 of cancer. I was the one who was supposed to go first. Now I’m just shy of 60. I still hate exercise but I shoot for 7 days in the gym. That means at the very least, I’ll get there 5. I wish there was a way to get people to understand what a gift life is. Thanks, Dr. M. for doing your part.
    Rudy

  4. I have Afib, have had an apparently successful ablation, knock on wood, been episode free for 7 months, last CAT indicates normal heart size and no issues. Have been taken off of Pradaxa and now on aspirin. Have a CHAD score of 0. Want to get back to exercise, used to be a runner, been over 2 years relatively sedentary and am a bit reluctant to start do to relapse concern. Can exercise alone result in relapse? Am also on Bystolic. Any thoughts would be appreciated.

    1. I know of no evidence that suggests exercising after ablation affects the chance of AF recurrence. I do know, however, that study after study show that AF recurrences after ablation relate to electrical reconnection of the PVs–through gaps in the line of block.

    2. I too had a successful ablation (6 months ago)… and I don’t use the word “apparently” because I also have been episode free. Once I got off Wayfarin, I started cycling again and am now back up to 100+ miles per week. I’ve been careful not to “push” too hard, but as of late I’ve been pushing it a bit and have had no symptoms. I really don’t think exercise alone can cause a relapse if all else is going well. I’d also bet you don’t need the Bystolic.

  5. Had cath ablation for a-fib last Sept and am now free of AF (so far) and off meds. Former runner for over 20 yrs, but psoriatic arthritis and OA in feet and hands and other places made me stop running. Now I cycle and walk and do elliptical and wt training as I can. I like to run and bike and the cycling is now getting limited by joints, esp in hands. Former duathlete, I enjoy the rhythmic aerobic training. Any ideas for other activities that will work my heart well but are doable with hand, foot and knee arthritis,etc. I want to keep my heart and mind healthy.

    1. This isn’t medical advice. Swimming comes to mind. Cycling on recumbent–wait did I say that–also pops in my head. THX for the comment.

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