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DRUG INCREASES HEART ATTACK SURVIVAL, PREVENTS SECOND ATTACKS

 DRUG INCREASES HEART ATTACK SURVIVAL, PREVENTS SECOND ATTACKS
 /ADVANCE/WINSTON-SALEM, N.C., Sept. 2 /PRNewswire/ -- A common prescription drug prolonged survival of heart attack victims and helped prevent subsequent heart attacks, according to a large-scale study conducted at the Bowman Gray School of Medicine and 44 other medical centers.
 Study researchers are reporting in the Sept. 3 issue of the New England Journal of Medicine that the drug captopril, when given within 16 days after a heart attack, reduced the death rate in heart attack patients by 19 percent, according to Dr. Henry S. Miller Jr., professor of internal medicine (cardiology.)
 The morbidity record was even better, Miller said, noting that patients taking captopril had 25 percent fewer subsequent heart attacks than patients getting a placebo over a 42-month period.
 Patients taking captopril had 22 percent fewer hospitalizations for congestive heart failure, and 37 percent fewer cases of severe heart failure during the 42 months.
 Captopril commonly is prescribed for high blood pressure and heart failure. In this study, called the Survival and Ventricular Enlargement (SAVE) study, the captopril was an "add-on" to standard treatment. "All the patients were treated like we normally treat them," said Miller. "The nice thing about the study was that all the new 'therapy' used for the treatment of heart attacks to reduce complications and death could be administered."
 The SAVE investigators said the benefits of captopril were observed both in patients who got clot-dissolving drugs -- such as streptokinase and tPA -- aspirin or a class of drugs called beta-blockers and those who did not.
 These results suggest "treatment with captopril confers additional improvement in outcome to selected survivors of myocardial infarction," they said in the New England Journal article.
 The total study, which involved 112 hospitals in the United States and Canada, included 2,231 patients, of which 1,116 got the placebo, and 1,115 got captopril. About 40 patients were at the Bowman Gray/Baptist Hospital Medical Center, the only Carolinas medical center in the study. The patients were followed for an average of 42 months between 1987 and 1992.
 "We can do something to improve the outlook for many patients after a heart attack, even when they have no symptoms of heart failure," said the overall principal investigator, Dr. Marc A. Pfeffer, a cardiologist at Brigham and Women's Hospital in Boston and a faculty member of the Harvard Medical School.
 "This new use of captopril adds further benefits to the many lifesaving advances in cardiac care developed in recent years," Pfeffer said.
 Pfeffer and the other investigators noted that survivors of acute myocardial infarctions -- heart attacks -- "are at a greatly increased risk for subsequent fatal and nonfatal cardiovascular events."
 The biggest predictor of future problems is the severity of dysfunction of the left ventricle, the most important of the heart's four chambers.
 This study focused on heart attack patients who had no symptoms of heart failure or of heart muscle death, but who had a measurable decline in ventricular function.
 The emptying of the ventricle -- the amount of blood pumped from the left heart -- is typically determined by what cardiologists call the "ejection fraction."
 Ordinarily, said Miller, the ejection fraction is 0.65 percent, but patients in this study had ejection fractions of 0.40 percent or less. The study was paid for by a grant from Bristol-Myers Squibb Institute for Pharmaceutical Research to Brigham and Women's Hospital.
 -0- 9/2/92/1800
 /CONTACT: Robert Conn, Office of Information, Bowman Gray School of Medicine of Wake Forest University, 919-716-4977/ CO: Bowman Gray School of Medicine ST: North Carolina IN: HEA MTC SU:


CM -- CH005 -- 5603 09/01/92 16:42 EDT
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Date:Sep 1, 1992
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