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CORONARY DISEASE TRIAL BACKS NON-SURGERY EARLY CARE Modern pharmaceuticals and lifestyle change can be as effective as invasive coronary stents or cardiac surgery in addressing stable coronary artery disease, according to results from a landmark international clinical trial. A global trial by a contingent of more than 50 international medical researchers representing the ISCHEMIA Research Group – with Flinders University’s Professor Joseph Selvanayagam being the Australian national lead researcher – has found that conservative early treatment of stable coronary disease with medications and lifestyle advice is as effective as early coronary angiography and revascularisation for patients with and without advanced kidney disease. “We didn’t find evidence that the initial invasive strategy reduced the risk of ischaemic cardiovascular events such as heart attacks or strokes, or death from any cause,” said Professor Selvanayagam, a Professor of Cardiology at Flinders University. “It’s a landmark study with a very important message for the number one health condition in Australia.” The results of the ISCHEMIA trials, which analysed comparisons of invasive surgery and conservative surgery patients over more than three years, were first reported at the American Heart Association meeting in November 2019, and have now been published in the New England Journal of Medicine. “This trial’s results show there’s no need to rush patients with stable coronary disease, and moderate-to- severe myocardial ischemia, to invasive coronary angiography,” Professor Selvanayagam said. “It’s perfectly safe to treat these patients with cholesterol lowering drugs, anti-platelet drugs and antianginal drugs, and then monitor their progress.” In the ISCHEMIA main trial, 5179 people from 320 centres in 37 countries, and with stable coronary disease and moderate-to-severe ischaemia were randomised to either a treat-to-target approach, using guideline medications and angiography only if treatment failed, or the same approach plus angiography within 30 days and revascularisation if feasible. “In most cases, patients in the medical therapy arm did perfectly fine and didn’t need to have invasive angiography and stenting/bypass,” Professor Selvanayagam said. “We can reserve stents or bypass options for patients who struggle with unacceptable side- effects from medications, or who have bad angina despite maximal medical therapies – although even here we have to make it clear to patients they’re taking operative options for symptom relief.” The primary outcome of a composite of five events — death from cardiovascular disease, heart attack or admission for unstable angina, heart failure or resuscitated cardiac arrest — occurred in 353 patients in the conservative arm of the trial and 318 in the invasive arm, being a difference which the researchers found was not significant. RESEARCH NEWS 21 SOOTHE CHILDREN’S COUGHS Oriental Botanicals Kids’ Cough Fighter includes ivy leaf to relieve children’s coughs. Also contains thyme and elecampane, which are traditionally used to clear respiratory mucus in Western herbal medicine. NO ADDED SUGAR Always read the label. Follow the directions for use. If symptoms persist, worsen or change unexpectedly, talk to your health professional. RETAIL PHARMACY • JUL 2020