There's been a major development in heart disease management. Still at the experimental stage, a drug known only as LCZ696 is gaining widespread attention.
"We haven't seen a breakthrough like this for more than 10 years," says Dr. Chris Labos, a cardiologist and bio-statistics expert at McGill University.
I hope this drug comes to Canada fast enough to help my patient Maria, 68, whose heart has been failing for the past three years. I can hear the fluid gurgling in her lungs even through the door of my exam room.
"You hear that gypsy music in my chest, Doctor Q?" she asks with a smile. Two small heart attacks have left her heart muscle weak. Even with modest activity, she can develop trouble breathing, swelling in her ankles, heart palpitations, maybe even bring on a third heart attack.
At its simplest, the heart is a pump, beating around 100,000 times a day. To keep the brain and body properly juiced, each beat has to count. But over time, diabetes, high blood pressure, obesity and cholesterol build-up can take their toll on the heart. With a weakening pump, you get a fluid traffic jam.
The new drug, from the pharmaceutical giant Novartis, is apparently so impressive that the experimental trial involving 8,000 patients in 1,000 research sites across the world was stopped early.
According to the New England Journal of Medicine, there was "an overwhelming benefit with LCZ696" – patients experienced fewer symptoms, hospitalizations and physical limitations. Most compellingly, the drug reduced deaths due to heart failure at a rate that's 20-per-cent better than currently available treatments.
Stopping a drug trial early because of benefits to patients is a dream goal for any company or university researchers. "Ideally, this might reduce the time to bring this drug to our patients," Labos says.
He remembers the time when a diagnosis of end-stage heart failure had a worse prognosis than many cancers, so this new drug "is a welcome development."
In fact, Dr. George Honos, an associate professor and chief of cardiology at the Université de Montréal, believes that Novartis will "submit [these findings] to Health Canada this fall."
That may expedite the drug approval process here by years. "This was a home-run trial," he notes.
"This is a designer drug," says Dr. Kim Connelly, a heart specialist and scientist at St. Michael's Hospital at the University of Toronto.
"[The drug] is a specially designed combination of medications, and it's already proved its case in a broad range of heart-failure patients."
Doctors are excited by this new tablet in part because we're used to hearing bad news about heart failure. It's a common, debilitating illness: According to the Heart and Stroke Foundation of Canada, more than 500,000 Canadians have the condition, and that number is growing as the Canadian population ages. Another disappointment is that a number of clinical trials, initially full of promise, have ended without improving our treatment options.
Also, there are many causes and triggers of heart failure, including the use of NSAIDs (common joint-pain medications), excess salt intake, chest infections and even wrong dosages of medication.
Maria often brings home-baked goodies when she visits me in the clinic. I think she believes that, by giving me just the right cake, I'll finally prescribe the magic drug that will relieve her symptoms.
Only time will tell, but perhaps LCZ696 will be that pill.
Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Dr. Shafiq Qaadri, MPP for Etobicoke-North, is a Toronto family physician, continuing medical education (CME) lecturer and medical writer.