新型抗炎药揭开心脏病之谜

皇后

https://www.economist.com/news/s ... -heart-disease-isnt
[size=36.0408px]A wonder drug for heart disease that isn’t that wonderful
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ON AUGUST 27th the results of a trial of an anti-inflammatory medicine called canakinumab were released at a meeting, in Barcelona, of the European Society of Cardiology. Press reports were gushing, telling of a fabulous new drug that would cut the risk of heart attacks and cancer at the same time. The coverage was so positive that people reading or hearing it might have been forgiven for wondering when this treatment would be available to everyone. The answer is probably “never”, for canakinumab’s benefits have been greatly oversold. This trial was, nevertheless, important. Though it offered no immediate treatment, it confirmed what has long been suspected—that inflammation is an important factor in heart disease.

It has been common knowledge for decades that one way to reduce someone’s risk of having a heart attack is to keep his cholesterol levels low. But that is only part of the story. About half of heart attacks happen to those who have what are considered normal levels of cholesterol. Trials show that even people who do not have high cholesterol levels benefit from being prescribed cheap, cholesterol-lowering statin drugs. Since another effect of these drugs is to reduce inflammation, the suspicion has been that this is where the protection is coming from. But the cholesterol-lowering properties of statins have made it impossible to isolate this effect.

The new study, co-ordinated by Paul Ridker of the Brigham and Women’s Hospital in Boston, could look at inflammation by itself because canakinumab reduces only that, and not cholesterol levels. Dr Ridker and his colleagues took 10,000 patients who had had heart attacks and who were receiving high doses of statins. They gave some of them quarterly injections of canakinumab in addition. Participants taking a 150mg dose of the stuff proved 15% less likely, over the four years the trial lasted, to suffer a further heart attack or a stroke than did those not so treated.

Patients on canakinumab also showed a drop in rates of death from cancers of several sorts, and in the actual incidence of lung cancer. As with heart disease, inflammation exacerbates the effect of cancer. The flip side of the study, though, is that there were significantly more deaths from infection among those who received canakinumab—an effect large enough to cancel out the drug’s positive effects on mortality, including its anti-cancer effects.

The excitement surrounding this trial is therefore scientific rather than clinical. It provides evidence for a possible new way of treating coronary-artery disease, by developing ways to inhibit inflammation. Canakinumab itself is a type of medicine called a monoclonal antibody. Many such drugs are expensive. They cost tens—sometimes hundreds—of thousands of dollars a year. Though appropriate for treating people with actual illnesses, or a serious risk of developing one, they are not suitable for use as general prophylaxes in the way that statins are. But other prophylactic ways of reducing inflammation might be.

Nor need such approaches be pharmaceutical. For many years, epidemiology has shown an association between consumption of oily fish and a lower risk of coronary-artery disease and strokes. A probable cause is the anti-inflammatory effect of fish oil, which is predominantly a type known as omega-3, because of a feature of its molecular structure. Indeed, an Italian study published in 2002 showed that one gram a day of supplementary omega-3 oil reduced death from cardiovascular disease by 30% in those who had recently survived a heart attack.

The best advice of all, though, is “eat less and exercise more”. Being overweight is, itself, a way of provoking inflammation. And exercising, independently of its effect on body weight, is also anti-inflammatory. Numerous studies show this, and that exercise protects directly against heart disease. Diet and exercise rarely make the front pages in the way that drug trials do—and should, of course, be supervised by a doctor if the individual concerned has a dodgy heart. But for most people they remain the best medicine of all.

http://jandan.net/2017/09/03/wonder-drug-heart.html

8月27日在巴塞罗那举行的欧洲心脏病学会会议上，波士顿布莱根妇女医院的保罗·里德克(Paul Ridker)博士公布了新型抗炎药Canakinumab的研究结果。然后铺天盖地的新闻随之而来，报道里说科学家发明了可以同时降低罹患心脏病和癌症死亡风险的神药。神药的药效是如此之好，不禁想问这个药啥时候能在医院买到呢。事实是，这个神药可能永远也买不到了，因为Canakinumab的药效被媒体夸大了。
虽非神药，但该药的研究结果揭开心脏病与炎症千丝万缕的关系。

根据多年来的临床经验，医生们都知道降低胆固醇水平有利于减少患者心脏病发作的风险，但胆固醇似乎与心脏病的关联不是非常紧密，因为一半的心脏病患者是胆固醇水平正常的人，但他们也可以通过服用物美价廉的他汀类降胆固醇药物来减少心脏病发作的风险。
他汀类药物的另一个药效是缓解炎症，所以有研究者怀疑是不是炎症与心脏病有关联。但该类型药文武双全的特性让研究者不敢妄下定论。

前文提到的研究中所用新型抗炎药Canakinumab与他汀类药物不同，它只针对炎症有效，因此可以单独把炎症拎出来分析对心脏病的影响。
为此，研究主导者里德克博士和他的小伙伴们找了1万名患有心脏病并正在接受高剂量他汀类药物治疗的患者，并让其中部分人接受每季度一次的Canakinumab抗炎药的治疗。在持续四年的实验中，每次注射150mg药物的实验组患者比对照组发作心脏病或发生脑中风的风险降低了15％。
实验组的数据中也发现患者接受Canakinumab治疗后癌症死亡率及肺癌的发病率的降低。其中机制和心脏病一样，癌症加剧都是因为炎症搞的鬼。
在研究中还提供了一个的反面证据：医生的处方包含抗生素的患者中，死亡的人数明显增多，因为细菌感染导致的炎症足以抵消抗炎药对心脏病及癌症的积极作用。

因此，研究者为这项试验兴奋不已，该药的实验结果证实了学界长期以来的假设：炎症也是心脏病的罪魁祸首。它为心脏病的治疗从炎症方向开辟了一条新途径。
而对于医生说，Canakinumab是一种归类为单克隆抗体的昂贵药物。使用单抗类药物的患者需要每年在治疗上花费数万甚至数十万美元。而且新药只适用于患心脏病或者正要发病的人，不像他汀类那样可以作普通人预防心脏病之用。

其实预防心脏病也不需要麻烦医生。
多年来统计学上的数据表明，多吃油性鱼类可以降低患冠状动脉类疾病的几率以及减少发生中风的风险。猜测其中原因是油性鱼中含有ω-型特殊分子结构的鱼油，具有相当不错的抗炎作用。事实上，在意大利2002年发表的一项研究显示，发作过心脏病的患者中，每天补充的ω-3型鱼油可以减少30％的死亡几率。
不过，最好的建议还是“少吃饭，多锻炼”。
体重超标本身就可以引发炎症，而且运动除了可以控制体重之外，也具有清除炎症的效果的。许多研究均证明运动可以直接预防心脏病。当然，如果你有一颗脆弱的心脏应该在医生的指导下生活和治疗。但是对于绝大部分人来说，运动仍然是最好的药物