Concomitant diet and drug intervention in secondary CHD prevention: The evidence base for Simvastatin
Introduction: The burden of Coronary Heart Disease has led to both pharmaceutical and dietary interventions for prevention and treatment. Various HMG-Co reductase inhibitors (including simvastatin) are now widely used to moderate the important risk factors total and LDL cholesterol. Statin prescription protocols recommend low fat diets as the first option, with statin treatment following if diet is unsuccessful. Continuation of diet also is recommended in conjunction with statin therapy. This study reviewed simvastatin efficacy trials to assess the evidence for concomitant dietary therapy. Methods: Randomised controlled trials of simvastatin were identified by a literature search of Medline Databases (1992 to 2006), English language journals, and reference lists of original articles, reviews and meta-analyses. Studies involving both genders (n>30) were assessed for published details on dietary advice, duration of dietary intervention, mechanisms to manage dietary adherence, and dietary analysis. Results: Review of 18 selected studies revealed a paucity of reported dietary control frameworks and analysis. Even where a diet was prescribed in the study design, reported dietary methods and outcomes were scant. Conclusions: There is a substantial gap in understanding of the context within which simvastatin is most efficacious. Further, this leaves little scope for post-hoc analysis to investigate potential dietary confounders of drug efficacy. Since dietary advice is often given in conjunction with drug prescription, a more rigorous approach to description of drug efficacy under specific dietary conditions is warranted. These findings also have implications for the design of pharmaceutical trials in general.
Population Health Congress 2008. A Global World - Practical Action for Health and Well-being