CHICAGO – Fish oil, vitamin D, new drugs, new rules on cholesterol: News from a conference of the American Heart Association over the weekend reveals a lot about what works and what is not for the prevention of heart attacks and other problems.
Dietary supplements have missed the mark, but a prescription fish oil has shown promise. A medicine has not only helped people with diabetes control blood sugar and lose weight but has reduced the risk of needing hospitalization for heart failure.
Good news for everyone: You do not have to repeat before you have a blood test to check your cholesterol. Do not stop at the donut shop on the way to the clinic, but eating something before the test is ok for most people, say the guidelines.
I am from the Heart Association and the American College of Cardiology and are supported by numerous other doctoral groups. No author has any financial links with drug manufacturers.
Here are some aspects of the conference that ends Monday:
Heart disease is the leading cause of death worldwide. High cholesterol leads to hardened arteries that can cause heart attack or stroke. When the guidelines were reviewed last time five years ago, they have distanced themselves from using only the number of cholesterol to determine who needs treatment and a formula that takes into account age, high blood pressure and other factors to better estimate the risk.
This was confusing, so the new guidelines combine both approaches, setting formula-based targets and taking into account individual circumstances such as other medical conditions or a family history of early heart disease.
"It will never be as simple as a single cholesterol," because it does not give a clear picture of the risk, said a member of the guide group, Dr. Donald Lloyd-Jones of Northwestern University.
If treatment is needed, the first option remains a statin, such as Lipitor or Crestor, which is sold as a generic one per day. For those at high risk such as those who have already had a heart attack, the guidelines suggest adding Zetia, which is also sold as a cheap generic, if the statin did not drop enough cholesterol.
Unless the two drugs help enough, strong, but more expensive drugs called PCSK9 inhibitors should be considered. Many insurers limit their coverage – Repatha, sold by Amgen and Praluent, sold by Sanofi and Regeneron – and the guidelines say they are not cost-effective except for those at greatest risk.
Finally, if it's not clear if someone needs treatment, the guidelines suggest a coronary calcium test that seeks to strengthen the arteries to help you decide. It's an X-ray type with a radiation dose similar to a mammogram and costs between 100 and 300 dollars, which most insurers do not cover. Lloyd-Jones and others have defended their use.
"Half of people will have a zero calcium score and can avoid a very safe statin," a quarter will have a high score and will need treatment, and the rest will have to weigh options with their doctors, he said.
Dr. Steven Nissen of the Cleveland Clinic, who had no role in the guidelines, called them an important improvement, but disagreed with "using a radiation test to decide whether to give a drug that costs $ 3 a month, "referring to the statin price. An inexpensive test to check the inflammation of the artery would be better, he said.
OIL OF FISH, VITAMIN D
Two major studies have yielded mixed results on fish oil or omega-3 fatty acids. There are different types, including EPA and DHA.
In a study of 26,000 healthy individuals, 1 gram per day of a combination of EPA / DHA, a dose and a type of many dietary supplements, has not shown clear ability to reduce the risk of heart or cancer problems .
But another study that tests 4 grams per day of Vascera, which is focused on EPA, has found that heart problems are encountered in people at greater risk for them because of high triglycerides, blood fats and other causes. Everyone had already taken a statin and there is concern about the results because Vasceda was compared to mineral oil that could interfere with statins and could have made the comparison group weaker. However, some doctors said that Vascepa's benefits seemed large enough to overcome this concern.
The study, which tested the lower amount of fish oil in the general population, also tested vitamin D, one of the most popular supplements, and found it did not reduce the risk of cancer or heart problems.
"I think we have to accept it is a good test," and the vitamin does not deserve, said Dr. Jane Armitage of Oxford University in England. "I see no benefit."
"Do not waste money on these supplements," which are not well regulated and of a different quality, said Dr. Deepak Bhatt of Brigham and Women's Hospital of Boston.
People with diabetes often die of heart disease or heart failure, and new diabetes medications have to be tested in large studies to show they do not increase heart rate. Such a drug, Jardiance, surprised doctors a few years ago by lowering the risk of heart attacks and strokes. A second drug, Invokana, later presented similar benefits, but with some worrying side effects.
A new study tested a third drug, Farxiga, in over 17,000 diabetics with other cardiac risk factors, and found a lower rate of hospitalization for heart failure or heart death – 5% of those with drugs versus 6 % placebo after four years of use. This is on the top of the drugs known benefits for controlling diabetes.
Certain infections and a serious build up of blood acids were more common with Farxiga, but these were rare and are known complications of the drug. It costs about $ 15 a day, much like similar drugs. The Farxiga plant manufacturer, AstraZeneca, has sponsored the study and many study leaders are consulting the company.
An independent expert, Dr. Eric Peterson, a Duke University cardiologist and one of the conference's leaders, said the doctors were keen to know if previous studies suggesting that these drugs could help the hearts were a flukes. The results of the new study, the largest so far, could make this class of drugs more widely used for diabetics with high cardiac risk or heart failure, he said.