CHICAGO – Fish oil, vitamin D, novel medications, new guidelines on cholesterol: News from a conference of the American Heart Association over the weekend reveals a lot about what works and what's not to avoid heart attacks and other problems.
Dietary supplements lost the mark, but a resistant prescription fish oil showed a promise. A drug has not only helped people with diabetes control blood sugar and lose weight, but also reduced the risk of need for hospitalization due to heart failure.
Good news for everyone: you do not have to accelerate before taking a blood test to check cholesterol. Do not stop at the donut shop on your way to the clinic, but eating something before the test is good for most people, the guidelines say.
They are from the Association of the Heart and the American College of Cardiology and are approved by many other doctoral groups. No author had financial ties for drug traffickers.
Here is the conference, which is added on Monday:
Heart disease is the leading cause of death worldwide. High cholesterol leads to hardened arteries that can cause a heart attack or stroke. When the guidelines were last reviewed five years ago, they moved away from the use of cholesterol numbers to determine who needs treatment and a formula that takes into account age, high blood pressure and other factors to estimate more widely or risk
This was confusing, therefore, the new guidelines combine both approaches, setting objectives based on the formula and considering individual circumstances, such as other medical conditions or a family history of early cardiopathy.
"It will never be as simple as a single cholesterol number," because it does not give a clear picture of risk, said a board member, Dr. Donald Lloyd-Jones from Northwestern University.
If the treatment is necessary, the first choice remains a statin such as Lipitor or Crestor, which are sold as generics for one penny a day. For people at high risk, like 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 lower cholesterol.
Only if these two medications do not help enough, they should be considered more powerful but expensive drugs called PCSK9 inhibitors. Many insurers limit their coverage: Repatha, sold by Amgen and Praluent, sold by Sanofi and Regeneron, and the guidelines say they are not profitable except for people at greatest risk.
Finally, if it is not clear if someone needs treatment, the guidelines suggest a coronary artery calcium test, which seeks hardening of the arteries to help decide. It is a type of x-ray with a dose of radiation similar to mammography and costs between $ 100 and $ 300, which most insurers do not cover. Lloyd-Jones and others defended their use.
"Half of the people will score zero calcium and can safely avoid statins," a quarter will score high and will need treatment, and the rest will need to weigh medical options, he said.
Dr. Steven Nissen of the Cleveland Clinic, who did not play any role in the guidelines, called them a great improvement, but disagreed with "using a radiation-based test to decide whether to give a drug that costs $ 3 per month," referring to statin price. A cheaper test to check the arterial inflammation would be better, he said.
FISH OIL, VITAMIN D
Two major studies gave 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 people, one gram per day of a combined EPA / DHA, a dose and a type that is found in many dietary supplements, did not show a clear ability to reduce the risk of heart or cancer problems.
But another study testing 4 grams per day of Vasilla de Amarin Corp, which is concentrated in the EPA, found that it cuts heart problems in people at higher risk because of high triglycerides, a type of blood fat and other causes. Everyone was already taking a statin, and there is concern about the results because Vascepa was compared to mineral oil, which may interfere with statins and may make the comparison group rate get worse. Even so, some doctors said the benefits of Vascepa seemed large enough to overcome that concern.
The study that tested the least amount of fish oil in the general population also tested vitamin D, one of the most popular supplements and found that it did not lower the risk of cancer or heart problems.
"I think we need to accept that it is a good test" and that the vitamin is not worth it, "said Dr. Jane Armitage from the University of Oxford of England. "We see no benefit".
"Do not lose the money in these supplements," which are not well regulated and are of variable quality, said Dr. Deepak Bhatt of Brigham and the Women's Hospital in Boston.
People with diabetes often die of heart disease or heart failure and new medications for diabetes are needed to be tested in large studies to demonstrate that they do not increase cardiac risks. One of these medications, Jardiance, surprised doctors a few years ago reducing the risk of heart attacks and stroke. A second medication, Invokana, later showed similar benefits, but with some worrying side effects.
A new study tested a third drug, Farxiga, in more than 17,000 diabetic patients with other cardiac risk factors and found a lower rate of hospitalization due to heart failure or heart failure (5 percent among people with drugs compared to 6 percent in a placebo group after four years of use. This is on top of the known benefits of diabetes control drug.
Certain infections and a severe accumulation of acids in the blood were more common with Farxiga but these were rare and were known complications of the drug. It costs about $ 15 per day, approximately the same as similar medications. Farxiga's manufacturer, AstraZeneca, sponsored the study and many study leaders consult for the company.
An independent expert, Dr. Eric Peterson, a cardiologist at Duke University and one of the leaders of the conference, said doctors were eager to know if previous studies suggesting these drugs could help the hearts to be a joke. The results of the new study, the largest so far, "could make this class of drugs much more common" for diabetics with high cardiac risk or heart failure, he said.
Marilynn Marchione can be followed in http://twitter.com/MMarchioneAP
The Department of Health and Science of the Association receives support from the Department of Scientific Education of the Howard Hughes Medical Institute. The AP is solely responsible for all content.