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CHICAGO (AP) – Fish oil, vitamin D, new drugs and new recommendations for cholesterol: news of a conference of the American Heart Association this weekend says a lot about what works and what that does not work to prevent heart attacks and other problems.
Dietary supplements missed the target, but a fish oil with a prescribing strength has proved promising. A drug has not only helped diabetics control their blood sugar and lose weight, but has also reduced their risk of hospitalization for heart failure.
Good news for all: it is no longer necessary to fast before a blood test to check for cholesterol levels. Do not stop at the donut shop before going to the clinic, but according to instructions, eating something before the test is acceptable.
They come from the Heart Association and the American College of Cardiology and are endorsed by many other groups of doctors. No author had a financial link with the drug makers.
Here are the highlights of the conference which will conclude on Monday:
CHOLESTEROL
Heart disease is the leading cause of death in the world. High cholesterol leads to the formation of hardened arteries that can lead to a heart attack or stroke. In the last revision of the guidelines, five years ago, they turned away from the number of cholesterol to determine the patients to be treated and adopted a formula that took into account age, hypertension, and other factors to estimate the risk in a more global way.
This was confusing, the new guidelines combine the two approaches, setting formula-based goals and taking into account special circumstances, such as other medical conditions or a family history of early heart disease.
"It will never be as simple as a simple cholesterol number" as this does not give a clear picture of risk, said one of the referral committee members, Dr. Donald Lloyd-Jones of Northwestern University.
If treatment is needed, the first choice is a statin such as Lipitor or Crestor, sold as generics at the penny a day. For high-risk people, 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 has not sufficiently lowered the rate cholesterol.
Only if these two drugs do not help enough, should newer, powerful but expensive drugs called PCSK9 inhibitors be considered. Many insurers limit coverage – Repatha, sold by Amgen, and Praluent, sold by Sanofi and Regeneron – and the guidelines indicate that they are not profitable except for people who run a very high risk.
Finally, if it is not clear if a person needs treatment, the guidelines suggest a calcium test in the coronary arteries, which looks for hardening of the arteries, to help decide. It's a type of X-ray with a radiation dose similar to that of a mammogram and that costs between $ 100 and $ 300, which most insurers do not cover. Lloyd-Jones and others have defended its use.
"Half of the people will have a zero calcium score and will be able to avoid a statin very safely," a quarter will score and require treatment, and others will weigh the options with their doctors, he said.
Dr. Steven Nissen of the Cleveland Clinic, who had no role in the guidelines, described them as great improvement but disagreed with "the use of a test involving irradiation to decide to whether to give a drug that costs $ 3 a month, "referring to the price of statins. A cheap test to check artery inflammation would be better, he said.
FISH OIL, 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 people, 1 gram per day of an EPA / DHA combo, a dose and type found in many dietary supplements, showed no obvious ability to reduce the risk of heart problems or cancer.
But another study testing 4 grams per day of Vascepa from Amarin Corp., which is an EPA concentrate, has shown that it has reduced heart problems in people most at risk for triglycerides, a type of fat in the blood and other reasons. All were already taking a statin, and the results are worrisome because Vascepa has been compared to a mineral oil, which may interfere with statins and may have worsened the situation of the comparator group. However, some doctors said that Vascepa's benefits seemed large enough to offset this concern.
The study that tested the lowest amount of fish oil in the general population also tested vitamin D, one of the most popular supplements, and revealed that she did not decrease the risk of cancer or heart problems.
"I think we have to accept the fact that it's a good test" and that vitamin is not worth it, said Dr. Jane Armitage of the University of Oxford in England. "We do not see any benefit."
"Do not waste your money with these supplements," which are not well regulated and whose quality varies, said Dr. Deepak Bhatt of Brigham and Women's Hospital in Boston.
DIABETES
People with diabetes often die from heart disease or heart failure, and new drugs need to be tested as part of in-depth studies to demonstrate that they do not have the disease. cause no cardiac risk. One of these drugs, Jardiance, surprised doctors a few years ago by reducing the risk of heart attack and stroke. A second drug, Invokana, has subsequently shown similar benefits, but with some disturbing side effects.
A new study has tested a third drug, Farxiga, in more than 17,000 diabetics with other cardiac risk factors and has shown a lower hospitalization rate because of heart failure or cardiac death – 5% among those taking this medication, compared with 6% in a group of patients. placebo group after four years of use. This is in addition to the known benefits of the drug for controlling diabetes.
Some infections and a severe accumulation of acids in the blood were more common with Farxiga, but they were rare and are known complications of the drug. It costs about $ 15 a day, about the same as similar drugs. The manufacturer of Farxiga, AstraZeneca, has sponsored the study and many study directors are consulting this company.
An independent expert, Dr. Eric Peterson, a Duke University cardiologist and one of the conference leaders, said the doctors were eager to know if previous studies suggesting that these drugs could help hearts were a hit. luck. The results of the new study, the largest to date, "could make this class of drugs much more commonly used" for diabetics with high heart risk or heart failure, he said.
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