CHICAGO (AP) – Fish Oil, Vitamin D, New Drugs, New Cholesterol Rules: News from an American Heart Association conference this weekend reveals a lot about what works and what does not prevent heart attacks and other problems.
Dietary supplements lacked the mark, but a prescription oil showed a promise. A drug not only helped people with diabetes control blood sugar and lose weight, but also lowered the risk that they would need hospitalization for heart failure.
Good news for all: You no longer need to fast before a blood sample to control cholesterol. Do not stay in the donut shop on the way to the clinic, but eat something before the test is good for most people, says the guidelines.
They are from the Heart Association and the American College of Cardiology and are approved by many other doctoral groups. No writer had financial ties to doctors.
Here are the highlights of the conference that break up 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 last revised five years ago, they moved from using only cholesterol to determine who needs treatment and against a formula that takes into account age, hypertension and other factors to more widely estimate risk.
It was confusing that the new guidelines mix both approaches, set goals based on the formula and take 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, Dr. Donald Lloyd-Jones of Northwestern University.
If treatment is needed, the first choice remains a statin like Lipitor or Crestor, which is sold as a generic for a crown per day. For people at high risk, like those who have already had a myocardial infarction, the guidelines suggest that Zetia, also sold as a cheap generic, if statin does not significantly lower cholesterol.
Only if the two drugs do not help enough should be considered powerful but more 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 cost-effective except for people with the highest risk.
Finally, if it is unclear if anyone needs treatment, the guidelines suggest a coronary artery test, which looks for cure of the arteries, to help determine. It is a type of X-ray with a radiation dose similar to a mammogram and costs $ 100 to $ 300, which most insurers do not cover. Lloyd-Jones and others defended their use.
"Half people will have a zero-caliber value and can avoid statin very sure," quarter will do high and need treatment, and the rest must weigh alternatives with their doctors, he said.
Cleveland Clinic Dr Steven Nissen, who had no role in the guidelines, called them a big improvement but did not agree to "use a test that involves radiation to decide if to give a drug that costs $ 3 per month", with reference at the price of statins. A cheap test to check for inflammation of the artery would be better, he said.
FISH COLOR, VITAMIN D
Two main 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 subjects, 1 gram per day showed an EPA / DHA combination dose, a dose and type found in many dietary supplements, no clear ability to lower the risk of heart disease or cancer.
But another study that tests 4 grams per day of Amarin Corp. Vascepa, which is concentrated EPA, found that heartburn problems in people at higher risk because of high triglycerides, a type of fat in the blood and other causes. Everyone already took the statue, and there are concerns about the results because Vascepa was compared with mineral oil, which could interfere with the statins and may have made the comparison group more dangerous. Still, some doctors said Vascepa's benefits seemed big enough to outweigh the worry.
The study that tested the lower 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 must accept that it's a good test" and that the vitamin is not worth, "says Dr. Jane Armitage from England's Oxford University. "We see no benefit."
"Do not waste your money on those dietary supplements", which are not well-regulated and of varying quality, says Dr. Deepak Bhatt from Brigham and Women's Hospital in Boston.
People with diabetes often die of heart disease or heart failure, and new diabetes medication must be tested in large studies to show that they do not increase heart rate risk. Such a drug, Jardiance, surprised doctors a few years ago by lowering the risk of heart attacks and strokes. Another medicine, 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 factors and found a lower hospitalization for heart failure or death from heart related causes – 5 percent of them on the drug against 6 percent in a placebo group after four years of use. It is on top of the drug's known benefits for controlling diabetes.
Certain infections and a serious build up of acids in the blood were more common with Farxiga but these were rare and are known complications of the drug. It costs about $ 15 a day, much the same as a similar drug. Farxiga's maker, AstraZeneca, sponsored the study and many study leaders consult the company.
An independent expert, Dr. Eric Peterson, a Duke University cardiologist and one of the conference leaders, said that doctors have been eager to know about the earlier studies that indicate that these drugs can help the hearts be a fluke. Results from the new study, the largest so far, "could make this class of drugs much more common" for diabetics with high heartbeat or heart failure, he said.
Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP
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