Fish oil, vitamin D, new drugs, new guidelines on cholesterol: the news of a conference of the American Heart Association during the weekend reveal a lot about what works and what does not work to prevent heart attacks and other problems .
Dietary supplements did not reach the mark, but a prescription fish oil proved promising. A medication not only helped people with diabetes manage their blood sugar and lose weight, it also reduced the risk of needing hospitalization for heart failure.
Good news for everyone: you do not have to fast before a blood test to control cholesterol. Do not stop at the donut store on the way to the clinic, but eating something before the test is fine for most people, the guidelines say.
They are from the Heart Association and the American College of Cardiology and are supported by many other groups of doctors. No author had financial links with drug manufacturers.
Here are the highlights of the conference, which concludes 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 revised five years ago, they stopped using only cholesterol numbers to determine who needs treatment and to a formula that takes into account age, high blood pressure and other factors to estimate risk more effectively. wide.
That was confusing, so the new guidelines combine both approaches, setting goals based on the formula and considering 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 number," because that does not give a clear idea of the risk, said a member of the board of directors, Dr. Donald Lloyd-Jones of Northwestern University.
If treatment is needed, the first option is still a statin like Lipitor or Crestor, which are sold as generics for a penny per day. For people at high risk, such as those who have already had a heart attack, the guidelines suggest adding Zetia, which is also sold as a low-cost generic, if the statin did not lower cholesterol enough.
Only if those two drugs do not help enough should new, potent but expensive drugs called PCSK9 inhibitors 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 profitable, except for the people who are most at risk.
Finally, if it is not clear if anyone needs treatment, the guidelines suggest a calcium test in the coronary artery, which seeks hardening of the arteries, to help decide. It is a type of X-ray with a radiation dose similar to a mammogram and costs between $ 100 and $ 300, which most insurers do not cover. Lloyd-Jones and others defended its use.
"Half of people will have a zero calcium score and can avoid a statin very safely," 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 it a big improvement, but he did not agree to "use a test that involves radiation to decide whether to administer a drug that costs $ 3 to mes ", referring to the price of statins. A cheap test to verify inflammation of the artery would be better, he said.
FISH OIL, 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 people, 1 gram per day of a combination of EPA / DHA, one dose and one type found in many dietary supplements, did not show a clear ability to reduce the risk of heart problems or cancer.
But another study that tested 4 grams per day from Vascepa Corp. of Amarin Corp., which is EPA-concentrated, found that it reduced heart problems in people at higher risk for them because of high triglycerides, a type of fat in the blood and other reasons. All were already taking a statin, and there is concern about the results because Vascepa was compared to mineral oil, which can interfere with statins, and may have worsened the situation of the comparison group. However, some doctors said Vascepa's benefits appeared to be 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 should accept that it is a good test" and that the 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 on those supplements," which are not well regulated and of varying quality, said Dr. Deepak Bhatt of Brigham and Women's Hospital in Boston.
People with diabetes often die of heart disease or heart failure, and new drugs for diabetes are required to be badyzed in large studies to show that they do not increase heart risks. One of these medications, Jardiance, surprised doctors a few years ago by reducing the risk of heart attacks and strokes. A second medication, Invokana, later showed similar benefits but with some troubling side effects.
A new study tested a third drug, Farxiga, in more than 17,000 diabetics with other cardiac risk factors and found a lower rate of hospitalization for heart failure or death from heart-related causes: 5 percent among those who took the drug versus 6 percent in a placebo group after four years of use. That is above the known benefits of the drug to control diabetes.
Certain infections and a severe accumulation of acids in the blood were more common with Farxiga, but complications of the drug were rare and known. It costs around $ 15 per day, roughly the same as similar medications. The Farxiga 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 have been anxious to know if previous studies suggesting that these drugs could help hearts were a casuality. The results of the new study, the largest so far, "could make this clbad of drugs much more widely used as standard" for diabetics with high cardiac risk or heart failure, he said.
Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP
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