CHICAGO (AP) – Fish oil, vitamin D, new medicines, new guidelines for cholesterol: News from the American Heart Association Association at weekends reveals a lot about what works and does not prevent heart attacks and other problems.
Nutritional supplements have missed the label, but fish oil with recipes has been a promise. The drug not only helped people with diabetes to control blood sugar and lose weight but also reduce the risk of hospitalization due to heart failure.
Good news for all: you no longer have to go to the blood test before cholesterol testing. Do not stop at the shop on the way to the clinic, but you eat something before the test is fine for most people, say directions.
They are from the Heart Association and the American College of Cardiology and have been confirmed by many other doctors. No author had any financial links with drug manufacturers.
Here are the most important news from the conference that ends on 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 last changed five years ago, they were relieved of the use of cholesterol to determine who should be treated according to a formula that considers age, high blood pressure, and other factors to better assess the risk.
This is confusing and new guidelines combine both approaches, set goals based on the formula, and take into account individual circumstances such as other medical conditions or family history of early heart disease.
"It will never be as simple as a cholesterol number," because it does not give a clear picture of the risk, said one board member, Dr. Donald Lloyd-Jones from Northwestern University.
If treatment is needed, the first choice remains statin such as Lipitor or Crestor, which are sold as a generic for one day per day. For people with a high risk, like those who have had a heart attack, guidelines point to the addition of Zetia, which is also sold as cheap generic if statin is not lower cholesterol.
Only if these two drugs do not help it enough, but powerful but expensive new medicines called PCSK9 inhibitors should be considered. Many insurers limit their coverage – Repatha, sold by Amgen and Praluent, which sells Sanofi and Regeneron – guidelines say they are not worthwhile, except for people at a very high risk.
Finally, if it is unclear whether somebody needs treatment, the guidelines point to the calcium coronary artery test, which requires arterial hardening to decide. It's a type of X-ray radiation with a mammography similar to the one that costs 100 to 300 dollars, which most insurance providers do not cover. Lloyd-Jones and others defended his use.
"Half of people will have zero calcium results and can avoid statin very safe", the fourth will score high and need treatment, and the rest will need to weigh the options with their doctors, he said.
Dr. Steven Nissen, Cleveland Clinic, who had no role in the guidelines, called them major improvements, but disagreed with "using radiation-intensive trials to decide if the drug would cost $ 3 per month," which refers to the price statins. An inexpensive test for artery inflammation would be better, he said.
OIL 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 people, the 1 gram daily EPA / DHA combo, dose and species found in many nutritional supplements has not shown a clear possibility of reducing risk for heart disease or cancer.
But another study that tested 4 grams of daily Amaca Vascepa, which was concentrated in EPA, found that heart problems are people at higher risk due to high levels of triglycerides, fat in the blood, and other reasons. All have already taken statin, and concern is due to the fact that Vascepa is compared with mineral oil, which can interfere with statins and may have deteriorated with the rough comparator group. However, some doctors claim that Vascepin's benefits are large enough to overcome that concern.
A study that tested a 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 reduce the risk of cancer or heart problems.
"I think we have to accept that this is a good test," and that vitamin does not pay, "Dr. Jane Armitage from Oxford University in England said," We see no benefit. "
"Do not spend money on those supplements," which are not well regulated and have different qualities, "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 drugs for diabetes must be tested in large studies to show they do not increase heart failure. One such remedy, Jardiance, surprised physicians a few years ago by reducing the risk of heart attacks and stroke. The other drug, Invokana, later showed similar benefits, but with some worrying side effects.
A new study has tested the third drug Farxiga in more than 17,000 diabetics with other cardiac risk factors and found a lower rate of hospitalization due to heart failure or cardiac death – 5 percent among drug users compared to 6 percent in placebo after four years of use. This is at the top of the known drugs for controlling diabetes.
Certain infections and severe bile acid accumulation were more common in Farxig but these were rare and drug complications were known. The cost is about $ 15 a day, about the same as similar medicines. The Farxiga manufacturer, AstraZeneca, sponsored the study and many study officers advise the company.
One independent expert, Dr. Eric Peterson, Cardiologist Duke University and one of the conference leaders, said doctors wanted to find out whether previous studies suggest that drugs could help their hearts. The results of the new study, the largest so far, "could use this class of drugs much more standardly" for diabetics with high risk of heart failure or heart failure, he said.