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With Your Next Fast-Food Meal—Add A Statin?

September 16, 2010

Would it make sense to offer a statin drug to customers in fast-food restaurants to offset the increased heart attack risk associated with eating, say, a cheeseburger and milkshake? Some British researchers recently made such a proposal and, to back it up, attempted to calculate a statin's ability to neutralize eating habits that can trigger a rise in cholesterol.

Here is what's behind this somewhat tongue-in-cheek strategy, presented in the American Journal of Cardiology. Many people, note the researchers, are going to ignore medical advice and eat unhealthy diets containing excessive amounts of cholesterol-raising fat and trans fat. Arguing that statins are inexpensive and relatively safe, they suggest that, along with condiments like salt, ketchup, and mayonnaise, fast-food restaurants could offer packets containing doses of generic statins to counteract the risk to cardiovascular health posed by fast-food offerings.

Would a statin tablet actually cancel out the harm of a high-fat meal? To answer that question, the researchers calculated the increase in heart disease risk associated with consuming the fat and trans fat in a McDonald's Quarter Pounder with cheese (chosen because it is so well known) and a small milkshake—which together contain 36 grams of total fat and nearly 3 grams of trans fat. Drawing upon data from studies on diet and heart attack risk as well as the results of clinical trials testing statins, the researchers concluded that most statins (with the exception of pravastatin) would "neutralize" the cardiovascular risk of regularly eating a cheeseburger and milkshake.

Of course, extrapolating from clinical trials can't take into account the impact a statin would have on eating the occasional cheeseburger. But there is some evidence to indicate that statins taken on less than a daily schedule have a protective effect. The authors also make it clear that the "MacStatin," as they dub their creation, is not intended as a substitute for systematic lifestyle improvements. Nor is it a panacea for all the ill effects of dining on fast foods.

Critics might object that handing out statins would encourage people to feel they can eat whatever they want without any consequences to their health. But it is already evident, from the epidemic of obesity and heart disease we see in Western countries, that many people don’t follow a healthy lifestyle. The free statin pill, declare the authors, "would add, at little cost, one positive choice to a panoply of negative ones."

Someday, perhaps. But even if something like a MacStatin comes to pass, there is no question that there are better ways to reduce your risk of heart disease than relying on an occasional pill—including limiting foods containing trans fat, exercising regularly, not smoking, and talking to your doctor about addressing any specific risk factors for heart disease that you may have.

Source: Ferenczi, E., et. al. Can a statin neutralize the cardiovascular risk of unhealthy dietary choices? American Journal of Cardiology. 2010 August 15; 106 (4): 587-592.

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Taking Statins Before Surgery Reduces Heart Attack Risk

September 16, 2010

It's been common practice for patients who have coronary bypass surgery or other coronary procedure to be given a statin drug afterwards, reflecting guidelines for these interventions. But researchers have been investigating the benefit of starting patients on statins prior to coronary procedures—and a new study finds that doing so reduces the risk of complications, most importantly heart attacks.

The researchers analyzed data from 21 clinical trials—involving nearly 5,000 patients—that examined statin therapy being given before coronary procedures. Most of the patients had not been statin users previously. Patients began statin therapy anywhere from 4 weeks to less than a day before their procedures.

Compared with patients getting a placebo, those receiving statins had a significantly lower incidence of heart attacks following percutaneous coronary intervention (PCI, commonly known as coronary angioplasty)—7.5% vs. 13% for the control groups, including placebo, usual care, and low-dose statin therapy. And pre-surgery statins significantly reduced the incidence of post-operative atrial fibrillation—the most common type of cardiac arrhythmia—for patients who underwent coronary artery bypass surgery.

Why is there a benefit from such short-term use of a statin? Lowering LDL ("bad") cholesterol substantially—the main effect of statins—requires weeks. But statins are thought to have additional "pleotropic" effects that include stabilizing vulnerable arterial plaques and reducing inflammation—and these effects may act quickly to provide cardiac protection.

Because the studies in this meta-analysis used different drugs and dosing regimens, the optimal dose, timing, and type of statin that should be used before coronary procedures isn't clear. Also, adverse side effects were not reported. However, given the safety record of statins, and the strength of this evidence, the authors of an accompanying editorial state that "no patient should undergo coronary procedures without statin therapy unless clear contraindications exist."

If you are planning to undergo an invasive coronary procedure, be sure to discuss pre-operative statin therapy with your doctor.

Sources: Winchester, D, et. al. Evidence of pre-procedural statin therapy: A meta-analysis of randomized trials. Journal of the American College of Cardiology, published online August 30, 2010. DOI: 10.1016/j.jacc.2010.04.023; and Eagle, K; Chopra, V. "Statins Before Coronary Procedures," Journal of the American College of Cardiology, published online August 30, 2010. DOI: 10.1016/j.jacc.2010.04.022.

Younger Folks Should Worry About Cholesterol

August 16, 2010

Is it really worthwhile for young adults to have their cholesterol tested? "Yes"—since unhealthy cholesterol levels even at a relatively young age can significantly increase the risk of heart disease later in life, according to a new study.

Researchers looked at data on more than 3,258 18- to 30-year-old men and women who were followed for 20 years. Those who had elevated levels of LDL cholesterol (so-called "bad" cholesterol) at the outset appeared more likely to develop heart disease later, as shown by the presence of coronary calcium, a strong predictor of heart disease risk. Nearly half of those with elevated LDL levels (160 mg/dL or greater) during young adulthood had coronary calcium by middle age, compared with only 8% of those with very low levels of LDL (less than 70 mg/dL). Even modest increases in LDL cholesterol levels of 130 to 159 mg/dL were associated with a higher prevalence of coronary calcium.

These results, reported in the Annals of Internal Medicine, suggest that high cholesterol levels in young adults may cause damage to arteries that persists and contributes to a greater risk of heart attack and stroke later on. Whether or not young adults with elevated LDL levels can safely benefit from cholesterol-lowering medication isn't clear. But, say the researchers, "young adults and their physicians should realize that what they eat and how much they exercise seem to matter even early in life...and that healthy behavior should not be deferred until middle age."

The American Heart Association recommends that everyone have their cholesterol tested starting at age 20. Children or adolescents with risk factors for heart disease may be advised by their doctors to begin testing earlier.

To lower your cholesterol with lifestyle measures:

  • Limit the amount of saturated fat, trans fat, and cholesterol you eat
  • Achieve and maintain a healthy weight
  • Increase the soluble fiber in your diet
  • Make regular physical activity a goal: Try to get at least 30 minutes of moderate-intensity activity (such as walking) on most days of the week

Sources: Pletcher, et. al. Nonoptimal Lipids Commonly Present in Young Adults and Coronary Calcium Later in Life: The CARDIA (Coronary Artery Risk Development in Young Adults) Study. Annals of Internal Medicine, August 3 2010; 153: 137-146.;
American Heart Association; and
National Heart, Lung and Blood Institute

HDL Cholesterol Gets a Boost from a Low-Carb Diet

August 16, 2010

Raising blood levels of HDL ("good") cholesterol is usually much harder to achieve than lowering LDL ("bad") cholesterol—which makes the results of a new study showing the impact diet can have on HDL levels all the more impressive.

The study compared the effect of low-carbohydrate and low-fat diets on weight loss and on other health-related goals, including cholesterol levels. All 307 people in the study—which appeared in the Annals of Internal Medicine—were obese at the start and were assigned to follow either a low-fat (1,200 to 1,800 calories a day with no more than 30% calories from fat) or low-carbohydrate (limited to 20 grams of carbohydrates a day initially, then gradually increased ) eating plan. People with dyslipidemia or diabetes were excluded from the study. Along with dietary guidelines, the participants received regular counseling on behavioral strategies to aid in weight control (such as keeping a food diary and increasing exercise).

Neither dietary approach proved superior for losing weight: Both groups lost similar amounts of weight, with weight loss averaging 24 pounds after one year and 15 pounds after two years. Both groups also experienced improvements in cholesterol levels, with drops in total cholesterol and LDL ("bad") cholesterol and a rise in HDL cholesterol.

But the increase in HDL was significantly higher for people following the low-carb diet. HDL levels rose by about 20% in the low-carb group and stayed at that increased level during the two-year study—which was more than twice the increase observed in the low-fat diet group.

In fact, the researchers noted, the degree of improvement in HDL cholesterol in the low-carb group was equivalent to improvements obtained with niacin, the most effective medication available for raising HDL.

If your HDL cholesterol is a primary concern—and if you are eating a low-fat, high-carbohydrate diet—replacing carbohydrates with fats, preferably unsaturated fats, may help boost HDL levels or at least keep them from dropping. Losing weight if you’re overweight and performing regular aerobic exercise (such as running or cycling) can also raise HDL.

Source: Foster, et. al. Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus a Low-Fat Diet. Annals of Internal Medicine, August 3 2010; 153: 147-157.

Cancer Risk Drops as "Good" Cholesterol Climbs

July 9, 2010

It's harder to raise HDL cholesterol—the "good" type of cholesterol known to reduce the risk of heart attacks and strokes—than it is to lower LDL ("bad") cholesterol. But raising HDL may pay dividends beyond helping to prevent a heart attack. Higher HDL levels may also curb the risk of cancer, according to a new study.

Researchers analyzed results from two dozen clinical trials that tested treatments for modifying cholesterol levels with statin drugs. The trials chosen also contained information about the incidence of cancer among the participants. The researchers found that every 10-point increase in levels of HDL cholesterol was associated with a 36% lower risk of developing cancer.

Because the study, reported in the Journal of the American College of Cardiology, is observational, it doesn't prove a causal effect of HDL on cancer. That would require a controlled trial. But the link is plausible: HDL has been shown to have anti-inflammatory and antioxidant properties that may fight the growth of tumors.

Whether the cancer benefit is ultimately proved or disproved, anyone with low HDL levels will gain by adopting the steps known to boost HDL. These include not smoking, engaging in regular aerobic exercise, and losing weight if you’re overweight. Drinking alcohol moderately (one or two drinks a day) also raises HDL, but because drinking alcohol carries health risks as well as benefits, experts don't recommend that nondrinkers start drinking just for the HDL effect. If you have very low HDL, your doctor may also recommend medication—specifically, niacin or a fibrate.

Source: Haseeb J., et al. "Baseline and On-Treatment High-Density Lipoprotein Cholesterol and the Risk of Cancer in Randomized Controlled Trials of Lipid-Altering Therapy," Journal of the American College of Cardiology, Vol. 55, No. 25, 2010, doi:10.1016/j.jacc.2009.12.069

Challenging the Heart Benefits of B Vitamins

July 9, 2010

Researchers discovered some time ago that increasing your intake of B vitamins can lower blood levels of homocysteine, an amino acid associated with an increased risk of heart attacks and strokes when blood levels are elevated. But will lowering homocysteine actually reduce your risk of cardiovascular disease?

It's not clear whether high homocysteine levels cause cardiovascular events, are a result of them, or are simply a marker for them. But in the hope that B vitamins—including folic acid, vitamin B12, and vitamin B6—will yield a cardiovascular benefit, researchers have conducted a number of studies with the supplements, which can lower homocysteine levels by about 25%.

Though several clinical trials carried out over the past five years cast doubt on a risk-reduction benefit, the trials were of short duration. However, a new study provides a more definitive answer—lowering homocysteine has no clear benefit.

The study, reported in the Journal of the American Medical Association, was a clinical trial of more than 12,000 heart attack survivors. The subjects—who took daily supplements of folic acid (2 milligrams) and vitamin B12 (1 milligram), or a placebo—were followed for almost seven years. Even though homocysteine levels dropped by 28% in the supplement group, the incidence of heart attack, stroke, cardiac surgery, and cardiovascular death was virtually the same in both groups.

"Taken together with the previous homocysteine-lowering trials...," the study authors concluded, "these results highlight the importance of focusing on drug treatments (aspirin, statins, and antihypertensive therapy) and lifestyle changes (in particular, stopping smoking and avoiding excessive weight gain) that are of proven benefit, rather than lowering homocysteine with folic-acid supplements, for the prevention of cardiovascular disease."

Source: "Effects of Homocysteine-Lowering With Folic Acid Plus Vitamin B12 vs. Placebo on Mortality and Major Morbidity in Myocardial Infarction Survivors," JAMA, 2010;303(24): (doi:10.1001/jama.2010.840)

Statins: Benefits Clearly Outweigh Risks

June 7, 2010

It's well-established that cholesterol-lowering statin drugs help prevent heart attacks and strokes. But the potential unintended effects associated with using statins, especially harmful ones, have been much debated. A new study analyzes 25 of these previous nut studies and reveals who can expect the biggest cholesterol-lowering effect from a daily snack of nuts.

Researchers in England collected data on more than 2 million patients, ages 30–84, from 368 medical practices throughout England and Wales. Just over 225,000 of the patients were new users of statins. The researchers looked at adverse effects reported by patients from 2002 to 2008, taking into account the type and dose of statins the patients used.

They found no significant risk for a wide range of health problems that have been attributed to statins at one time or another during the nearly three decades that statins have been in use. These include Parkinson's disease, rheumatoid arthritis, dementia, osteoporosis, and several common cancers, including lung, breast, and prostate cancer. And there was a reduced risk of esophageal cancer among the statin users.

But the study did reveal an increased risk for some conditions. Both men and women statin users were at risk of myopathy (muscle pain), liver dysfunction, acute renal failure, and cataracts—and the risks were spread equally among the different brands of statins, except for a higher risk of liver dysfunction associated with fluvastatin.

Still, in absolute numbers, these risks were small. Based on the data, for every 10,000 women treated with a statin, an estimated 74 extra patients (compared with 10,000 patients not taking a statin) would experience liver dysfunction and 39 would experience myopathy. But the same 10,000 statin users would experience 271 fewer cases of cardiovascular disease. Moreover, muscle and liver side effects are largely reversible.

The study isn't likely to change the guidelines doctors use in prescribing statins, but it may encourage closer monitoring for adverse effects, especially during the first year of statin use, when risks in the study were highest.

Source: Hippisley-Cox, J, Coupland, C. BMJ 2010;340:c2197. DOI:10.1136/bmj.c2197.

Snack Your Way to Lower Cholesterol

June 7, 2010

Many studies have been done on nuts and their effect on cholesterol, and researchers have consistently found the effect is favorable—which presumably is a key reason that eating nuts of all kinds has been linked to a reduced risk of heart disease. A new study analyzes 25 of these previous nut studies and reveals who can expect the biggest cholesterol-lowering effect from a daily snack of nuts.

In this latest analysis, researchers from Loma Linda University in California pooled the data from 25 studies from around the world, involving close to 600 people. Those who consumed 20% of their calories from nuts (that's 2.5 ounces of nuts a day for a 2,000-calorie diet) reduced their LDL ("bad") cholesterol by about 7%, though lower amounts were also effective.

The benefits were most pronounced in people who had higher levels of LDL to begin with, those with a lower body mass index (BMI), and in those who ate a Western diet compared with people consuming a Mediterranean diet, which is lower in saturated (animal-derived) fats and refined carbohydrates.

The reason for these benefits? Nuts are rich in unsaturated fats, the kind that improve blood cholesterol, especially when eaten in place of animal fats and refined carbohydrates. Nuts are also rich in B vitamins, potassium, copper, magnesium, fiber, arginine (an amino acid that helps relax blood vessels), sterols (which also help lower cholesterol), and other plant substances that may benefit the heart in various ways. The FDA allows the qualified health claim that eating 1.5 ounces of nuts a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.

But keep in mind that, while the fats in nuts may be heart-healthy, they also carry calories. In fact, nuts have 160 to 200 calories per ounce. Limiting yourself to an ounce or two a day may be enough to get some benefit. How many nuts are in an ounce? The numbers vary, but pistachios offer more nuts per ounce (47) than others, such as cashews (18), pecans (19 halves), and almonds (23).

Source: Sabate, J, Oda, Keiji, Ros, Emilio. Archives Internal Medicine, 2010;170(9):821-827.

Added Sugars Tied to Worsening Cholesterol Levels

May 11, 2010

Put sugar on the list of dietary factors that have a negative impact on cholesterol. A new study has found that consuming high amounts of sugars added to processed foods and beverages is associated with increasing levels of blood triglycerides and lowering protective HDL ("good") cholesterol.

Other studies have shown a link between carbohydrates in the diet and unhealthy changes in cholesterol levels—and between carbohydrates and weight gain. But this study, published in the Journal of the American Medical Association, is the first to focus on added sugars and cholesterol.

Using data from a large ongoing national health survey, researchers looked at consumption of added sugars among 6,113 survey respondents. Those in the lowest sugar intake bracket consumed, on average, 3 teaspoons of added sugar a day; those in the highest intake bracket, 46 teaspoons, amounting to 25% of daily energy intake from added sugars.

As sugar consumption rose, lipid levels progressively worsened. Average HDL cholesterol slipped from 58.7 milligrams per deciliter (lowest-sugar group) to 47.7 (highest sugar), while, respectively, triglycerides rose from 105 to 114. People in the highest intake group were 20% more likely to have high triglycerides (more than 150 milligrams per deciliter), putting them at increased risk of cardiovascular disease. And 60% were more likely to have a high ratio of triglycerides to HDL, which also increases cardiovascular risk.

The bottom line: For decades, American dietary guidelines focused on saturated fat as the primary trigger in the diet for unhealthy changes in cholesterol. But trimming saturated fat from your diet and replacing it with sugar can also contribute to heart-damaging cholesterol levels.

Statins May Help Protect Replaced Hips

May 11, 2010

Taking a statin drug may reduce the risk of complications among patients who have had hip replacement surgery, according to a recent study.

Researchers for the study, published in The Journal of Bone and Joint Surgery, examined medical records of a national database of patients who had undergone hip replacement. They found that patients prescribed statins for controlling their cholesterol were far less likely to need a second replacement (revision surgery) ten years after their first surgery.

Statins may aid in bone formation and they also reduce inflammation—effects that help prevent an implant from becoming loose.

Further research is needed. But if these results are confirmed, one day statin therapy may be a standard recommendation for people undergoing hip replacement.

A Statin for Primary Prevention Benefits Older Adults

April 21, 2010

In analyzing data from a landmark study, researchers found that taking a statin drug to prevent heart attacks and other cardiovascular events in healthy people with elevated levels of C-reactive protein had the greatest benefit for adults age 70 and older.

Doctors have debated the value of prescribing statin drugs for older adults, since there is limited information on their effectiveness and safety when it comes to preventing first heart attacks in people age 70 and over. To help address this question, researchers analyzed data from the 2008 JUPITER study, a large, randomized-controlled clinical trial that compared rosuvastatin (Crestor®) with a placebo in nearly 18,000 men and women with no history of cardiovascular disease. All the people in the study had normal levels of LDL ("bad") cholesterol but high levels of C-reactive protein (CRP), a marker of chronic inflammation associated with an increased risk of cardiovascular problems.

The study included 5,695 people 70 or older—a larger number of people in that age range than in most previous studies of statins. Among these older subjects, those who took rosuvastatin had fewer heart attacks and strokes than subjects who took a placebo. The 70-and-older group also had a greater reduction in cardiovascular events compared with subjects younger than 70.

Though this analysis indicates that statin therapy has a clear benefit for older adults, more research is needed to confirm the value of routinely using CRP testing as a tool for cardiovascular risk assessment.

Eating a High-Carb Diet Poses Heart Risk in Women

April 21, 2010

A large study of 45,000 people found that women who consume a lot of bread, pizza, rice, and other carbohydrate-rich foods that rank high on the glycemic index are at increased risk of heart disease.

The study, published in Archives of Internal Medicine, relied on information obtained via questionnaires from Italian villagers about their diets. For every person in the study, researchers were able to calculate the average glycemic index (GI) of the foods they ate. The GI ranks foods containing carbohydrates by their effect on blood glucose (sugar); foods with a high GI are those quickly broken down into glucose, which leads to a rapid rise in blood sugar. High-GI foods include sugary foods (such as honey or jam) and refined grains such as bread made from white flour and white rice.

After seven years, 463 people in the study had developed heart disease. The researchers found that, among women in the study, increasing carbohydrate intake with high-GI foods was associated with increased risk of heart disease. An increased intake of carbs with low-GI foods, on the other hand, was not associated with increased risk, nor was total intake of carbs. There was no link between heart disease and carbs among the men in the study. One theory, according to the researchers, is that a high-GI diet may suppress levels of HDL ("good") cholesterol and triglycerides in women more than in men.

It is possible that reducing the intake of high-GI foods could lower a woman's risk of heart disease—but as of now, there is insufficient evidence to support the use of low-GI diets for heart health.

Saturated Fats and Heart Disease: Replacement Is the Key

April 7, 2010

For years, saturated fats have been tagged as the leading dietary culprit behind high cholesterol levels and heart disease—and experts have emphasized reducing intake of saturated fats to lower the risk of heart disease. But a new study indicates it's important to focus on what you eat in place of saturated fats.

Saturated fats are found primarily in animal products such as meat, butter, cheese, and whole milk. These fats tend to raise levels of LDL ("bad") cholesterol, though the effect varies from person to person. In response to concerns about high cholesterol and heart disease, Americans have cut back on the amount of saturated fat in their diet (in part because the food industry has reduced saturated fat levels in food products). At the same time, the overriding tendency when people reduce their saturated fat intake has been to increase their consumption of refined carbohydrates—which include pasta, white breads, and sugary baked goods.

Unfortunately, this trade-off often has an adverse effect on blood cholesterol—lowering HDL ("good") cholesterol and increasing triglycerides and smaller, more dangerous LDL particles. At the Harvard School of Public Health, researchers analyzed eight well-designed randomized clinical trials in which subjects specifically replaced saturated fat calories by increasing their intake of polyunsaturated fats—which come from vegetable oils and include safflower, sesame, and corn oils. This type of fat is also found in seeds and nuts.

The meta-analysis, published in the open-access journal PLoS Medicine, found that people who replace saturated fat in their diet with polyunsaturated fats reduced their risk of heart disease by 19%, compared with control groups who did not. (The study didn't address the effect of consuming monounsaturated fats, such as those found in olive oil and canola oil.) The findings suggest that increasing the intake of polyunsaturated fats could significantly reduce the rate of heart attacks among American—as long as those fats are replacing saturated fats. It's important to avoid consuming more fat calories overall, since weight gain and obesity not only adversely affect cholesterol levels but heart health generally.

Update on Study of Controversial Cholesterol Drug

April 7, 2010

Vytorin®, an expensive and heavily promoted brand-name drug that combines a statin with another cholesterol-lowering agent, ezetimibe, has been the subject of much media scrutiny. A large-scale clinical trial called IMPROVE-IT is designed to test the drug's effect on heart disease—but the results are not expected until 2013.

Many experts have questioned the cardiovascular benefit of Vytorin. A study called ENHANCE, published in 2008 in The New England Journal of Medicine, found that this medication was no more effective than a statin alone at slowing the rate of arterial thickening in the neck (an indicator of heart disease risk)—even though Vytorin lowered LDL cholesterol further. The study raised the possibility that, despite ezetimbe's effectiveness in lowering LDL cholesterol, it may not reduce the risk of heart attacks or strokes.

IMPROVE-IT, which will include up to 18,000 subjects, is under way to answer that question. When the trial was first announced several years ago, investigators expected it to be completed by 2011. But in an update published recently in the American Heart Journal, they stated that the estimated end date is now June 2013.

The investigators also noted that, because of this longer duration, more patients than originally anticipated will have stopped taking the drug—and this could "cause the treatment effect to be diminished." Nevertheless, they believe that IMPROVE-IT will "provide a definitive answer regarding . . . clinical outcomes."

In the meantime, there is widespread agreement among experts that Vytorin (or ezetimibe alone, which is marketed under the brand name Zetia®) should be reserved for people at high risk of heart disease and heart attack who cannot reach a desired level of LDL cholesterol any other way. The decision about starting to use Vytorin or ezetimibe (or stopping if you are already using one of the drugs) should be made in consultation with your doctor.

Testing a Cholesterol Drug Combination in People with Diabetes

March 18, 2010

Aggressive treatment to reduce cardiovascular risk in people with type 2 diabetes can involve combination drug therapy. But does taking more than one drug to control cholesterol levels produce a real benefit?

People with diabetes tend to have a cluster of risk factors that increases their risk of heart disease, and these include elevated triglycerides and low levels of HDL ("good") cholesterol as well as high levels of LDL ("bad") cholesterol. Therefore, some patients are treated with a type of cholesterol drug called a fibrate, which can improve triglyceride and HDL levels.

In a new study, published in The New England Journal of Medicine, researchers tested the effect of a fibrate-statin combination against a statin alone among 5,518 patients with type 2 diabetes.

After nearly five years, patients taking the combination experienced 291 major cardiovascular events, including fatal and nonfatal strokes and heart attacks, compared with 310 in the statin-only group—a difference not considered statistically significant. A small subgroup of patients with the highest triglyceride levels and the lowest HDL levels may have experienced some benefit, since they showed greater improvement in lipid levels than the overall group. Further research is needed to clarify whether a fibrate should be prescribed for such high-risk patients. But most diabetic patients who are already on statins won’t be helped by taking the additional drug.

Scanning for Abdominal Calcium May Reveal Risk for the Heart

March 18, 2010

Experts have known for some time that calcium deposits in coronary arteries may signal the presence of heart disease. Now a new study has found that calcium in arteries in the abdomen may also be a useful predictor of cardiovascular risk.

Researchers analyzed computed tomography (CT) scans of the abdominal area (taken for a variety of reasons) of 367 patients who showed no signs of heart disease at the time of the CT scans—but who all underwent coronary angiography (used to diagnose coronary artery disease) within a year of the scans. The findings were reported recently at the American College of Cardiology 2010 Scientific Sessions.

After a follow-up period of just over two years, 65 of the patients had died. Analysis of the CT scans showed that calcification in the abdominal aorta—which supplies blood to much of the abdominal cavity—was associated with increased mortality as well as with coronary artery disease. Abdominal calcium scores were significantly higher in patients with coronary artery disease—and among patients with a score of zero, only 7 out of 62 showed signs of coronary artery disease.

It is too early to recommend that abdominal CT scans be ordered to screen for coronary artery disease. But when abdominal scans have already been done on patients being evaluated for cardiovascular problems, the information may help cardiologists in decisions about treatment.

What Is a Diagnosis of Metabolic Syndrome Worth?

March 11, 2010

Experts have argued about whether metabolic syndrome is a distinct disorder. But even if it isn't, a new study suggests that a diagnosis of metabolic syndrome can help focus attention on people at high risk of cardiovascular disease—and offer targets for prevention efforts.

According to the way it is commonly defined, metabolic syndrome is a condition characterized by a cluster of problems that include abdominal obesity, elevated triglyceride levels, low levels of HDL ("good") cholesterol, high blood pressure, and high levels of blood sugar. A person with three of these components is considered to have metabolic syndrome. People with the syndrome—an estimated 47 million Americans—have a greater incidence of all types of cardiovascular disease, including fatal and nonfatal heart attacks and strokes.

But metabolic syndrome appears to have no more impact on disease risk than the individual risk factors that make it up, according to a study in the Archives of Internal Medicine. Researchers reviewed seven clinical trials that monitored coronary plaque progression in nearly 3,500 patients, of whom 57% had metabolic syndrome. When the researchers made adjustments for the individual factors in predicting risk, metabolic syndrome no longer offered any advantage as an independent predictor. Among the individual factors, elevated triglycerides and abdominal obesity were most strongly associated with the progression of plaque.

The researchers suggest that, even though metabolic syndrome may not directly affect coronary arteries, diagnosing the condition in someone emphasizes that he or she is at high risk of cardiovascular disease—and may help motivate patients to make health-enhancing lifestyle changes, especially changes aimed at losing weight and lowering high triglycerides.

Smoking Exposure and Children's Hearts

March 11, 2010

Smoking, clearly, is bad for your heart, and research has shown that secondary smoke—passive smoking—has also been linked to an increased risk of heart disease in adults. But what is the impact of passive smoking on children? A new study provides an answer.

The study, published in Circulation: Cardiovascular Quality and Outcomes, tracked 494 healthy children up through the age of 13. Blood levels of cholesterol and other lipids were periodically measured, as were levels of cotinine, a by-product of nicotine that indicates recent exposure to tobacco smoke. The researchers found that, as exposure to tobacco smoke increased, so did levels of ApoB, a protein present on particles of LDL ("bad") cholesterol. In some studies, high levels of ApoB have been more strongly linked to a risk of heart attacks than high LDL levels. Smoke exposure in the children was also associated with increased thickness of arterial walls, which is a marker of early atherosclerosis.

The conclusion: Even minimal exposure to tobacco smoke at an early age may increase the risk of a heart attack—which is why children should always have a smoke-free environment.

Taking a Cholesterol-Lowering Statin May Increase the Risk of Diabetes

February 24, 2010

For years, experts have recommended that anyone with diabetes take a statin drug to lower their risk of heart disease. Now a new study suggests that statins slightly increase the risk of developing diabetes. But does the risk outweigh statins' cardiovascular benefit?

Researchers analyzed data on more than 13 placebo-controlled studies testing therapy with statins. The studies involved more than 90,000 people—of whom 2,226 on statins developed diabetes over an average of four years compared with 2,052 new diabetes cases among those who did not take statins. The risk of taking statins, therefore, was 9%, considered statistically significant (meaning it did not occur by chance). This translates into one patient among 255 who took statins developing diabetes.

The diabetes risk is not associated with one particular statin, but with the class of drugs as a whole—and the risk was highest in studies involving older subjects, according to the new analysis, which was published in The Lancet.

The researchers concluded, however, that the risk of diabetes is low compared with the reduced risk of heart attacks and other coronary events associated with taking statins. This is especially true for people at moderate to high risk of heart disease. The reward/risk ratio is less clear for people at low cardiovascular risk; therefore, anyone at low risk who is prescribed a statin may want to discuss the specific benefit with his or her doctor. And if you have been taking a statin, especially if you are older, ask your doctor about testing blood glucose levels to check for diabetes.

Focusing on the Positive May Protect Hearts

February 24, 2010

People who tend to express positive emotions are less likely to develop heart disease than those who don't, according to a recent study. Does this mean that the power of positive thinking can help prevent a heart attack?

The study, published in the European Heart Journal, assessed 1,739 healthy adults for their risk of heart disease and, using self-reporting techniques and clinical evaluation, also measured the subjects' degree of "positive affect"—being able to experience and express positive emotions such as enthusiasm, contentment, and joy. The researchers also measured negative emotions such as hostility, anxiety, and depression.

Over a 10-year period, according to the researchers, people with little or no positive affect were at significantly higher risk of developing heart disease than those with moderate or high levels of positive affect—even after adjusting for the subjects' age, gender, and risk factors for heart disease. The finding also held true when taking into account negative emotions reported by people who were judged to be positive overall.

The researchers noted that their observational study doesn't establish a causal connection between emotional states and the risk of heart disease. It's too soon to know, therefore, if making an effort to be positive can actually prevent heart disease. Studies are underway to determine if people with cardiovascular disease who become depressed experience any benefit from taking steps to increase positive affect. In the meantime, it can't hurt—and it certainly may help—to work a positive experience or two into your life each day.

Cholesterol Drug Is Approved for Primary Prevention

February 10, 2010

For the first time, a cholesterol-lowering statin drug—rosuvastatin (Crestor®)—has received FDA approval for the primary prevention of cardiovascular disease. Under new labeling, the drug can be prescribed for people with no history of coronary heart disease and who have normal levels of blood cholesterol—but have elevated levels of C-reactive protein (CRP), a marker of chronic inflammation associated with an increased risk of heart attacks and other cardiovascular events.

According to the new labeling, rosuvastatin can be prescribed for men age 50 or older and women 60 or older who are free of heart disease, have LDL ("bad") cholesterol levels in a normal range (below 130 mg/dL), and CRP levels of 2.0 milligrams mg/dL or higher, which is considered elevated.

The new approval is based on the findings of the JUPITER trial—a large, randomized-controlled study reported in 2008 that compared rosuvastatin with a placebo in nearly 18,000 people who matched the description of patients in the new labeling. In the JUPITER trial, the people taking rosuvastatin had 50% fewer heart attacks and strokes than those taking a placebo.

Elevated CRP levels can be detected with a simple blood test. Whether to have CRP levels measured is something to discuss with your doctor. If you do get tested, any treatment decisions should also take into account your other risk factors and overall risk profile for heart disease.

Gout and Heart Attacks in Women

February 10, 2010

Gout, the rheumatic disease that can cause sudden pain and swelling in a joint, is known to increase the risk of heart attacks in men. Now a new study shows that women with gout are at even higher heart attack risk.

Gout is caused by excess deposits of uric acid, a waste product, in a joint or in the surrounding tissue. The deposits accumulate as crystals inside the joint. A gout attack, which can be triggered by alcohol, certain medications, illness, or stress, typically involves a joint in the foot, but can also strike the ankle, heel, knee, wrist, finger, or elbow.

Two million Americans have gout, and while most of them are men, the condition affects about 220,000 women. Risk factors for gout include a family history of the disorder, excess weight, high alcohol intake, hypertension, high cholesterol, and diabetes.

For a study published in Annals of Rheumatic Diseases, researchers analyzed health data on more than 9,500 gout patients and 48,000 patients without gout. Focusing on cardiovascular events that occurred over an average of 7 years, the researchers found that women with gout were 41% more likely to have a fatal or non-fatal heart attack than women who didn't have gout. The comparable increased risk among men with gout was only 11%.

The findings, note the researchers, should encourage aggressive management of cardiovascular risk factors in all patients with gout.

Red Yeast Rice: Comparable to a Statin?

January 28, 2010

The dietary supplement red yeast rice, which has been shown to lower cholesterol levels, is cheaper than a prescription statin drug. But is red yeast rice a sound alternative? It's worth asking—especially since a new study has found that people with high cholesterol respond just as well to red yeast rice as they do to pravastatin.

Researchers compared the two substances in a small study of 43 subjects who had been treating high cholesterol with a statin other than pravastatin—and had stopped treatment because of muscle pain (myalgia), the most common side effect associated with statin drugs. As part of a new treatment regimen, the subjects took either red yeast rice or pravastatin daily; they also participated in a program emphasizing improvements in diet and exercise.

After 12 weeks, their levels of LDL ("bad") cholesterol had decreased by virtually the same amount (27% in the pravastatin group, 30% in the red yeast rice group) and reports of muscle pain were also similar—and on the low side. The results were reported in the American Journal of Cardiology.

The ability of red yeast rice to lower cholesterol is no mystery: Red yeast rice extract contains a naturally occurring statin, lovastatin (which is also the active ingredient in one of the statin drugs). But because the manufacture of dietary supplements is unregulated, you can't be certain of the dosage or purity of any red yeast rice product you buy in a drugstore or health food store. So despite the study's positive results, you are better off opting for generic pravastatin, which is well regulated, has been extensively tested, and is also one of the least expensive statins. If you do want to try red yeast rice, be sure to talk to your doctor first.

A New (and Quick) Measure of Heart Health

January 28, 2010

By identifying 7 risk factors and lifestyle behaviors associated with heart disease, the American Heart Association (AHA) has provided a definition of "ideal cardiovascular health" that everyone can understand—part of a program aimed at improving the cardiovascular health of all Americans.

The 7 steps, published online in the journal Circulation, include standards for body weight, exercise, diet, cholesterol levels, blood pressure, and fasting blood sugar. Depending on how an adult scores in these areas, his or her cardiovascular health will be graded as poor, intermediate, or ideal. The AHA program also explains how you can improve your heart health and keep track of your progress.

To see how you rate in heart health with the 7-step checklist, visit My Life Check™.

Popular Pain Drug May Interfere with Aspirin's Heart Benefits

January 14, 2010

Despite warnings that celecoxib (Celebrex®) can increase the risk of a heart attack, millions of people continue to take this medication for the relief of arthritis or other pain. Many people who take Celebrex also take a daily low-dose aspirin (81 mg)—which helps prevent the formation of blood clots—to reduce the risk of a heart attack or a stroke. But Celebrex, suggests a recent study, may actually offset aspirin's heart-protective effects.

Celebrex is an NSAID—a nonsteroidal anti-inflammatory drug—that belongs to a class of medications known as cox-2 inhibitors, which promise to relieve pain while reducing the odds of experiencing stomach upset and other gastrointestinal side effects associated with older NSAIDs such as ibuprofen and naproxen. Celebrex is the only cox-2 inhibitor currently sold (two others, Vioxx and Bextra, were taken off the market because they carried a greater risk of cardiovascular disease).

New research, published in the Proceedings of the National Academy of Sciences, indicates that celecoxib binds to an enzyme involved in the clumping of platelets—blunting aspirin's anticlotting effect. The researchers also looked at blood samples of animals and found more clumping of platelets in animals given both drugs than in animals given only low-dose aspirin.

Previous studies in people have shown that Celebrex doesn't interfere with aspirin taken at a standard dose (325 mg). But if these newest findings on the effects of low-dose aspirin are confirmed in human studies, people who benefit the most from low-dose aspirin—such as those with unstable angina or who have had a first heart attack—would have to exercise caution in using Celebrex.

A New Finding on Race, Vitamin D, and Heart Attacks

January 14, 2010

A number of studies have established a clear link between low blood levels of vitamin D and heart disease. Recently, researchers reported that low vitamin D levels (usually defined as less than 20 nanograms per milliliter of blood) may help account for higher mortality rates due to heart disease and stroke among black Americans.

Vitamin D is a hormone that is obtained through sun exposure as well as diet—and certain factors appear to hamper vitamin D absorption among blacks. Because darker skin pigment absorbs less sunlight, people with dark skin synthesize less vitamin D than whites when exposed to the same amount of sunlight. In fact, blacks need significantly more sun exposure than whites to achieve the same levels of vitamin D. A good dietary source of vitamin D is milk, which is typically fortified with the vitamin. But blacks may consume less milk than whites due to a higher incidence of lactose intolerance.

In a study published in Annals of Family Medicine, researchers looked at data involving more than 15,000 U.S. adults, 10% of whom were black. The data included measurements of vitamin D blood levels, death rates due to cardiovascular disease, and other cardiac risk factors such as smoking status and body weight.

Adults with the lowest vitamin D blood levels had a 40% higher risk of death from cardiovascular disease. Overall, blacks had a 38% higher risk of cardiovascular death than whites—and vitamin D deficiency accounted for about two thirds of the increased risk. A third of blacks were in the lowest quartile of vitamin D levels, while 91% of whites were in the highest.

It's unclear whether raising vitamin D levels with dietary supplements will reduce the risk of heart disease—but most experts agree that vitamin D levels of at least 30 to 40 nanograms per milliliter are desirable. To reach these levels, many people—and especially blacks and individuals over age 60 (older people produce less vitamin D from sun exposure)—should consume 800 to 1,000 IU of supplemental vitamin D daily.

HDL Cholesterol Not As "Good" in People with Diabetes

December 30, 2009

HDL cholesterol is known as "good" cholesterol because it transports LDL ("bad") cholesterol out of arteries and so helps to lower the risk of heart disease and heart attacks. HDL also has beneficial effects on the lining of blood vessels. But HDL cholesterol may not be as beneficial in the presence of type 2 diabetes, according to a new study in the journal Circulation—although taking niacin, which raises levels of HDL cholesterol, appears to restore HDL's benefits in people with diabetes.

Researchers compared samples of HDL cholesterol from 10 healthy people with samples taken from 33 people who had type 2 diabetes and metabolic syndrome, a condition that typically includes low levels of HDL. Laboratory analysis of the samples showed that the protection HDL provides blood vessels—it can help repair damage to the lining of vessels as well reduce future damage, increasing the ability of vessels to expand—was "substantially impaired" in the people with diabetes. This was true even though they were taking a statin drug for lowering LDL cholesterol.

The patients with diabetes were then given either a placebo or extended-release niacin daily. After 3 months, not only did the patients receiving niacin have higher HDL levels, but also the protective effects of HDL cholesterol had improved substantially, as had blood vessel function.

Because the study was small and most of the people in the study were men, more research is needed to confirm whether or not everyone with type 2 diabetes would benefit from taking niacin.

More Proof of C-Reactive Protein's Role in Heart Disease

December 30, 2009

Elevated levels of C-reactive protein (CRP)—which is produced by the liver and is a marker of chronic inflammation—often accompany or signal an increased risk of a heart attack. But is CRP as powerful an indicator of heart disease as more established risk factors such as cholesterol levels, smoking, and high blood pressure? A new study concludes it is.

The study, a meta-analysis published in the Lancet, included data on 160,000 patients who participated in 54 long-term studies. The researchers found that an elevated level of CRP is as consistent as high cholesterol and high blood pressure over a period of several years in predicting the risk of heart disease, ischemic stroke, and mortality.

The analysis doesn't show whether a high level of CRP contributes to directly causing heart attacks and other coronary events or whether it is simply a marker for inflammation or another causal factor. But it does lend more weight to the argument that CRP testing—a topic of intense debate among experts—has real value, especially for patients considered at intermediate risk according to established risk factors.

Menopause May Trigger a Jump in Cholesterol

December 17, 2009

It's well established that the risk of heart disease in women increases dramatically after middle age and the transition through menopause—marked by a woman’s final menstrual period. But is the increase due to aging or to changes associated specifically with menopause? A new study finds that menopause directly affects a key heart disease risk factor: harmful cholesterol levels.

Over a nine-year period, researchers tracked 1,054 women from different ethnic groups who, at the beginning of the study, were pre- or perimenopausal—with an age range of 47 to 52. None of the women had heart disease or took hormone therapy. The women underwent annual examinations that included evaluating a variety of heart disease risk factors, including blood pressure, blood glucose and insulin, and levels of cholesterol and other blood lipids (fats). By the tenth exam, all of the women had experienced their final menstrual period.

The researchers found that, within a year before and after the final menstrual period, total cholesterol and LDL ("bad") cholesterol rose substantially in nearly all the women—by an average of 9% for LDL levels and 6.5% for total cholesterol. Such a dramatic increase was not true of the other risk factors for heart disease, which changed at a steady rate throughout the length of the study—indicating an effect of aging, not menopause. The pattern of changes was similar across the different ethnic groups.

Further research may turn up identify other effects of menopause on a woman's risk of heart disease. But these findings, published in the Journal of the American College of Cardiology, strongly suggest that monitoring cholesterol levels in women at midlife should help in the primary prevention of heart disease.

C-Reactive Protein Indicates Long-Term Risk of Heart Disease

December 17, 2009

High blood levels of C-reactive protein (CRP), a marker of chronic inflammation in the body, have long been thought to contribute to heart disease. Now new research shows that, even in people with normal levels of LDL cholesterol, high CRP levels pose an increased risk of heart attack and stroke stretching over years.

The research built on findings from JUPITER, a large well-designed clinical trial that showed that a cholesterol-lowering statin drug—which also lowers CRP—can prevent heart disease in people with normal LDL levels but elevated CRP. Because the benefits of the drug were so pronounced, JUPITER was halted after only 2 years, though it was intended to last four. After the results were published in 2008, some critics questioned whether the results would have stayed consistent if the study had lasted longer.

For the current study, published in the Journal of the American College of Cardiology, researchers analyzed data from another large—but longer-term—study on cardiovascular risk factors. Focusing on subjects who would have been candidates for JUPITER based on their ages and CRP and cholesterol levels, the researchers analyzed heart disease risk over an average of 7 years rather than 2 years—and found that the "JUPITER-eligible" subjects had a risk of a cardiovascular event (a heart attack or stroke) similar to that of subjects in the JUPITER study who received a placebo, suggesting that the risk persisted over a longer period.

Based on their findings, the authors of the study suggest that continuing to perform CRP screening on people with normal cholesterol levels could identify those who are at higher risk of heart disease.

Cholesterol Levels Fall in U.S., But Too Many Americans Go Untreated

December 2, 2009

The percentage of Americans with unhealthy levels of LDL ("bad") cholesterol fell by about 30% between 1999 and 2006, according to an analysis of data on 7,044 subjects in a series of nationwide surveys. However, about one fifth of the subjects still had elevated LDL levels. Moreover, a large number of subjects didn't undergo any cholesterol screening—and even among those who were screened, many didn't receive adequate treatment for high cholesterol.

The researchers, who published their results in the Journal of the American Medical Association, credited the reduction in LDL levels to wider use of cholesterol-lowering statin drugs (from 8% in 1999 to 16% in 2006). But they found that about two thirds of those considered at high risk for coronary heart disease didn't get medications to bring their LDL cholesterol to target levels recommended by government guidelines. And, among survey participants with elevated LDL levels, one-fourth were screened but were not informed about the results.

In an editorial accompanying the study, two cardiologists suggested that current guidelines for cholesterol testing and treatment are "overly complicated" and should be simplified—which could help insure that people who will most benefit from cholesterol-lowering treatment receive it.

An Alternative to Measuring Cholesterol Levels

December 2, 2009

Testing for substances in the blood called apolipoproteins can provide just as reliable an assessment of risk for coronary heart disease as standard cholesterol testing, according to a new study in the Journal of the American Medical Association.

Apolipoproteins are proteins that make up a portion of the lipids (fats in the blood) that we refer to as "good" and "bad" cholesterol—HDL (for high-density lipoprotein) and LDL (low-density lipoprotein). Apolipoprotein A1 is present in HDL, while apolipoprotein B is the major protein component of LDL.

A number of studies have shown that high levels of apo B are strongly linked to a risk of heart attacks. Some research has also indicated that the ratio of apo B to apo A1 correlates better with an increased risk of heart disease than does total cholesterol or individual levels of HDL and LDL. But experts have disagreed as to whether testing of apo B and apo A1 should replace conventional testing of cholesterol levels.

For the current study, researchers at the University of Cambridge in England gathered data from cholesterol and apolipoprotein testing on 302,000 men and women, average age 59, with no symptoms of heart disease who had participated in 68 long-term studies in 21 countries. Their primary finding was that the subjects' relative risk of heart disease and ischemic stroke using apolipoprotein test results was nearly identical to the risk indicated by levels of HDL cholesterol and total cholesterol. The finding, say the researchers, suggests that future discussions about whether to test cholesterol levels or apolipoproteins should focus on practical considerations—such as cost and availability of different tests—rather than which test produces the best results.

A secondary finding in the study may also prove important. Fasting is currently recommended to obtain an accurate reading when measuring HDL and triglycerides in a cholesterol screening. But in their analysis, the researchers found that fasting did not have an impact on risk assessment—suggesting that testing could be simplified by skipping the fasting requirement.

Niacin Trumps a Heavily-Promoted Cholesterol Drug

November 22, 2009

A new study has raised questions about the benefit of Zetia® (ezetimibe), a cholesterol-lowering drug that is a component of the best-selling drug Vytorin®, which combines Zetia with a statin. The results of the study, published in The New England Journal of Medicine, showed that for patients with high cholesterol, adding niacin to a statin drug was better for reducing the buildup of arterial plaque than adding Zetia.

The small study involved only several hundred subjects who were at risk for heart disease and already taking a statin. The researchers, who presented their results at an annual meeting of the American Heart Association, had subjects add another drug to their regimen, either Zetia—which lowers LDL ("bad") cholesterol by a different mechanism than a statin—or Niaspan, a prescription extended-release form of the B vitamin niacin, which raises HDL ("good") cholesterol.

After evaluating thickening in the walls of the carotid artery—a way to track plaque buildup—the researchers found that Niaspan decreased thickening while Zetia had no significant impact. The Niaspan-statin group also had fewer heart attacks over the course of the 14-month study, though that particular benefit isn't as significant because of the study's small size and the fact that the study was halted prematurely.

Two earlier studies also found that, while Zetia lowered LDL cholesterol, it did not reduce arterial plaque. Many experts now agree that Zetia, taken alone or with a statin, should at best be a drug of last resort, reserved for patients who cannot reach their cholesterol targets any other way. A large-scale clinical trial, with up to 18,000 subjects, is under way to test whether Vytorin can reduce the incidence of heart attack and stroke. Results aren't expected until 2012.

Selenium and Cholesterol Levels

November 22, 2009

As a potent antioxidant, selenium is supposed to ward off many chronic diseases, including cancer. But to date, no large-scale studies have shown that taking supplements of selenium produces any benefit. In fact, a new study has found that selenium supplements could increase the risk of heart disease by raising cholesterol levels.

Researchers at the University of Warwick in England took blood samples from 1,042 subjects, ages 19 to 64, and analyzed the samples for levels of selenium and cholesterol. Higher levels of selenium—more than 1.20 mol/L (micromoles per liter)—were associated with higher levels of total cholesterol: on average, an increase of 8%. Subjects with high selenium also showed a 10% average increase in levels of non-HDL cholesterol, another measurement of blood lipids (fats) that can help predict the risk of a heart attack.

Nearly half of the subjects with the highest selenium levels reported that they took selenium supplements. The optimal dose of selenium is unknown, but most people already obtain adequate amounts of selenium—more than the recommended dietary allowance (RDA)—from diet alone. By taking supplements, they may be doing themselves more harm than good.

For Middle-Aged Women, Heart Attack Risk Is on the Rise

November 10, 2009

It's been common knowledge that, before their 50s, women enjoy a dramatically lower risk of heart attack than men in that age group do—presumably due to a protective benefit from female hormones. But a new study has found that, while middle-aged men still have higher rates of heart attack and heart disease than middle-aged women, the gap is narrowing.

Researchers examined data on heart attack rates from national health surveys on more than 4,000 men and women ages 35 to 54 over two time periods: 1988–1994 and 1999–2004. In both periods, men had more heart attacks than women. But the percentage of women having a heart attack increased—from 0.7% to 1%—in the second time frame, while the heart attack rate for men improved from 2.5% to 2.2%.

The researchers, writing in Archives of Internal Medicine, also looked at Framingham coronary risk scores, which take into account such heart disease risk factors as levels of total cholesterol and HDL ("good") cholesterol, blood pressure, and smoking status. Again, although overall risk scores remained higher in men than in women, men's risk for a heart attack improved in recent years, while women's risk worsened. The only risk factor that improved among women was HDL cholesterol levels.

The researchers suggest that a more aggressive approach to controlling heart disease risk factors can help counteract what they call this "ominous trend" in women's cardiovascular health.

Low Cholesterol May Reduce Risk of Aggressive Prostate Cancer

November 10, 2009

Along with offering protection against a heart attack, low levels of total cholesterol may provide an additional benefit for men. In a study of more than 5,000 men aged 55 and older, those with desirable levels of total cholesterol—below 200 mg/dL—were less likely to develop high-grade prostate cancer than men with higher cholesterol levels.

The men had been enrolled in the Prostate Cancer Prevention Trial, which was designed to test whether the drug finasteride can prevent prostate cancer. Researchers analyzed data from the trial to see if there was an association between blood cholesterol levels and prostate cancer.

They found no association between cholesterol levels and overall risk of prostate cancer. But among men in the trial who had received a placebo, high cholesterol levels were associated with an increased risk—as much as 60%—of high-grade prostate cancer. (A benefit from low cholesterol did not show up among men who received finasteride—possibly because finasteride prevented the same number of high-grade cases that low cholesterol would have prevented.)

Though it affects only a small proportion of men with prostate cancer, high-grade disease (identified by a Gleason score of 8 to 10) tends to grow and spread rapidly and to have a poorer prognosis.

This study, published in Cancer Epidemiology, Biomarkers, & Prevention, follows other studies that have found a link between the use of statin drugs and a reduced risk of advanced-stage prostate cancer. The association between statins and prostate cancer overall has not been consistent, however, and only a randomized clinical trial would clarify whether men with prostate cancer can prevent the progression of the disease by using statins or other cholesterol-lowering drugs.

The Latest on Vitamins and Heart Attack Prevention

November 1, 2009

Taking supplements of folic acid and other B vitamins can lower homocysteine—an amino acid in the blood that, at elevated levels, is linked to an increased risk of heart attacks and other cardiovascular events.So scientists have been testing a popular hypothesis—that consuming B vitamins might offer protection against heart disease.

But a major review by the Cochrane Collaboration has shown that vitamin B supplements have no effect on preventing heart attacks or strokes. The review analyzed eight randomized clinical trials that included a total of 24,210 subjects who were at risk for heart disease or already had heart disease. The subjects took either B vitamins at varying dosages or a placebo. The B-vitamin supplements did not reduce the risk of developing heart attacks or strokes or of deaths associated with cardiovascular disease.

Of course, it's important to get sufficient B vitamins through your diet. In addition, women who can become pregnant need at least 400 micrograms of folic acid daily to prevent birth defects—for which a supplement is usually recommended. But there is no reason to take supplements of folic acid or other B vitamins to lower homocysteine levels.

A Link Between Heart Disease and Hip Fractures

November 1, 2009

Heart disease and osteoporosis—bone loss characterized by an increased risk of fractures—have been thought of as independent disorders that are both common in older people. But a new study suggests that various forms of cardiovascular disease actually increase the risk of a future hip fracture.

Earlier studies established that stroke is a risk factor for hip fractures—with the most common explanation being that stroke increases the risk of falls. In this latest study, published in the Journal of the American Medical Association, Swedish researchers analyzed data on 15,968 twins to determine if other forms of cardiovascular disease increase hip fracture risk—and if there is an underlying genetic predisposition for both conditions.

In their analysis, the rate of hip fractures was highest in subjects of both sexes who earlier had been diagnosed with stroke or heart failure, followed by those with ischemic heart disease. The rate was lowest for people without any cardiovascular disease. Among pairs of twins, those free of cardiovascular disease also had an increased rate of hip fracture if their co-twins had any of these health problems—and this link was strongest among identical twins, suggesting the likelihood of a genetic predisposition.

The researchers recommend that people with a recent diagnosis of cardiovascular disease have their risk of a future fracture evaluated with a bone scan and a checkup for clinical risk factors for bone loss and fractures.

Can Statins Benefit People With Normal Cholesterol?

October 8, 2009

People with cholesterol levels in a desirable range—but who have high levels of whole-body inflammation—may benefit just as much from taking a statin drug as people with high cholesterol. This was the conclusion of a new analysis of the JUPITER trial, a large study published in 2008 which found that taking rosuvastatin (Crestor®) cut heart attack risk by 50% in relatively healthy men and women with normal levels of LDL ("bad") cholesterol but elevated levels of C-reactive protein (CRP), a marker of inflammation.

In this latest analysis, published online in the journal Circulation: Cardiovascular Quality and Outcomes, researchers examined whether the absolute risk reduction among the nearly 18,000 JUPITER subjects justifies a wider use of statin therapy in the primary prevention of heart attack and stroke. The results suggest that the benefit of statins for people with elevated CRP/low cholesterol is comparable, if not superior, to the benefit shown in previous trials of statin therapy for people with high cholesterol. The findings, say the study authors, may contribute to discussions about new guidelines for the primary prevention of heart disease.

Keep in mind that statins are not the only way to make a dent in C-reactive protein. Evidence suggests that heart-healthy lifestyle measures, especially losing weight if you are overweight, can also lower CRP levels.

Using Nontraditional Risk Factors to Assess Heart Attack Risk

October 8, 2009

You're probably familiar with the established risk factors that your doctor uses to assess your risk of developing heart disease (and therefore your risk of a heart attack). They include your age, gender, levels of total blood cholesterol and HDL ("good") cholesterol, blood pressure, and smoking status.

In recent years, researchers have also identified various other risk factors that appear linked to heart disease. These include C-reactive protein, homocysteine, lipoprotein(a), fasting blood glucose, and calcium deposits in coronary arteries.

But is there any benefit in testing for nontraditional risk factors in people with no symptoms of heart disease? Recently, researchers from the U.S. Preventive Services Task Force, a panel of experts who guide national health care, reviewed more than a decade's worth of studies on using nine nontraditional risk factors to assess the risk for heart disease. Their aim was to see if significant numbers of people at intermediate risk for heart disease—based on established risk factors—were likely to be reclassified at high risk with further testing for novel risk factors. Their conclusion: There is insufficient evidence to support the routine use of any of these other risk factors for additional risk assessment.

Hopefully, more research will clarify who might benefit from such testing. In the meantime, you should first rely on screening with established risk factors. If you are found to be at intermediate risk, you and your doctor can discuss whether other tests might help in making treatment decisions to lower your risk.

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