Tag Archives: statins

An Update on New Research – Straight from the Source!

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IMG_8348rt5x7bwThere is always plenty of research being conducted on heart disease prevention, but this week I decided to go straight to the source. This week I will be blogging directly from the Cardiometabolic Health Congress in Boston – a collection of presentations on recent concepts and new research in the treatment of conditions like high blood pressure, high cholesterol and diabetes. The goal? To prevent heart disease and stroke.

Here are some highlights from the first day:

High Cholesterol: The big news in cholesterol treatment is the development of a new class of potent drugs, PCS-K9 inhibitors, (Which I previously reported on here) which are different from statins – they lower cholesterol potently, but must be given by injection. For now, they are reserved for patients with seriously elevated levels while taking statins – or those intolerant of statins.

While statins are very effective in patients with a history of heart disease, many patients who take them have never had cardiovascular disease – they were prescribed purely for prevention. Many people given statins are actually at low long term risk – and the statin may not impact their risk further. Recent research shows that we can refine which patients benefit by using a test to look for early evidence of plaque buildup in the arteries. This test, called a coronary calcium scan (or heart scan) is cheap and quick, and can clarify which patients really will benefit from a statin.  Here is a recent article from the New York TImes with more details.

Obesity: Anyone who has tried to lose weight know the frustration of seeing the weight return over time. We often attribute this to poor will power, but research now shows that certain hormones are activated that actually “stimulate” the body to gain weight – like a weight “thermostat” that tries to return to a prior setting. New research is trying to interrupt this cycle and allow weight to stay off.

Research also shows that there are different “types” of obesity – many people consider themselves overweight, but are otherwise very healthy – normal blood pressure, blood sugars, and cholesterol. In others, their weight leads to chronic issues and eventual complications. So always think of your weight in the context of your overall health.

Finally, when we decide to eat something, we assume we are doing so in response to feeling “hungry”. But research show that we often eat in response to other cues – sights and smells, emotional states, and availability of food. (A great example of “mindless” eating is chomping on popcorn while we are engrossed with a movie) So if you struggle with willpower, try to limit these non-hunger “cues” – remove unhealthy food from the house, and try to steer clear of temptations as you go about your day.

Tomorrow, we will hear about new research into high blood pressure and diabetes. (As always – these are general concepts – only your doctor can address your specific health issues).

A New Option for Patients Who Can’t Tolerate Statins

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IMG_8348rt5x7bwFor over 20 years, statins (such as atorvastatin and simvastatin) have been one of our primary weapons to fight heart and vascular disease, because of their ability to reduce cholesterol, and subsequently prevent heart attacks and strokes. But in many patients, statins are poorly tolerated or ineffective at reducing cholesterol to  the desired target.

Recently, a new class of cholesterol-fighting drugs were discovered, and the first of these agents has been approved by the FDA. These medications, called PCS-K9 inhibitors, work differently than statins, and do not seem to have the common side effects of statins, such as muscle soreness. They appear to markedly lower cholesterol, and appear to be safe.  This article in the Wall Street Journal nicely summarizes the promise of these drugs, as well as the drawbacks (the drugs are very expensive, and must be given by injection).

In addition to those drawbacks, the new agents have yet to establish a long-term track record of safety and prevention of heart attacks and strokes. So initially, these agents will be reserved for patients who have genetic elevations of cholesterol, and those with known cardiovascular disease for whom statins are ineffective or not tolerated. In the near future, more agents will become available (lowering their price), and further studies will guide how to best use them.

In the meantime, statins remain our best weapon against high cholesterol – and are safe and well tolerated, even when given for many years. And as the above article documents, well-done studies have shown that most muscle soreness in patients on statins is either unrelated to the medication, or resolves when a different statin is used.

And of course, remember that diet and exercise, not just medications,  are effective weapons against high cholesterol.

More articles about cholesterol:

Overview of Prevention

The New Cholesterol Guidelines: What do they mean for you?

 

The New Cholesterol Guidelines: What do they mean for you?

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Kanny S Grewal MD 5x7 (4)As you may of heard, some experts created new guidelines for clinicians to treat high cholesterol, and they have generated quite a bit of controversy, since they are a big departure from prior guidelines. The big new difference is that they no longer emphasize having “target” levels of cholesterol, LDL, etc and rather focus on just using statins at low, moderate, or high doses based on the patients level of “risk”, which is calculated from a formula based on age, sex, and various risk factors. This could be a sound approach, since some experts feel that simply being on a statin will reduce heart risk, regardless of how much a patients “numbers” actually change. They also conclude that most other types of cholesterol medications, besides statins, don’t have much impact on heart disease and are not generally recommended. The controversy is that the recommended formula to calculate an individual’s long-tern risk has not been thoroughly tested, and it seems to overestimate risk in many groups of patients.

What messages can we “take home” from these new guidelines? Here are a few:

1. The best treatment for high cholesterol remains lifestyle – diet and exercise.

2. The decision to start medication therapy should be individualized and come from the patient, after a thorough discussion with their clinician about risk.

3. Patients with established heart disease clearly benefit from statin therapy, which clearly reduces future risk of heart attack and stroke.

4. For patients without a history of heart disease or stroke,the benefit may be very negligible, unless they fall in a “high risk” group based on other risk factors such as diabetes. These patients should discuss the pros and cons of medication therapy with their doctor.

4. One way to think of statin therapy: it reduces future risk of heart attack and stroke by one-third in everyone. That means a 300 lbs diabetic who just had a heart attack, and a 30 year old fitness fanatic in perfect shape. The difference is the baseline risk. If you start with a risk of 1 in 100 of a heart attack the next 5 years, is that 1/3 reduction really worth taking a potentially toxic pill every day? Probably not. But 1 in 10, or 1 in 5? Probably yes.

So if you have been recommended therapy, or already on therapy, for high cholesterol, ask your doctor about your cardiovascular risk both with and without medication. And more importantly, stay active, maintain your weight, and focus on your diet!

Here is an some excellent summaries of the debate about the new cholesterol guidelines:

Dr. Krumholtz discussion in New York Times

Experts Reshape Treatment Guide for Cholesterol