Category Archives: Heart

Blood Test to Help Predict Heart Disease

The FDA has cleared for marketing a test that could help predict risk for coronary heart disease events in people with no history of heart disease. The PLAC Test for Lp-PLA2 Activity assesses the level of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) — a marker of vascular inflammation.
Researchers used the test to measure Lp-PLA2 levels in 4600 people aged 45 to 92 who were free of CHD at baseline. After a median follow-up of 5 years, people with Lp-PLA2 levels above 225 nmol/min/mL had a higher rate of CHD events than those with lower levels (7.0% vs. 3.3%). The FDA said that the test predicts risk most accurately in black women.

FDA news release

Belly Fat an Independent Risk Factor for Sudden Cardiac Death

The association of general obesity with sudden cardiac death appears to be mediated through traditional cardiovascular risk factors, whereas abdominal obesity may pose an independent risk for sudden death, a Heart study suggests.
The findings, according to editorialists, suggest that waist-to-hip ratio might be better than BMI for predicting sudden cardiac death. The mechanisms responsible for the association remain speculative, however.
The recommended waist circumference for men is less than 102 cm, and for women is less than 88 cm.

Heart

Does Aspirin Prevent Heart Attacks in Women?

In women over the age of 45, with no personal history of heart disease, 100 mg of aspirin taken daily prevented a relatively small number of heart attacks and even a smaller number of colorectal cancers. The risk of major gastrointestinal bleeding remained high.

In women over the age of 65, with no personal history of heart disease, the benefits of cardiovascular protection increased and incidence of colorectal cancers decreased, with 100 mg of aspirin, but at the expense of an even higher risk of bleeding.

The authors conclude that aspirin “is ineffective or harmful in the majority of women with regard to the combined risk of cardiovascular disease, cancer, and major gastrointestinal bleeding.” However, “selective treatment” in older women may be reasonable.

In most women, the benefits of regular aspirin use for primary prevention don’t outweigh the risks, a Heart study suggests.

Heart

No Benefit of Fish Oil Supplementation for Preventing Heart Disease

Consumption of fatty fish rich in long-chain ω-3 polyunsaturated fatty
acids is associated with lower risk for heart disease
and death, but no heart benefits have been demonstrated for
supplementation with ω-3 fatty acids. The macular xanthophylls lutein
and zeaxanthin are purported to have anti-inflammatory effects, and
people with higher lutein levels have lower levels of coronary
palque.

In this study participants were randomized to daily DHA (350 mg) plus EPA (650 mg),
lutein (10 mg) plus zeaxanthin (2 mg), both, or neither. During median
follow-up of about 5 years, 460 CV events were identified. Incidence
of these events did not differ significantly among the four groups,
nor did adverse events.

This is the latest of several large trials to show no benefit of fish
oil supplementation in lowering risk for cardiovascular disease (NEJM
JW Gen Med May 8 2013). As with most dietary supplements,
epidemiological associations that suggested lower risk have not been
borne out in clinical trials of supplementation. Eating Atlantic
salmon and trout is still a better bet.

Bonds DE et al., JAMA Intern Med 2014 May 174:763

CVS to Stop Selling Tobacco

CVS Caremark has announced plans to stop selling tobacco products at
all of its pharmacies by Oct. 1.

A JAMA viewpoint, co-written by CVS’s chief medical officer, notes
that pharmacy chains, including CVS, are adding retail health clinics
to assist in treating chronic conditions like hypertension,
hyperlipidemia, and diabetes, “all conditions exacerbated by smoking.”
The article continues: “Although the sale of tobacco products in CVS
pharmacies produces more than $1.5 billion in revenues annually, the
financial gain is outweighed by the paradox inherent in promoting
health while contributing to tobacco-related deaths.”

Several medical societies, including the American Lung Association,
came out in support of the move and encouraged other pharmacies to
follow suit.

In other anti-smoking news, the FDA is about to release a new anti-
smoking campaign aimed at high-risk youth aged 12 to 17. “The Real
Cost” will target teens’ concerns, such as the cosmetic consequences
of smoking.

CVS statement

Aspirin Not Approved for Primary Prevention of Heart Attacks or Strokes

Aspirin shouldn’t be marketed for primary prevention of heart attack 
or stroke, the FDA has announced. The statement follows the agency’s 
rejection on Friday of Bayer Healthcare’s decade-old petition 
requesting approval of a primary prevention indication.

Aspirin is still widely used for primary prevention. The American 
Heart Association currently supports its use for primary prevention 
when recommended by a physician in high-risk patients. (There is 
widespread agreement that for secondary prevention, aspirin’s benefits 
outweigh the risks, and it should be used to prevent a second heart 
attack or stroke after an earlier cardiovascular event.)

In its statement, the FDA said it had “reviewed the available data and 
does not believe the evidence supports the general use of aspirin for 
primary prevention of a heart attack or stroke. In fact, there are 
serious risks associated with the use of aspirin, including increased 
risk of bleeding in the stomach and brain.”

FDA consumer information

Dietary Fiber After Heart Attack Linked to Improved Survival

Consuming more dietary fiber after myocardial infarction is associated 
with a reduced risk for death, a BMJ study finds.

Researchers analyzed long-term data about diet and other risk factors 
from more than 4000 healthcare professionals who had an MI. Nine years 
after the MI, people who were in the highest quintile of fiber 
consumption had a 25% lower risk for death from any cause. Overall, 
there was a 15% reduction in mortality risk associated with every 10-g/
day increase in fiber intake.

The strongest association was observed for fiber derived from cereals 
and grains. A strong benefit was also found for people with the 
largest increases in fiber consumption after their MI. The findings 
remained significant after adjustment for other factors known to 
influence survival after MI. However, the authors acknowledge that 
they were unable to “fully adjust for all known or unknown healthy 
lifestyle changes.”

The authors note that less than 5% of people in the U.S. consume the 
minimum recommended amount of fiber (25 g/day for women and 38 g/day 
for men).

BMJ article