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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Powerful new cholesterol drugs (PCSK9 inhibitors) offer hope - Should FDA approve?

Powerful new cholesterol drugs (PCSK9 inhibitors) offer hope - Should FDA approve? | Heart and Vascular Health | Scoop.it

More than 30 million Americans take statins to lower their cholesterol, according to estimates. But these popular drugs don't work for everyone. Now the FDA may be poised to approve two drugs in this new class.

Seth Bilazarian, MD's insight:

Drs. Harlan Krumholz and Steven Nissen do a good job summarizing the difficult task the FDA faces, regarding whether to approve these new drugs called PCSK9 inhibitors.

These powerful cholesterol lowering drugs have been shown to be safe in trials of 1 -2 years duration and can lower cholesterol by 50 -60% (compared to statins that lower cholesterol by 35 - 50%) without the side effect of muscle aches seen with statins.

Should the FDA wait 2 - 3 more years for trials to be completed or allow use earlier for patients with marked cholesterol elevation?

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New Cholesterol Guidelines => Statin Nation

New Cholesterol Guidelines => Statin Nation | Heart and Vascular Health | Scoop.it

12.8 Million more adults are eligible for statin therapy based on a new study
attempting to determine the effect of new ACC/AHA guidelines
for the management of cholesterol, with the increase seen mostly
among older adults without cardiovascular disease. Among adults
60 and 75 years without cardiovascular disease, the percentage
eligible for such therapy would increase from 30.4% to 87.4%
among men and from 21.2% to 53.6% among women.

Statin Nation - graphic is from Cardiosource  World News at http://www.joomag.com/magazine/cardiosource-worldnews-april-2014/0842627001398192120

Seth Bilazarian, MD's insight:

Are you among the 12.8 million Americans for whom statin is now recommended?

The new atherosclerotic cardiovascular risk calculator (ASCVD) is available as a smartphone app at 

https://itunes.apple.com/us/app/ascvd-risk-estimator/id808875968?mt=8

or

online at:

 http://tools.cardiosource.org/ASCVD-Risk-Estimator/


Use the risk calculator and the current guidelines recommend treatment with statin cholesterol lowering medication  if the 10 year risk of stroke MI or other vascular disease is greater than 7.5% based on this calculator.

 

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askdrmaxwell's curator insight, May 26, 2014 5:17 PM

Cholesterol guidelines have gotten so low, few people can meet them, thus they are prescribed statin drugs. 

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New Cholesterol guidelines from ACC/AHA.

New Cholesterol guidelines from ACC/AHA. | Heart and Vascular Health | Scoop.it

This downloadable spreadsheet is a companion tool to the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. The spreadsheet enables health care providers and patients to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD), defined as coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke, based on the Pooled Cohort Equations and the work of Lloyd-Jones, et al., respectively. The information required to estimate ASCVD risk includes age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status,  Its here =>

http://goo.gl/d9NldB

Seth Bilazarian, MD's insight:

Many changes for management of patients with statin medications, based on 2013 ACC/AHA guidelines.  My Vlog review of these changes for community based physicians and patients at theheart.org and Medscape reviews the changes. 

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John Mills's curator insight, March 1, 8:58 AM

Quality Chia Seeds Online Store

 

The Cholesterol Guidelines:

 

Many changes for management of patients with statin medications, based on 2013 ACC/AHA guidelines.  My Vlog review of these changes for community based physicians and patients at theheart.org and Medscape reviews the changes. 

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Trends in Prescribed Drugs Treating Diabetes, Hypertension, and High Cholesterol for Persons under Age 40 in the US

Trends in Prescribed Drugs Treating Diabetes, Hypertension, and High Cholesterol for Persons under Age 40 in the US | Heart and Vascular Health | Scoop.it
From 2000 to 2010, the number of people in the U.S. civilian noninstitutionalized population under age 40 obtaining at least one outpatient prescription anti-diabetic or anti-hypertensive increased.From 2000 to 2010, the total number of outpatient prescriptions for persons under age 40 increased for anti-diabetics, anti-hypertensives, and statins—41%, 49%, & 179%, respectively.Comparing 2000 with 2010, for persons under age 40 in the U.S. civilian noninstitutionalized population inflation adjusted total expenses increased for anti-diabetics (126%) and for statins (97%).From 2000 to 2010, for persons under age 40, the inflation adjusted average cost per drug purchase of a prescription anti-diabetic increased 61% from $77 to $124.From 2000 to 2010, for persons under age 40, the inflation adjusted average cost per drug purchase of a prescription anti-hypertensive and statin decreased.
Seth Bilazarian, MD's insight:

Despite the rise in obesity and incident diabetes and other associated risk factors such as high blood pressure and high cholesterol in children and young adults the treatment rates have increased very little over 10 years. Despite the known long term hazards there is a lack of data on treatment in patients less than 40 years old and therefore real hesitancy to treat by physicians.

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New Rules for Boosting Good Cholesterol

New Rules for Boosting Good Cholesterol | Heart and Vascular Health | Scoop.it
Scientists agree that raising HDL (or good) cholesterol can reduce the risk of heart disease. But after a string of surprising clinical trials, they're not sure whether drugs can do the job.
Seth Bilazarian, MD's insight:

We do not have an effective medicine that raisies the good cholesterol (HDL) AND is proven to lower heart and vascular disease.  The great hope that the B vitamin niacin would fill this promise has been dashed by two consecutive studies.  No point in using these medicines that have cost and side effect now that they have disappointed us twice on the prevention front.

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What is PCSK9?

What is PCSK9? | Heart and Vascular Health | Scoop.it
Watch a video to learn more about the PCSK9 pathway
Seth Bilazarian, MD's insight:

The current best cholesterol lowering medicine we have are the statins.  These medicines like Lipitor (atorvastatin), Crestor (rosuvastatin) and sImvastatin lower LDL (bad cholesterol) by 30 - 50%.  For some patients with very high levels of LDL this is not low enough.  For other patients the statin medicines cannot be tolerated most commonly because of the side effect of muscle aches.  In both situations an alternative to statins is needed.

The PCSK9 inhibitors are an exciting next step that MIGHT prove to be the next big thing.   Studies are now ongoing in the US to test whether these medicines are safe over the long term AND whether the lowering of LDL that they provide (about 50%) also results in lower cardiovascular event rates for patients (less heart attacks and strokes).  The FDA is considering whether to approve these drugs this year before these trials are completed.

This is an excellent video explaining our current understanding of how these medicines lower the LDL level measured in patient's blood.  Stay tuned!

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Relation Between Optimism and Lipids in Midlife

Relation Between Optimism and Lipids in Midlife | Heart and Vascular Health | Scoop.it

The hypothesis that optimism is associated with a healthier lipid profile was tested. The participants were 990 mostly white men and women from the Midlife in the United States study, who were, on average, 55 years old.  Models examined the cross-sectional association between optimism and lipid levels, accounting for education and health status (e.g., chronic medical conditions).

After adjustment the results suggested that greater optimism was associated with greater HDL cholesterol and lower triglycerides. Optimism was not associated with low-density lipoprotein or total cholesterol. The findings were robust to a variety of modeling strategies including the effect of cholesterol treatment. The results also indicated that diet and body mass index might link optimism with lipids.

This is the first study to suggest that optimism is associated with a healthy lipid profile; moreover, these associations can be explained, in part, by the presence of healthier behaviors and a lower body mass index.

Seth Bilazarian, MD's insight:

The associations were small but clinically significant. The optimism effect is similar in size to the effect of physical activity.  From the paper, "optimism might serve as a precursor to healthy behavior by motivating " behavior for favorable expectations of the future.

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Preventable Deaths from Heart Disease & Stroke infographic

Preventable Deaths from Heart Disease & Stroke infographic | Heart and Vascular Health | Scoop.it

Important progress has been made, but more is needed to continue to save lives, particulalry for people under 65 yeras.  Black men are at the highest risk of dying early fromheart disease and stroke.  Counties in Southern states have the greratest risk overall.

Seth Bilazarian, MD's insight:

Nearly 800,000 Americans die each year from heart disease and stroke.  Most of the major risk factors can be manged or prevented: high blood pressure, high cholesterol, diabetes, smoking, unhealthy diet, physical inactivity and obesity.

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Egg consumption and risk of coronary heart disease and stroke

Egg consumption and risk of coronary heart disease and stroke | Heart and Vascular Health | Scoop.it

Higher consumption of eggs (up to one egg per day) is not associated with increased risk of coronary heart disease or stroke. The increased risk of coronary heart disease among diabetic patients and reduced risk of hemorrhagic stroke associated with higher egg consumption in subgroup analyses warrant further studies.  The authors concluded that the findings of their meta-analysis “do not support a positive association between egg consumption and cardiovascular disease outcomes in the general population

Seth Bilazarian, MD's insight:

The great roller coaster ride of eggs as good, neutral or bad food source continues.  The main problem with eggs is a high level of cholesterol (about 200 mg/ large egg) The dietary limit recommended daily by the AHA is 300 mg.  The great attraction to eggs are that they are high in protein. Several potential reasons for the lack of an overall association between egg consumption and coronary heart disease or stroke re considered in teh discussion. Although dietary cholesterol influences plasma concentrations of serum cholesterol, the effects are relatively small. In addition, epidemiologic studies have found weak or little association between dietary cholesterol intake and cardiovascular disease risk.

 For now we can relax our restriction on eggs.

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Statin Usage - National Survey

Statin Usage - National Survey | Heart and Vascular Health | Scoop.it

Learn about statins and understand the risks of high cholesterol through the official Web resource for the USAGE Survey, the largest known cholesterol survey in the US (10,100 participants)

 

Key Findings
Survey participants were highly satisfied with the info provided to them about  cholesterol & its treatment with statins:
=> 85% USAGE participants consider their physician to be one of two most valuable resources for info
=>  53% USAGE participants use their physician as the sole source of information on statins

=>  Only about half of USAGE participants remember their cholesterol levels (knowing your numbers us correlated with treatment success)

=>  Only about half of USAGE participants remember receiving recommendations on diet & exercise at every doctor's office visit.

=>  one out of three USAGE participants had statin side effects andstopped medicine without first discussing the issue with their physician.

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