Posts Tagged "CVD"

The U.S. Preventive Services Task Force, in a draft statement, is recommending low-dose aspirin to prevent both cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who have a 10-year CVD risk of 10% or greater (grade B recommendation). Patients aged 60 to 69 should talk to their clinicians about whether the benefits of daily aspirin outweigh the risks (grade C).

Patients using aspirin as a preventive must have a life expectancy of at least 10 years and be willing to take it daily for that length of time. The USPSTF notes that patients at increased risk for bleeding shouldn’t use daily aspirin.

The task force says there is insufficient evidence to make a similar recommendation for adults younger than 50 years or older than 70 years (both grade I statements).  The task force previously published separate recommendations on aspirin use for preventing CVD (2009) and colorectal cancer (2007); this is the first update to address the combined benefit.

Source: Journal Watch

Among men with high cholesterol and erectile dysfunction, a short course of statin therapy was associated with improvements in both measures, shows a new meta-analysis. The study was presented at the American College of Cardiology (ACC) 2014 Scientific Sessions and simultaneously published online in the Journal of Sexual Medicine

These findings “may improve adherence to statin therapy . . . [because] we know that in primary prevention a large proportion of patients stop talking [a statin] or take a much lower amount than prescribed,” lead investigator Dr John B Kostis (Rutgers Robert Wood Johnson Medical School New Brunswick, NJ) said during a press briefing. For example, in a 90 000-patient study, 35% took less than a quarter of prescribed statins and 60% took less than half, and in an 11 000-patient study, 47% of patients stopped taking the statin, he said.

Erectile dysfunction is often the first sign of CVD, like the canary in the coal mine, Kostis pointed out. “What do you do with a person who has erectile dysfunction? You evaluate them for CVD.”

“Over the years, it’s become apparent that erectile dysfunction is an indication of decreased vascular health in men and is considered by many to be a significant CV risk factor,” moderator Dr Jeffrey Kuvin (Tufts Medical Center, Boston, MA) echoed. “Whether erectile function improves due to a reduction in LDL-C or perhaps other pleiotropic effects of statins still remains unclear. I think [this] meta-analysis strongly shows that statin therapy improves erectile dysfunction after only a short duration of therapy.”

Erectile dysfunction affects an estimated 18 to 30 million American men, more often after age 40, and common causes include heart disease, high cholesterol, high blood pressure, diabetes, obesity, tobacco use, depression, and stress, according to an ACC statement.

Many older men have erectile dysfunction along with diabetes and atherosclerotic disease, for which they are frequently prescribed statins, Kostis noted. Previous research has suggested, however, that statin therapy may lower testosterone levels.

The investigators searched for randomized controlled trials that examined the effect of statin therapy on erectile function. They identified 11 such trials in which men completed the International Inventory of Erectile Function survey, which consists of five questions, each scored on a five-point scale, where low values represent poor sexual function.

The trials had an average of 53 patients per study, for a total of 647 patients. Men had an average age of 57.8 years and received statins for about 3.8 months.

During this time, average LDL-C levels dropped significantly from 138 to 91 mg/dL in the treated men but were virtually unchanged in control groups.

In men who took statins, erectile-function scores increased by 3.4 points, from 14.0 to 17.4 points—a 24.3% increase. The increase in erectile-function score was about one-third to one-half of that reported with phosphodiesterase inhibitors, such as sildenafil (Viagra, Pfizer), tadalafil (Cialis, Lilly), or vardenafil (Levitra, Bayer/GlaxoSmithKline), and larger than the effect of lifestyle modification or testosterone, Kostis said.

Some people have called statins a “double-edged sword,” he noted. On one hand, they improve endothelial function, which may improve blood flow to the penis; but on the other hand, they lower the level of cholesterol, a precursor of testosterone. However, these 11 studies showed that “the beneficial effect [of statins on erectile dysfunction] predominates.”

Strengths of the meta-analysis were that it included all published randomized trials about the topic, and the benefit remained after multiple sensitivity analyses. However, limitations were the inclusion of small studies with few participants and diverse statins, treatment duration (1.5 to six months), and patient types.

“A well-powered, placebo-controlled trial with a factorial design (for example, phosphodiesterase inhibitors, testosterone, and statin) would clarify the effect of statins in relevant patient subsets,” Kostis concluded. These drugs are not recommended as a primary treatment for erectile dysfunction in patients with normal cholesterol levels, he cautioned—another potential area for further rigorous research.

Source: Medscape

A new study published in the New England Journal of Medicine reports that the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) guidelines for the treatment of cholesterol would increase the number of U.S. adults eligible for statin therapy by nearly 13 million. Older adults without cardiovascular disease would comprise the majority of the increase.

The previous Third Adult Treatment Panel (ATP III) guidelines of the National Cholesterol Education Program (ATP-III) recommended statin therapy for patients with cardiovascular disease or diabetes and low-density lipoprotein (LDL) cholesterol levels of >100mg/dl. For primary prevention, LDL cholesterol level plus the Framingham risk score (10-year cardiovascular disease risk calculator) were used to determine whether statin therapy was warranted.

The new ACA/AHA guidelines recommend the following:

• Statin      therapy to all adults with known cardiovascular disease regardless of LDL      cholesterol level;
• Statin      therapy for patients with an LDL cholesterol level of ≥190mg/dL      (4.91mmol/L);
• Statin      therapy for patients 40–75 years of age with diabetes or a 10-year risk of      cardiovascular disease of >7.5% with an LDL cholesterol level of      ≥70mg/dL (1.81mmol/L) or higher.

Michael J. Pencina, PhD, from the Duke Clinical Research Institute, and colleagues analyzed fasting sample data from 3,773 individuals ages 40–75 in the National Health and Nutrition Examination Surveys (NHANES) collected from 2005–2010. Of the total patients,1,583 (42.0%) were receiving or would be eligible for statin therapy based on the ATP III guidelines, vs. 2,135 participants (56.6%) who would be eligible based on the 2013 ACA/AHA recommendation. Using these statistics, the authors estimate that nearly half of the adult U.S. population between the ages of 40–75 with triglyceride level of <400mg/dL would be eligible for statin therapy (56 million, 48.6%). This is a net increase of 12.8 million potential new statin users and an increase of 11.1 percentage points over those eligible under the ATP III guidelines.

With the increase in adults eligible for statin therapy, the authors suggest that there will be higher treatment rates among both those who are and are not expected to have future cardiovascular events, particularly in men. The effect would be seen in older (ages 60–75) vs. younger (ages 40–59) cohorts, as 77% in the older age group would be eligible compared to 30% in the younger group.

Read more in the New England Journal of Medicine here.

Nearly a third of American adults have high blood pressure, also known as hypertension. Often called the “silent killer” because it provides few warning signs, hypertension increases a patient’s risk for heart attack and stroke. New research suggests eating a vegetarian diet could help combat this deadly disease. A healthy blood pressure is 120/80 mm HG. Previous studies have shown that each increase of 20/10 mm Hg in that number doubles the patient’s risk of cardiovascular disease. But lowering that top number just 5 mm HG can reduce your chances of dying from cardiovascular disease by about 7%. And eating more fruits and vegetables may be a good way to do that, according to the new study, published Monday in the scientific journal JAMA Internal Medicine.

In seven clinical trials, participants following a vegetarian diet had a systolic blood pressure that was 4.8 mm Hg lower on average than their omnivore counterparts’. The vegetarians’ diastolic blood pressure was lower by an average of 2.2 mm Hg. In observational studies, the difference was slightly bigger. A vegetarian diet was associated with an average decrease of 6.9 mm Hg for systolic blood pressure and 4.7 mm HG for diastolic blood pressure. Many factors could be affecting the vegetarians’ blood pressure. Vegetarian diets are often lower in sodium and saturated fats, while being higher in fiber and potassium.

Vegetarians also tend to have lower body mass indexes because fruits and vegetables are less energy dense – meaning you can eat more of them for fewer calories. The definition of a “vegetarian diet” differs from person to person, so the researchers can’t tell you how much meat is too much. Some of the observational studies also did not adjust for lifestyle factors such as exercise or alcohol intake that could have affected the results. Eating more fruits and vegetables as part of an overall healthy diet could help lower your blood pressure, says study author Dr. Neal Barnard. You should also try to limit your sodium intake, exercise regularly and avoid drinking alcohol excessively.

Source: CNN

While overall mortality from heart disease is declining, the number of younger women with heart disease is growing. A new study by the Canadian-led global INTERHEART group shows that nine factors account for 90% of the risk for a first myocardial infarction:

• Smoking
• Lipids
• Hypertension
• Diabetes
• Obesity
• Diet
• Physical Activity
• Psychosocial Factors

Cardiovascular disease has been the leading killer of American women since 1908. Death rates from heart disease are increasing in women aged 35 to 54 years, most likely as a result of obesity. Cardiovascular disease causes one death per minute in the U.S.– that amounts to a staggering 421,918 deaths every year. More than 12 million women in the U.S. are suffering from Type II diabetes. Across the globe, heart disease is the leading cause of death in women in every major developed country and most emerging economies.

The US Food and Drug Administration (FDA) is now officially investigating the potential that FDA-approved testosterone products increase the risk of serious adverse cardiovascular outcomes .

The agency cites two studies, one of which was published just two days ago, both reported by heart wire, that suggests men taking the testosterone supplements have an increased risk of death, MI, or ischemic stroke.

“We are providing this alert while we continue to evaluate the information from these studies and other available data and will communicate our final conclusions and recommendations when the evaluation is complete,” according to the FDA.

In the newest study, men treated with testosterone were significantly more likely to have an MI in the first 90 days after starting the medication. In the three months after the start of testosterone therapy, the risk of MI overall was increased by 36% and was even higher in older men. For those aged 65 years and older, the risk of MI was more than twofold higher in the 90 days after filling the prescription.

The second study, which was also an observational analysis, of Veterans Affairs (VA) patients, found that testosterone therapy in men was linked with an increased risk of death, MI, or ischemic stroke.

The agency stresses that testosterone products are approved for use in men with low testosterone levels and an associated medical condition, such as a failure of the testicles to produce testosterone because of a genetic condition or chemotherapy. Other medical conditions include problems with the hypothalamus or pituitary gland that result in low testosterone levels. The FDA says that these testosterone therapies are not approved for men with low levels without the associated medical condition.

The FDA says that patients should not stop taking testosterone therapy unless they first consult with their physician but adds all physicians need to consider the risk/benefit profile when considering a prescription for their patient. “The prescribing information in the drug labels of FDA-approved testosterone products should be followed,” they write.

Source: MedScape

Vitamin-D deficiency is much more strongly linked to fatal than nonfatal CV events, results of a large prospective study suggest. “Although our results were able to confirm an approximately 27% increased total CV risk in subjects with vitamin D deficiency, they indicate that the risk is much stronger for (and possibly even confined to) fatal CVD events,” write the researchers. Previous observational and randomized trials linking serum 25-hydroxyvitamin D (25(OH)D) concentrations with increased CVD risk have typically used only a single vitamin-D measurement and did not separately examine fatal and nonfatal outcomes, they note. The current population-based cohort study enrolled 9949 adults aged 50 to 74 years recruited during regular health checkups at primary-care practices in 2000 to 2002. There were more women than men (59% vs 41%); most participants (59%) had inadequate vitamin-D levels (<50 nmol/L). Blood samples were collected at baseline, 5, and 8 years. Mean follow-up was 9.2 years for mortality and 6.5 years for the end points of CVD, CHD, and stroke. A total of 854 patients had a nonfatal CVD event, 176 had a fatal CVD event, 460 had a nonfatal CHD event, 79 had a fatal CHD event, 313 had a nonfatal stroke, and 41 had a fatal stroke. Overall, the proportion of individuals who had no events was significantly lower among those with vitamin-D deficiency. The association continued after adjustment for age, sex, and season of blood drawn, with hazard ratios ranging from 1.46 for total CVD to 1.58 for total stroke.

Source: MedScape