Heart Health

The very high cost of very low cholesterol

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

The FDA recently approved two new drugs that quickly and effectively lower LDL cholesterol levels. This exciting development is tempered by the very high cost of these drugs. These costs can even trickle down to others on the same insurance plan as people taking these new drugs. Several politicians and institutions have spoken out against these high costs, but it is unlikely that the prices will be lowered anytime soon. For now, these drugs should be reserved only for those whose other efforts to reduce LDL have been unsuccessful.

Update on the SPRINT trial: Preliminary results pan out

Deepak Bhatt, MD, MPH

Formally published results of the SPRINT trial confirm the early conclusions released in September. A target systolic blood pressure (the top number) of 120 mm Hg or less offers real health benefits, including a lower risk for cardiovascular problems and even death. Even if you don’t have high blood pressure, the results are so compelling that everyone should know his or her blood pressure and develop a plan with a primary care physician to achieve and maintain the “ideal” blood pressure for them.

Overweight children are at risk for heart disease as adults

Nandini Mani, MD
Nandini Mani, MD, Contributing Editor

In a recent study of nearly 9,000 overweight and obese children and teens, doctors found that these young people had concerning blood pressure readings and worrisome cholesterol and blood sugar levels. In adults, such test results suggest a much higher risk for heart disease — so they are of particularly great concern in children. The good news is that with help and support, kids can lose weight — the results are a healthier, happier childhood and a greater chance of a healthier, longer adult life.

“Stress” cardiomyopathy: A different kind of heart attack

Deepak Bhatt, MD, MPH

The expression “you almost gave me a heart attack” is often used to express sudden shock or surprise. In fact, there is a specific type of heart attack commonly linked with sudden emotional stress. It is called takotsubo cardiomyopathy. Although it was once believed to be less harmful than a “typical” heart attack (which is caused by a lack of blood flow to the heart muscle), doctors are now learning more about this condition and finding that it can be just as dangerous for patients as the more common type of heart attack. More research is needed to learn how to best care for people with takotsubo cardiomyopathy and lower their risk for future heart problems.

Standing up for better heart health

Nancy Ferrari
Nancy Ferrari, Senior editor, Harvard Health

Spending less time sitting and more time standing lowers blood sugar, cholesterol, and weight — all of which translates into a lower risk for heart disease. So says a study of Australian adults published in the July 30 issue of the European Heart Journal. Every two hours a day spent sitting was associated with an increase in weight and waist size, as well as in levels of blood sugar and cholesterol. As you might expect, time spent walking rather than sitting not only lowered cholesterol and blood sugar levels, but also reduced waist size and weight. Simply substituting two hours of standing for sitting also improved blood sugar and cholesterol levels. By making slight changes in your lifestyle to incorporate more standing, you could add important health benefits.

A promising new treatment for high triglycerides

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

Say “fat in the bloodstream” and most people think of cholesterol. But there’s another type of fat shouldn’t be ignored: triglycerides. High triglycerides can increase the risk of having a heart attack. Existing drugs lower triglycerides, but aren’t that good at preventing heart attacks. That’s why a report on a new way to lower triglycerides, published in today’s New England Journal of Medicine, is generating some excitement among cardiologists. The new approach uses weekly injections of “antisense oligonucleotides,” or ASOs. These are pieces of DNA that short-circuit the liver’s production of triglycerides. The NEJM report shows that ASOs can reduce triglyceride levels by as much as 70%. Keep in mind that this was a phase 2 trial, which is designed to test whether a drug does what it is supposed to do (in this case, lower a person’s triglyceride levels). Larger, longer-term studies will be needed to see whether ASOs actually reduce the risk of heart disease, and what sorts of side effects they cause.

CPR during cardiac arrest: someone’s life is in your hands

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

Cardiac arrest is the ultimate 911 emergency. The heart stops sending blood to the body. Death occurs in minutes — unless a bystander takes matters into his or her hands and starts cardiopulmonary resuscitation (CPR). This keeps blood circulating until trained and better-equipped first responders arrive on the scene to jump-start the heart back into a normal rhythm. Two new studies in JAMA provide compelling proof that efforts to train people to do life-saving CPR pay off. Many organizations sponsor CPR and AED training programs. Two notable ones are the American Heart Association and the American Red Cross. Many local departments of public health also provide CPR training, including “friends and family” classes for people close to someone at risk of cardiac arrest. The investment of time and effort to learn CPR is small. The potential payoff — saving a life — is huge.

Bypass surgery an “uncommon” cause of memory loss, cognitive decline

Howard LeWine, M.D.
Howard LeWine, M.D., Chief Medical Editor, Internet Publishing, Harvard Health Publications

Coronary artery bypass surgery (CABG) offers a new lease on life for thousands of people each year. But it has also been blamed for “brain fog,” a loss of memory and thinking skills that follows the procedure in some people. Such brain problems are often called “cognitive impairment.” But the operation itself may not be to blame, according to a review in today’s Annals of Internal Medicine. A team of mostly Veteran’s Affairs researchers concluded that intermediate and long-term cognitive impairment after cardiovascular procedures “may be uncommon.” That said, they recommend that anyone thinking about open-heart surgery or other large cardiovascular procedure should discuss with the surgeon the possibility of cognitive impairment.

FDA strengthens warning that NSAIDs increase heart attack and stroke risk

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

Back in 2005, the FDA warned that taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen increased the risk of having a heart attack or stroke. Last week it took the unusual step of further strengthening this warning. This was done on the advice of an expert panel that reviewed new information about NSAIDs and their risks. Because NSAIDs are widely used, it’s important to be aware of downsides of taking an NSAID and to take steps to limit the risk. The new warnings point out that heart attack and stroke risk increase even with short-term use, and the risk may begin within a few weeks of starting to take an NSAID. The risk increases with higher doses of NSAIDs taken for longer periods of time. The risk is greatest for people who already have heart disease, though even people without heart disease may be at risk.

Half of heart disease deaths could be prevented

Patrick J. Skerrett, Former Executive Editor, Harvard Health

Heart attack, stroke, and other cardiovascular diseases kill nearly three-quarters of a million Americans each year. They are the leading cause of death, accounting for nearly 30% of all deaths in the United States. But according to a new study published online yesterday in the Annals of Internal Medicine, many of these deaths can be prevented. Researchers from the Rollins School of Public Health at Emory University in Atlanta estimated that eliminating five key risk factors for cardiovascular disease — smoking, high cholesterol, high blood pressure, type 2 diabetes, and obesity — would prevent more than half of all U.S. deaths from cardiovascular disease. Realizing that elimination may not be possible, they asked what would happen if, as a nation, we were able to do as well as the residents of the best-performing states. The result was a more modest 10% reduction in cardiovascular disease–related deaths.