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.
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.
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.
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.
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.
Young adults with even slightly above-normal blood pressure may be more likely to have heart problems later in life, according to a new study in the Journal of the American College of Cardiology. The study focused on nearly 2,500 men and women who were 18 to 30 years old when the study began and whose health was followed for 25 years. Those with slightly high blood pressure, a condition known as prehypertension, were more likely to have had signs of heart disease in middle age. Echocardiograms showed they were more likely to have developed problems with the heart’s left ventricle.
If you’re a chocoholic, the news out of England is tantalizing: middle-aged and older adults who eat up to 3.5 ounces of chocolate a day (that’s more than two standard Hershey bars) seem to have lower rates of heart disease than those who spurn chocolate. At least that was the conclusion of a study that followed the health of nearly 21,000 resident of Norfolk, England, for 11 years. Most of the previous studies on the chocolate-heart connection found that only dark chocolate offered any cardiovascular protection. In the Norfolk study, any type of chocolate, including milk chocolate, seemed to have the same beneficial effect. I routinely write my patients a prescription for exercise, and sometimes for eating more vegetables and fruits. I won’t be writing any prescriptions for chocolate in the foreseeable future. But I won’t be telling them not to eat chocolate—in moderation of course.
High cholesterol is a key culprit in the development of cardiovascular disease, the leading cause of death in the United States and many other developed countries. We know that lowering cholesterol helps prevent heart attacks and strokes. But an unanswered question remains: how low should you go? New research published online today in The New England Journal of Medicine suggests that lower is better. In a large clinical trial, participants who took a cholesterol-lowering statin plus ezetimibe, a different type of cholesterol-lowering drug, had lower levels of harmful LDL cholesterol and experienced fewer heart attacks and strokes than participants taking a statin alone. The new findings provide a strong rationale for using ezetimibe when a statin alone isn’t enough.
A strong or weak hand grip carries more than just social cues. It may also help measure an individual’s risk for having a heart attack or stroke, or dying from cardiovascular disease. As part of the international Prospective Urban and Rural Epidemiological (PURE) study, researchers measured grip strength in nearly 140,000 adults in 17 countries and followed their health for an average of four years. Each 11-pound decrease in grip strength over the course of the study was linked to a 16% higher risk of dying from any cause, a 17% higher risk of dying from heart disease, a 9% higher risk of stroke, and a 7% higher risk of heart attack. Interestingly, grip strength was a better predictor of death or cardiovascular disease than blood pressure. What’s the connection? It’s possible that grip strength measures biological age.
Atrial fibrillation is a heart rhythm disorder that affects millions of people. It can lead to potentially disabling or deadly strokes. Researchers from Johns Hopkins University School of Medicine adding motion-tracking software to standard MRI heart scans of 149 men and women with atrial fibrillation. The scans revealed specific changes in the muscles of the left atrium that increased stroke risk in some of the volunteers. These changes were not associated with age or other risk factors for stroke. This could help many people with this condition to avoid taking warfarin or other clot-preventing medications for life. But it is much too early to include MRI as part of the standard evaluation of people with atrial fibrillation — not to mention that such scans would significantly increase the cost of these evaluations. For now, doctors will continue to use standard tools to help determine stroke risk.