Wednesday, December 16, 2009

Jumpin' Jupiter: How About a Little Statin Common Sense

Well, by now I am certain most of you have heard that the FDA, based on the results of the JUPITER Study, has approved rosuvastatin (Crestor) for men over 50 and women over 60 with normal LDL-cholesterol levels (LDL <130>2.0 mg/dL), elevated high-sensitivity C-reactive protein (hs-CRP >2.0mg/dL) and triglycerides under 500 mg/dL.

I have had a chance to review both the glowing recommendations and scathing condemnations of this FDA action and find them to be as frustrating as they are amusing. I THINK A LOT OF FOLKS NEED TO GET A GRIP! I advise EVERYONE to read Dr. Davis' well-reasoned, common-sense analysis of the JUPITER results on his latest HealthCentral blog post. He brilliantly dissects the issue for us and calmly separates the useful health info from the useless hysteria on both sides of the aisle.

Here is my take/synopsis and some important things to remember.

1. Always bear in mind the difference between cause and association. Nobody said CRP "causes" heart disease. In fact, it is more likely than CRP is simply an indicator that you have something else that does cause heart disease (i.e. CRP is just "associated" with heart disease). Find that root cause and treat it. A statin may not be the best treatment for the specific root cause of your elevated CRP (but maybe it is).

2. Virtually all drugs have good effects and unwanted side-effects. But, the effects are different for everyone. Statins reduce LDL cholesterol and CRP - no question. They are neither magic nor poison. My advice is to study, analyze, ask questions then make an informed decision. I take Crestor (5mg) - but as little as I think is prudent based on my unique circumstances!

3. It is worth mentioning that researchers found a signficant increase in diabetes among participants. Factor this into your personal equation.

In short, it is nuts to both crucify statins or propose they be put in the water supply. I mean, really, does it a take a rocket scientist to figure this much out?

Looking out for your heart health,


Wednesday, December 9, 2009

New Genetic Link for Vitamin D and Heart Health

And now comes more genetic proof that Vitamin D is an important heart health player. Once it became established that a "Vitamin D receptor" existed in the heart it was only a matter of time before researchers began teasing out why nature put it there.

New research shows that a gene variant of CYP27B1, which blocked production of an enzyme responsible for Vitamin D activation, accounted for a greater than two-fold risk for congestive heart failure (odds ratio 2.14, 95% CI 1.05-4.39). For a quick stats lesson on all that numeric gobbledygook it means that the researchers were "confident" that if they repeated their research 20 times they would get a result showing a increased risk of anywhere from 1.05 to 4.39 in 19 of the trials (95% of 20). The 95% figure is considered the minimum confidence threshhold for accepting a statistical result as valid. You can also look at the "confidence interval" (CI). If the interval does not include "1" (no risk difference) you are fairly certain your experiment determined a greater risk (a range above 1) or a lower risk (a range below 1). We can decipher "odds ratio" another day!

Of note was that a single SNP (the C allele of SNP rs4646536 for all you gene freaks out there like me) was the culprit. The large NIH VITAL Trial will provide more definitive data on both Vitamin D and Omega-3 links to heart disease when it is completed sometime in 2014. Until at least then, I will be taking my 8000IU of Vitamin D (what I need to hit a blood level of 60ng/dL - everyone is different).

Looking out for your heart health,


Monday, December 7, 2009

To Nap, Siesta, Perchance to Sleep?

Time for a "Seinfeld" blog about next to nothing. Which is about how much sleep I got last night. Along with a bottle of 2007 Malbec I just bought, it got me daydreaming about the 2007 EPIC study that drew an association between napping and heart disease. I say association because nothing in the study proved napping causes a reduction in heart disease. The EPIC people (mostly cancer researchers) simply noted that people who napped had fewer coronary deaths. It could be they are just a more laid-back bunch!

Fortunately, the CARDIA study provides some hard data on sleep and calcium scores that supports a good night's sleep. For those who are Track Your Plaque Members the TYP Library provides the best heart disease reversal "Cliff Notes" on the issue (as it almost always does). Here is the link.

Sleep and the Track Your Plaque program:Does sleep quantity or quality cause plaque to grow?

That's all for today. Time for that nap!

Looking out for your heart health,


Friday, December 4, 2009

CETP Redux: Lower is Better . . . No, Wait, Higher is Better?

Higher HDL inhibits heart disease, right? CETP inhibits HDL production, right? Ergo, find an agent that inhibits CETP, raises HDL, and you will reduce heart disease right? Well, maybe! Then again, maybe not.

The torcetrapib debacle showed that CETP can be inhibited thereby generating spectacular increases in HDL but you actually increase risk due to side effects like raising blood pressure (side effects that are not produced by newer agents like anacetrapib and dalcetrapib). There is also some question that the HDL produced by CETP inhibition may be defective. Now comes a new study that shows CETP inhibition in and of itself my be atherogenic.

Given that one of my problems is low HDL, I was so damn hopeful that CETP agents would be part of my personal cure. I think it is time to bet my family farm on something else while we wait another decade for the evidence. Yes, I think it will take that long to figure it all out. I suggest we start dreaming about some other miracle advance (sigh)!

Looking out for your heart health,


Wednesday, December 2, 2009

Cool New Heart Scan Technology

In another sign that Dr. Davis and Track Your Plaque had it right all along, a small study at Beth Israel Deaconess Medical Center of the RCadia Automated CT Analyzer provided a high negative predictive value and may help move patients quickly through the emergency room.

"the algorithm of ECG, serial enzymes, and perfusion imaging is both expensive as well as time-intensive, so clearly there is a need for a quick noninvasive test, and recent studies have shown that [coronary computed-tomography angiography] CCTA fits the bill very nicely. But there are problems with CCTA—one of them is the off-hours availability of expert coronary CTA readers,"

The automated analyzer could have a role as a second reader in the emergency-department setting as an aid to normal expert CCTA readers. It's available at all hours, it interprets raw data—there's no waiting for 3D reformats—and there are cost savings to be had from rapid triage of this group of patients,"

Dr Girish Tyagi
Radiological Society of North America 2009 Scientific Assembly.

The study pitted the analyzer the consensus interpretation of two expert readers. For 100 analyzable studies, the automated analysis yielded a negative predictive value of 98%. The COR Analyzer's overall sensitivity was 83% and its specificity was 82%. RCadia Analyzer identified five of the six patients with significant stenosis found by the expert readers (five true positives, one false negative) and yielded 16 false positives and 78 true negatives.

Not perfect but the fact that "big money" is starting to invest in the technology and hospitals are beginning to use CCTA as a replacement for the expensive, time-consuming (and wasting) series of ECGs, enzyme tests, and perfusion studies speaks volumes!

Looking out for your heart health,


About Ads on This Blog

Yeah, I guess I am a phillistine now that Google Ads run on my blog. As you probably know Track Your Plaque is a non-paying gig and we refuse to run ads on the member site (members voted this down even if it meant reducing the $6.65 per month membership fee that keeps the site out of hock). So, we are experiementing with "monetization" (fancy word for running ads) on the free, non-member stuff like our blogs.

NOTE: These ads are not endorsements by me or Track Your Plaque! They are what they are, links to sites with products and services that the advertisers believe will interest readers of this blog. Caveat emptor!



Tuesday, December 1, 2009

Whistleblowers Unite! And Get That Second Opinion!

We can only hope that this whistleblower wins his case! Basically, this doc claims he was fired for objecting to an arrangement where by a manufacturer of medical products was offering advance access to new products (in this case a heart valve) only if a hospital raised their purchases of the company's other products (such as stents).

So, let's be clear about the allegation here. The suggestion is that if a hospital wants the latest and greatest medical technology it would have to commit to purchasing products that it decided it did not need before. LIKE MAYBE A STENT THAT MIGHT OTHERWISE HAVE NOT BEEN RECOMMENDED TO SOME UNSUSPECTING PATIENT?

The moral of the story is that the pressure to do unnecessary procedures is real. Always get a second opinion!

Looking out for your heart health,


P.S. This is also why I value the posts from Track Your Plaque's "Spy on the Inside" our very own member who works in a cath lab!

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