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"June 29, 2009 | Shelley Wood Boston, MA - A massive, National Institutes of Health-sponsored study looking at whether vitamin-D and/or omega-3 fatty-acid supplementation can reduce the risk of developing heart disease, stroke, or cancer will get under way in January 2010, according to a website for the study. Drs JoAnn Manson and Julie Buring (Harvard Medical School/ Brigham and Women's Hospital, Boston, MA) will head up the Vitamin D and Omega-3 Trial (VITAL). The study is aiming to enroll 20 000 men and women, one-quarter of whom will be black. According to a Brigham and Women's Hospital press release, the study is intentionally aiming to illuminate a potential racial and ethnic disparity hypothesized to be linked to vitamin D [1]. "African Americans have a higher risk of vitamin-D deficiency as well as a greater frequency of diabetes, hypertension, and certain types of cancer," a press release notes. For VITAL, women need to be over age 65 to enter the study; men need to be over age 60. Study participants will be randomized to one of four groups: daily vitamin D (2000 IU) and fish oil (1 g); daily vitamin D and fish-oil placebo; daily vitamin-D placebo and fish oil; or daily vitamin-D placebo and fish-oil placebo. The trial will run for five years and is expected to cost US $20 million."

"March 18, 2009 | Marlene Busko Palm Harbor, FL - In a large study of adolescents, low serum levels of 25-dihydroxyvitamin D (25[OH]D) strongly predicted prevalence of hypertension, hyperglycemia, and metabolic syndrome [1]. The findings were reported at the AHA 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. Adolescents with vitamin-D levels in the lowest quartile were almost four times more likely to have metabolic syndrome than those with vitamin-D levels in the highest quartile. "I think that is quite alarming," lead author Dr Jared P Reis (Johns Hopkins Medical Institutions, Baltimore, MD) said in an AHA podcast issued to the media."

"November 25, 2009 | Michael O'Riordan Orlando, FL - Treating healthy women with low LDL cholesterol but elevated high-sensitivity C-reactive protein (hsCRP) levels with rosuvastatin (Crestor, AstraZeneca) cuts their risk of cardiovascular events in half, according to a new analysis of Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER). The reduction in risk is consistent with the reduction observed in the overall trial, and with the 42% benefit observed in men.

"Largest-ever meta-analysis finds CRP is unlikely to be causal for CVD December 21, 2009 | Lisa Nainggolan Cambridge, UK - In the largest and most comprehensive meta-analysis to date looking at C-reactive-protein (CRP) levels and risk of coronary heart disease (CHD) and stroke, British researchers conclude that CRP is unlikely to be a causal factor for cardiovascular disease [1]. Although CRP concentration was linearly associated with CHD, stroke, and vascular mortality, as well as nonvascular mortality, statistical adjustment for conventional cardiovascular risk factors "resulted in considerable weakening of associations," note the scientists of the Cambridge-based Emerging Risk Factors Collaboration (ERFC), who report their findings online December 21, 2009 in the Lancet. In an editorial accompanying the paper [2], Drs S Matthijs Boekholdt and John JP Kastelein (Academic Medical Center, Amsterdam, the Netherlands) say the UK authors "are to be commended for this impressive data set." Although the findings "add weight to the evidence of noncausality" for a role of CRP in the development of cardiovascular disease, "the debate can be resolved only by randomized trials with agents that specifically target CRP, and such compounds are currently under development," say the Dutch doctors. Commenting on the new meta-analysis for heartwire, Dr Paul Ridker (Brigham and Women's Hospital, Boston, MA), a long-time advocate of CRP and the lead investigator of the JUPITER trial, said: "Whether or not CRP is 'causal' for heart disease is neither the crucial issue at hand nor relevant for public health. What is crucial is getting international agreement that CRP identifies higher-risk individuals who would not otherwise qualify for a life-saving therapy, and then showing that such individuals clearly benefit from treatment. The new meta-analysis demonstrates the former, and JUPITER demonstrates the latter." "

"Quality of HDL differs in diabetics but improves with niacin therapy December 22, 2009 | Michael O'Riordan Hannover, Germany - A small study published this week hints that the effects of HDL cholesterol differ in healthy patients from those with diabetes mellitus [1]. HDL cholesterol in individuals with diabetes has impaired endothelial protective functions compared with the HDL from healthy subjects, although treatment with extended-release niacin can improve these endothelial protective effects, according to researchers. Publishing their findings online December 21, 2009 in Circulation, lead investigator Dr Sajoscha Sorrentino (Hannover Medical School, Germany) and colleagues write that because recent HDL-raising intervention studies have yielded mixed results, "circulating HDL-cholesterol levels alone likely do not represent an adequate measure of therapeutic efficacy, and indexes of HDL functionality are urgently needed for assessment of the potential of HDL-targeted therapies to exert vasoprotective effects." Speaking with heartwire, senior investigator Dr Ulf Landmesser (University of Zürich, Switzerland), said the results have implications for clinical research. "We have to understand that we can't look only at the HDL levels in the plasma, but we need to look at the quality," he said. "The quality of the HDL is not the same in different patients. This is very important for targeting HDL as a treatment. Second, niacin therapy is a promising way not only to raise HDL but also to improve the quality; it is a good treatment option, especially if the larger outcomes data are positive.""

"March 29, 2009 | Michael O'Riordan Orlando, FL - Reducing LDL cholesterol and high-sensitivity C-reactive protein (hs-CRP) in primary-prevention patients treated with rosuvastatin (Crestor, AstraZeneca) results in better event-free survival than when neither of these targets are achieved or when LDL cholesterol alone is reduced, a new analysis shows [1]. Presenting the results of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study during an afternoon press conference at the American College of Cardiology 2009 Scientific Sessions, investigators say that initial interventions for low-risk primary-prevention patients remains lifestyle and dietary modifications, but for those choosing drug therapy, "reductions in both LDL cholesterol and hs-CRP are indicators of the success of treatment with statin therapy.""

"Ann Arbor, MI - New laboratory research suggests that the COX-2 inhibitor celecoxib (Celebrex, Pfizer), might impede the action of "baby" aspirin [1]. Dr Gilad Rimon (University of Michigan, Ann Arbor) and colleagues found evidence that this was the case in a dog model and say that "it will be important to determine" whether the same is true in humans. The report was published online December 1, 2009 in the Proceedings of the National Academy of Medicine. Celecoxib is the only COX-2 inhibitor to have remained on the market in the US, and doctors who recommend this painkiller often coprescribe a daily low dose of 81 mg of aspirin (known as a "baby" dose) to counteract any possible prothrombotic effects of the coxib, while minimizing potential gastrointestinal toxicity of the aspirin. Senior author of the new work, Dr William L Smith (University of Michigan, Ann Arbor), explained to heartwire that previous studies in humans have shown that celecoxib does not interfere with the effect of a standard dose of aspirin (325 mg), but any potential interaction of celecoxib with the lower dose has not been examined. Stagger dosing to avoid any potential problems First, Smith explained that he and his colleagues looked in vitro at celecoxib and found that it binds to one of two available sites on the COX-1 enzyme. "This surprised us," he commented. "It appears to interfere with the ability of some other drugs to affect COX-1, most notably aspirin." Second, in beagles, they administered the dog-equivalent of a baby dose of aspirin in humans and then gave some of the animals the equivalent of 100 mg of celecoxib twice daily in addition. "Celecoxib plus aspirin interfered with the normal effect of low-dose aspirin on platelets," he notes. Smith says this observation obviously requires confirmation in humans, but in the meantime he suggests "getting around the problem" by patients taking the low-dose aspirin at least 15 to 30 minutes before the celecoxib is taken, "because

"November 24, 2009 | Lisa Nainggolan Orlando, FL - Inadequate levels of vitamin D are associated with an increase in the risk of cardiovascular disease and death, a new observational study has found. Dr Tami L Bair (Intermountain Medical Center, Murray, UT) reported the findings here at the American Heart Association 2009 Scientific Sessions. Bair and colleagues followed more than 27 000 people 50 years or older with no history of cardiovascular disease for just over a year and found that those with very low levels of vitamin D (30 ng/mL). Those deficient in vitamin D were also twice as likely to develop heart failure as those with normal levels. "We concluded that even a moderate deficiency of vitamin D was associated with developing coronary artery disease, heart failure, stroke, and death," said coauthor Dr Heidi May (Intermountain Medical Center). However, "it is not known whether this is a cause and effect relationship," she told heartwire. Because this study was observational, more research is needed "to better establish the association between vitamin D deficiency and cardiovascular disease," she noted."

"July 9, 2008 | Michael O'Riordan Boston, MA - The consumption of a diet containing vegetable oils rich in alpha-linolenic acid (ALA) is associated with significant reductions in the risk of nonfatal MI, a new study has shown [1]. Investigators say the protective effect of ALA is evident among individuals with low intakes, suggesting the greatest benefit might be in developing countries, where fatty-acid consumption is limited. "The potential for benefit is great when the baseline intake is low," said lead investigator Dr Hannia Campos (Harvard Medical School, Boston, MA). "In countries where people eat very little fish-and some of these countries have almost no sources of omega-3 fatty acids because they cook with corn or sunflower oils-the consumption of vegetable oils with ALA could have a major impact on heart disease." In an editorial accompanying the published study [2], Dr William Harris (University of South Dakota, Sioux Falls) said that the data are suggestive and would be good news for individuals who will not or cannot eat fish, but more studies are still needed. "If ALA were able to do the same 'heavy lifting' that [eicosapentaenoic acid] EPA and [docosahexaenoic acid] DHA do, this would be welcomed news, because the capacity to produce ALA is essentially limitless, whereas there are only so many fish in the sea," he writes. "

October 17, 2006 | Steve Stiles Boston, MA - A review of the literature on the health effects of dietary fish or fish-oil intake has a reassuring message for seafood lovers, anyone eating fish for health reasons, and perhaps most everyone else [1]. Levels of mercury and other contaminants in commercially bought fish are low, and their potential risks are overwhelmed by likely reductions in cardiovascular mortality, according to a report in the October 18, 2006 issue of the Journal of the American Medical Association. "The main message is really that everybody should be eating one or two servings of fish or seafood per week for their health," Dr Dariush Mozaffarian (Harvard School of Public Health, Boston, MA) told heartwire. In his analysis, coauthored with Dr Eric B Rimm (Brigham and Women's Hospital, Boston, MA), regular "modest" intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the two long-chain n-3 polyunsaturated fatty acids (PUFAs) abundant in finfish and shellfish (collectively referred to as "fish" in the article), is associated with a 36% drop in coronary disease mortality (p Those potential benefits are immense compared with the highly publicized but apparently low health risks associated with methylmercury, dioxins, and polychlorinated biphenyls (PCBs) that have been found in some fish species, they write. The evidence suggests a potential for neurodevelopmental deficits from early exposure to methylmercury, but the risk is likely diminished by limiting intake of fish with high methylmercur

"June 21, 2006 | Michael O'Riordan Rome, Italy - One of the possible ways in which long-chain omega-3 fatty acids play a role in decreasing cardiovascular events is by entering advanced atherosclerotic plaques. According to the results of a new study, investigators were able to show that the incorporation of eicosapentaenoic acid (EPA) into advanced plaque was associated with a decreased expression of various matrix metalloproteinases (MMPs) involved in causing plaque instability, as well as with decreased plaque inflammation. These are results of the Omacor Carotid Endarterectomy Intervention (OCEAN) study, presented here this week at the International Symposium on Atherosclerosis by Dr Philip Calder (University of Southampton, UK). "By increasing the availability of omega-3 fatty acids, they appear in advanced atherosclerotic plaques, indicated in this study by the carotid artery, and this results in lower numbers of macrophages, foam cells, and T cells, as well as the lower expression of inflammatory markers," said Calder. "Histologically, this results in a plaque that appears to be less inflamed and more stable. This may contribute to reduced mortality in patients consuming omega-3 fatty acids, for example, in the GISSI Prevenzione trial.""

July 16, 2008 | Shelley Wood Beer-Sheva, Israel - Both a low-carbohydrate diet or a Mediterranean-style diet may be "effective alternatives" to a low-fat diet, with more favorable effects on lipids and/or glycemic control, new research suggests [1]. The two-year study, which managed to keep almost 85% of the 322 study participants on one of the three diets for the entire period, offers the hope that weight-loss diets can be tailored to personal preferences, without sacrificing efficacy, researchers say. "Several recent one-year dietary studies have led the American Diabetes Association to state in January 2008 that low-carb diets should be considered for a maximum of one year," lead author on the study, Dr Iris Shai (Ben Gurion University of the Negev, Beer-Sheva, Israel), told heartwire. "The current two-year study suggests that one low-fat diet doesn't fit all, meaning that the old paradigm should be reconsidered." Shai and colleagues publish the results of the Dietary Intervention Randomized Controlled Trial (DIRECT) in the July 17, 2008 issue of the New England Journal of Medicine

"Nov 14, 2005 | Michael O'Riordan. Dallas, TX - The addition of eicosapentaenoic acid (EPA) to low-dose statin therapy significantly reduced the incidence of major coronary events, largely driven by a reduction in unstable angina, when compared with patients taking statins alone. A subgroup analysis of the study, which involved a large number of primary-prevention patients, revealed that statin-treated secondary-prevention patients gained the most benefit from fish-oil supplementation. Dr Mitsuhiro Yokoyama Presenting the results of the Japan EPA Lipid Intervention Study (JELIS) during the late-breaking clinical-trials session at the American Heart Association Scientific Sessions 2005, Dr Mitsuhiro Yokoyama (Kobe University Graduate School of Medicine, Japan) said that the mechanism of benefit with EPA, a seafood-based, long-chain, n-3 polyunsaturated fatty acid, appears to be unrelated to the effects of cholesterol lowering. Commenting on the results of the study for heartwire, Dr Lawrence Appel (Johns Hopkins University School of Medicine, Baltimore, MD) said the findings are impressive given that the benefit of fish oil was observed on top of a regimen of statin therapy. He added that there are still some unknowns about which patient population would benefit most from fish oil."

Pittsburgh, PA and Shiga, Japan - The low rate of atherosclerosis and heart disease in Japanese people may be related to their very high levels of marine-derived omega-3 fatty acids rather than genetic factors, a new study suggests [1]. The study, published in the August 5, 2008 issue of the Journal of the American College of Cardiology (available online July 28), was conducted by a group led by Dr Akira Sekikawa (University of Pittsburgh, PA, and Shiga University of Medical Science, Japan). They found that compared with white or Japanese American men living in the US, Japanese men living in Japan had twice the blood levels of omega-3 fatty acids-a finding that was independently linked to low levels of atherosclerosis. "The death rate from coronary heart disease in Japan has always been puzzlingly low. Our study suggests that the very low rates of coronary heart disease among Japanese living in Japan may be due to their lifelong high consumption of fish," Sekikawa said." Results showed that the Japanese men had the lowest levels of atherosclerosis, whereas whites and Japanese Americans had similar higher levels. The Japanese men also had twofold higher levels of marine-derived omega-3 fatty acids than white and Japanese Americans. In addition, the significant differences between Japanese and American men in multivariable-adjusted IMT and CAC prevalence became nonsignificant after adjustment further for marine-derived omega-3 fatty acids.

"July 10, 2008 | Shelley Wood New York, NY - Despite eating a diet rich in omega-3 fatty acids, Alaskan Eskimo are developing subclinical atherosclerosis at an early age, likely due in large part to heavy smoking, a new study shows [1]. According to investigators, in a paper published online July 10, 2008 in Stroke, rates of carotid atherosclerosis in the mostly young to middle-aged subjects participating in the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study were significantly higher than those reported in US population-based studies of other ethnic groups. But as Dr Alexis Cutchins (Weill Cornell Medical College, New York, NY) and colleagues report, rates of current smoking among the Eskimo population studied were also four to six times higher than that of other US populations in similar studies. "I don't think there's anything very surprising here, but I guess what is novel is that the findings relate to a population that has not been studied much, if at all, in this regard," study coauthor Dr Mary J Roman (Weill Cornell Medical College) told heartwire. "And I think that the message is one that has public-health implications for everybody else: this is basically a reiteration of the fact that smoking is a very potent cardiovascular risk factor, and I think the indoctrination that most of us have received about the ills of smoking have clearly not penetrated the Alaska Eskimo population.""

"November 25, 2009 | Susan Jeffrey Naples, Italy - A new meta-analysis confirms that high salt intake is associated with increased risks of stroke and total cardiovascular disease (CVD) [1]. The pooled relative risk showed that an average difference of about 5 g of salt per day was associated with a 23% increased risk of stroke, the researchers report, and a 17% increase in CVD risk. The average habitual salt intake in most Western countries is 10 g per day, double the level currently recommended by the World Health Organization. "Given that the case-fatality rate for stroke is estimated at one in three, and that for total cardiovascular disease at one in five, a 23% reduction in the rate of stroke and a 17% overall reduction in the rate of cardiovascular disease attributable to a reduction in population salt intake could avert some one and a quarter million deaths from stroke, and almost three million deaths from cardiovascular disease each year," the researchers, with lead author Dr Pasquale Strazzullo (University of Naples Medical School, Italy), conclude. Moreover, because of some imprecision in salt-intake measurements in these cohort studies, the actual effects are likely to be underestimated, they add. The study was published online November 24, 2009 in the British Medical Journal."

"In one room on the last day of the conference, four invited faculty members meticulously made the case for an already-available substance as an example of the kind of agent the others were looking for. Their message: omega-3 polyunsaturated fatty acids (PUFAs), usually derived from fish oil, garner far less attention as a heart-failure therapy than they deserve, given the wealth of laboratory and clinical evidence supporting a treatment effect."

"Orlando, FL - Adding extended-release niacin (Niaspan, Abbott) to statin therapy results in a significant regression of atherosclerosis as measured by carotid intima-media thickness (IMT), whereas the addition of ezetimibe (Zetia, Merck/Schering-Plough) to statin therapy did not, according to an eagerly anticipated study "