ER worker's heart stopped, leaving her 'the color of Cookie Monster'

Adults With Coronary Artery Disease Not Meeting Cholesterol Targets

FRIDAY, July 7, 2023 (HealthDay News) — Most adults with coronary artery disease (CAD) do not meet low-density lipoprotein cholesterol (LDL-C) targets, according to a research letter published in the July 3 issue of the Journal of the American Medical Association.

Rahul Aggarwal, M.D., from Brigham and Women's Hospital in Boston, and colleagues used data from the National Health and Nutrition Examination Survey (January 2015 to March 2020) to assess lipid control among 25,531 U.S. Adults (≥20 years) with reported CAD.

The researchers found that among adults with reported CAD, 67.9 percent were receiving statin therapy and 6.4 percent were receiving ezetimibe. Age-adjusted mean LDL-C was 94.4 mg/dL, with 73.5 percent of participants having an LDL-C level ≥70 mg/dL. Among adults with reported CAD receiving statin therapy, 4.2 percent also reported receiving ezetimibe. The age-adjusted mean LDL-C level among adults with CAD receiving statin therapy was 82.2 mg/dL, with 65.2 percent having an LDL-C level ≥70 mg/dL. Among participants reporting CAD but not receiving statin therapy, 10.9 percent were receiving ezetimibe. The age-adjusted mean LDL-C level was 120.4 mg/dL, with 91.0 percent having an LDL-C level ≥70 mg/dL.

"Achievement of guideline-directed targets for LDL-C among adults with reported CAD was low, with almost three in four participants not meeting American College of Cardiology/American Heart Association guideline targets and nine in 10 not meeting European Society of Cardiology guideline targets," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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American Heart Association Releases First Guideline Overhaul In A Decade

The American Heart Association (AHA) and the American College of Cardiology published an updated joint guideline for chronic coronary disease on July 20 that reaffirms the importance of regular physical activity and a healthy diet, while offering new recommendations about drugs, dietary supplements, screenings, and patient participation in care decisions.

The material, presented in the journal Circulation and in the Journal of the American College of Cardiology, is the first comprehensive update concerning the treatment of chronic heart disease in a decade. Chronic heart disease is a condition that occurs when arteries become narrowed by a buildup of fatty material within their walls.

"Therapies and treatments have evolved over the years, so chronic coronary disease is no longer a death sentence — this is a very treatable condition," says the chair of the guideline writing committee, Salim S. Virani, MD, PhD, the vice provost for research at Aga Khan University in Pakistan, a cardiologist at the Texas Heart Institute, and an adjunct professor at Baylor College of Medicine in Houston. "If patients and clinicians are able to institute guideline-directed lifestyle changes and therapies, there is a lot of hope of having a quality of life and lifespan that are very close to normal."

Healthy Eating and Physical Activity Still at the Core

The new guideline stresses that dietary habits, regular exercise, not smoking, and proper sleep continue to be the foundation for managing chronic heart disease.

Per previous AHA recommendations, people with chronic heart disease should get at least 150 minutes per week of moderate-intensity aerobic activity (such as brisk walking, hiking, and dancing) or at least 75 minutes per week of higher-intensity aerobic activity (such as running, swimming, and walking up stairs). They should also engage in activities that build muscle strength two or more days a week.

When it comes to diet, the advice is to stick with a Mediterranean-type eating plan with high intake of healthy plant-based foods and lean protein, as well as lower quantities of saturated fat (for example, red meat) and salt.

There are no major changes in the new guideline regarding these lifestyle habits; people should know these recommendations are still crucial, according to Dr. Virani. And again, the guideline strongly advises not smoking and getting a good night's sleep.

Patients Need to Take an Active Role in Devising a Treatment Plan

After completing a risk assessment, doctors are encouraged to educate patients on symptom management and treatment options so they can actively participate in decisions about their care.

"The guideline emphasizes shared decision-making with the patient and physician," says Harmony Reynolds, MD, who coauthored a commentary on the guideline and serves as the director of the Sarah Ross Soter Center for Women's Cardiovascular Research at NYU Langone Medical Center. "Patients have different priorities about their health and ultimately they are the ones who should make the decision about their care."

Awareness of the latest recommendations on heart disease treatment can help patients with this process. For instance, Dr. Reynolds points out that for years a blocked artery was commonly treated with bypass surgery or insertion of a stent to open the artery. While these operations can still provide good results, research in recent years has shown that some patients may do just as well taking medications and don't need an invasive procedure to live longer. Patients need to be informed so they can make the best decisions for themselves in consultation with their healthcare team.

The new recommendations also spotlight how chronic heart disease management is a "team sport," Virani says. Patients may need to gather information from and coordinate with a range of care professionals, including physicians, nurse practitioners, physician assistants, nurses and nursing assistants, pharmacists, dietitians, exercise physiologists, physical, occupational, and speech therapists, psychologists, and social workers.

Diabetes Medications Like Ozempic and Mounjaro May Help the Heart

Over the past decade scientists have improved their understanding of how medications can best serve a patient. Researchers have found, for example, that two classes of medications traditionally used to treat type 2 diabetes — SGLT-2 inhibitors and GLP-1 receptor agonists like Ozempic and Mounjaro — have potential cardiovascular benefits in addition to blood sugar management. Even in heart patients who don't have type 2 diabetes, the medications have been shown to help with weight loss, reduce the progression of kidney disease, and lower the risk of cardiovascular crises.

"These medications can be used even in the absence of diabetes because they are beneficial to the heart," says Virani.

Guideline Addresses Statin Alternatives Like Bempedoic Acid

Other drug developments include the possible use of new cholesterol medications — such as ezetimibe, PCSK9 inhibitors, bempedoic acid, and inclisiran — for people who may not be able to manage cholesterol levels with statins.

Another recommendation concerns beta-blockers, medications that lower blood pressure by decreasing the heart rate and forcing the heart's contractions. Routine use of beta-blockers for longer than one year is not advised in chronic heart disease patients who have not had a heart attack within the past year, or those who have so-called left ventricular ejection fraction at or above 50 percent (meaning the heart is pumping blood effectively to meet the body's needs, per the AHA).

In regard to antiplatelet medicine, a type of blood thinner, Virani says that doctors have learned how to use them over a shorter and shorter duration in patients who have stent procedures.

When It Comes to Dietary Supplements for Heart Disease, the Jury Is Still Out

Although dietary supplements are a huge industry, and many people buy them every year in hope that they will improve their heart disease, the guideline writers found that there was not enough evidence showing that nonprescription nutrition or dietary supplements — including omega-3 fatty acids, vitamins C, D, or E, beta-carotene or calcium — were beneficial for people with a chronic heart condition.

"These nutrients are important, but there's no substitute for getting them through a healthy diet," says Reynolds.

Regular Stress Tests May Not Be Helpful

Reynolds adds that many patients have had a misconception that getting a stress test on a regular basis would help them even if they are having no symptoms.

"Many patients have an incorrect belief that a stress test will detect a problem before it bothers them," says Reynolds. "This guideline suggests doing testing only when people have a change in their symptoms. A stress test when somebody feels different (chest discomfort, shortness of breath) definitely has a role."

While the advice in the new guideline is directed at clinicians, Virani believes patients can get great benefit from reading the recommendations as well.

"I think by being aware, it only helps patients," he says. "Understand your disease as much as you can and have a very open conversation about treatments with your healthcare provider."

Vitamin D Supplements May Benefit Heart Health, Research Finds

Australian researchers followed a group of older adults to determine whether vitamin D supplements could reduce the risk of major heart disease events, such as heart attack and stroke.

The researchers gave the test group a monthly vitamin D supplement which they took for five years.

The results show a small risk reduction for certain major cardiovascular events.

Vitamin D is a fat-soluble vitamin that is important for bone health and immune system support that may offer a number of health benefits.

A study recently published by The BMJdetails a clinical trial led by a group of Australian researchers who wanted to learn what impact vitamin D may have on reducing major heart disease events such as heart attacks and strokes.

The researchers followed a group of older adults between ages 60 and 84. This particular age group is known to be at a higher risk for developing heart disease.

While the scientists did not find that vitamin D had any impact on strokes when comparing the control and test groups, they did learn that the rate of major cardiovascular events was 9% lower in the group that took the vitamin D supplement.

Considering how deadly cardiovascular disease (CVD) can be and the burden it may have on the healthcare system, scientists have been looking for ways to improve treatments for such diseases and prevent them.

According to the study authors, prior studies did not show a connection between vitamin D and reducing cardiovascular disease risk, but the authors thought those studies had limitations.

The authors noted that "vitamin D has biological effects which suggest it could influence cardiovascular disease," which prompted them to do a more in-depth study focusing on older adults.

The researchers recruited 21,315 people ages 60 to 84. They excluded participants already taking vitamin D supplements or had a history of certain conditions, such as sarcoidosis and hypercalcemia.

The test group took vitamin D once per month for five years in the form of a 60,000 IU vitamin D-3 pill. The control group took a placebo.

The researchers collected baseline information to learn about the socioeconomic status, lifestyle, and dietary habits of the participants. They monitored the participants throughout the study for adverse events and took surveys, and checked blood samples to make sure the participants adhered to taking their vitamin D supplements.

Additionally, the participants provided access to their medical records so the researchers could obtain information about cardiovascular events, medications prescribed, and any mortality data.

Some past observational studies have suggested a possible association of higher blood levels of vitamin D with lower rates of heart disease.

While clinical studies have not confirmed that vitamin D supplementation positively impacts heart health, this new study shows that it may provide some benefits.

Of the participants taking vitamin D, heart attack incidents were 19% lower compared to the placebo group.

The vitamin D group also had lower rates of coronary revascularization, which can include procedures such as a coronary artery bypass graft (more commonly referred to as a heart bypass).

While the overall rate of major cardiovascular events was 9% lower in the groups taking vitamin D, the study findings did not show a lower rate among stroke events.

The authors noted a caveat to the 9% reduction – they say it is possible that people taking statins or other cardiovascular drugs could have contributed to this reduction.

"For total major cardiovascular events, there was some indication of a stronger effect in those who were using statins or other cardiovascular drugs at baseline," write the authors.

For this reason, the authors say more testing is needed before they can definitively say that vitamin D alone helps with heart disease.

"In conclusion, these findings indicate that vitamin D supplementation might reduce the incidence of major cardiovascular events, particularly myocardial infarction, and coronary revascularization," write the authors.

"This protective effect could be more marked in those taking statins or other cardiovascular drugs at baseline. Subgroup analyses in other large trials might help to clarify this issue," the authors continue.

Dr. Yu-Ming Ni, a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California, spoke with Medical News Today about the study.

Dr. Ni did not consider the study results significant enough to show that vitamin D supplements help reduce cardiovascular disease rates.

"In reviewing this study, it is tempting to conclude that there may be a trend toward a benefit for vitamin D supplementation for cardiovascular disease prevention, particularly as it relates to preventing heart attacks (myocardial infarction)," he said.

Dr. Ni said that compared to existing research on vitamin D and heart disease, the current study "did not demonstrate a significant benefit of vitamin D supplementation, even if there was a trend toward one."

While Dr. Ni did not think the study showed promise for using vitamin D to reduce cardiovascular disease risk, the doctor said it is still a vital supplement for bone health.

Dr. Dmitriy Nevelev, an associate director of cardiology at Staten Island University Hospital in New York, had a slightly different take on the study when discussing it with MNT.

After pointing out that other large studies have researched vitamin D and heart disease and shown no "significant effect," Dr. Nevelev said "many of these studies had limitations such as suboptimal adherence with daily therapy, insufficient dose of vitamin D, or an overall lower risk population."

"This study overcame some of these limitations by providing a once-monthly treatment with high adherence and enrolling a large, clinically diverse population. The findings overall supported the notion that vitamin D supplementation may reduce the risk of heart disease, albeit mildly," Dr. Nevelev continued.

Like the study authors, Dr. Nevelev believes further research is needed on vitamin D supplements and heart disease.

"Even if the findings do not immediately impact our approach to supplementation, they provide a reason to continue research to determine if there is a particular population that stands to benefit," said Dr. Nevelev.

"Of particular interest was the finding that patients who took statins saw a more pronounced reduction of heart disease with supplementation, possibly because vitamin D allows the liver to more efficiently process these medications."

— Dr. Dimitriy Nevelev

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