COVID-19: Do I Need to Stop or Change My Meds?

COVID-19: Do I Need to Stop or Change My Meds?

HEART HEALTH

Ask a Pharmacist

Do I Need to Stop or Change My Meds?

COVID-19 is a very new virus, and there is a lot that we still do not know about it. There have been some recent claims or speculation about how certain drugs may interact with the COVID-19 infection, but nothing yet has been proven. Some of the medications discussed throughout media sources recently include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and non-steroidal anti-inflammatory drugs (NSAIDs), all of which are very common among CCA patients.

There is a protein, ACE2, in our bodies that the COVID-19 virus binds to and thereby enters targeted cells. An early concern was that patients on medications like ACE inhibitors, ARBs, or NSAIDs that also work on ACE2, may be at an increased risk of getting COVID-19 or having worse outcomes. However, this has not been proven, and in fact, there are recent suggestions that the opposite occurs with ACE inhibitors and ARBs, and that being on one of these medications may be beneficial in the setting of COVID-19.

Below, we aim to help you understand your risks and the best plan of action in these uncertain times. As always, it is highly recommended that you speak to your healthcare provider before changing any of your medications.

ACE inhibitors and ARBs

What are ACE inhibitors and angiotensin receptor blockers (ARBs)?
ACE inhibitors and ARBs are medications commonly used to treat high blood pressure or heart failure and include lisinopril, enalapril, losartan, irbesartan, and valsartan.

Should I continue to take my ACE inhibitor or ARB?

To date, there is no data to support this hypothetical concern. The American College of Cardiology (ACC) and American Heart Association (AHA) both recommend continuing to take ACE inhibitors or ARBs as directed by your healthcare provider. Recently there has been one small study published that provided encouraging data for continuing the use of ACE inhibitors and ARBs. While this evidence is preliminary, it is promising that the benefit of these medications in cardiovascular health may outweigh the risk in COVID-19. Overall, the use of guideline-directed medical therapy is key in controlling blood pressure, and stopping them could lead to a heart attack or stroke.

In conclusion, the FDA, WHO, and CDC are currently unaware of any scientific literature connecting the use of NSAIDs, ACE inhibitors, or ARBs and worsening or causing COVID-19 infections. The information being reported is mainly from purely observational studies, and not based on scientific data. New studies are planned, and we will continue to keep you updated as any new information emerges.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

What are NSAIDs?
NSAIDs include medications you may know more commonly as ibuprofen (Motrin, Advil), naproxen (Aleve), celecoxib (Celebrex), and aspirin. They are commonly used to reduce fevers and relieve mild pain.

Is it safe to continue taking NSAIDs?

There are currently no studies that suggest taking NSAIDs increase your risk of getting COVID-19 or worsening outcomes with COVID-19 infection. The European Society of Cardiology (ESC) and the Food and Drug Administration (FDA) are both unaware of any scientific data to support the worsening of COVID-19 infection associated with NSAID use. The concern to avoid the use of these medications is theoretical, and at this time, patients can continue to use them safely and as directed. The National Institute for Health (NIH) suggests using the lowest dose of NSAIDs, for the shortest period of time, to provide relief of pain and fever, and this is especially important for those with cardiac conditions and kidney issues.

Is there an alternative medication I can take for fever or pain?

If you are looking for a medication to help with pain and fever reduction that is not an NSAID, Tylenol (acetaminophen) is an option! The CDC currently states that acetaminophen (Tylenol) is an appropriate choice to help reduce pain and fever related to COVID-19 infection. Over-the-counter (OTC) products are safe and effective when you follow the directions on the label and use them as directed by your healthcare provider. The maximum daily recommended dose of acetaminophen (Tylenol) is 3,000 mg per day.

Is it safe to take my ‘baby’ Aspirin?

Yes! A low or “baby” dose, 81 mg, aspirin is commonly taken for heart health. The findings of “aspirin worsening COVID-19” are unfounded. It is very important to continue aspirin therapy as it has significant benefits, especially after a heart attack, a coronary stent, or stroke. Aspirin works by a different mechanism of action than other NSAIDs, and thus the cardio-protective effect and the reduction in risk of cardiovascular events outweigh any theoretical risk of aggravation of COVID-19 symptoms.

Please call Capital Cardiology Associates or the Clinical Pharmacy Team at Capital Cardiology Associates for more information, questions, or concerns.

Stay well and wash your hands!

Written by Emily Kronau Pharm Intern, Dylan Carmody Pharm Intern, Emily Plumadore PharmD, Kate Cabral PharmD, BCCP

References:
1. Center for Drug Evaluation and Research. FDA advises patients on use of NSAIDs for COVID-19 [Internet]. U.S. Food and Drug Administration. FDA; [cited 2020Apr3]. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19
2. Coronavirus [Internet]. World Health Organization. World Health Organization; [cited 2020Apr3]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
3. Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2020Apr3]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/index.html
4. Uncertainty Surrounds Use of OTC Anti-Inflammatory Drugs in Patients With COVID-19 [Internet]. Pharmacy Times. [cited 2020Apr9]. Available from: https://www.pharmacytimes.com/news/uncertainty-surrounds-use-of-otc-anti-inflammatory-drugs-in-patients-with-covid-19
5. New Study Provides First Clinical Insight into ACE-inhibitors and ARBs in patients with COVID-19 [Internet]. Pharmacy Times. [cited 2020Apr13]. Available from: https://www.pharmacytimes.com/news/new-study-provides-first-clinical-insight-into-ace-inhibitors-and-arbs-in-patients-with-covid-19
6. HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19 [Internet]. American College of Cardiology. 2020 [cited 2020Apr13]. Available from: https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19

What we have learned about the coronavirus

What we have learned about the coronavirus

HEART HEALTH

What we have learned about the coronavirus

“We are learning about
this virus every day and
working together to
benefit all of us.”

It has been a month since the coronavirus spread throughout New York, closing schools, sending non-essential workers home, canceling public events, clearing our social calendars, and stalling the economy. When the first reports of patients infected with coronavirus disease 2019, COVID-19, in China surfaced in early January of 2020, most Americans were focused on the beginning of the new year. In only a few months, we have transformed into a society on PAUSE as medical officials and elected leaders responded to a virus that can only be viewed under an electron microscope, virtually unknown to science until its effect was reported on the nightly news.

Scott Purga, MD, FACC

What has the Capital Region medical community learned about the coronavirus and how might that knowledge help end this pandemic? That is the question we posed to Dr. Scott Purga, a board-certified cardiologist at Capital Cardiology Associates, who is part of the area’s COVID-task force. “What’s new for all of us is that we are learning about this virus every day. Our team is quite thorough and working together to provide the best care. You may see things on the news about how hospitals were overwhelmed, that is not the case in Albany. We had extra time to get our systems in place.” Dr. Purga joined me on a recent episode of HeartTalk, presented by Capital Cardiology Associates to discuss the treatment, recovery, and possible cure options during this pandemic.

What we have learned

It has been established that COVID-19 is highly contagious and quickly spread across the globe after first being reported in Wuhan, China, on December 31, 2019. The World Health Organization began publishing risk assessments and advice to the public health crisis that was developing in Wuhan medical institutions. On January 13, the first confirmed case of COVID-19 in Thailand was reported, signaling that the virus had traveled outside of China. Fast forward to February 29 when the first death from the virus was reported in America. Dr. Purga explained the challenge with COVID-19 is in identifying those who have the virus. “We have seen COVID-19 in patients with the main presenting symptom of fever, chills, the usual flu-like symptoms, but then a substantial portion also have lung involvement.” The virus had reached America during the peak of the seasonal flu. Common respiratory viruses (like the common cold and influenza) affect young children, those with health conditions, and adults 65+ at greater rates, causing a spike in hospitalization. Unlike the cold and flu, coronavirus “can progress to pneumonia, which can become severe, requiring intensive care unit (ICU)admission. A large subset also have cardiac complications, either from the virus itself or from breathing issues associated with the virus. Anywhere from 10-20% are going to have a heart issue coming from the coronavirus infection, particularly those that are more severe cases,” noted Dr. Purga.

Another unique twist to coronavirus is that an infection can be generally mild. “A substantial portion, manly younger and healthier people with fewer comorbidities, they have a relatively mild illness with flu-like symptoms with shortness of breath for a few days but can recover quickly,” commented Dr. Purga. Mild symptoms create an opportunity for the virus to spread to others through a cough, sneeze, or any close contact. This is why there is a concern about hand washing, wearing masks, and adhering to social distancing. And like the cold and flu, coronavirus is transmitted from germs that can live for hours on unsanitized surfaces.

Dr. Lance Sullenberger, COVID-19 task force

“Once inside, the virus attacks the body’s immune cells and is able to ‘get inside’ to replicate using our own cells to make more copies of the virus. The concern here is that this virus spreads to affect the lungs, which is the major reason that this virus is deadly. This virus is able to get through certain receptors on the cell surfaces. You may have heard about the ACE receptor. (Cell receptors play a key role in passing chemicals into cells and in triggering signals between cells.) There are some theories that COVID is using these receptors to gain entry into cells. A lot of that is being studied every day by researchers,” said Dr. Purga. Even worse, coronavirus may trigger the body’s immune system into overdrive, causing inflammation in the lungs, causing Acute Respiratory Distress Syndrome (ARDS), which requires the use of a ventilator to assist with breathing. “The downside is two-fold, we are learning about residual damage to the heart and lungs from the virus as well as the fact that these people can spread the virus to others without realizing it. We think a good percentage of people are asymptomatic, meaning that they have the virus infection but have no symptoms of it. They can be walking around with friends, spreading the virus without realizing it. That is the double-edged sword when you have milder cases.”

COVID-19 Task Force members at Albany Med

Working together

There is no specific antiviral treatment recommended for COVID-19, and no vaccine is currently available. While we have been separated during this pandemic with social distancing and the New York State on PAUSE guidelines, a group of Albany-area medical professionals has formed to combat this virus, together. Special COVID-19 task forces have been assembled at area hospitals, comprised of emergency room nurses and physicians, nursing care, respiratory therapists, ICU physicians, and cardiologists. “We do this in a controlled fashion, keeping everyone safe, isolating COVID patients for treatment,” detailed Dr. Purga. “The cardiologists consult the attending internal physicians on the care and treatment progress. Our diverse backgrounds are the strength of the team; we can bring new ideas to each other and share what we know from our unique specialties and training. Our team at Albany Med can collaborate with the team at St. Peter’s to benefit all of us. It is a good atmosphere and quite unique!”

There are two main goals in ending the COVID pandemic: treating symptoms and finding a cure. Currently, there is considerable discussion on the effectiveness of drugs used to treat other illnesses on COVID patients. Dr. Purga addressed the two most popular drugs being used to treat symptoms. “Under controlled circumstances, it is useful to give these drugs under physician supervision. Zithromax, or as it is called ‘Z-pack,’ is typically used for community pneumonia, pneumonia caught outside of the hospital, and some other bacterial infections. It also can reduce inflammation in the lungs. That is why we think it may be helpful in combatting the lung problems associated with coronavirus. Hydroxychloroquine is traditionally an anti-malarial drug that is used to fight that parasitic infection. It also has some anti-inflammatory properties and has been used in autoimmune conditions like lupus. The thought here is that by reducing the body’s response, this may reduce the frequency of severe complications, needing a ventilator and other respiratory problems. They are being used together with the hope that they are helping. It’s premature to say that they are making a definitive impact yet.” It has also been reported that remdesivir, a drug developed to treat disease caused by the Ebola virus, could possibly stop the virus from being able to copy and spread to other parts of the body. The drug was successful in animals and laboratory dishes, but scientists insist on more studies to confirm its effectiveness in people. “There is a lot to come, with the use of other off label anti-inflammatory medication options that are being used in the hospital, on the treatment of COVID symptoms,” added Dr. Purga.

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The race for a cure

As of April 8th, there were 115 COVID-19 vaccines under development around the world. The most advanced candidates have recently moved into clinical development, some looking to being human testing this year. Time is the one commodity scientists will need to develop a cure. Even Dr. Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases (NIAID), has questioned a drug being developed within a year. While scientists have cracked COVID-19’s code in record time (determining the genetic sequence of the virus), there are still critical steps in developing a vaccine. Researchers will use clinical trials to test for dangers, and adverse side effects in small to large populations before a cure can be released. “Typically, randomized trials, say for a new heart drug that comes to the market, that usually takes several phases of trials over years to develop approval from the FDA. In the case of the COVID virus, the CDC and FDA have are expediting approval of trials and allowing us to enroll patients quickly due to the rapid need for this data,” said Dr. Purga.

Healthcare during the new normal

One concern that has developed while we wait for things to return to normal is that doctors throughout the United States have reported treating fewer patients than normal for heart attack and stroke symptoms since the start of the COVID-19 pandemic. This week, the Journal of American Medical Association reported results from a large study involving patients hospitalized with COVID-19 in the New York City area, that people with obesity, diabetes, and high blood pressure are at greater risk for complications from the coronavirus. I asked Dr. Purga about the issue of patients not reporting their conditions out of fear of the virus. “My message is if you have a true concern, a new symptom: chest pain, shortness of breath, dizziness — any of our red flag cardiac symptoms — do not stay home. Heart disease isn’t on hold just because there is a viral outbreak. People have heart attacks, stroke, arrhythmia even while staying at home during this pandemic. The hospitals have isolated patients being treated for COVID conditions. Setting foot in the hospital does not mean you are going to catch coronavirus. I would encourage people who are presenting heart or cardiac symptoms to call their primary doctor, call our office, or if it is an emergency, go to the hospital.”

(l to r): Karen Canniff, NP with Dr. Scott Purga – holding a portable ultrasound unit

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates

Diabetes Alert Day

Diabetes Alert Day

HEART HEALTH

Diabetes Alert Day

How to avoid becoming a
statistic in America’s
diabetes trend

American Diabetes Association Alert Day is observed annually on the fourth Tuesday in March. This one-day “wake-up call” informs the American public about the seriousness of diabetes and encourages all to take the diabetes risk test and learn about your family’s history of diabetes. This year, I had a conversation with Bob Russell, Upstate New York Executive Director of the American Diabetes Associates (ADA) and Felix Perez, Market Director for the ADA in Albany.

There are some shocking stats on diabetes: Almost 10% of the American population is affected by diabetes. Nearly 1 in 4 American adults living with diabetes are unaware they have it. Bob Russell was personally compelled to change that statistic because he is one of those Americans. He was twenty-five years old when he was diagnosed with type 1 Diabetes. “I was in the best shape of my life. I wasn’t sure what it meant. I certainly didn’t realize that it was a life-long disease that I would be dealing with. I remember joking with my doctor, ‘a few less beers, a few less chicken wings, right?’ I didn’t understand the complete change in lifestyle,” said Russell.

Three types of diabetes

There are three main types of diabetes – type 1, type 2, and gestational. Understanding what type and what the options are available is part of the problem of living with diabetes. “It’s a multi-pronged disease,” Russell begins. “That’s where the confusion begins. Diabetes is often a punchline in movies and TV shows. ‘Oh, there’s a plate of chocolate; you must have diabetes.’ That’s not the reality of it. We have kids as young as ten months old being diagnosed with this; it really is an auto-immune disease.” In all types, diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin or when the body cannot make good use of the insulin it produces.

What you need to know about diabetes

Type 1.The CDC estimates that nearly 1.6 million Americans have it, including about 187,000 children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control. Type 1 diabetes occurs at every age, in people of every race, and of every shape and size.

Type 2.Type 2 diabetes is the most common form of diabetes and accounts for around 90% of all cases. It means that your body doesn’t use insulin properly. While some people can control their blood sugar levels with healthy eating and exercise, others may need medication or insulin to help manage it.

Gestational diabetes (GDM). This type of diabetes consists of high blood glucose during pregnancy and is associated with complications to both mother and child. It happens to millions of women. GDM usually disappears after pregnancy, but women affected, and their children are at increased risk of developing type 2 diabetes later in life.

Health risks of uncontrolled diabetes

Diabetes is treatable; it does become dangerous when glucose levels are uncontrolled. Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes. “This is called ‘the silent disease,'” adds Russell. Undiagnosed and uncontrolled diabetes leads to a wide array of health problems like high blood pressure, unhealthy cholesterol levels, and high blood sugar levels. This is a long-term process, a development that occurs over the years where a normally healthy person becomes less active over time gains bodyweight, which leads to a lifetime of damage to vital organs. “By the time you realize what is happening, that damage is already done and can’t be reversed.”

Diabetes has been proven to affect your vision, one of the warning signs that Bob Russell recalled before his diagnosis. “I was having problems with my vision. I got new glasses. Two weeks later, I went for blood work. That’s when I got a call from the nurse that I needed to meet the doctor in the emergency room right now. My blood sugar levels were 790. I was feeling fine, but there were symptoms that were leading up to this. Excessive thirst, frequent urination. When you are active, you don’t think these are a sign of diabetes. That’s the problem.”

Common diabetes complications

Vision.
High blood sugar can damage blood vessels in the eyes which are the leading cause of blindness in adults age 20-74 according to the National Eye Institute. This is why a yearly eye exam is important.

Nerve damage.
High blood sugar affects the hands and feet. Uncontrolled blood sugar levels can also lead to chronic brain damage.

Heart disease.
The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease (CVD).

Kidney disease. Diabetes is a major cause of kidney failure and other kidney problems.

Pregnancy complications.
Women with any type of diabetes during pregnancy risk a number of complications if they do not carefully monitor and manage their condition.

Know your risk

Since diabetes can strike anyone at any age, at any time, the message of Diabetes Alert Day is to know your risk. “One of the tools we use is the ADA Risk Test. It’s seven simple questions you take; all it takes is 60 seconds of your time,” said Perez. The test collects your age, gender, family history, high blood pressure history, level of physical activity, race, height, and weight. A high score on the online Risk Test (five or higher) means an individual has a significant risk for having undiagnosed pre-diabetes or type 2 diabetes; however, only a blood test can determine a diagnosis. In my case, it led to having a conversation on my risk of type 2 with my doctor during my yearly visit. During my doctor’s appointment, we discussed how losing 10-15 pounds can make a big difference, as well as the role of even occasional tobacco use, affects my cholesterol levels.

Pre-diabetes affects almost 88 million Americans. The American Heart Association described pre-diabetes as a point where your blood sugar levels are higher than normal, but not yet crossing the threshold of a diabetes diagnosis. “Three years ago there were 84 million people living with pre-diabetes, meaning that they are not there yet, but they are headed in that direction. The CDC just released their latest report; the number is now 88 million people. We are going in the wrong direction,” added Russell. Many people with pre-diabetes develop type 2 diabetes within ten years. Overweight adults over the age of 45 with a family history of type 2 diabetes are at risk. We also know that African Americans, Hispanics/Latinos, American Indians, Pacific Islanders, and some Asian Americans are at higher risk. You can make lifestyle and health changes, like losing 10-15 pounds, for example, to lower your risk of advancing to type 2 diabetes.

Knowledge is key. That is the message from diabetes alert day. Take the ADA Self Test. Talk with your doctor about your family history and personal risk. Have your A1C levels checked with a simple blood test, if recommended. Most importantly, stay active and live well. You can live with diabetes. While there is no cure, millions of people live healthy lives. The American Diabetes Association has a great online resource, the ADA Support Community, a dedicated and passionate online community that shares education, health recipes, and activity/exercise workouts to keep you living your best life.

Written by Michael Arce, Marketing Coordinator. Host of HeartTalk presented by Capital Cardiology Associates.

Why Statins?

Why Statins?

PATIENT EDUCATION

Why doctors prescribe statins

How a half a billion-year war between ancient
bacteria and fungi have helped to lower
cholesterol and become a new weapon
to fight cancer

About 40 million adults in the U.S. take a statin to lower their cholesterol and to reduce their risk of heart disease, heart attack, or stroke. New research suggests a possible anti-cancer benefit for statins. Dr. Robert Benton, Director of Research at Capital Cardiology Associates, explains how statins became one of the standard medications prescribed for heart health.

The link to lowering cholesterol production

Some say the history of statins in medicine begins with Virchow, the German pathologist and one of the 19th century’s foremost leaders in medicine and pathology. He discovered a yellow, fatty substance on the artery walls of patients dying of heart disease or a heart attack before the turn of the century. That plaque was later identified as cholesterol. At that time, physicians were not convinced of the link between cholesterol and coronary heart disease. That connection would not be made until the 1950s.

The Seven Countries Study, initiated in the 1950s, brought together researchers from all over the world. It became a collective effort to study their common questions about heart and vascular diseases among countries with different traditions in diets and lifestyles. This study focused on coronary disease and cholesterol in Italy, Spain, South Africa, and Japan from 1952 to 1956 and Finland, Italy, and Greece from 1956 to 1957. We learned that cholesterol, blood pressure, diabetes, and smoking are universal risk factors for coronary heart disease. The discovery was made that when the body makes too much cholesterol, there is a higher risk of heart disease, heart attack, or stroke.

Researchers began studying how to lower cholesterol to benefit patients. They tried using diet modifications at first, promoting the eating pattern they found in Italy and Greece in the 1950s and 60s, now popularly called “The Mediterranean Diet.” By the mid-1960s, scientists were exploring for ways to alter how cholesterol was produced, chemically. In the 1970s, a microbiologist in Japan, Akira Endo, added research into how antimicrobial agents reduced cholesterol. “It’s almost like the discovery of penicillin. You find the effect of one organism on another and use that to attack a problem. This is a similar thought process that led to finding statins,” noted Dr. Benton. By 1978, the first statin, lovastatin, was discovered.

What is a statin

“A statin is an enzyme that works in your liver to help you make cholesterol, usually at night. What the statins do as a class of medicine, is prevent that long chain of metabolic steps from being completed,” explained Dr. Benton. By the mid-1980s, lovastatin became available for prescription use and was able to reduce LDL cholesterol, producing very few side effects effectively. “I don’t remember my first statin prescription; it was probably in medical school in the early 1990s. When I became a cardiologist, that’s when statins became standard in the care of patients. There were other medicines that we used before that which were not as effective,” recalled Benton.

Simvastatin (Zocor) was the second statin used clinically. Pravastatin (Pravachol) followed in 1991, fluvastatin (Lescol) in 1994, atorvastatin (Lipitor) in 1997, cerivastatin (Baycol, Lipobay) in 1998, and rosuvastatin (Crestor) in 2003. “What happens is there is one chemical entity, and science tries to make it better. Can it be better absorbed, lasts longer, have a better target, or durability? Clinical trials then test to see if it’s safe and effective in lowering cholesterol and heart disease endpoints. That’s how you make the progression through the different statins that have been prescribed over time,” outlined Dr. Benton. Today, statins are one of the most common medicines prescribed in the U.S., with about 40 million people taking them. “Statins are clearly the first-line therapy along with modifications in diet and exercise in lowering cholesterol. Certainly, for secondary prevention, a person who has had a heart attack or stroke should be on a statin. A person with diabetes should be on a stain. These are generic medicines that do not cost very much,” states Benton.

Statin controversy

For a 42-year old drug, statins have had their fair share of reviews and criticism. A bitter dispute erupted in September of 2016 among doctors over suggestions that statins should be prescribed to millions of healthy people at low risk of heart disease. The controversy focuses on who should receive statings and how common/serious are the side effects. Dr. Benton is well aware of the conflict, “like any medicine; there is a risk/benefit profile. I think there is no controversy for being on a statin for secondary prevention after a cardiac or vascular event – that’s not an issue.” In 2013, a joint task force of the American College of Cardiology and the American Heart Association released guidelines for treating cholesterol. These guidelines focused on treating the patient based on his or her risk of developing heart disease, not a target number.

GROUP I

People without cardiovascular disease who have risk factors for the disease and a higher 10-year risk of a heart attack. This group includes people who have diabetes, high cholesterol, high blood pressure, or who smoke and whose 10-year risk of a heart attack is 7.5 percent or higher.

GROUP II

People who already have cardiovascular disease related to hardening of the arteries (atherosclerosis). This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, ministrokes (transient ischemic attacks), peripheral artery disease, or prior surgery to open or replace coronary arteries.

GROUP III

People who have very high LDL (bad) cholesterol. This group includes adults who have LDL cholesterol levels of 190 mg/dL (4.9 mmol/L) or higher.

GROUP IV

People who have diabetes. This group includes adults who have diabetes and an LDL between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), especially if they have evidence of vascular disease or other risk factors for heart disease such as high blood pressure, smoking or being older than age 40.

The most common side effect of statins is muscle ache or pain. “Somewhere around 5 to 10% of people have muscle ache or myalgia. That’s real,” said Dr. Benton. Typically, aches and pain can be eliminated by changing the dose, frequency, or type of statin. Please talk with your doctor about your concerns as they can usually find a statin that you can tolerate without side effects. “There are people who are at a predisposition to have mild muscle aches. In extreme rare occurrences, there is dissolution of the muscles, they become destroyed, but that is a sporadic occurrence.”

There is a controversial link between statins and memory loss. A John Hopkins review of dozens of studies on the use of statin medications to prevent heart attacks shows that the commonly prescribed drugs pose no threat to short-term memory and that they may even protect against dementia when taken for more than one year. “All medications, including stat-ins, may cause side effects, and many patients take multiple medicines that could theoretically interact with each other and cause cognitive problems,” says Kristopher Swiger, a primary author of the study. In 2015, the U.S. Food and Drug Administration (FDA) made labeling changes to statins to outline the potential for non-serious and reversible side effects, which include: memory loss and confusion, increased blood sugar, increased hemoglobin A1c levels.

Statins anti-cancer properties

Doctors at Duke University School of Medicine in Durham, North Carolina investigated whether statin use affected outcomes in veterans at a VA Medical Center who had been diagnosed with colorectal cancer. They found that after five years, those taking a statin were 38% less likely to die from colorectal cancer. How does a cholesterol drug fight cancer? Dr. Benton explained how statins block the same enzyme the body needs to make cholesterol, called HMG-CoA. This process also slows cancer cell growth. “There are multiple enzymes in cancer cells. Statins, as a class of medicines, have many different targets that they work on. Any type of chemical entity that would interfere with that pathway of growth is probably a method of preventing cancer cells from progressing. I don’t think you are going to find people treating cancer with statins; it may be an off-target approach. You need cancer medicines, chemotherapy or biologics, or radiation, but statins may have some augmented type of function.” Research is also underway on the anti-cancer properties using statins and the diabetes drug metformin (often prescribed together) in men with prostate cancer. Men who took both drugs in a study lived longer than those who only took the statin or those who didn’t take either drug. Researchers believe the drug combo may help slow the growth process of prostate cancer. Expect to see more news on clinical trials using either metformin or a statin in cancer treatment in the coming months.

Written by Michael Arce, Marketing Coordinator

The High Cost of Obesity

The High Cost of Obesity

HEART HEALTH

The High Cost of Obesity

How the obesity trend will
impact more than the American
healthcare system in ten years

“Ten years from now, nearly half of U.S. adults will be obese if current trends continue.” Those were the findings in a study published in the New England Journal of Medicine by researchers from the Harvard T.H. Chan School of Public Health. The team stated that by 2030, 48.9% of adults nationwide will be obese. Obesity affects low-income adults, minorities, and women at higher numbers. It is also one of the three major controllable risk factors in the development of heart disease. “Unfortunately, for myself and my colleagues, we see this trend increasing at an alarming rate,” commented Dr. Heather Stahura, a board-certified cardiologist at Capital Cardiology Associates.

What is obesity?

Harvard researchers shared in their December 2019 findings that they used body-mass index (BMI) data collected from the Behavioral Risk Factor Surveillance System Survey (1993–1994 and 1999–2016) and the National Health and Nutrition Examination Survey. These were large studies of over 6.2 million adults (18 and over) from all 50 states. There has been a controversy within the medical community on the relevancy of BMI. Body mass index is a measure of body fat based on height and weight that applies to adult men and women. There is an online calculator from the National Heart, Lung, and Blood Institue where you enter your height (in feet and inches) along with your weight to compute your BMI. For example, a man who is 6 feet 0 inches, weighing 220 pounds would have a BMI of 29.8. Dr. Stahura points out that this calculation is where the problem begins.

“Obesity means different things to different people. If you want to look at hard endpoints, you will look at BMI. A BMI between 18-25 is considered normal. Over 25 is overweight. Anyone above 30 would be obese. The problem with BMI is that you cannot always say that someone with a BMI of 29.8 is overweight,” explained Dr. Stahura. In this example, the person with a BMI of 29.8 is me, a 42-year old male who ran almost 30 miles in the month of January. “You have to consider the whole person. BMI because it calculates your height to weight, there are outliers. If you are very tall, you may look like you have a higher BMI but be quite healthy. Five pounds of muscle weighs the same as fat. I would say muscle weight is healthier than fat. I think it matters more where you are carrying visceral fat – it’s worse around the stomach than your legs and rear.” This discrepancy, looking at the hard data without considering the patient body composition, is one area where the Harvard study came under fire. The team reported that 1 in 4 adults are projected to have severe obesity by 2030 (BMI above 35), and the prevalence will be higher than 25% in 25 states. The locations of these obese states/areas were the second area of controversy.

Why do some areas of the country struggle with body weight?

Lead study author, Zach Ward, addressed how the obesity prevalence is lower in some states than in others. “Obesity is rising in every state in the United States. And, some states are going to be at a very high level. We find that severe obesity is growing very rapidly in about 25 states.” Three of the states with the highest levels of obesity are Alabama, Arkansas, and Mississippi. “This is a hot button topic,” replied Dr. Stahura. “Unfortunately, a lot of Southern states suffer from a lower socioeconomic status. These states have to conserve their funds, making resources stretch further.” The Harvard team acknowledged that awareness was critical in combatting the obesity crisis. “It’s really hard to lose weight; it’s really hard to treat obesity. Prevention has to be a the forefront to combat this growing epidemic,” noted Ward.

The cost of obesity

There is long-standing research measuring the effect of obesity on the American healthcare system. The medical costs of obesity in the United Staes were estimated to be around $147 billion in 2008, according to the Centers for Disease Control and Prevention (CDC). There are also concerns that this health epidemic will impact all aspects of the American economy. Obesity imposes costs in the form of lost productivity and foregone economic growth as a result of lost workdays, lower productivity at work, mortality, and permanent disability. “One of the reasons we did this study was to help state policymakers,” said Ward. “And there’s a lot that they can do. One of the most effective and cost-saving interventions is limiting the intake of sugar-sweetened beverages. Some states are implementing a sugar-sweetened beverage tax. Which we find in some areas would actually save more money than it costs to implement.”

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Do smoking and soda bans work? “There is an interest in your government, believe it or not, in having you live a healthy lifestyle,” declares Dr. Robert Benton, Clinical Research Director at Capital Cardiology Associates. “The costs of health care are huge in this country. We could save so much if people ate a healthy diet and exercised. Why not let people know that? Why not remind people of that? Not to the point of being onerous but allowing you to make your own decisions, giving you the information to be confident with your lifestyle choices.”

One of the key points stressed by every government health agency, medical professional, and healthcare expert is the need of at least 30 minutes of moderate physical activity every day to combat obesity, heart disease, and other health issues. A healthy diet that emphasizes eating whole grains, fruits, vegetables, lean protein, low-fat and fat-free dairy products, and drinking water is also recommended. “There is a notion of being ‘fit but fat.’ When I talk with my patients, I encourage any activity or exercise, just moving more, even if the scale isn’t reflecting the change they want, as long as they are getting out and moving, that’s a success,” added Dr. Stahura. Having a healthy diet pattern and regular physical activity is also important for long term health benefits and prevention of chronic diseases such as Type 2 diabetes and heart disease, both long-term by-products of obesity and a sedentary lifestyle with poor health choices.

Written by Michael Arce, Marketing Coordinator
Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.