Niacin, Statins And Difficulties Of Drug Discovery

John LaMattina, Contributor

Former president of Pfizer Global Research covering news in pharma.

About a dozen years ago, a team of Merck scientists met with upper management to discuss a new approach for treating cardiovascular disease. The approach was simple, but clever. The scientists had a way of turning a well known and widely used drug, niacin, into an even better and safer drug, thereby expanding its usage.

Niacin, also known as vitamin B3, is known to raise HDL (“good cholesterol”) by about 25% as well as modestly lower LDL (“bad cholesterol”) and triglycerides. It had been used for decades to help patients control their blood lipid levels based on results from a trial done in the 1960s known as the Coronary Drug Project, which looked at niacin versus placebo in men who had a previous heart attack over a period of five years. While niacin showed no difference from placebo in the death rate of the men in this study, fewer patients on niacin had a non-fatal heart attack or stroke, by 26% and 24%, respectively. This study provides the basis for the use of niacin in cardiovascular disease.

Sudden Cardiac Death: Are You at Risk?

Source: Article first appeared in "Know Your Man Inside Out" by SingHealth / Her World

Did you know?

Heart attacks are not confined to the old. Even young men can get a heart attack leading to sudden death.  80 per cent of all sudden cardiac death are related to coronary heart disease which, in most cases, can be prevented.

What causes young men to die suddenly?The most common cause is sudden cardiac death (SCD), of which 80 per cent is related to coronary artery disease (CAD) (see box below), with or without a heart attack.

Unfortunately, over half of sudden cardiac death victims have no prior symptoms. Some patients have chest pain, breathlessness or sweating. When these occur in a patient at risk of heart problems, treatment should always be sought immediately.

An SCD attack is not the same as a heart attack. SCD is caused by an abnormal heart rhythm due to an abnormal ‘electrical circuitry’ of the heart. A heart attack is caused by blockage of the arteries supplying blood to the heart. The subsequent damage to the heart muscle may or may not lead to an SCD attack. It is estimated that 1,000 Singaporeans die from SCD every year, about half of whom are below 60 years old.

Learn to recognise these symptoms

• Central or left-sided chest pain often associated with sweating, nausea or breathlessness. The pain is described as something weighing heavily on the chest and is usually brought about by physical or emotional stress. It usually goes away within minutes when the stressful activity is stopped.

• Shortness of breath. Because the heart muscles are damaged by the shortage of blood supply or from a heart attack, it can’t pump blood efficiently to meet the body’s needs.

• Discomfort on exertion, jaw tightness on exertion or after meals. These symptoms immediately subside on resting.

In anyone at high risk for heart disease (eg diabetics, high cholesterol, hypertension, strong family history of heart disease), any chest symptom, even atypical, should be investigated. Diagnosis is made with an electrocardiogram and blood tests.

Treatment may involve hospitalisation and ways to restore blood flow in the coronary artery (by angioplasty or thrombolysis).

If you are around...

1. Call the ambulance immediately. Early treatment increases survival rate.

2. Perform chest compression CPR. This will also improve the chances of survival.

Cardiac Artery Disease (CAD) CAD is a common type of heart disease where fatty deposits accumulate in the coronary artery and impede the blood flow. Reduced blood flow to the heart can cause chest pain (angina). A sudden, complete blockage can lead to a heart attack. Many people who have this form of heart disease are not aware they have it. CAD develops slowly and silently over decades. It can go virtually unnoticed until it produces a heart attack. You can prevent or slow down CAD by taking steps to improve your heart health. Drugs and surgical techniques can open up narrowed coronary arteries, but the best long-term solution is to make the right lifestyle choices.

Are You in the High-Risk Group?Age: Age increases a person’s susceptibility to heart disease. Gender: Men are three to five times more likely to have coronary heart disease than women. However, the risk for women increases after menopause. Five to 10 years after menopause, women have the same risk for coronary heart disease as men. Ethnicity: Compared with Chinese, South Asians (Indians, Sri Lankans, Pakistanis, etc) are three times more likely to suffer from coronary heart disease. Malays have double the risk compared with Chinese. Obesity: People who have excess body fat – especially located around the waist – are more prone to heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart. It also raises blood pressure, blood cholesterol and triglyceride levels, and lowers HDL, ("good" cholesterol levels). It is also associated with the development of diabetes mellitus. Family history: You can be at higher risk of heart disease if your immediate family members (parents, children, brothers and sisters) have a history of premature heart disease. Certain risk factors tend to run in some families. If there is a history of heart disease in your family, you should try very hard to control your other risk factors. "In general, adults should know their family history of heart disease or sudden death. They should know their cholesterol level and know if they have diabetes mellitus and abnormal blood sugar levels. If you have any high-risk factor, get your doctor’s advice on how to improve those risk factors, change your lifestyle and dietary habits, and embark on a safe exercise programme."  Dr Teo Wee Siong, Senior Consultant Cardiologist, National Heart Centre http://www.healthxchange.com.sg/healthyliving/SpecialFocus/Pages/Sudden-Cardiac-Death-Are-You-at-Risk.aspx?

Pregnancy Increases Heart Attack Risk

By ABC News | ABC News Blogs

Ike S. Okwuosa, MD reports:

CHICAGO -  Heart attacks are often linked to high blood pressure, diabetes and smoking. But a new study suggests pregnancy can also increase the risk.

"There are significant hormonal changes that occur during pregnancy that affect the coronary arteries," said study author Dr. Uri Elkayam, professor of medicine, cardiology, and obstetrics and gynecology at the University of Southern California.

Those pregnancy-related hormonal changes,  Elkayam said, leave women "susceptible to clots."

Elkayam and colleagues reviewed 150 cases of heart attack during pregnancy between 2005 and 2011. They presented their findings today at the 61 st conference of the American College of Cardiology in Chicago.

Heart attacks are usually triggered by  atherosclerosis - a build-up of plaque that narrows the arteries and makes it harder for blood to flow.  But only a third of heart attacks that occur during pregnancy are caused by atherosclerosis, Elkayam said. Rather the vast majority are caused by a tear of one of the three layers that make up a blood vessel known as a dissection.

Seventy percent of spontaneous coronary dissections occur in women and 30 percent of those occur during pregnancy or immediately after, according to Dr. Sharon Hayes, a cardiologist at the Mayo clinic in Rochester, Minn. who was not involved in the study. "We have known for decades that young women with heart attack have higher mortality than men at the same age and also have very different cardiovascular disease risk factors," she said.

Heart attacks are usually treated with clot-busting drugs and balloons or stents that open up the narrowed artery. But for pregnant women with dissections, typical treatments can make the situation significantly worse.

Elkayam found that "performing a coronary angiogram, in which you inflate a balloon and place a stent, in 5 percent of the patients made things worse… In patients who are stable, we advise to evaluate the patient non-invasively, and only the high risk patient should undergo a cardiac catherization," he said.

A heart attack occurring in a young, previously healthy young woman is very unusual, with a reported incidence of 1/16,000. Elkayam emphasized that "women should not be afraid to become pregnant because the incidence of a heart attack is very small."

Dr. Okwuosa is an internal medicine resident Northwestern Memorial Hospital's Feinberg School of Medicine.

http://news.yahoo.com/blogs/abc-blogs/pregnancy-increases-heart-attack-risk-192805072--abc-news.html;

Live life healthy or just live happy?

By Yahoo! SHE Staff | Yahoo! SHE

It’s not possible to live happy if you’re not healthy. However, there are some people who have equated healthy living with an agonizing life where one eats nothing but oat bran and vegetables. That’s not necessarily a bad thing—if that’s what makes you happy. But if it isn’t, then it’s baffling why you would associate healthy living with that scenario alone.

You have to understand that a healthy life is not exactly a life of deprivation. It only seems that way because—at least in this aspect of our lives—most of us acquire bad habits first before we learn good ones. We learn to enjoy fastfood before we’re told that we’d be candidates for heart attacks if we ate it everyday. We get hooked on the taste of fried food before we find out that feasting on greasy stuff would make us pile on unwanted pounds. We enjoy junk food before we’re told that they’re not really good for us.

It can’t be denied that fried food and chips taste good. If they didn’t, we wouldn’t be craving for them in the first place. But while they may transport us to grease heaven or processed food nirvana each time we munch on them, we have to understand that our bodies will give up on us if they’re all we eat. We all know is. It’s not rocket science.

We admire people who’ve pledged to live healthy lives in every way. They exercise, they only eat organic produce, and they’ve quit junk food. In a perfect world, we’d all have their will to reject all unhealthy temptation. However, this isn’t a perfect world. It’s good to aim for perfection—but it’s best to get real and do commit to a game plan that you can keep up with.

That being said, the general rule is for you to put limitations on—as well as checks and balances for—your so-called bad habits. If you must have fastfood, decide that you would only have twice a week at most. If you like fried food, make sure you only have it every other day. If you crave for junk food, enjoy it only once a week. In addition to eating more fruits and vegetables, you have to get moving. It’s nice to sit back and relax—but being healthy requires “sweat equity” as well. You have to work for it. Walking for an hour each day is a good way to start.

Bottom line: Living healthy doesn’t necessarily mean that you’ve signed up for punishment. It only means that you have to be better at controlling your cravings for things that are bad for you. Now, shouldn’t that make you happy?


http://ph.she.yahoo.com/live-life-healthy-or-just-live