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.

Is it Time for a Heart Health Screen?

Source: Contributed by the National Heart Centre Singapore (NHCS), this article was first published in Asiaone as part of a series on heart health. 

In Singapore, cardiovascular disease - a class of diseases affecting the heart and blood vessels - is the leading cause of death and morbidity. Coronary heart disease - a subset of cardiovascular disease - is the number two killer. It is the failure of the coronary arteries or vessels supplying oxygen to the heart and surrounding tissue. Coronary heart disease (also known as coronary artery disease) is expected to afflict more people at a younger age as we become more sedentary and develop unhealthy eating habits. Coronary heart disease is known to develop over a long time and can go undetected in the early stages as there may be no symptoms. For some patients, the onset of a major heart attack with its attendant complications is the first and only symptom of coronary artery disease. This can be avoided if more patients, especially those with known risk factors, keep track of their heart health. What is heart health assessment? Heart health assessment plays an important part in the early diagnosis and treatment of heart disease. This is especially important for people who do not seem ill. "This is because cardiovascular risk factors could be detected, allowing for earlier therapy," explains Dr Paul Chiam, Consultant Cardiologist at the National Heart Centre Singapore. "Early heart problems (if any) could also be picked up. Treatment - including lifestyle modification - can help to prevent or delay complications". A basic assessment is relatively pain-free, except for routine blood taking. The assessment usually begins with a medical history review and a detailed physical examination. It also includes tests such as the ECG (electrocardiogram), chest x-ray, and fasting lipid and glucose profiles to evaluate basic cardiac status and risk profile. The results will help to determine if the risk factors for heart disease - such as high blood pressure, diabetes or elevated cholesterol levels - are present. Besides cardiovascular risk factors, early heart conditions such as underlying heart artery blockages can be picked up. Early intervention can prevent the condition from becoming worse. Who can do the screening? A family physician or GP can provide most of the basic screening. He or she may refer patients to a cardiologist for further tests, such as an exercise stress test, based on clinical findings from the basic screening. Who should have heart health screening? The recommended age to start assessing heart health for most people is around 40-45 years. For people with strong family history of heart disease, they should perhaps start earlier, at around 35 years old. As for the frequency of the check-ups, Dr Chiam says, "Depending on the patient's clinical history and the risk profile, the doctor may recommend that a checkup be done every one to five years." What are the tests for heart disease? Blood testsThis analyses cholesterol levels, kidney and liver function and diabetes mellitus. It can also confirm if you are having a heart attack if you are experiencing chest pain Electrocardiogram (ECG) Identifies abnormal heart rhythm and evaluates if symptoms of chest discomfort are due to heart disease. The patient will be asked to lie on a bed and electrodes will be placed on his chest, arms and legs. These electrodes help to detect the electrical activity of the heart. Patient can breathe normally during the procedure, but should avoid moving or talking to prevent distortion of test results. This test takes about 5 to 10 minutes. Chest x-ray Diagnoses abnormalities in cardiovascular and pulmonary systems - heart, lungs and blood vessels. Exercise stress testThis assesses the response of the heart to increased workload and demand for blood supply during exercise or exertion. Electrodes are placed on the patient's chest for ECG monitoring before the test. The patient's ECG and blood pressure are taken at rest. The patient is then asked to walk on the treadmill machine. The speed and gradient of the slope will increase every 3 minutes to stress the heart gradually. During the test, the patient's blood pressure, heart rate, ECG and general condition are monitored closely. The patients should inform the doctor to stop the test at any time if they are feeling tired, unwell or unable to continue. The procedure takes up to 1 hour, inclusive of preparation time. Calcium score on CT scan By assessing the amount of calcification in the coronary arteries, this test detects coronary artery disease at an early stage when there are no symptoms and helps to determine its severity. The technologist begins by positioning the patient on the computed tomography (CT) examination table, usually flat on the back. Straps and pillows may be used to help the patient maintain the correct position and to hold still during the scan. Electrodes for ECG will be attached to the chest to monitor heart beats. This makes it possible to record CT scans when the heart is not actively contracting. Patients are asked to hold their breath for a period of 10 to 15 seconds while images are recorded. You may also feel a little warm upon injection of the contrast, which should subside after a short while. When the examination is completed, you will be asked to wait until the technologist verifies that the images are of high enough quality for accurate interpretation. Sign up for our free e-newsletter to stay up-to-date with the latest health tips ! http://www.healthxchange.com.sg/healthyliving/SpecialFocus/Pages/Is-It-Time-For-A-Heart-Health-Screen.aspx

Stroke and Heart Attack Symptoms You Never Saw Coming

Sunday, 18 Sep 2011 05:43 PM

By Katrina Turner

Strokes and heart attacks are among the deadliest conditions in the United States. And while a stroke affects your brain and a heart attack affects your heart, the main symptoms and causes for both are frighteningly similar — four things in particular that you are about to discover.

Consider these similarities:

• Both are caused by a blockage in the arteries
• Both can vary greatly from minor to fatal
• Both can happen suddenly, without warning
• These four things happen before both (click here to see stroke and heart attack symptoms)

According to the American Heart Association, heart attack is the most common cause of death in the United States. Stroke is the third-highest cause of death and is also a top culprit for long-term or permanent physical disability.

Click to watch Dr. Crandall’s video on four hidden stroke and heart attack symptoms.

In a heart attack, the longer the heart stops pumping blood, the faster your internal organs begin to die. During a stroke, the longer your brain is deprived of oxygen-rich blood, the more brain cells are damaged beyond repair. The bottom line is, whether it’s a stroke or a heart attack, the longer it takes to get medical assistance, the greater the chance of permanent damage or death.

Timing is critical for both events, and any initial symptoms need to be reported immediately!

Unfortunately both conditions can strike without warning, meaning strokes and heart attacks happen with virtually no symptoms at all. So it’s important to learn how to recognize even the most unlikely cues.

According to cardiovascular disease expert Dr. Chauncey Crandall, the reason people don’t recognize certain symptoms of a stroke or heart attack is because they don’t even notice them. That’s why he has created a special video presentation to help the public discover four little-known stroke, heart attack, and heart disease symptoms before it’s too late to intervene and repair survive the damage.

Editor’s Note: For a limited time, Newsmax Health is making Dr. Crandall’s heart health video available at no charge. Click here to watch him explain how to identify four little-known stroke and heart attack symptoms.

Stroke or heart attack survival and recovery heavily depend on how quickly the patient acts. As a matter of fact, statistics shows the main problem resulting in disability and death stems from the time delay on the patient side. It is the amount of time between when your symptoms begin and when you see a doctor.

The elapsed time from symptom to emergency room should be less than one hour. Heart attack and stroke victims can benefit from new medications and treatments unavailable in years past. Certain new drugs can stop some strokes and heart attacks in progress, reducing and possibly reversing damage and ultimately saving a life.

However, for these treatments to be effective the drugs must be given quickly after stroke or heart attack symptoms first appear; the timeframe for efficacy is within the first 45 minutes to an hour.

That’s why knowing what to look for in terms of symptoms is critical, especially when they’re the kind that most people don’t think to associate with a stroke or heart attack. Since both strokes and heart attacks are caused by artery blockage, taking measures to recognize one will help prevent the other.

Watch this important video to learn how to recognize four unusual stroke and heart attack symptoms now, and share it with your loved ones. You could save a life, possibly even your own.

Editor’s Note: Click here to see these Dr. Crandall’s video on four hidden stroke and heart attack symptoms.

Read more on Newsmax.com: Stroke and Heart Attack Symptoms Video by Dr. Chauncey Crandall
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