Steven Nissen, MD
Chairman, Department of Cardiology Cleveland Clinic Miller Family Heart and Vascular Institute
Monday, June 6, 2011 - Noon
This is an exciting time for new innovations and research in the area of heart disease. Dr. Steven Nissen answers your questions.
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Christine: I understand there is an all-inclusive heart test that can be scheduled that shows any deficiencies in your system. Can you let me know the name of the test?
Steven_Nissen_MD: There are no all inclusive heart tests. Good medical practice requires that we order the right tests in the right patient. Any test that claims that "one size fits all" is not credible.
lmgaiso: Would a coronary calcium score, CT angio or carotid ultrasound be of any value. I have chest discomfort during exercise that is believed to be exercise-induced asthma based on symptoms and a 19 minute stress test. However, the testing for exercise-induced asthma was equivocal. I am 42 yr old male, non-smoker, no-DM, normal blood pressure, and low cholesterol. What about coronary MRI?
Steven_Nissen_MD: I strongly recommend against having a coronary calcium score, ct angiogram, or coronary MRI. These tests are not helpful in patients with your history. We do sometimes perform an imaging stress test to look for the presence of inadequate blood flow in part of the heart muscle. But - it really depends on whether your symptoms sound typical of coronary heart disease.
Peppy: There seems to be a lot of conflicting information out there about the importance of troponins, especially after PCI/stent. What is the latest info on the part this marker plays in the long term prognosis of a patient? Mine rose after the PCI and it seems I was and still do run a very low troponin three and a half years later. My cardiologist said not to worry about it as it probably was the test. I dunno. Your thoughts?
Steven_Nissen_MD: This is a very controversial subject. A small troponin leak after stenting probably does not adversely affect prognosis. But a rise to 5 times normal or greater does seem to indicate a higher risk of subsequent cardiac problems.
Coronary Artery Disease Symptoms
slaine: I am a 54-year old woman. From time to time I feel like something heavy is on my chest and it is hard to breathe. Other times I feel my heart racing. An EKG on a physical exam last summer was normal. I am not an alarmist, but is there something else I should check on?
Steven_Nissen_MD: Women can develop coronary heart disease at your age and their symptoms are sometimes different from the symptoms experienced by men. A careful cardiac evaluation would be appropriate and may include a stress test if your physician believes that the pain is likely or possibly due to coronary heart disease.
Coronary Artery Disease Treatment
faliawan: My brother in law had his LAD 100% blocked. He went through stenting. Is it enough or he has to go through an open heart surgery eventually? I’ll be thankful if you could give an opinion in general without asking for the catheterization images as I did e-mail them to you, but you said they had inadequate quality. I live in Pakistan.
Steven_Nissen_MD: There is not enough information in your email to provide a recommend a recommendation - We would be happy to evaluate your brother in person or through our online evaluation process - www.eclevelandclinic.com.
Peppy: How common is stent thrombosis with the Taxus II stent. I had one placed three and a half years ago. Cardiologist stopped the plavix at 3 years. Scared me to death! Is late stent thrombosis common in this "older" stent?
Steven_Nissen_MD: It is uncommon 3 years after stenting.
chris66: I am a 44 yr old female and in 2005 I had a double bypass for a block in my left main. In 2006 I had a stent put in because I was told the LIMA graft failed to mature ( which this is confusing because some DRs have said it only grows as much as it needs too but others do not ) the stent is now 100 percent blocked. I was told my lad is small and diffused. I get chest pain and upper left back shoulder blade pain when walking. One dr at a very good hospital has told me there was no need to do any test because there is nothing that can be done. My question is I have had stress echos done with no pain but then 2 weeks later in a angio they found out the Lima failed and the stent was blocked. My current Dr said it would be normal because the vein graft is clear. I do have a 40 percent block in the left circumflex. Is there a better test that they can do and any no treatments for a diffused artery? Thank You. Chris
Steven_Nissen_MD: It sounds like you have a complicated problem from a failed bypass graft. This can only be evaluated via a face to face visit with a review of your angiograms by one of our interventional cardiologists. We would be pleased to see you in person - or via a remote consultation from our website. http://my.clevelandclinic.org/eclevelandclinic/myconsult/default.aspx - or call 800-659-7822
JamesJ: Approximately 2 months ago my cardiologist found an instent restenosis in the focal area of the PLB. One stent is inside of stent in this area. He tried to rotocut the plaque inside the stent, but he was unable to do so because of the angle. Therefore, he used a balloon to open the stent. "tenting was not felt to be appropriate given the two layers in a small-caliber vessel." I believe this same area has clogged again because of returning symptoms. Would irradiation therapy be advised to prevent the repeated in-stent restenosis in this area? Please advise me what you would do. I would like a permanent solution to this problem.
Steven_Nissen_MD: This is a difficult problem. The use of radiation to prevent restenosis has not worked out well and we do not recommend it.
The best solution would be to have one of our interventional cardiologist review your angiogram and see what approach may be possible.
It all depends on the exact anatomy. There may be other options but we would have to see the films to render an opinion. This evaluation can be done in person or through our online myconsult.
martinaxel: Having had triple by-pass in 2001, wondering if the literature speaks to how long these are 'good' for? Thank you.
Steven_Nissen_MD: If your bypass was performed at the Cleveland Clinic, it comes with a 50 year warranty (just kidding). Bypasses using the internal mammary artery in the chest wall tend to stay open for many years - even decades.
We have many patients going strong 20 years after bypass surgery. I hope you are one of them.
wdklemperer: What do you think of a strict low-fat vegan diet as a means to prevent and reverse atherosclerosis (e.g., see work by Caldwell Esselstyn and Colin Campbell)?
Steven_Nissen_MD: There is not credible scientific evidence to support these ultra low fat diets. This is a fad - not science. The best diet is a Mediterranean diet that actually contains significant amounts of fats - but includes healthy mono-unsaturated and polyunsaturated fats rather than animal fats. I strongly encourage you to stay away from these highly restrictive fad diets
rjfp: Dr Nissen - Could you comment on the Ornish or Pritikin diets as a means of avoiding angioplasty and/or bypass surgery? And do your internists recommend a particular diet as being optimal in preventing heart disease? Thank you.
Steven_Nissen_MD: In my opinion the Ornish and Pritikin diets are unhealthy. They are extremely low in fat but high in carbohydrates. There is no evidence that these extreme diets are a substitute for proper medical care.
The best evidence suggest that the Mediterranean diet has the most health benefits. This diet contains healthy fats from vegetable oils, like olive and canola oil, whole grain foods and a limited amount of meat products.
A balanced and sensible diet is better than any of the fad diets.
Eugene: I noticed while reading about stress tests," Avoid caffeinated products (cola, Mountain Dew, chocolate products, coffee or tea) for 24 hours before the test, as caffeine will interfere with the results of the test. Also avoid decaffeinated or caffeine-free products, which contain trace amounts of caffeine. DO NOT SMOKE ON THE DAY OF THE TEST, as nicotine will interfere with the results of your test." So my question is, if I normally smoke 2 packs a day and drink coffee from 5am to 11pm every day, my body is not going to be in "typical condition" for the test. Why would you consider your results an accurate reflection of the way I am?
Steven_Nissen_MD: The reason you should avoid caffeine prior to a stress test is that it interferes with a chemical that is sometimes used to simulate the effects of exercise in patients who are unable to exercise on a treadmill.
In addition, smoking can lead to an abnormal test not related to coronary blockages.
I must caution you that smoking is probably the worst habit a patient with heart disease can have. I strongly encourage you to stop smoking immediately.
Cholesterol and Medications
kazba: 2008 angioplasty with stent at left descending artery installed. Was 85% blocked. Cardiologist said "we call that a widow maker"! I was on Plavix until August of 2010, 2 yrs. + 2 mos. Now on 325 mg aspirin daily plus Simvastatin 80mg every other night (my choice instead of every night) + Coreg 25mg tab 2x/day & amlodepine/Benaz 5-20mg 1x/day. I'm not keen on continuing the Simvastatin. I have always had low to normal cholesterol but am told since the heart attack I need the readings to be lower. Can too low readings also be harmful? Also I am now reading of some research that is looking at ACE inhibitors & beta blockers as they relate to increased risk of recurrence in breast cancer (was diagnosed with DCIS (ductal carcenoma in situ) early this year. Thank you!
Steven_Nissen_MD: It is not possible for you to have too low a level of LDL cholesterol. We do not recommend the 80 mg dose of Simvastatin because it has an unacceptably high risk of muscle toxicity.
If you need more than 40 mg of simvastatin, there are better choices. Your decision to take simvastatin every other day is unwise. These drugs should be taken in the conventional fashion.
There is no credible evidence that ACE inhibitors or beta blockers increase the risk of breast cancer. Unfortunately there is much erroneous information available on the internet. I am afraid you have been a victim of misinformation.
cuddlefur4: I have significant cardiovascular issues and am taking Norvasc, Zebeta, occasional Lasix, Coumadin, Zetia, and Crestor. My concern is with the Zetia and Crestor. I know they have the capability to effect muscles and joints. I am 52 yrs. old and I'm concerned about the long-term effects of these drugs. My cholesterol is well-controlled with them.
Steven_Nissen_MD: Statin drugs like crestor are very safe and can be taken indefinitely. The biggest risk comes when patients who need these drugs to treat their cholesterol stop them.
If you are having no difficulty with the current medications, stay on them.
Peppy: Statins give me migraine headaches. I am tolerating 2.5mgs. of Crestor right now. But my LDL was 59, Tri's 105, HDL 38. I don't want my disease to progress. Is this amount of statin enough to halt progression. If not what else can I do besides lifestyle/exercise and low dose Crestor?
Steven_Nissen_MD: Your LDL is well controlled on this low dose of crestor. An exercise program is always desirable for patients with heart disease.
lmgaiso: Is Lower LDL always better? On 20mg of Lipitor, my LDL and HDL were 41 and 34, respectively. On 10mg of Lipitor, my LDL and HDL were 52 and 47. Which is the better profile? Moving from 10mg to 20mg drops my LDL by 11 but at the expense of 13 HDL. I have significant fam hist of CAD. I realize that this hasn't been studies, but what is your speculation?
Steven_Nissen_MD: This is a unique property of lipitor. Unlike other statins, higher dosages are associated with less improvement in HDL. I think you were better off on the 10 mg dose. If your HDL stays low, certain other statins like zocor (generic) and crestor (branded) seem to raise HDL by more than lipitor.
Nosie: Is there any evidence to show that taking 20mg of Pravastatin per day can stabilize valve disease progression? My cholesterol was fine before taking the statin, but my valve disease seems to have stayed pretty level for several years since I've been on it.
Steven_Nissen_MD: Several studies have attempted to determine whether statin drugs like pravastatin can slow the progression of aortic stenosis. All of these studies failed to show any benefit whatsoever of statin drugs preventing progression of aortic stenosis. However, these drugs are very effective at lowering cholesterol and reducing risk of heart attack, stroke and death when given to patients with an elevated cholesterol.
tlang918: Niaspan, should I keep taking 2000 mg per day?
Steven_Nissen_MD: Tough question. We are still digesting the results of the recently stopped niaspan study. Until the study is published, we are recommending patients continue treatment as long as they are doing well. Patients should not stop taking the medication because they hear a news report. We really need to study the scientific findings before we are ready to make recommendations.
lmgaiso: Why was the niaspan study stopped?
Steven_Nissen_MD: The stated reason was "futility" meaning that the statisticians had determined that continuing the study could not have led to a positive result. We won't have all the information until this study is published.
tlang918: Niaspan government study results from last week?
Steven_Nissen_MD: Please see answer above.
CharlesL: I recently read an article about plavix and contraindicating problems with ppi's, like aciphex. what can you advise me regarding this. my gastro doc gave me an rx for aciphex and knew I was on plavix. I recently asked a cardiologist why I was much less sensitive to bruising, and now think this may be the reason - the plavix was being affected. one cardio clinic said I absolutely should not have been on aciphex, but another cardiologist told me it's ok.
Steven_Nissen_MD: This is a controversial area. In our opinion, plavix and aciphex can be taken together, but more research is needed to be absolutely certain. If you need both drugs, I suggest you continue them.
Joel: I am a 57 year old male who first had a stent and 6 months later had triple bypass surgery for CAD. My doctor had me taking Plavix for 1 year after the stent placement, even though I had bypass 6 months later. Now I see advertisements for Plavix on tv stating that Plavix is used for Acute Coronary Syndrome. My question - since this is a new indication for Plavix, is it helpful to my health for me to start taking it again? My doctor told me 6 months ago there is no evidence Plavix helps bypasses. However, they are prescribing it for ACS - for chest pain and history of heart attack. I need as much help as I can get - I want to live! Is there evidence that shows Plavix will help me and should be used for patients like me now? Thank you.
Steven_Nissen_MD: I agree with your doctor. We recommend plavix for one year after a drug eluting stent. But we do not administer this drug routinely for patients after bypass surgery. Please keep in mind all drugs have risks. In the absence of proving benefits it would be unwise to take plavix.
There are many other things you can do to protect your heart including diet, exercise, blood pressure management, cholesterol management, etc. I hope you are doing all of those things.
nutzy: AFTER 2 liver transplant cases what is your opinion about using Multaq(dronedarone) for treatment in persistent ,or permanent Atrial fibrillation?
Steven_Nissen_MD: Multaq is a relatively new drug for atrial fibrillation that has not shown evidence of liver toxicity to date. However, there is limited information about the safety of the drug. It is not very effective and tends to cause significant GI side effects. The jury is still out on this new drug and we generally avoid new drugs unless absolutely necessary.
clara: I have had bypass surgery - 2 grafts & aortic valve. 2009 1 stent and 9 months ago 3 more stents. I am on Plavix & 2 baby aspirin. My mother died of bleeding in the brain (not an injury). I am concerned about staying on these blood thinners. I have DES stents, but I have been told that some doctors let their patients come off of Plavix around 18 months. I have been told that I am of a possible higher risk because of genes.
Steven_Nissen_MD: The current recommendations specify taking plavix for 12 months after a DES. There is not evidence of a benefit from longer term administration. The best dose of aspirin is one baby aspirin per day - not two. The higher dose is not more effective and may have higher risks. Regarding whether to stop plavix, you should discuss this carefully with your physician.
mh: My cardiologist suggested a couple of years ago that research showed those with acute coronary syndrome should be on beta blockers. Is that the current thinking? Beta blockers make me feel so awful that I'd rather not be on them unless really needed.
Steven_Nissen_MD: We usually treat patients with ACS with beta blockers, for a year or two. But, it may be possible to stop the drugs in which the coronary blockage causing the ACS has been treated with a stent or bypass surgery.
If the problem that caused ACS is fixed, most patients can come off beta blockers
Activity and Exercise
DonnaR: If heart damage has occurred after an m.i., can exercise bring the heart muscle back to health? To what extent? My doctor wants me to exercise 150 min./week. Will this really help the repair? A total recovery?
Steven_Nissen_MD: Your doctor has given you very good advice. We know that exercise helps patients with coronary artery disease in many ways. Although it will not restore your heart muscle, it allows the remaining muscle to handle the workload better. The benefits of exercise after a heart attack are extraordinary and I strongly urge you to follow your physician's advice in this regard.
Race22: Husband just had heart attack on 5/21. Doesn't have follow-up cardiology appt. until 6/27. Has two job interviews scheduled for this week. He is a machinist required to stand 8-10 hours per day. Is it recommended that he wait a particular time-period before seeking work? He was not working previously and this job is important to our family.
Steven_Nissen_MD: There are no absolute rules about resuming work after a heart attack. Many cardiologists, including myself believe that getting back to a regular lifestyle is important in recovery and I would encourage your husband to follow through with his job interviews - but please talk to your cardiologist - Because heart attacks are different and the size and location of your husband's heart attack may make a difference.
chris66: I wrote to u earlier with the failed Lima graft and blocked stent and diffused LAD . I would exercise because I needed to loose weight and it would help my heart but I get pain in my upper left shoulder area around 2 blocks of walking is there anything else I can do ?
Steven_Nissen_MD: Pain in the shoulder is not typical of pain from coronary heart disease but you should consult your physician. If you do well on a stress test and have no evidence for re-narrowing of your stented artery, you can probably exercise safely.
Race22: My husband was a smoker for 38 years and had a H.A. on 5/21. He has been unable to fully give up smoking as of yet. Is it of the utmost importance that he quit completely immediately or will he be able to utilize a program to reduce the amount over a period of time? His heart attack included two blockages in the coronary artery, one 70% blocked, the other almost 100% blocked. Now he has two medicated stents. Thanks.
Steven_Nissen_MD: Stopping smoking is an urgent priority with life saving implications. Reducing consumption of cigarettes is completely ineffective in virtually all patients. Patients who cut back on the number of cigarettes per day simply hold the smoke for longer in their lungs and smoke more of the cigarette so that they get the same amount of nicotine as before they "cut back."
Continuing smoking after two stents is terribly self-destructive and he should stop immediately.
Sometimes a nicotine patch or gum can help - please talk to your doctor.
Abnormal Heart Rates – Arrhythmias
pvcmarathoner: I have no underlying heart disease but have PVC's every third beat and frequent bouts of lightheadedness including one episode of syncope. The PVC’s go away when my heart rate reaches 120. Heart MRI, echocardiogram, Holter Monitor and Event Monitor were all normal except for the PVC's. I have a resting heart rate of 50 and normal BP. I am a marathon runner. My cardiologist is recommending RF ablation but says it is okay to train for and run a marathon in November prior to the surgery. Interested in any thoughts and/or advice?
Steven_Nissen_MD: We do not recommend RF ablation for simple PVCs. Particularly in patients with an otherwise normal heart. You may want to seek a second opinion from our electrophysiologists - you can contact us online www.clevelandclinic.org/heart or call our number toll free 800-659-7822.
kangaroo: I am 72 yo male with no apparent medical conditions except constant PACs for the last 3 years The PACS occur when I lay down on the bed or my heart rates slow down below 60 per minute, or when I get tired in the afternoon around 3-5 PM. When I lay down on the bed ( on the back or on the side), they always occur. Is there such things like positional PACs ?
Steven_Nissen_MD: Most PACs are not serious but you should have a careful cardiac evaluation to rule out the presence of other forms of heart disease.
Many heart rhythm problems are affected by the resting heart rate so it is not surprising that this problem occurs when you are resting and your heart rate drops.
pvcmarathoner: Regarding "simple pvc's": does it matter how many pvc's you are having? I'm over 20,000 per day.
Steven_Nissen_MD: It may seem difficult to accept, but PVCs themselves are not particularly dangerous or ominous. The cause of the PVCs should be investigated. The primary issue is understanding whether the PVCs are associated with heart disease or not. If there is no other heart disease, patients can have pvcs for many years with no apparent harm.
marieclaire: 82 year old female with paroxysmal atrial fib with pacemaker rate mostly controlled with multiple meds. Would ablation be indicated to reduce stroke ?
Steven_Nissen_MD: The problem of stroke in atrial fibrillation is important. Most patients with atrial fibrillation should be on one or another blood thinner which dramatically lowers the risk of stroke. The decision of whether to perform an ablation is complex and must be made on an individual basis. Our electrophysiology doctors would be happy to evaluate you in person or via an econsult.
FruitFirst: I'm a 69 year old male. I have had arrhythmia problems since 1993 in 2006 I had Medtronic EnRhythm pacemaker implanted taking Bata Blockers and Calcium Chanel Blockers to lower the rate and let Pacemaker keep the rate from going to low. It worked fair from 2006 to Nov 2010 having only 980 episodes fast A-V >400/180 >99 hours duration NS V-T Super V-T and A-Fib. In November I was given Albuterol Ventolin against my wishes since then I have had more than three hundred Episodes on Fast A-V and Short V-T and NS V-T what % of success would you expect from Ablation having 4 different types of Arrhythmia
Steven_Nissen_MD: There is not sufficient information for me to speculate about the likelihood of a successful ablation - but one of our electrophysiology physicians would be happy to see you in consultation, Interestingly, drugs like albuterol can worsen cardiac arrhythmias. You really do need to see an EP specialist.
kazba: Please explain what a PVC is.
Steven_Nissen_MD: A PVC is an early heart beat triggered within the left ventricle, the main pumping chamber of the heart. These beats are not triggered by the heart's own natural pacemaker.
jamesditto: Dr Nissen, back in 2009 I had my aortic valve replaced and some of the ascending aorta. All went well and I am doing the things now I could not do prior. My question is what tests should be done EVERY year to make sure the valve is not getting clogged again. I have a yearly checkup at the local CC facility.
Steven_Nissen_MD: I am pleased you are doing so well. There is no routine testing required although some cardiologists like to perform an echocardiogram periodically to check on the status of the prosthetic aortic valve. If you develop recurrent symptoms, further testing will be necessary and should be done promptly.
rachelb: I know that statins reduce the risks of blockages but is there anything we can do to avoid valve disease as we age? Many people I know in their 50s and 60s are being told they need a valve repair.
Steven_Nissen_MD: Unfortunately, we cannot prevent most forms of valvular heart disease.
jamesditto: Why is it that Cardiologists never tell those taking statins that they are depleting the CoQ10 in the body and that it must be replenished?
Steven_Nissen_MD: I recognize that there are many "cult" websites advocating the use of CoQ10, but there are no solid scientific studies demonstrating a benefit for supplementation of CoQ10 in patients taking statins.
concerned1: nov 09 I have homograph replace of aortic valve and aorta. i have had 5 episodes of syncope and am diagnosed with severe aortic stenosis after only year and half after having homograph done by va. what could have happened? i had first valve replacement done 1998 with bovine valve 2nd replace 09. now facing THIRD aortic valve replacement. i have heard rumors of mis-match homograph. candidate for aortic conduit surgery, being third replacement?
Steven_Nissen_MD: You certainly have had a tough time. The issues with early failure of a prosthetic valve are complicated. I would encourage you to see one of our cardiologists for careful evaluation.
We have a group of specialists who have focused their careers on patients with complex heart disease and
efpat: I had NYHA Class 1 heart failure with an LBBB and very long QRS and EF of 25%. I was implanted with a CRT-D 11/09 with remarkable results. EF of 50+. I was and remain on optimal meds - 75 mg of carvidelol, 32 of atacand, 25 of spironolactone. I also take 2000 mg of metformin for diabetes and 10 mg lipitor and triplix for hypertriglycerimia. and finally 81 mg aspirn and 75 mg plavix after a TIA 8 years ago.
Steven_Nissen_MD: It is great to hear your success story. In some patients CRT D can be remarkably affective and it sounds like you are one of them. Your medications seem entirely reasonable and appropriate.
efpat: Sorry. I forgot the question - if my EF stays high can I attempt to get off the heart failure meds?
Steven_Nissen_MD: I would not. Although we do not have precise information, you are doing so well that I just wouldn't want to take the risk.
Peppy: Dr. Hazen's recent study concerning arterial plaque formation and gut bacteria was fascinating. Is this recent information changing dietary recommendations to heart patients at Cleveland Clinic? The study is "hard on" meat as well as some fatty fish. Does this mean vegetarian or vegan is the best lifestyle for heart patients?
Steven_Nissen_MD: Dr. Hazen's work is preliminary and we have no dietary recommendations for now.
mh: What role does sleep apnea play in heart health in general, and with heart disease in particular?
Steven_Nissen_MD: There appears to be an association with sleep apnea and heart disease, but this understanding is only beginning to emerge. We don't have evidence yet whether treating sleep apnea reduces the risk but, it makes sense.
rbaldassari: I have CAD. Heart attack 2 years ago w/two stents. I also have PTSD from another event. I have hyper vigilance syndrome. How does the stress of PTSD affect my heart. I have age 62. Lp(a) of 60. Meds include Lipitor (80mg); Niaspan (1,500 mg); Coreg, Lisinapril. Also on meds for PTSD.
Steven_Nissen_MD: We do not have much information about the effects of PTSD on patients with heart disease, but in general, stress is not healthy for patients with heart disease. Anything you can do to reduce your stress levels is worthwhile. Your medications seem very reasonable and appropriate.
Cleveland_Clinic_Host: We do have a webchat coming up on June 29th on the topic of Stress, Depression and Heart Disease that you may be interested in.
fanjean4: can someone with severe hypothyroidism has heart problem ?
Steven_Nissen_MD: Yes - severe hypothyroidism affects every organ system including the heart - if you have this condition, you should see an endocrinologist to receive thyroid replacement.
DougF: I have researched magnesium and the medical research is overwhelming. I have stopped talking about it because everyone has had positive reactions including myself. The study of over 800,0 00 people in Sweden on Ischemic heart disease is pretty impressive. Why has the medical profession ignored magnesium? I am retiring in three weeks and plan to write a research grant with a chemical supplier and University such as UNC or Duke. I wish your clinic was closer since I believe you are the leaders on heart research. I am somewhat like a Chris Bernard very persistent.
Steven_Nissen_MD: Magnesium has no value whatsoever in patients at risk for heart disease. Careful studies show no benefits and potentially serious risks from this supplement. It is particularly dangerous in patients with kidney disease. Unfortunately, there are many inaccurate recommendations available on the internet that mislead patients. This is one of them.
srbrsn11: Are there any current studies for an artificial RCA?
fran: Do you have any information about the apo milano study? My friend in North Dakota said he has been asking for years and is hoping to hear something about it this summer.
Steven_Nissen_MD: We are still trying to figure out how to make this potentially useful drug but the difficulty has kept us from succeeding to date. Stay tuned.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Nissen is now over. Thank you again for taking the time to answer our questions about hot topics in cardiology.
Steven_Nissen_MD: Thanks for having me today - a lot of great questions.
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