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Tweet Chat with Dr. Nissen, 3/20/13

Wednesday, March 20, 2013 – Noon


Dr. Steven Nissen, Chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, hosts a monthly Tweet-Chat @ClevClinicHeart:

A Review of Recent Heart News

HeartRN: Welcome to the twitter chat with Dr. Nissen. We will talk about what's in the news. Last week the ACC meeting held in San Francisco - lots of new studies.

Dr. Nissen : The biggest news was the HPS2-THRIVE study looking at the effects of Niacin in 25000 patients. Study investigators were very aggressive in reporting harm from Niacin but ....

Niacin was given with a second drug known as laropiprant, a prostaglandin inhibitor. There is considerable evidence suggesting that laropiprant may be a bad actor. Therefore, HPS2-THRIVE does not definitively prove harm from niacin alone.

That being said, most cardiologists are moving away from niacin after two failed studies including HPS2-THRIVE. In HPS2-THRIVE there were excess diabetic complications, infection and bleeding with niacin treated patients.

HeartRN: Dr. Nissen, did you see the study regarding vitamin D and African Americans' affect on BP. Can you comment?

Dr. Nissen: The study showed that vitamin D seemed to lower blood pressure in blacks. There were significant limitations in the study including higher blood pressure in patients that got high dose vitamin D. Importantly, these were NOT patients with hypertension! Everybody had a normal blood pressure. Showing a reduction in blood pressure in patients with normal blood pressure isn't very useful or enlightening.

HeartRN: Lots of interest in the news about a study suggesting that sugary drinks "cause" 180,000 deaths worldwide.

Dr. Nissen: Pretty close to "junk science." I don't advocate sugary drinks, but this study made huge leaps from sugary drink consumption to predictions about death. They didn't actually measure death rates. This is another example of a disturbing trend sensationalizing poor studies. However, don't go out and drink a 64 ounce big drink.

HeartRN: Another study at ACC reported that cholesterol levels rise in winter.

Dr. Nissen: The cholesterol increase was only about 8 percent and no clinical consequences were shown. A question we all asked was why cholesterol levels rise in winter? Most likely people exercise less and crave fatty foods during cold months. Best advice: don't indulge in saturated fats regardless of season. Eat good fats.

HeartRN: A study in NEJM showed that a Mediterranean diet can reduce heart risk by 30%.

Dr. Nissen: Very high quality study in 7500 people. It blows the low fat diet myth out of the water. This is bad news for people who have argued for years that all fats are bad like Dr. Caldwell Esselstyn. It is good news for people advocating a sensible, balanced and tasty diet. This diet includes olive oil, nuts, fruits, legumes and other tasty foods. Eat a Mediterranean diet, live long and enjoy life!

HeartRN: A study at ACC meeting suggests women get cardiac rehabilitation less often than men.

Dr. Nissen: Cardiac rehab is amazingly effective in patients with a variety of conditions, including heart failure. Unfortunately cardiac rehab is vastly underused.

If you have coronary disease, have had an intervention, or bypass heart failure or peripheral disease, strongly consider a 12 week cardiac rehab program. Data show reduced mortality in women undergoing cardiac rehab. Same is true for men.

HeartRN: Another controversial area is use of Digoxin.

Dr. Nissen: Digoxin is the drug derived from a very old medicine: digitalis leaf. One study at ACC showed that digoxin reduces heart failure admissions. However, a study last fall showed that digoxin increased mortality in patients with atrial fibrillation. At last week's ACC, another study showed increased mortality with digoxin in patients with atrial fibrillation.

What should we believe? We just don't have solid answers. Talk to your doctor.

HeartRN: Study on March 12 in JAMA on smoking cessation.

Dr. Nissen: Patients who quit smoking gained 6 - 8 lbs over 4 years but heart disease mortality was reduced by 50 percent. Great answer to a question we hear from many smokers. Don't let fear of weight gain keep you from stopping smoking - it can save your life.

Questions from Participants:

Old Gymnast: Is it the exercise that helps or the rebuilding of confidence in your body?

Dr. Nissen: In disease of the leg arteries, cardiac rehab allows people to walk farther and faster. Exercise training during rehab improves the efficiency of heart function which is probably why mortality declines.

OldGymnast: Niaspan to help HDL cholesterol particle size. Go or no go? Long term drawbacks?

Dr. Nissen: We are moving away from Niacin due to negative studies. Particle measurements are not useful and a waste of money.

OldGymnast: What is the current recommendation for duration one should take Plavix following stents for MI?

Dr. Nissen: Depends on type of stent. For most patients with drug eluting stents (DES) we recommend 1 year. For patients with regular stent we recommend 3 months

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of Cleveland Clinic institution or other Cleveland Clinic physicians.

Reviewed: 3/13

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