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Tweet Chat with Dr. Nissen (7/30/12)

Monday, July 30, 2012 – Noon


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

Heart RN: Welcome Dr. Nissen. Lots in the news this past week about heart health. Let's examine what's real and what's not.

Heart RN: Recent study claims eating eggs is as dangerous as smoking. True?

Dr. Nissen: Bad science; poor quality study. No direct evidence of harm from eggs. Eggs in moderation are acceptable for patients with heart disease. All of these studies have common flaws: confusing association with causation. There is no convincing evidence that ultra low fat and cholesterol diets have proven benefits in heart disease.

Heart RN: Big news recently suggesting that blood type predicts whether patients develop heart disease. True or False?

Dr. Nissen: Another example of poor quality study. Many of these studies are from the Nurses Health Study & have been proven unreliable.

Heart RN: Dr. Nissen, are there any good studies?

Dr. Nissen: Absolutely. Excellent analysis of JUPITER study data shows that the benefits of statins outweigh the risk of developing diabetes.

Heart RN: Recent News - could chocolate and antioxidants boost brain function? Lots of press on this one; what do you think?

Dr. Nissen: Wish it were true. We all love chocolate. But, it’s another great example of "junk science" pitched cleverly to media.

Scott Tennant ‏: @ClevClinicHeart Study suggests that negative effects of sitting in an office all day outweigh benefits of exercise. Thoughts?

Dr. Nissen: Solid science suggests the more you exercise the lower your risk of heart disease and longer you are likely to live. Don't expect a few minutes of exercise to counteract a full day sitting at a desk. Exercise more, live long & prosper!

Heart RN: In the news this week - new testing strategy can diagnose heart attacks in an hour - true or false?

Dr. Nissen: It is true - but it is not new! This test has been around for years & is used routinely. No big breakthrough here.

Heart RN: Here is another common question: What should you do if you need a statin drug to control cholesterol but have muscle pain?

Dr. Nissen: It is important to try different statins - some in very low doses to find one you can tolerate. Some patients will respond to taking a statin 3 times per week which is better than nothing.

Stay tuned. There is a new class of drugs coming within 2 - 3 years that can lower LDL by up to 70%. These new drugs are called PCSK9 inhibitors and are taken by injection once a month. Really promising!

So far the PCSK9 inhibitors have not caused muscle pain so they may be ideal for statin intolerant patients.

Heart RN: We often get questions about taking vitamins instead of statins. Is there any replacement?

Dr. Nissen: Unfortunately no. Lots of snake oil out there. Buyer beware.

Marilyn Mann: @ClevClinicHeart Dr. Nissen, can you comment on Cochrane Review of benefits of antihypertensives in mild hypertension?

Dr. Nissen: Mild hypertension (HTN) is a controversial issue. Emerging consensus states that we need better studies of the benefits and risks of lowering blood pressure in people with borderline HTN. New guidelines are due soon which are likely to recommend higher BP targets for the elderly. Some people ask: what is elderly? My definition is anybody older than me (I am 63)! The best approach for mild hypertension may be dietary. Please read about the DASH diet.

Scott Tennant: One more for Dr. Nissen: Daily fish oil supplements - Helpful? What does the evidence suggest?

Dr. Nissen: Evidence for benefit of fish oil is very disappointing. Recent large trial in diabetes showed no benefit at all. The jury is still out but I am not optimistic. Better alternative: eat more fish!

Heart RN: What is the current study of drugs to raise HDL?

Dr. Nissen: Current status of drugs to increase HDL is very controversial. So far all the studies have failed to show benefits - but hope springs eternal. We know that low HDL is associated with cardiovascular disease but haven't figured out how to raise it successfully. Big studies are ongoing for several new classes of HDL raising drugs. If these fail everyone will begin doubting hypothesis.

Heart RN: We covered HDL and LDL - how about triglycerides?

Dr. Nissen: Unfortunately, there is no evidence that reducing triglycerides lowers heart disease risk. The FDA continues to approve drugs to lower triglycerides but without evidence of improvement in outcomes.

Heart RN: Thank you Dr. Nissen for your time today. See you next month for our next tweet chat with Dr. Nissen.

Reviewed: 08/12

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