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Tweet Chat with Dr. Nissen (12/19/12)

Wednesday, December 19, 2012 – Noon

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


HeartRN: Welcome Dr. Nissen to our monthly twitter chat. . Dr. Nissen, what is holiday heart syndrome?

Dr.Nissen:  Sometimes after a binge of alcohol & caffeine, people develop atrial fibrillation, even with a normal heart.

HeartRN: Recent news stories about aspirin resistance. What is that all about?

Dr. Nissen:  Older research suggested some people do not respond to aspirin, which we use as an important blood thinner. The new research questions whether there are non-responders. It is not clear who is right. For now, keep doing what you are doing.

Dr. Nissen: Same researchers questioned whether coated aspirin is safer for the stomach. Who cares? The most important thing is the dosage, for most patients 81 mg baby aspirin is best. Check with your doctor.

HeartRN: On a recent Dr. Oz show, physicians were questioning the use of statins, what do you think?

Dr. Nissen:  This one was way out there. Very fringe stuff. Statins for high LDL cholesterol is one of the best studied therapies of all of medicine. There will always be eccentric naysayers. I suggest you ignore them.

HeartRN: Dr. Nissen, they mentioned not giving statins to children or women due to the dangers. What do you think?

Dr. Nissen: I agree that most children should not be treated until age 13. Women have the same benefits as men. Advising women with high cholesterol and heart disease not to take statins is irresponsible and dangerous.

HeartRN: Lots of information on increased heart attack risk during the switch to daylight savings time in the news.

Dr. Nissen: Not the best research. It is hard to accept that an hour less sleep can bump heart attack rates so much.

HeartRN: Another study last week suggests Mediterranean diet is best for heart health.

Dr. Nissen:  We agree that this moderate and sensible diet makes the most sense. Avoid extreme diets such as the current craze for ultra low fat or ultra low carb diets.

MarilynMann: Dr Nissen, if HPS2-THRIVE fails, will you stop prescribing niacin?

Dr. Nissen:  Yes. The study is big enough to answer the question of the benefits of niacin in a definitive fashion.

MarilynMann: Dr Nissen, do you think PCSK9 inhibitors will be approved based on LDL-lowering, or will FDA want outcomes data first?

Dr. Nissen: PCSK9 inhibitors are powerful drugs for lowering LDL given by injection once or twice per month. Whether FDA will approve without a clinical outcomes trial is controversial. My best guess - a compromise with approval after the outcomes trial is fully enrolled but not completed.

HeartRN: This week, the AHA listed the top 10 developments in heart disease research for 2012.

Dr. Nissen: I don't agree with all of their selections although some are important advances.

  • A new procedure, still experimental can lower BP by interrupting nerves to the kidney without surgery. This is very promising research that is already available in Europe. Current studies will confirm or refute the benefits in U.S. patients within 18 months.
  • AHA also highlighted two studies suggesting that sugar sweetened drinks are associated with childhood obesity. We agree. Too much sugar is bad, but the research showed very small weight increases - so this is not the answer to obesity.
  • AHA also highlighted the impact of lifestyle factors in lowering risk of heart disease & stroke. This one is a no-brainer. Not smoking, regular exercise, & healthy diet are appropriate for everyone.
  • Number 10 on the AHA list was a comparative study of coronary artery bypass surgery vs. stenting for diabetic patients. There was a huge benefit for bypass surgery over stenting with a reduction in mortality. This should change practice.

HeartRN: Dr. Nissen, would you add any other to the top list of advances?

Dr. Nissen: Another big development in 2012 was FDA approval of 2 new obesity drugs, the first since 1999. Lorcaserin (belviq) works in the brain to suppress appetite but is only modestly effective. Qysmia is more effective, combines two drugs that have been around a long time. Up to 15% weight loss.

The bottom line, lot's of pent up demand for weight loss agents that actually work but don't expect miracles. I strongly warn to avoid over-the-counter dietary supplements for weight loss. Most supplements are fraudulent and some are unsafe. The only thing you will lose is your money.

HeartRN: Dr. Nissen - thank you for meeting with me today and answering our questions. We will see you in 2013!

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