Tweet Chat with Dr Nissen (4 17 13)
Wednesday, April 17, 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 and answers to your questions
Heart RN: Let's get started with the chat! Here are a couple questions from our participants. Dr. Nissen, a question about coffee and blood pressure was asked. Is there an effect?
Dr. Nissen: People have been studying the heart effects of coffee for decades, must be thousands of studies. On balance, no compelling evidence about harm or benefit including blood pressure. If you like coffee - drink it. But probably best not to overdo it. A single cup of coffee contains about 50 mg of caffeine. We don't recommend more than 200 mg in a day.
Heart RN: Dr Nissen, we also had a question about amiodarone and cancer risk - a recent study.
Dr. Nissen: A very weak study coming from Taiwan. Increased cancer did not reach statistical significance. Most people who take amiodarone take it for major conditions. We must always benefit risks vs. benefits for any therapy. Amiodarone is not a drug we use without thinking carefully because it does have other proven adverse effects.
Heart RN: Let's go to what is in the news. Study showed high heart rate at rest signals higher risk of death. What do you think?
Dr. Nissen: This one is probably correct. People with high resting heart rate often have other medical issues. It is probably not the heart rate itself that is dangerous, but the conditions that cause it. For example, some people have a high heart rate due to chronic anemia which can be a sign of other serious disorders.
Heart RN: What about cholesterol and its link to Alzheimer's?
Dr. Nissen: This new research suggests a mechanism for how high cholesterol may cause dementia. Very preliminary. There is a known link. High cholesterol causes plaque in arteries in both the heart and brain. This causes heart attacks and strokes particularly multiple mini strokes that can lead to dementia.
Heart RN: Next in the news - walk or run to lower heart disease ...
Dr. Nissen: We have known for years that exercise reduces risk for heart disease. The intensity of exercise is not so important. Walking can be nearly as good as running and it is easier on the joints. Whether you walk, run, swim or cycle - Just Do It! The dividends are enormous.
Heart RN: A separate study showed that sitting associated with high risk of heart disease.
Dr. Nissen: Makes sense - it is a couch potato disease. If you work at a desk job, find a way to walk around periodically during the day.
Heart RN: What about the study that discussed baldness and heart disease risk?
Dr. Nissen: My hair disappeared 30 years ago so I read this carefully! It may be true. Men with baldness have high testosterone levels, which make them better lovers. Just like estrogen may protect some women, testosterone may increase risk in men but the effect is very, very small.
Men: don't worry about your hairline - focus on the things you can do something about. These include blood pressure, cholesterol, exercise, diabetes and smoking.
Heart RN: The American Heart Association posted a study on beetroot juice this week.
Dr. Nissen: The study involved only 15 people; monitored for 24 hours. Not exactly a definitive study. The reduction in blood pressure may be temporary and related to nitrates in the juice. Blood pressure reduction from nitrates is not sustained so I wouldn't go out and buy a gallon of beetroot juice.
Heart RN: Some new drugs in development that interest people. Can we talk about what is down the road?
Dr. Nissen: One of the most promising is the PCSK9 inhibitors that lower the bad cholesterol (LDL). It seems to work even in patients that can't tolerate statins; lowering LDL by up to 70%. The downside is that they are injectable - but the good news is that they only need to be taken 1x a month. For people that cannot control their cholesterol levels, these drugs will be huge. Depending on the result of current studies they could be approved within two years.
There are still lots of activity around raising the good cholesterol, HDL. Despite disappointing results, we are still trying. There are two oral drugs called CETP inhibitors that more than double the good cholesterol levels. We expect results of trials within 3 - 5 years. Stay tuned.
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