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Tweet Chat with Dr Nissen (11 21 12)

Wednesday, November 21, 2012 – Noon

Description

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

HeartRN: Lot's of new studies coming out of the American Heart Association meeting.

Dr. Nissen: Very controversial study of chelation called the TACT trial.

  • This trial was sponsored by the complementary and alternative medicine program at the NIH.
  • The study took 10 years and 32 million dollars of tax payer money to complete.
  • Study investigators claim that chelation reduced cardiovascular events by 18%.
  • Most scientists including me do not believe the results. Many study flaws identified.
  • Flaws included loss of 17% of the pts. Study stopped midway for 9 months after criminal records of some investigators discovered.
  • Bottom line - Don't seek chelation treatment, it is still quackery.

HeartRN: Dr. Nissen can you talk about the FREEDOM trial?

Dr. Nissen: Important study compared bypass surgery to multi-vessel stenting in diabetic patients.

  • Less risk of death for patients with bypass vs. stenting.
  • Study strongly suggests that diabetic patients with many blockages should have bypass not stenting.

HeartRN: Dr. Nissen - I understand there was another trial presented about an HDL raising drug.

Dr. Nissen: Dalcetrapib raised HDL about 40% but had absolutely no benefit on clinical outcome.

  • Many people again raising concern whether raising HDL is a useful approach.
  • I see it differently. Dalcetrapib was a weak drug compared with other HDL raising therapies under study.
  • We are just launching a study of Evacetrapib which can raise HDL more than 100% and lower LDL 25%.

HeartRN: For more information look on www.clinicaltrials.gov ?

Dr. Nissen: Yes. The bottom line: jury is still out on HDL raising but concerns persist that these drugs may not ultimately work.

HeartRN: Is there anything new about lowering the bad cholesterol (LDL)?

Dr. Nissen: Lot's of buzz about PCSK9 inhibitors, injectable drugs that can lower bad cholesterol by up to 70%. We are going to study one of these drugs in 2013 - stay tuned.

HeartRN: Other studies in the news recently - One says that unemployment may increase chance of heart attacks. What do you think?

Dr. Nissen: We have known for years that severe emotional stress can trigger heart disease such as death of a spouse.

  • It is not surprising that unemployment might cause high levels of stress worsening heart disease.
  • But - please keep in mind, that these are observational studies not the best source of evidence.

HeartRN: A related study suggested that transcendental meditation may reduce heart attack.

Dr. Nissen: I'm more skeptical about this one. The quality of scientific evidence is relatively low.

HeartRN: Another recent study links declining fitness to increased risk of heart attack and death.

Dr. Nissen: No surprises here. Exercise and fitness show strong links to improve health. In a world of drugs and devices, people shouldn't overlook the basics like exercise.

HeartRN: How much exercise do you suggest for your patients?

Dr. Nissen: At least 250 miles per week of brisk running (just kidding)! Studies show that with exercise, more is better. So do as much as you can.

HeartRN: Getting back to HDL, can you talk more about raising HDL?

Dr. Nissen: There are interventions that raise HDL that seem to reduce heart risk.

  • These include light to moderate alcohol consumption which can raise HDL 10 - 15 %.
  • But we don't suggest taking up drinking for heart health.
  • But, if you choose to drink moderately it does seem to raise HDL and lower heart risk.

HeartRN: We are closing shortly, any questions for Dr. Nissen?

Question from billM: Does taking statins increase anxiety?

Dr. Nissen: There is no evidence that statins increase anxiety. Not taking statins can lead to heart attack which definitely increases anxiety!

HeartRN:Thank you Dr. Nissen for sitting with us for this twitter chat. Happy Thanksgiving everyone!

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 the Cleveland Clinic institution or other Cleveland Clinic physicians.

Reviewed: 11/12

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