Heart Beat November 2019 Issue

In The News: November 2019

Dangerous Triglyceride Levels Tamed with High-Dose Fish Oil

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Low-dose dietary supplements of omega-3 fatty acids have little effect on lowering cardiovascular risk (see article on page 6). However, high doses of omega-3, either eicosapentaenoic acid (EPA) alone or EPA plus docosahexaenoic acid (DHA), can significantly lower cardiovascular risk in patients with high triglyceride levels. The U.S. Food & Drug Administration (FDA) has approved several products-Lovaza®, Omtryg®, Vascepa® and Epanova®-that are now available by prescription. Results of the REDUCE-IT trial, presented at the American Heart Association (AHA) 2018 Scientific Sessions, showed that in patients with elevated triglyceride levels and cardiovascular disease or diabetes plus one additional risk factor, 4 grams per day of purified EPA reduced the risk of a major cardiovascular event by 25%. In a science advisory issued Aug. 19 online in Circulation, the AHA summarized the findings of 17 clinical trials in which high-dose EPA or EPA plus DHA reduced triglyceride levels by 30 to 36%. The AHA concluded they are a safe and effective option for reducing triglycerides whether used alone or in combination with other lipid-lowering drugs.

TAVR Approved for Low-Risk Patients Needing Valve Replacement

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If you need to have your aortic valve replaced, there's a good chance it can be done minimally invasively. In August, the U.S. Food & Drug Administration (FDA) approved transcatheter aortic valve replacement (TAVR) for low-risk patients. The procedure had been allowed only in patients at high or moderate surgical risk. Adding low-risk patients means nearly anyone qualifies for the procedure, which allows an aortic valve to be replaced without surgery. The FDA's decision was based primarily on the result of the PARTNER 3 clinical trial, which showed that TAVR was associated with a significantly lower risk of death from any cause, stroke and rehospitalization in low-risk patients, compared with surgical aortic valve replacement (SAVR).

Now that TAVR is approved for patients in all risk categories, it will become the default treatment for aortic valve stenosis. Whether TAVR is better than SAVR for certain patients is still unknown. These include the very young, those with bicuspid valves and those with heavy calcium deposits in the tissue surrounding the aortic valve.

Off-Pump Bypass Surgery Risky for Some Patients

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In off-pump coronary artery bypass grafting (CABG), the heart is not stopped with a heart-lung machine. Instead, only a portion of the heart is clamped off while the surgeon attaches the bypass graft. Although 23% of CABGs were done off pump in 2002, its popularity has fallen as long-term problems have surfaced. Now, researchers reported Aug. 1 in the Journal of the American College of Cardiology that patients who underwent off-pump CABG for a blockage in their left anterior descending artery had nearly twice the risk of death from any cause within three years. They determined the technique often resulted in incomplete revascularization and a bypass graft that became blocked.

As the use of off-pump CABG in routine revascularization procedures continues to decline, it is likely to remain a viable option when the use of the heart-lung machine poses an unreasonable risk.

Breast Cancer Patients with Abdominal Fat at Increased Heart Risk

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Breast cancer survivors with visceral fat deposits are at greatly increased risk of developing cardiovascular disease, researchers reported online Aug. 1 in the Journal of Clinical Oncology. When they looked at nearly 3,000 breast cancer survivors, they discovered that women with fat surrounding their abdominal organs or deposited within their muscles had a 70% higher risk of heart attack, heart failure or stroke within an average of six years. The increased risk was present even in women of normal weight and those with no other cardiovascular risk factors. Although certain types of chemotherapy are known to increase cardiovascular risk, the increased risk seen in women with visceral and intramuscular fat deposits was independent of the type of cancer treatment they had received.

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