The Latest on the Heart Beat; No Symptoms, No Asthma?; Sound Asleep and Eating, Too
The Latest on the Heart Beat
The first significant evidence that medication can reverse heart disease, not just slow or stop it, emerged last week at a national meeting of heart experts and in the Journal of the American Medical Association. The treatment was a high dose of Crestor, the newest and most powerful member of the cholesterol-lowering statin family. Should everyone with heart disease be on a similar regimen? For now, patients who ask their physicians can expect a cautious response.
In the study, a tiny ultrasonic probe was inserted into partly clogged coronary arteries of several hundred patients to measure the fatty plaque. The patients took 40 milligrams a day of Crestor, the highest approved dose. Measurements after two years showed an average reduction of nearly 7 percent. Although Crestor maker AstraZeneca funded the study, Cleveland Clinic cardiologist Steven Nissen, who directed it, did not personally benefit.
The key, says Nissen, was that Crestor drove LDL, the plaque-building cholesterol, somewhat lower than other statins typically do. It also had more success at raising HDL, which removes LDL from the blood. But do the lower numbers and reduced plaque translate to fewer heart attacks and other incidents? Nissen is firm. "The relationship is well established," he says. But cardiologist Rob Califf of Duke University Medical Center wonders about long-term safety. "Crestor hasn't even been tested in a big clinical trial," he says.
Thin no more. The heart meeting also was stirred by dire findings about the blood thinner Plavix. Most people who have had a "cardiovascular event" such as a heart attack or angina pain are put on long-term low doses of aspirin to prevent dangerous clots. Many physicians add Plavix because of studies suggesting increased protection without major bleeding. But a large study published last week in the New England Journal of Medicine found that Plavix offers no such benefit--and poses a death risk as much as 77 percent higher than aspirin alone. "More is not always better," says Douglas Weaver, head of the division of cardiovascular medicine at Henry Ford Health System in Detroit, who moderated a discussion at a heart meeting in Atlanta. "There's simply no reason to prescribe it." Avery Comarow
No Symptoms, No Asthma?
If you believe your asthma goes away when the symptoms do, you may be making matters worse. Doctors at Mount Sinai School of Medicine in New York reported in the March issue of Chest that people with a "no symptoms, no asthma" attitude are less likely to take their medications as prescribed, to have checkups, and to use tests that measure lung function. "Asthma is very common and can be fatal but is easily controllable with medications," says lead author Ethan Halm--so most trips to the ER are preventable.
People with asthma have chronic inflammation of the airways and often need daily anti-inflammatory medicines such as inhaled steroids so that irritants are less likely to trigger an attack. Halm advises regular checkups no matter how great you feel. And if the doctor prescribes daily treatment, take your medicine. Cory Hatch
Sound Asleep and Eating, Too
Insomniacs considering the sleep medication Ambien might be put off by last week's news reports of sleepwalking, sleep-eating, and even sleep-driving by people taking the popular drug. But Mark Mahowald, a doctor at the Minnesota Regional Sleep Disorders Center who tracks such behaviors, says extreme examples are rare and most sleepwalking is harmless--and it can affect people using alcohol, other sleep medications, or nothing at all. Ambien is the most widely prescribed sleep medication by far, which could explain why it seems particularly linked to these incidents, he says. It's important, though, to take your medicine as directed; raising the dose or mixing a sedative with alcohol can increase the risks of something strange happening. Helen Fields
This story appears in the March 27, 2006 print edition of U.S. News & World Report.
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