Several new guidelines and position papers offering the most up to date information to ensure that clinicians practice evidence-based medicine were released at the Canadian Cardiovascular Congress 2009 this week. Among them are the following: 2009 CCS Canadian Cholesterol Guidelines 2009 CCS Consensus Conference Update on the Guidelines for the Management of Adults with Congenital Heart Disease CCS/Canadian Association of Radiologists Consensus Training Standards for Cardiac CT 2009 CCS Heart Failure Guidelines Guidelines are one of the highest priorities of the Canadian Cardiovascular Society (CCS), says their president Dr. Charles Kerr. "They are one of our most important services and are the highest rated by clinicians, " he says. "For example, the CCS heart failure guidelines website has received a huge number of hits this year - in the hundreds of thousands. They have an enormous impact." The CCS usually puts out one set of guidelines each year. This year, the CCS guidelines committee, chaired by Dr Michelle Graham, coordinated the release of 10 guidelines and position statements.
Adding ezetimibe to atorvastatin significantly boosted the attainment of lipid targets as specified by both Canadian and European guidelines in elderly patients aged 65 and older and the combination produced superior results than simply increasing the dose of atorvastatin alone, Dr. Christian Constance told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society. "The population of people age 65 and older is growing but very few studies have looked at the efficacy of lipid-lowering drugs in this group of patients. We wanted to see whether adding ezetimibe to atorvastatin would be as effective as doubling or even quadrupling the dose of atorvastatin in this age group, " said Dr. Constance, of the University of Montreal. The study included 2, 055 patients who were at high risk for coronary heart disease or who had been diagnosed with arterial vascular disease and who were not at the following cholesterol targets: Less than 2 mmol/L for low density lipoprotein cholesterol (LDL-C) Less than 4 mmol/L for total cholesterol (TC) TC to high density lipoprotein cholesterol (HDL) ratio less than 4 Less than 0.
Besides their tremendous value in treating high cholesterol and lowering the risk of heart disease, statins have also been reported to potentially lower the risks of other diseases, such as dementia. However, a study in the October Journal of Lipid Research finds that similar statin drugs can have profoundly different effects on brain cells - both beneficial and detrimental. These findings reinforce the idea that great care should be taken when deciding on the dosage and type of statin given to individuals, particularly the elderly. John Albers and colleagues compared the effects of two commercially used statins, simvastatin and pravastatin, on two different types of brain cells, neurons and astrocytes (support cells that help repair damage). By directly applying the drugs to cells as opposed to administering them to animals, they could eliminate differences in the drugs' ability to cross the blood-brain barrier as a reason for any differing effects. Albers and colleagues looked at the expression of genes related to neurodegeneration, and found that indeed, despite using biologically equivalent drug concentrations, differences were seen both between cells, and between drugs;
Two new studies from the US published this week negate concerns that have been around since early studies done decades ago suggested that low cholesterol leads to some types of cancer: one in fact affirms that undiagnosed cancer is the likely cause of lower total cholesterol while the other found evidence linking low cholesterol and decreased risk of high-grade prostate cancer among older men. The two studies, along with an editorial discussing the new questions they raise, are published in the OnlineFirst 3 November issue of Cancer Epidemiology, Biomarkers & Prevention. Dr Demetrius Albanes, a senior investigator at the National Cancer Institute in the US and co-author of the study that looked at the link between total and High-Density Lipoprotein cholesterol (HDL, sometimes called "good cholesterol") and cancer risk said that while early studies suggested that low cholesterol might increase the risk of some cancers: "Our study affirms that lower total cholesterol may be caused by undiagnosed cancer.
A pair of studies in Cancer Epidemiology, Biomarkers & Prevention, lay to rest the decades-long concern that lower total cholesterol may lead to cancer, and in fact lower cholesterol may reduce the risk of high-grade prostate cancer. Demetrius Albanes, M.D., a senior investigator at the National Cancer Institute, said early studies suggested that low cholesterol could increase the risk of certain types of cancer. "Our study affirms that lower total cholesterol may be caused by undiagnosed cancer. In terms of public health message, we found that higher levels of 'good cholesterol' (HDL) seem to be protective for all cancers, which is in line with recommendations for cardiovascular health, " said Albanes. The researchers observed 29, 093 men from the Alpha-Tocopheral, Beta-Carotene Cancer Prevention Study cohort for 18 years, making it the largest and longest study of its kind. In that follow-up period, they noted 7, 545 cancer cases. Low total cholesterol blood levels were associated with an 18 percent higher risk of cancer overall, similar to the increases seen in previous studies, but this risk disappeared when the researchers excluded cases that occurred in the early years after the original blood draw.
Men with lower cholesterol are less likely than those with higher levels to develop high-grade prostate cancer - an aggressive form of the disease with a poorer prognosis, according to results of a Johns Hopkins collaborative study. In a prospective study of more than 5, 000 U.S. men, epidemiologists say they now have evidence that having lower levels of heart-clogging fat may cut a man's risk of this form of cancer by nearly 60 percent. "For many reasons, we know that it's good to have a cholesterol level within the normal range, " says Elizabeth Platz, Sc.D., M.P.H., associate professor at the Johns Hopkins Bloomberg School of Public Health and co-director of the cancer prevention and control program at the Johns Hopkins Kimmel Cancer Center. "Now, we have more evidence that among the benefits of low cholesterol may be a lower risk for potentially deadly prostate cancers." Normal range is defined as less than 200 mg/dL (milligrams per deciliter of blood) of total cholesterol. Platz and her colleagues found similar results in a study first published in 2008, and in 2006, she linked use of cholesterol-lowering statin drugs to lower risk of advanced prostate cancer.
Researchers from the UCLA Henry Samueli School of Engineering and Applied Science have for the first time successfully reconstituted in the laboratory the enzyme responsible for producing the blockbuster cholesterol-lowering drug lovastatin. The research, published Oct. 23 in the journal Science, could potentially lead to the development of other compounds with similarly beneficial effects. The lovastatin-synthesizing enzyme is one of the most interesting but least understood of the polyketide synthases, which are found in filamentous fungi and which play a crucial role in the synthesis of "small molecule natural products" - pharmacologically or biologically potent compounds produced by living organisms, many of which are the active ingredients in pharmaceuticals. Commonly used antibiotics, such as tetracycline, are produced by polyketide synthases. Polyketides represent a class of 7, 000 known structures, of which more than 20 are commercial drugs, including the immunosuppressant rapamycin, the antibiotic erythromycin and the anticancer drug doxorubicin.
A new study from the University of Warwick has discovered taking too much of the essential mineral selenium in your diet can increase your cholesterol by almost 10%. Selenium is a trace essential mineral with anti-oxidant properties. The body naturally absorbs selenium from foods such as vegetables, meat and seafood. However, when the balance is altered and the body absorbs too much selenium, such as through taking selenium supplements, it can have adverse affects. A team led by Dr Saverio Stranges at the University's Warwick Medical School has found high levels of selenium are associated with increased cholesterol, which can cause heart disease. In a paper recently published in the Journal of Nutrition, the research team examined the association of plasma selenium concentrations (levels of selenium in the blood) with blood lipids (fats in the blood). The researchers found in those participants with higher plasma selenium (more than 1.20 В mol/L) there was an average total cholesterol level increase of 8% (0.
Dr. Samie Jaffrey Receives Competitive NIH Director's T-R01 Award Speedier Lab Testing With Results That Glow in the Dark Dr. Samie Jaffrey, associate professor of pharmacology at Weill Cornell Medical College, is among the first researchers to win a prestigious NIH Director's Transformative R01 award from the National Institutes of Health. Dr. Jaffrey and his colleagues are developing innovative protein recognition technologies that may some day speed up lab testing by instantaneously measuring proteins within biological samples. Protein detection is essential for diagnosing illnesses, detecting environmental toxins, and for most types of biomedical research. Protein detection typically takes hours or days, and requires antibodies that specifically bind these proteins. Specialized techniques are required to transform the binding of these antibodies into signals that detect the presence of these proteins. Dr. Jaffrey and his lab are developing new protein recognition tools that rapidly emit light upon binding specific target proteins.
Nearly one in three adult Americans have triglyceride (trig) levels that are above normal and nearly 34 million have low HDL "good" cholesterol levels. To help increase awareness about the importance of HDL and trigs, Abbott has launched two Web sites: http://www.knowyourhdl.com and http://www.knowyourtrigs.com. "Unhealthy high triglyceride and low HDL levels are factors that can raise the risk of heart disease, " said Eliot A. Brinton, M.D., associate professor, University of Utah, School of Medicine. "Understanding cholesterol and lipids, fats found in the blood, can be confusing, but it's important patients know what HDL and triglycerides are and how they can affect heart health." Often, cholesterol conversations center on LDL, the "bad" cholesterol. These Web sites focus on commonly overlooked HDL and trigs and the role they play in health. Other information featured includes tips on diet, exercise and how patients can talk to their doctor about their risk factors for heart disease.