Speaker: Gary A. Mayman, MD, Associate Professor, Cardiology Section, Department of Pediatrics, University of Nevada School of Medicine, and Co-Director, Children’s Heart Center, Las Vegas, Nevada
A group of overweight children who received a dietary supplement of fish oil containing omega-3 fatty acids (Omega RX, Zone Labs), showed a significant improvement in their lipid profiles, in contrast to children who did not receive the supplementation.
In studies of adults, there is growing evidence that diets high in omega-3 fatty acids decrease the risk of fatal ischemic heart disease and that early intervention might reduce the risk of cardiovascular complications later in life. A study was thus designed to assess the effects of dietary fish oil supplementation on the lipid profiles in overweight children and adolescents.
Forty-nine children, enrolled in a medically supervised weight-management program, participated in a 12-week, randomized clinical trial. All of the youngsters, 10 to 18 years of age, had a body mass index (BMI) above the 95th percentile. They received a diet low in glycemic load and participated in a supervised exercise program. They were assigned to a control placebo group or to a group receiving 3 grams of fish oil daily. Fasting blood samples were drawn in the first, sixth, and 12th weeks. A paired t-test for statistical analysis was conducted.
At the first visit, the lipid profiles were similar in both study groups. At week 12, the children receiving fish oil showed significantly improved triglyceride levels (reduced from 157 ± 74 mg/dl at baseline to 120 ± 49 mg/dl), compared with the controls (reduced from 163 ±118 to 155 ±77 mg/dl) at the end of the study. For children whose triglyceride/HDL-C ratio was greater than 3, there was a significant increase in HDL-C levels in those who received fish oil supplementation.
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In the treated patients, HDL-C levels rose from 37 ±5 mg/dl at week one to 41 ±7 mg/dl at week 12. In the control group, HDL-C levels increased from 34 ±4 mg/dl at week one to 35.6 mg/dl at week 12.
Although the intensive nutritional counseling, exercise, and psychological assistance resulted in improved lipid profiles in both groups of patients, it was the addition of omega-3 fatty acid supplementation that caused a marked improvement in the lipid profile, compared with only diet and exercise.
Diet/Statin Therapy Reduces Coronary Heart Disease in Mild Hypercholesterolemia
Speaker: Haruo Nakamura, MD, PhD, Emeritus Professor of Medicine, National Defense Medical College, Tokorozawa City, Saitama, Japan, and Study Chair of the MEGA Study
A combination of low-dose pravastatin (Bristol-Myers Squibb) markedly reduced the risk of coronary heart disease (CHD) in people with only moderately elevated cholesterol levels. This is the first time that a low-dose statin reduced the CHD risk in a low-risk population in a manner similar to that reported in statin trials of high-risk populations.
In the Management of .Elevated Cholesterol in the Primary Prevention Group of .Adult Japanese (MEGA) trial, 7,832 patients with mild hypercholesterolemia and no history of CHD were assigned to receive either dietary changes or diet plus day in a prospective, randomized, open-label, blinded-endpoint evaluation design. Mild hypercholes-terolemia was defined as a total cholesterol level of 220 to 270 mg/dl.
The doses for the active-treatment patients could be titrated to 20 mg/day of pravastatin if their total cholesterol level was above 200 mg/dl at eight weeks after the initial administration.
The follow-up schedule was originally to last for five years. Patients who consented to extend the study at the 60th month were followed for a maximum of 10 years.
Even a small reduction in cholesterol levels brought about significant changes in CHD risk. After an average follow-up period of 5.3 years, there was a 33% decrease in the incidence of CHD in the mildly hypercholesterolemic men and women who received dietary therapy and low-dose pravastatin, compared with the diet-only subjects. There were 3.3 CHD events per 1,000 person-years in the active-treatment patients and 5.5 CHD events per 1,000 person-years in the diet-only patients.
At the start of the study, the average baseline total cholesterol value was 243 mg/dl, and the LDL-C level was 157 mg/dl.
At 5.3 years of follow-up observation, total cholesterol levels in the diet-only patients decreased by 2.1%; for the diet/prava-statin patients, they decreased by 11.5%. LDL-C concentrations decreased by only 3.2% for the diet-alone patients, whereas they were lowered by 18% in those receiving diet plus pravastatin canadian.
The MEGA study suggests that low-risk populations such as the Japanese can significantly reduce their risk for CHD without aggressive lipid-lowering treatment. Whether these results can be applied to statins other than pravastatin is unclear.
Early Invasive Strategy in Women with Non-ST-Segment Elevation Acute Coronary Syndrome Linked to Aggressive Pharmacotherapy and Better In-Hospital Outcomes
Speaker: William E. Boden, MD, Professor, University of Connecticut School of Medicine, and Director, Division of Cardiology, Hartford Hospital, Hartford, Connecticut
Women who underwent cardiac catheterization within 48 hours of admission for high-risk non-ST-segment elevation acute coronary syndrome (NSTE ACS) were significantly more likely to receive American College of Cardiology/American Heart Association (ACC/AHA) Guideline-driven pharmacology and counseling for therapeutic lifestyle changes during hospitalization and to have lower in-hospital mortality rates than women who underwent delayed or no cardiac catheterization.
It has been suggested that women with NSTE ACS receive less adjunctive pharmacotherapy and are less likely to have cardiac catheterization than men, but it is unclear whether this disparity has a negative effect on clinical outcomes. To answer this question, the study population of the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the ACC/AHA Guidelines) Quality Improvement Initiative were screened and assessed.
Among 119,257 consecutive patients with high-risk NSTE ACS, 33,804 women were identified from January 1, 2001, to October 2005. Of these patients, 15,733 women underwent cardiac catheterization in less than 48 hours, whereas cardiac catheterization was delayed for more than 48 hours or was not performed for 18,071 individuals during their index hospital-ization.
The women undergoing early cardiac catheterization received pharmacotherapy at significantly higher rates upon discharge than women with delayed or no catheterization. In order of higher rates of usage, these agents included (Sanofi Aventis/Bristol-Myers Squibb), aspirin, statins, beta blockers, and angiotensin-converting enzyme
These women were also given higher rates of referrals to cardiac rehabilitation, smoking cessation, and dietary counseling. Most important, this more aggressive pharmacotherapy and counseling resulted in significantly lower rates of (1) in-hospital mortality and (2) death or myocardial infarction compared with the women who received delayed cardiac catheterization or none at all.