New study finds EPA and DHA omega-3s lower risk of coronary heart disease

EPA and DHA omega-3s reduce the risk of coronary heart disease (CHD), according to results of a new, comprehensive meta-analysis published in the Mayo Clinic Proceedings.

03 jan 2017--Among randomized controlled trials (RCTs), there was a statistically significant reduction in CHD risk in higher risk populations, including:

• 16 percent in those with high triglycerides and 14 percent in those with high LDL cholesterol.
• A non-statistically significant 6 percent risk reduction among all populations in RCTs, a finding supported by a statistically significant 18 percent reduced risk of CHD among prospective cohort studies.

"What makes this paper unique is that it looked at the effects of EPA and DHA on coronary heart disease specifically, which is an important nuance considering coronary heart disease accounts for half of all cardiovascular deaths in the U.S.," said Dr. Dominik Alexander, lead author and Principal Epidemiologist for EpidStat. "The 6 percent reduced risk among RCTs, coupled with an 18 percent risk reduction in prospective cohort studies—which tend to include more real-life dietary scenarios over longer periods—tell a compelling story about the importance of EPA and DHA omega-3s for cardiovascular health."
Additional study details include:

• The study reviewed 18 randomized controlled trials (RCTs) and 16 prospective cohort studies, with 93,000 and 732,000 subjects, respectively.
• The study examined outcomes such as myocardial infarction, sudden cardiac death and coronary death.
• The study compared the results of RCTs, which explore interventions under strict clinical conditions, to those of prospective cohort studies that are observational, and followed larger populations for longer periods of time.

"There are important public health implications related to reducing the risk of coronary heart disease, and therefore we are encouraged by the results of this comprehensive analysis," said Dr. Harry Rice, Vice President of Regulatory and Scientific Affairs for the Global Organization for EPA and DHA Omega-3s (GOED), which funded the study. "It's also important that the observed risk reductions were even stronger in patient populations with elevated triglycerides and LDL cholesterol levels, two risk factors that affect more than one quarter of the American population."
"The results confirm that increasing omega-3s is a healthy lifestyle intervention that can contribute towards reductions in CHD risk," added Adam Ismail, Executive Director of GOED. "Remember that increasing omega-3 intakes is basically just improving the quality of one's diet slightly, like reducing the amount of sodium or increasing your dietary fiber. It is a simple, inexpensive, and achievable change that most consumers need to make to optimize their health."
An accompanying editorial in Mayo Clinic Proceedings also acknowledges the importance of the study. "The meta-analyses of Alexander and colleagues suggests that omega-3 fatty acid intake may reduce risk of adverse CHD events, especially among people with elevated levels of TGs or LDL-C....omega-3 fatty acid intake of at least 1 gram of EPA+DHA per day, either from seafood or supplementation (as recommended by the American Heart Association), continues to be a reasonable strategy," said the authors.
Study authors did point out that further clinical trials looking specifically at CHD outcomes may continue to provide a better understanding of the promising beneficial relationship between EPA/DHA and CHD risk. Current RCTs have varying durations, different baseline CHD status for study participants, and utilize several methods for patient selection and randomization. Future studies should:

• Increase patient populations to account for dropout rates in longer trials.
• Extensively detail how subjects are diagnosed to create uniform diagnostic criteria.
• Be appropriately powered to detect an effect in current clinical conditions.
• Measure baseline omega-3 intake or status of study participants to determine the extent to which it confounds results.

More information: Mayo Clinic Proceedings, DOI: 10.1016/j.mayocp.2016.10.018
The study was supported by a grant from GOED, which played no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.


Provided by GOED

Coronary artery calcium score improves CHD risk prediction

11 oct 2015—Inclusion of the coronary artery calcium (CAC) score improves coronary heart disease (CHD) risk prediction, while the absence of CAC reclassifies many patients as not eligible for statins, according to two studies published in the Oct. 13 issue of the Journal of the American College of Cardiology.
Robyn L. McClelland, Ph.D., from the University of Washington in Seattle, and colleagues derived and validated a novel risk score to estimate 10-year CHD risk using CAC and other traditional risk factors. The algorithm was developed in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort involving 6,814 participants. The researchers observed significant improvement in risk prediction with inclusion of CAC in the MESA risk score (C-statistic, 0.80 versus 0.75; P < 0.0001). Evidence of very good discrimination and calibration was seen in external validation in two studies.
Khurram Nasir, M.D., M.P.H., from Baptist Health South Florida in Miami, and colleagues examined the implications of the absence of CAC in reclassifying patients from a risk stratum in which statins are recommended to one in which they are not. Data were included from 4,758 participants from the MESA cohort. The researchers found that for most of the 50 percent of participants eligible for statins, eligibility was due to having a 10-year estimated atherosclerotic cardiovascular disease risk of ≥7.5 percent. Forty-one percent of those recommended statins had CAC = 0. Of the participants eligible (recommended or considered) for statins, 44 percent had CAC = 0 at baseline.
"The absence of CAC reclassifies approximately one-half of candidates as not eligible for statin therapy," the authors write.
One author from the McClelland study disclosed financial ties to General Electric. Several authors from the Nasir study disclosed financial ties to the pharmaceutical, biotechnology, and technology industries.

More information: Full Text - McClelland (subscription or payment may be required)

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Coronary calcium scores may help predict risk of death in patients without family history of heart disease

Current guidelines only recommend coronary artery calcium (CAC) scoring for low-risk patients if they have a family history of early heart disease.

07 april 2014—A new Emory University study shows that coronary artery calcium (CAC) scoring, a type of low-dose CT scan, accurately predicts the risk of dying over the next 15 years in patients with and without a family history of early heart disease. The findings were presented this week at the American College of Cardiology meeting in Washington, D.C.

A coronary artery calcium scan is a simple, non-invasive test that uses low-dose X-rays to measure the amount of calcium in plaque on the walls of the arteries of the heart.

"While we found that CAC scoring is accurate at predicting the risk of death over a 15-year period in all patients, this is the first study to show it is most accurate in those without a family history of early heart disease," says Joseph Knapper, MD, an internal medicine resident at Emory University School of Medicine.

"This suggests there may be a benefit to expanding CAC testing to all low-risk patients, regardless of their family history, allowing patients to learn about their risks sooner and take actions to decrease them."

Current guidelines only recommend CAC scoring for low-risk patients if they have a family history of early heart disease.

Knapper and his colleagues followed 6,300 patients with a family history of early heart disease, and about 2,800 patients without a history. Each study participant underwent a CT scan to receive a CAC score and was interviewed to establish their risk factors for heart disease (i.e. cigarette smoking, high blood pressure, diabetes, etc.). Researchers tracked the patients for 15 years and recorded deaths that occurred in that time period, regardless of the cause.

They found that patients with a higher CAC score were more likely to have died over the 15-year period, even after controlling for other risk factors such as smoking and high blood pressure. Most importantly, the highest risk CAC scores (greater than 1,000) showed a nearly eight times higher risk of death compared to the lowest risk score in patients without a family history, whereas in those with a family history the risk was increased less than four-fold.

Knapper says further research, including cost analysis, is needed before a recommendation could be made to expand CAC screening guidelines.

Provided by Emory University

Calcium supplementation does not increase coronary heart disease concludes new study

Researchers presenting at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases showed the results of a meta-analysis of randomized controlled trials of calcium supplements. The results do not support the hypothesis that calcium supplementation, with or without vitamin D, increases coronary heart disease or all-cause mortality risk in elderly women.

05 april 2014--The results of a study presented today at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases do not support the hypothesis that calcium supplementation, with or without vitamin D, increases coronary heart disease or all-cause mortality risk in elderly women.

The investigators, from centres in Australia, Denmark and the USA, undertook a meta-analysis of randomized controlled trials of calcium supplements with or without vitamin D. They searched for two primary outcomes: coronary heart disease and all-cause mortality verified by clinical review, hospital record or death certificate. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966 – May 24, 2013 for potentially eligible studies, reference lists were checked, and trial investigators were contacted where additional data was required. Eligibility criteria included randomized controlled trials of calcium supplementation with or without vitamin D with events with a mean cohort age >50 years. Trial data were combined using a random-effects meta-analysis to calculate relative risk of heart disease events in participants supplemented with calcium.

Of the 661 potentially eligible reports, 18 met the stringent inclusion criteria, contributing information on 63,564 participants with 3,390 coronary heart disease events and 4,157 deaths from any cause. Five trials contributed coronary heart disease events with pooled relative risk (RR) for calcium of 1.02. And 17 trials contributed to all-cause mortality data with pooled RR for calcium of 0.96. The meta-analysis showed that calcium supplementation with or without vitamin D does not increase coronary heart disease or all-cause mortality risk in elderly women.

More information: OC34 The effects of calcium supplementation on coronary heart disease hospitalisation and death in postmenopausal women: a collaborative meta-analysis of randomised controlled trials. J. R. Lewis, K. L. Ivey, S. Radavelli-Bagatini, L. Rejnmark, J. S. Chen, J. M. Simpson, J. M. Lappe, L. Mosekilde, R. L. Prentice, R. L. Prince. Osteoporos Int. Vol 25, Suppl. 2, 2014

Provided by International Osteoporosis Foundation

Psychological interventions halve deaths and CV events in heart disease patients

Psychological interventions halve deaths and cardiovascular events in heart disease patients, according to research from Athens, Greece, presented at the Acute Cardiac Care Congress 2013.

13 oct 2013--The Acute Cardiac Care Congress 2013 is the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC). It takes place 12-14 October in Madrid, Spain.

Dr Zoi Aggelopoulou, a nurse and one of the study authors, said: "The nurses on our coronary care unit observed that patients were less likely to have another heart attack, die, or return to hospital when we talked to them about their treatment, played music for them or helped religious patients to say prayers. It made us think that coronary heart disease is not just physical but also has a psychological component."

She added: "We wanted to find out if others had observed the same thing, and whether psychological support had a real impact on the outcomes of patients with coronary heart disease."

The current study was a meta-analysis of 9 randomised controlled trials. The researchers evaluated whether psychological interventions could improve outcomes of patients with coronary heart disease when combined with a conventional rehabilitation programme.

The researchers found that the addition of psychological interventions reduced mortality and cardiovascular events by 55% after 2 years or more.

Dr Aggelopoulou said: "We found a huge benefit of psychological interventions after 2 years, with less patients dying or having a cardiovascular event and therefore fewer repeat hospital visits. The interventions included talking to patients and their families about issues that were worrying them, relaxation exercise, music therapy, and helping them to say prayers."

She added: "Patients want to know what will happen to them when they leave hospital, whether or not they can have sex, and how to take their medication. Our research shows that giving them information and providing reassurance decreases the chances of them dying or having another heart attack. Patients can help instigate this new culture of information by asking more questions and getting more involved in decisions about their treatment."

Population-based studies have shown that psychological factors may have an influence on the likelihood of having a heart attack in the first place. The factors include depression, social isolation, low socioeconomic status, and chronic stress such as occupational or marital distress and stress from caregiving.

Dr Aggelopoulou said: "The results of our study strengthen the evidence that psychological factors have a big role to play in heart disease. Not only do they impact on the risk of having a heart attack, but they also affect the future outlook of a patient who has had a cardiovascular event. This validates our view that cardiovascular disease is not just a physical disease but also has a substantial psychological component."

The researchers concluded that psychological interventions should be incorporated into the rehabilitation of patients with coronary heart disease. Dr Aggelopoulou said: "More clinical trials are needed to clarify which interventions are most effective and how they can best be implemented."

She concluded: "We can help our patients by simply talking to them or introducing new things like music therapy into our clinical practice. Coronary units are busy places – in Greece we sometimes have 1-2 nurses for 10-20 patients in the coronary care unit and we are under time pressure. But our finding that the addition of psychological support on top of physiological therapies reduces death and cardiovascular events by 55% should be a wake-up call that these interventions really do work. Preventing repeat hospital visits would free up the time we need to implement them."

Provided by European Society of Cardiolog

Fructose consumption increases risk factors for heart disease

A recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM) found that adults who consumed high fructose corn syrup for two weeks as 25 percent of their daily calorie requirement had increased blood levels of cholesterol and triglycerides, which have been shown to be indicators of increased risk for heart disease.

31 july 2011--The American Heart Association recommends that people consume only five percent of calories as added sugar. The Dietary Guidelines for Americans 2010 suggest an upper limit of
25 percent or less of daily calories consumed as added sugar. To address this discrepancy in recommended consumption levels, researchers examined what happened when young overweight and normal weight adults consumed fructose, high fructose corn syrup or glucose at the 25 percent upper limit.

"While there is evidence that people who consume sugar are more likely to have heart disease or diabetes, it is controversial as to whether high sugar diets may actually promote these diseases, and dietary guidelines are conflicting," said the study's senior author, Kimber Stanhope, PhD, of the University of California, Davis. "Our findings demonstrate that several factors associated with an elevated risk for cardiovascular disease were increased in individuals consuming 25 percent of their calories as fructose or high fructose corn syrup, but consumption of glucose did not have this effect."

In this study, researchers examined 48 adults between the ages of 18 and 40 years and compared the effects of consuming 25 percent of one's daily calorie requirement as glucose, fructose or high fructose corn syrup on risk factors for cardiovascular disease. They found that within two weeks, study participants consuming fructose or high fructose corn syrup, but not glucose, exhibited increased concentrations of LDL cholesterol, triglycerides and apolipoprotein-B (a protein which can lead to plaques that cause vascular disease).

"These results suggest that consumption of sugar may promote heart disease," said Stanhope. "Additionally our findings provide evidence that the upper limit of 25 percent of daily calories consumed as added sugar as suggested by The Dietary Guidelines for American 2010 may need to be re-evaluated."

Provided by The Endocrine Society

Alcohol Associated With Lower Heart Disease Risk


Study finds Spanish men who drink alcohol have less coronary events than non-drinkers

23 nov 2009-- Men who drink alcohol are at lower risk of coronary heart disease than their non-drinking counterparts, according to a Spanish study published online Nov. 19 in Heart.

Larraitz Arriola, M.D., of the Public Health Department of Gipuzkoa in San Sebastian, Spain, and colleagues analyzed data on 15,630 men and 25,808 women who comprised the Spanish cohort of the European Prospective Investigation into Cancer to look at the relation between alcohol intake and coronary heart disease events during 10 years of follow-up.

For men, the researchers found that the crude coronary heart disease incidence rate was 300.6 per 100,000 person-years, while the rate was 47.9 per 100,000 for women. There was a reduced risk of coronary heart disease in men, associated with their extent of alcohol consumption -- hazard ratio 0.90 for former drinkers, 0.65 for low-level consumers, 0.49 for moderate drinkers, 0.46 for heavy drinkers, and 0.50 for those who consumed more than 90 grams a day. The authors further note that the small number of coronary events may explain why the benefits detected among women were not statistically significant.

"The results of our study show a negative association between alcohol intake and coronary heart disease," the authors write. "We can also state, although with caution, that our study is free of the so called 'abstainer error' and that residual confounding does not influence the results obtained to any significant degree."

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Thigh Size Can Have Impact on Risk of Heart Disease

Too little muscle mass may explain why small thighs are associated with higher risk

09 sept 2009-- A thigh circumference below 60 centimeters is associated with increased risk of cardiovascular and coronary heart disease and premature mortality in both men and women, according to a study published online Sept. 3 in BMJ.

Berit L. Heitmann, Ph.D., of Copenhagen University Hospital in Denmark, and Peder Frederiksen, of Glostrup University Hospital, also in Denmark, conducted a study of 1,436 men and 1,380 women. Measurements of the subjects' height and weight, along with thigh, hip and waist circumference were taken in 1987 to 1988 and the cohort was followed up for 10-year incidence of cardiovascular and coronary heart disease and 12.5 years for total death.

Subjects with a thigh circumference of approximately below 60 centimeters had increased risk of premature death, but there was no benefit to either men or women of having thighs larger than this, the investigators found. The association held even after abdominal obesity, general obesity, and cardiovascular and lifestyle risk factors were taken into account.

"The risk was more highly related to thigh circumference than to waist circumference. In this regard, it is important to note that modifiable risk factors for abdominal obesity, or behaviors to selectively reduce waist circumference, are generally unknown," the authors write. "Thigh muscle mass, on the other hand, can be selectively increased by lower body physical activity, and a clear public health recommendation to change this risk factor can be easily communicated."

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Traditional risk assessment tools do not accurately predict coronary heart disease

08 jan 2009--The Framingham and National Cholesterol Education Program tools, NCEP, do not accurately predict coronary heart disease, according to a study performed at the Yale University School of Medicine in New Haven, CT.

The study included 1,653 patients who had no history of coronary heart disease; although 738 patients were taking statins (cholesterol lowering drugs like Lipitor) because of increased risk of developing coronary heart disease. All 1,653 patients underwent a coronary CT angiogram and doctors compared their risk of coronary heart disease, determined by the Framingham and NCEP risk assessment tools, to the amount of plaque actually found in their arteries as a result of the scan. Results showed that 21% of the patients who were thought to need statin drugs before the scan (because of the Framingham and NCEP assessment tools) did not require them; "26% of the patients who were already taking statins (because of the risk factor assessment tools) had no detectable plaque at all," said Kevin M. Johnson, MD, lead author of the study.

"Risk assessment tools are used by physicians implicitly. Physicians use them as a way to separate and treat patients accordingly. Ultimately, the Framingham influences what every physician does, but I feel it is not good enough to show what is happening with each individual patient," said Dr. Johnson.

"The average person tends to put a lot of weight on family history, but the association between that and coronary heart disease is only modest," said Dr. Johnson. "We are living in an era where genetic research is in the headlines, but reality is a lot more complicated than that," he said.

"There are still 400,000 people a year who die from heart attacks and have no warning signs at all; doctors want to be able to find those people before that happens and I hope this study gets people interested in finding out better predictors for coronary heart disease," said Dr. Johnson.

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This study appears in the January issue of the American Journal of Roentgenology. For a copy of the full study, please contact Heather Curry via email at hcurry@arrs.org.

About ARRS

The American Roentgen Ray Society (ARRS) was founded in 1900 and is the oldest radiology society in the United States. Its monthly journal, the American Journal of Roentgenology, began publication in 1906. Radiologists from all over the world attend the ARRS annual meeting to participate in instructional courses, scientific paper presentations and scientific and commercial exhibits related to the field of radiology. The Society is named after the first Nobel Laureate in Physics, Wilhelm Röentgen, who discovered the x-ray in 1895.

No Plus Seen for Apolipoproteins on Coronary Risk Assessment

FRAMINGHAM, Mass., Aug. 15 -- For assessing coronary risks, measuring apolipoprotein levels adds nothing to prognostic information derived from conventional lipid measurements, found investigators here.
An elevated apo B:apo A-I ratio was associated with a coronary heart disease hazard ratio of 1.39 per standard deviation in men and 1.40 in women, virtually identical to the risk ratios for total cholesterol:HDL-C and LDL-C:HDL-C, Ramachandran S. Vasan, M.D., of Boston University, and colleagues, reported in the Aug. 15 issue of the Journal of the American Medical Association.
Dr. Vasan and colleagues reported findings from a retrospective analysis of data on 3,322 participants in the fourth examination cycle (1987-1991) of the Framingham offspring cohort. Lipid measurements included total cholesterol, HDL-C, LDL-C, non-HDL-C, apo A-I, apo B, and three ratios: total cholesterol:HDL-C; LDL-C:HDL-C; and apo B:apo A-I.
"In both sexes, models using the apo B:apo A-I ratio demonstrated performance characteristics comparable with but not better than that for other lipid ratios," said Dr. Vasan and colleagues. "The apo B:apo A-I ratio did not predict coronary heart disease risk in a model containing all components of the Framingham risk score including total cholesterol:HDL-C."
The results may help resolve strong disagreement over the relative prognostic value of apo B and apo A-I versus conventional lipid parameters. Inconsistent data had emerged from previous studies, some showing apolipoprotein measurement superior and others the opposite, "fuelling an intense debate," said the authors.
After a median follow-up of 15 years, 291 of the participants had developed coronary disease (198 men, 93 women). In a multivariate model that adjusted for nonlipid coronary disease risk factors, total cholesterol was associated with a coronary disease hazard ratio of 1.39 in men and women. Calculation of the LDL-C:HDL-C ratio led to a hazard ratio of 1.35 in men and 1.36 in women.
Both the total cholesterol:HDL-C ratio and the apo B:apo A-I ratio offered statistically significant improvement in reclassification of coronary disease risk at 10 years. The improvement was similar with the two lipid measurements, although the total cholesterol:HDL-C ratio was numerically superior.
In statistical models that incorporated components of the Framingham risk score, the apo B:apo A-I ratio was not significantly associated with coronary disease. The hazard ratio was 1.23 for men and 1.14 for women. Moreover, including apo B:apo A-I in the models did not significantly improve the prognostic value of the models.
"This observation suggests that apo B:apo A-I ratio does not provide incremental predictive utility over established coronary heart disease risk factors including traditional lipid measures," the authors concluded.
They did note several limitations of the study. "Our sample consists predominantly of middle aged whites of European descent, limiting the generalizability of our findings to other age groups and ethnicities," they wrote. "Specifically, the mean age of our study participants was 51 years, and it is accepted that the incidence of coronary heart disease in women escalates after menopause. Indeed, the overall incidence rate was higher in men than in women. Moreover, total cholesterol and LDL-C did not predict coronary heart disease in sex-specific models, but we observed statistically significant associations in the sex-pooled analyses."
There were no financial disclosures reported. The study was supported by the US Department of Agriculture Research Service; the Swedish Heart-Lung Foundation, a Bergmarks Travel Grant, and the National Heart, Lung, and Blood Institute. Primary source: JAMASource reference: Ingelsson E et al. "Clinical utility of different lipid measures for prediction of coronary heart disease in men and women." JAMA 2007;298:776-785.

High-Dose Statin Confers Additional Benefit in Older Patients with CHD

High-dose atorvastatin offers additional cardiovascular benefit to older adults with coronary heart disease, reports a study in Annals of Internal Medicine.
A secondary analysis from the manufacturer-supported Treating to New Targets study examined cardiovascular events among some 3800 adults aged 65 and older with CHD who were randomized to receive 80 mg or 10 mg of atorvastatin. Mean LDL cholesterol levels in the two groups were reduced to 72 mg/dL and 97 mg/dL, respectively, by 12 weeks and remained stable throughout the study.
During a median follow-up of 5 years, the primary endpoint — a composite of death due to CHD, nonfatal MI, cardiac arrest, and stroke — occurred in fewer high-dose than low-dose recipients (10.3% vs. 12.6%).
The authors say their findings support "National Cholesterol Education Program guidelines for use of intensive LDL cholesterol–lowering therapy in high-risk older persons," as well as American College of Cardiology and American Heart Association recommendations to lower LDL cholesterol to well below 100 mg/dL "in any patient with established CHD."

Flu Epidemics Linked to Surge in Coronary Heart Disease Deaths

HOUSTON, April 20 -- A large percentage of influenza deaths are the result of disease-triggered acute myocardial infarctions, researchers here reported on the basis of autopsy-proven data.
In a week during a flu epidemic, the chances of dying of a heart attack increased by 30% and of dying of chronic ischemic heart disease by 10%, reported Mohammad Madjid, M.D., of the University of Texas here, and colleagues, online in the European Heart Journal.
Influenza causes up to an estimated 92,000 U.S. deaths a year as a result of myocardial infarction alone, they reported on the basis of their clinical observations and analyses of published trials.
Many of these deaths could be prevented if every high-risk patient had an annual flu shot. Dr. Madjid and colleagues wrote.
Working with Russian colleagues at the St. Petersburg Medical Academy, the researchers studied the impact of influenza on coronary deaths (acute myocardial infarction and chronic ischemic heart disease) in autopsies conducted from 1993 to 2000 in St. Petersburg.