Stroke

Eloquent efficacy for Eliquis in atrial fibrillation patients

artist painting  Preliminary results from the International Society on Thrombosis and Haemostasis (ISTH) meeting and the ARISTOTLE study show that a comparison of Eliquis (apixiban) to an older blood thinner called warfarin (Coum

Lipitor, Zocor and Pravachol in high doses appear to pose increased risk of diabetes

man at desk thinking Two years ago, what researchers call a “signal of risk” was identified for one member of the cholesterol lowering drugs known as statins (what your doctor would call HMG-Co-A reductase inhibitors) app

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man at desk thinking Two years ago, what researchers call a “signal of risk” was identified for one member of the cholesterol lowering drugs known as statins (what your doctor would call HMG-Co-A reductase inhibitors) appeared in the JUPITER study for Crestor (rosuvastatin) [Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statins trails. Lancet 2010; 375:735-742]. What this meant was that Crestor appeared to be associated with about a 9% increased risk of diabetes.

A new study being presented at the American Diabetes Association-ADA meeting (Preiss D, Sesshasai, SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared to moderate-dose statin therapy. JAMA 2011; 305:2556-2564) looked at 32,752 people. The studies reviewed included A to Z, IDEAL, PROVE-IT, SEARCH and TNT. What this new analysis found was that high dose statin use (Lipitor-Atorvastatin, Pravachol-pravastatin and Zocor-simvastatin) appears to carry roughly a 12% increased diabetes risk. It is crucial to remember that overall, the benefits (avoiding heart disease and heart attack, etc.) outweigh the risk of diabetes for this family of medicines.

members circle The studies reviewed looked at Lipitor, Pravachol and Zocor. Prove IT compared 40 mg of Pravachol to 80 mg of Lipitor in 4,162 people. A to Z had a more complicated format, but looked at a given time of Zocor 40 mg then changed to 80 mg of Zocor in some patients. Other patients received 4 months of dietary counseling and placebo followed by 20 mg of Zocor for roughly 4,500 people. TNT was a large study of 15,464 people and involved treating to new targets and compared 80 mg of Lipitor to 10 mg of Lipitor. IDEAL looked at 8,888 people after a heart attack and compared 80 mg of Lipitor to 20 mg of Zocor. Finally, SEARCH looked at 80 mg of Zocor compared to 20 mg of Zocor and also tried to sort out the role of folic acid and vitamin B 12

As always, talk to your doctor about any questions regarding your medicines BEFORE you make any changes in your treatments. Visit Amazon author central:

http://www.amazon.com/James-J.-Rybacki/e/B000APKNZM to find the EGPD update on statins and cholesterol with recommendations about diabetes testing and statin use.

Zocor (simvastatin) and high dose muscle risks: Safety recommendations by FDA

cannon in New Orleans  The FDA released an 80 mg simvastatin (Zocor, Vytorin, Simcor) news release today, citing safety label changes for the highest dose of this widely used cholesterol-lowering medicine.

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cannon in New Orleans  The FDA released an 80 mg simvastatin (Zocor, Vytorin) news release today, citing safety label changes for the highest dose of this widely used cholesterol-lowering medicine. Roughly 2.1 million prescriptions have been written for products containing this 80 mg dose and the changes made today are the result of FDA review of a 7 year study.

The highest approved dose of simvastatin has been associated with an increased risk of muscle injury (or myopathy)...especially during the first year of use. What the FDA is recommending is that the 80 mg dose should be used only in patients who have been taking this dose for 12 months or more and HAVE NOT had any muscle toxicity. They further added that this dose should NOT be prescribed to new patients. The FDA also revised the labels of combination products that contain simvastatin to caution against combinations with certain other medicines which may increase the blood levels of simvastatin (an undesirable drug-drug interaction).The FDA made its conclusions based on the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine.

It is important to note that such a pattern of increased risk HAS NOT been found with the 40 mg or lower doses. Patients with concerns should talk to their doctors BEFORE making any changes to their medicines.  There is NO DOUBT that lowering of bad (LDLc) cholesterolis a key to decreasing risk of heart attack and stroke. The full FDA news release can be found at www.fda.gov.

RISKY BUSINESS and NSAIDS after a heart attack

Non-steroidal anti-inflammatory drugs (NSAIDS) risky after a heart attack

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Non-steroidal anti-inflammatory drugs (NSAIDS) risky after a heart attack

man loading gun A startling 83,675 heart patient study found that use of NSAIDS in people who have previously had a heart attack had a 45% increased risk of repeat heart attack or death in the first seven days of treatment and this increased to 55% if treatment continued for 3 months.

Diclofenac (Voltaren and generic) was associated with increased risk immediately and ibuprofen and rofecoxib (Vioxx-now removed from the market) showed increased risk early after treatment was started. In a further surprise, this study showed that diclofenac was associated with an even higher heart risk than Vioxx which was previously removed from the market because of heart risks.

Importantly, naproxen (Aleve, others) was found to have the lowest heart and blood vessel (cardiovascular) risk and the authors of this large Danish study suggested that naproxen might be the preferred NSAID in heart patients. Still, it was noted that naproxen use was linked to higher stomach and intestine (gastrointestinal) bleeding and that such bleeding in people who have had a heart attack has a worse prognosis.  

While the study itself is very large and pharmacies in Denmark are required to register dispensed prescriptions (which helps ensure complete registration), the researchers did note that this is an observational study. This means that there is a lack of information about heart function (left ventricle ejection fraction), blood pressure, lipid tests, smoking and other clinical aspects of the patients which could have (although unlikely) accounted for some of the excess risk which was seen.

For now, it appears that any NSAID use should be carefully considered and used in the lowest dose for the shortest possible time. The NSAIDS studied included ibuprofen (Motrin, others); Rofecoxib (Vioxx-now off the market); celecoxib (Celebrex); diclofenac (Voltaren, cataflam, others); a category called others  and naproxen (Aleve, others. Only naproxen was not associated with an increased risk of repeat heart attack or death in the people studied.

 

Source: Olsen, AMS, Fosbol, EL, Lindhardsen, J, et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction In patients with prior myocardial infarction: A nationwide cohort study. Circulation 2011;DOI:10.1161/CIRCULATIONAHA. Available from http://circ.ahajournals.org

An AACE Against Diabetes

people talking on a street An AACE Against Diabetes has prompted a lot of discussion  

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member's circle Knowing more about how diseases or conditions ar best managed raises the treatment and results bar for clinicians and patients and their families.

people talking on a street An AACE guideline release on diabetes has prompted a lot of discussion  

Diabetes multiplies the risk of heart disease and is a leading cause of kidney failure, blindness and stroke. The fight against this killer must be personalized…something which the American Association of Clinical Endocrinologists (AACE) has recognized in their new guidelines (Handelsman, Y, Mechanik, J, Blonde, L, Et al.).

The new guidelines outline specific ways that clinicians can develop a COMPREHENSIVE care plan for diabetes mellitus, and stresses the need to move beyond a simple focus on sugar (glycemic) control. This comprehensive approach is based on strong evidence that diabetes impacts heart and blood vessel (cardiovascular) disease risk, death (mortality) and quality of life.

Importantly, the AACE guidelines recognize that every patient is unique and evidence-based use of technology, treatment and comprehensive lifestyle management will lead to the best (optimal) results or outcomes. The framework of the guidelines is built in an easy to understand question and answer format and covers prevention, education, therapeutic lifestyle changes, goals, sleep and depression as well as risk reduction amongst many key points in the 53-page document.

The Executive summary covered in the first 14 pages could teach any medical student, enhance any clinician and lead many patients to get a comprehensive approach to key dangers of diabetes and address far more than the usual sugar control. Added points cover best use of technology, preventing nerve, heart, kidney, lifestyle changes, high blood sugar in the hospital, fats, risk factors and even often missed difficulties such as depression and sleep-related challenges.

You can see the guidelines at www.aace.com. For families and children at risk for or for those living with diabetes, the guidelines will surely be a pathway to prevention or an organized approach to optimal outcomes that should be embraced by clinicians, patients and their families.

This website is not intended as medical advice, and you should consult your doctor before changing or adding any medicines or vitamins to those you may now be taking and about applying any strategies BEFORE you adopt any approach in this report. While diligent care has been taken to ensure the accuracy of the information provided during the preparation of this edition, no claim is made that all known actions, uses or side effects, strategies for cost containment, targets or cholesterol pathways are included in this report. The accuracy and currentness of information are ever subject to change relative to new guidelines, new information derived from drug research, development and general usage.