- Good afternoon. I am Donna Arnett,
past president of the
American Heart Association,
and coming to you today on November 10th,
from the great city of Chicago,
where we're starting the
American Heart Association.
And I'm going to wrap up
some of the great science
that was presented today.
First off this morning was an update
for our cholesterol guidelines,
and the room was packed.
Standing room only, and
that crowd generated
a lot of interesting questions,
and I would encourage you to go to
the Journal of the American
College of Cardiology,
or Journal Circulation, and pull down
the new cholesterol guidelines.
You can get an executive summary,
and you can get the full guideline free
at Circulation or JACC.
So today had a lot of great science
in the space of prevention
that I do believe is going to have
some major impacts on treatment
of cardiovascular disease.
The first trial that
generated the most interest
was a trial called "Reduce IT."
In the Reduce IT study,
a very specific form
of fish oil, specifically EPA,
was used: icosapent ethyl.
It was used in a very large
dose: four grams per day.
Randomized in patients who already had
subclinical or clinical
cardiovascular disease,
or they had diabetes and at least
one other major risk factor.
All of the individuals on this study
were taking statin therapy, and their
triglyceride levels
were between 150 and 500
milligrams per deciliter.
So it's a very common patient
seen in clinical practice.
So they found that this
drug, relative to placebo,
had a profound effect on
cardiovascular mortality,
stroke, and cardiovascular outcomes,
with a 25% reduction in risk.
Another study on fish oil
was a lower dose fish oil.
That study is called "Vital."
Now it was interesting,
because it was what's called
a factorial study, so they were testing
two different interventions.
One, fish oil, which
was just one gram a day,
and it's that combined fish oil
that has DHA and eicosapentaenoic acid.
So it also had, in addition
to that drug treatment
tested against placebo,
another arm that was testing
vitamin D supplementation against placebo,
in a two by two factorial design.
Now what was unique about the Vital study
is that study was completely
about primary prevention
of major cardiovascular disease.
And also, the incidence of
cancer and cancer mortality.
So we really expected, and were hopeful
that the major outcome
of total MI, stroke,
and cardiovascular deaths
would show an effect
of fish oil supplementation, but alas,
the findings were null.
There was an interesting
subgroup finding that showed
about a 20% reduction in total MIs,
in the primary prevention
treatment group for fish oil.
Interestingly, vitamin D supplementation
in people who had fairly
normal levels of vitamin D,
showed no benefit for
cardiovascular disease at all.
There was a subgroup analysis that showed
that vitamin D supplementation
reduced cancer mortality,
but that's a subgroup analysis,
and so more work is needed.
One other really interesting phenomenon
that they discovered in that trial,
in the subgroup analyses, was that the
fish oil supplementation
was more effective
in African-Americans as a group.
They worked very hard.
Out of their 26,000
patients that they enrolled,
over 5,000 were African-Americans,
and they found that fish
oil was more effective
in African-Americans.
They also found that your
intake of fish had an effect.
So people with a low intake of fish,
and that was less than one
and a half servings a week,
of fish, had a better
benefit, as did people
with multiple cardiovascular risk factors.
So Vital, a robust null
finding for overall
total cardiovascular mortality,
and for cancer incidence,
there was no effect.
So the last study I'm going to describe
is a new study and a new
theory around inflammation
and treating inflammation
that's independent
of other conditions.
So that study was called "CIRT."
And in the CIRT trial,
patients were randomized
to methotrexate, a drug that's used
to treat rheumatoid arthritis.
And so that study was stopped prematurely,
it was a study with,
again, a null finding,
so there was no impact
of using methotrexate
to reduce cardiovascular
events in patients
who were at high risk for an event.
So that wraps up today's biggest science
from the American Heart Association.
We heard things that
really will have an impact
on clinical practice, and
there are two more days
of great science to come in the next two,
so look forward to having more great news
from the American Heart Association.
