The ENHANCE Study, Bad News for Vytorin, or Not?

Vytorin, the drug that was purported to lower cholesterol in a unique manner, has fallen off the crest of it's wave, or has it? News out this week, highlighted in today's edition of Time magazine points to the results of the ENHANCE study as "evidence" that Vytorin doesn't work. As usual the media seems to be jumping the gun to create a controversy. Despite the current evidence-based belief that lowering LDL cholesterol has a positive effect on cardiovascular disease reduction, the media is purporting that Vytorin is a failure at disease reduction.

You are probably familiar with Vytorin's "food and family" advertisements, such as this one at U-Tube; they are really eye-catching in their colors and reflections of food in the choice of people in the ads. These advertisements are correct on at least one point; the body's different cholesterol levels are affected by both what one eats and genetics. The advertisements also state that when the Vytorin pill was compared to the cholesterol lowering ability of other statins alone that it was more effective at lowering LDL cholesterol, and their study evidence supports that statement.

Vytorin is a pill that combines the statin simvastatin (Zocor, produced by Merck Manufacturing) and ezetimibe (Zetia, produced by manufacturer Schering-Plough) into one pill. Ezetimibe's method of lowering cholesterol is to prevent the building blocks of cholesterol from being absorbed in the intestinal tract, rather than preventing their manufacture in the liver, which is how the statin drugs work. The ENHANCE study compared Vytorin alone to Zocor alone, and measured their effectiveness on plaque size in the carotid (large neck) arteries. This is where the real controversy lies for me. To my knowledge there is no evidence that plaque size alone will predict disease outcomes. There are a multitude of factors involved in disease development, including plaque make-up (the kind of cholesterol particles inside it), its stability and location, and a person's genetic factors that determine whether or not plaque becomes a problem in a given individual.

Dr. Michael Richman discusses the results of the ENHANCE study here in his blog. He's not ready to give up on Vytorin yet, because he believes that there is enough clinical evidence that lowering LDL cholesterol lowers the risk of developing cardiovascular diseases, including heart attack and stroke. I have to agree with him there; we certainly have years of evidence from Framingham alone to support this hypothesis.

Dr. Richmond sites Dr. Robert Harrington from the Duke Clinical Research Institute, who says that ENHANCE was not meant to be an "outcomes" study, meaning that the measurement of markers such as plaque size have never been proven to be equal to the risk of disease development or progression. In other words, there are other factors involved in the development of cardiovascular disease that are not measured by plaque size alone. One such example is the still-developing evidence that the one of the reasons that statins are effective is their anti-inflammatory properties. Dr. Harrington is involved in one of three large clinical outcomes studies of Vytorin currently underway, and he notes that until these results are known, we have to rest on our current knowledge that lower LDL equals lower disease rates.

Vytorin has certainly been shown to reduce LDL cholesterol, and it was on that basis, as well as its safety profile, that it was FDA approved for use in controlling cholesterol. If you are currently taking Vytorin because you could not control your LDL cholesterol level on a statin alone, and you and your health care provider are happy with your results, then I would not be in a rush to stop taking the drug.

In health,

Laurie

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Technorati Tags: Vytorin, Zetia, statins, heart disease, cholesterol, LDL, plaque, health and wellness

Today is the first day...

Ok, so in an effort to stick to the PLAN to blog more, I am starting off the week with a "short one," not an epic blog. We'll see how it goes.

Headline at Web MD today relates that researchers at the University of Connecticut* (right in my back yard) have been studying the effects of the superfood broccoli on the outcomes of oxygen deprivation to the hearts of rats. Seems they fed broccoli extract to the rats along with their regular chow; the control rats got plain water. After a month they subjected the rats to oxygen deprivation to simulate a heart attack, and the rats that had been fed the broccoli extract faired better than the controls. When compared to the controls the broccoli fed rats had better heart pumping ability, less heart muscle damage, and higher levels of heart-health chemicals (no explanation of what was measured in this summary article) during the oxygen deprivation.

It's no surprise really that the broccoli extract was heart protective. Broccoli contains two strong antioxidants, selenium and sulforaphane ; there is also evidence that these antioxidants may help fight various types of cancer. So if you needed more evidence to eat your veggies to protect your heart, this study would support those healthy choices. Hate broccoli (especially cooked, like me)? Try shredding it into your salad, like cutting cabbage for slaw. How about one of these recipes? For more general tips for finding ways to increase your intake of these nutrient-rich foods here are some great tips for "sneaking" superfoods into your diet here.

* Reported in the Journal of Agricultural and Food Chemistry.

Happy eating and disease fighting! Laurie


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Technorati Tags: diet, nutrition, healthy eating

Bloggers' Stress and Heart Attacks

Good thing I went for a long, brisk, walk-jog with the dog today, part of my resolution to improve my aerobic fitness and lose another 5 pounds. It also helps me to relax, and I was incredibly stressed out today by a long list of things to do, including writing a new blog entry.

Seems I am not the only one who's stressed by the need to create fresh content in a timely manner that actually interests my readers. This week the New York Times reported on the December 28th heart attack of Giga Omni Media's Om Malik, the driving force behind the company's multiple profitable blogging sites, including gigaom, which features Malik's writing, along with others. The Times points out that it can be very stressful to stay ahead of other writers in a topic area, and to keep the content lively and interesting.

Members of Malik's team, however, also report that he had a few bad habits that probably contributed to his heart disease, including smoking cigars and cigarettes and drinking lots of coffee. Mr. Malik himself is quoted as saying, "Friends and family have purged my apartment of smokes, scotch and all my favorite fatty foods -- I am even going to be drinking decaf."

Malik has a tough road ahead of him because it sounds like he's being forced to make a lot of significant life changes under "do or die" circumstances. This forced change works really well for some people, who think "I have to do this or I'll surely hasten my death." For others however, it causes resentful defiance, that can be expressed as,"I'll show them who's in control; I'll do what I please!"

Under any circumstance it can be difficult for us to maintain good health habits even when we want to, because it's easier to fall back on old habits when the going gets tough. We eat, drink too much coffee or alcohol, or smoke because we think that these habits help us to reduce stress and they are often associated in our minds with feeling good. So at this time of the year, while our resolutions to improve our health by eating better, drinking and smoking less (or not at all) or losing weight are fresh in our minds, ask yourself, "When I am unable to keep my resolutions why is it that my plans fail?"

It's my opinion that we set ourselves up for failure because we don't properly change our thinking about the challenge we face. Let's take my favorite resolution as an example. A person will say, "I'm going on a diet." When you read the word 'diet,' what are the first words or thoughts that come to your mind? Deprivation? Starvation? Losing all the good food from your life? The memory of some past dieting failure(s)? Suppose instead you choose not to go on a "diet" but that you tell yourself, "I am going to learn new eating habits that are healthier for me." From the start I'd guess that you feel less threatened by this statement.

You are not telling yourself that you aren't going to have dessert, or chocolate, or chips (my personal favorite), but you are committing yourself to a healthier lifestyle. Who can argue that that concept is a threat to your fun? In fact, research tells us that if we associate being healthier with positive feelings we are more likely to embrace that change because we will feel better.

Next you have to set yourself up with some measurable goals that have a time frame attached to them. If you don't, you'll keep finding excuses to put the change off because you still haven't given yourself the tools to succeed. Suppose you don't know where to begin; your goal might be, "I will call within the next week to make an appointment with a dietitian." Or, if you know what you need to do, pick one small place to start, such as, "I will add a salad to 2 meals a week starting one week from now." This might be followed with "the following week I will measure my carb portions and limit them to one serving based on the label serving size."

You might want to leave the "biggie" that's in your mind, such as controlling the sweets until you have had some success with the easier steps. This helps you to build what's called "self-efficacy," which is the belief that you can accomplish something. Once you are successful with solving a problem, the research tells us that you will be more likely to build upon those past successes to find strategies that will work for your more difficult challenges.

If you have words of advice on how you were successful at changing your tough habits, please share them with all of us here. We can all use some new ideas and encouragement year round when it comes to making life-altering habit changes, and I'll even send the link to Mr. Malik to offer our encouragement.

By the way, Malik's blog often has multiple posts a day (although he has a lot of help)! I'll be happy to accomplish two a week this year. I think if I set a goal to write one less epic post a week (short and sweet as they say), then I could get it done. Now about that time line...

Take care, Laurie

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Technorati Tags: Om Malik, GigaOm, resolutions, heart health, heart attack, diet, exercise, fitness

10 Tips for Eating From Salad Bars

I recently read a great article about eating from salad bars and wanted to share some tips with you. This meal choice can be very heart-healthy or it can be worse than a fast food burger and fries, depending upon your choices. Here are my suggestions, with a nod to my favorite dietitans, who helped me to tune up this article.

1. Choose the high in folate and vitamin C dark leafy greens instead of iceberg lettuce. Good choices are spinach, endive, mixed "baby" greens containing multicolored lettuces and romaine.


2. Choose vegetables from "all the colors of the rainbow," such as red radishes, peppers and tomatoes, green peppers, cucumbers and broccoli, yellow peppers, purple cabbage, orange carrots, and tan (fresh) mushrooms. Avoid veggies in marinades, dressings, sauces, or mayonnaise, which add fat, salt, and calories that you can't control. Avoid things or eat limited quantities that were probably once canned such as artichoke hearts and asparagus out of season, because they can be high in sodium. Limit quantities of olives, because they are high in sodium (about 10 medium olives equals 825 mg of salt, more than 1/3 of what the average person should consume in a day). On the flip side olives are a source of monounsaturated, heart-healthy fats and can be enjoyed in moderation if you like them.


3. Ditto choosing colorful fresh fruits from the bar, because they contain lots of vitamins A and C, carotinoids, fiber and potassium. Most have no fat as long as they are not bathed in a syrup (avocados are the exception, but again this is a monounsaturated fat). Just be mindful of the serving size of fruits especially if they are are canned or dried, as the calorie count will be higher, or if you have diabetes and are carb-counting.


4. Add beans: just 1/2 cup of chickpeas or kidney beans add about 5 grams of fiber and 7 grams of protein. This will help to fill you up and will stay with you for longer than the veggies and greens alone. Count the sodium into your day if you are limiting sodium intake as this serving size can give you about 360 mg of sodium. (If you're adding beans to a salad at home rinse then first to remove a large portion of the salt).


5. Choose lean meats and fish such as chicken or turkey (white meat) that looks roasted (avoid the breaded pieces), tuna without mayo, or shrimp. Watch the salt content here too, don't have both beans and tuna or cured meats (bacon, ham, or salami) on the same salad or you'll OD on sodium.


6. If you really want the cheese, choose a tiny sprinkling of a highly flavored cheese like parmesan, feta, or blue, otherwise you'll be adding a lot of fat calories and salt. Choose low-fat options if they are available.


7. Avoid dressed items like pasta salad, tuna with mayo, coleslaw, or potato salad for what I hope are obvious reasons (fat, calories and salt you can't control sound familiar)?


8. Limit toppings such as croutons, nuts & seeds, and fried noodles & onions. They are very tasty and I can't help wanting a little crunch, but they can contain a lot of calories and fat.


9. Dressing can be low or high fat, depending on your choice. Creamy dressings tend to be higher in fat and calories than vinaigrette's and Italian dressings. Creamy dressings are about 160 calories per 2 tablespoons and contain about 16 grams of fat! Compare that to a reduced calorie dressing or "light" dressing, where you get about 60 calories and 6 grams of fat per serving. If you like it, dress with lemon or vinegar and olive oil, which are often available on the salad bar. These allow you to really control the fat that you place on the salad. If you have the option of putting your dressing on the side, do so. Then you can dip a corner of you forkful of veggies into the dressing just before you put it into your mouth. You'll get an initial blast of flavor without an excessive amount of dressing on your otherwise healthy salad.


10. I don't know about you, but sometimes I really want bread with my salad. If you do be sure to pick a whole grain option, thereby increasing your fiber and B vitamins.

Salads are a great option for a meal, but remember that salad bars are full of items that are there to entice you to purchase them because they add weight to the salad and increase the store's profits. Those items can also put weight on the customer due to high fat and calorie consumption. Don't be tricked into purchasing lots of items that aren't good for you by following these easy steps to a healthy salad bar meal!

Bon Appetite! Laurie

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Technorati Tags: diet, nutrition, healthy eating, heart health