My Blog

By James Joseph Rybacki, Pharm.D. 1/8/19

Even when patients are treated to blood pressure and cholesterol goals, they still have heart attacks and some of them die. This sobering fact has led to an emerging residual cardiovascular risk, residual inflammatory burden and a number of other explanations.

The CANTOS or the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study took a look at the idea that inflammation had a role in cardiac events. The results did indeed show that 150 mg of canakinumab worked better than a sugar pill at preventing bad (adverse) heart (cardiac) events.

You may not have heard about canakinumab unless you’ve been ready nerdy research or have recently attended a heart meeting. This experimental medicine is a MAB (monoclonal antibody) that works against an inflammatory molecoule called interleukin-Beta. The goal of CANTOS was to see how placebo stacked up against canakinumab in people with a history of heart attack (MI) and an elevated high sensitivity C-reactive protein levels (HsCRP).

It appears that the evidence is growing (swelling) for some kind of role of inflammation, but the exact cause of the swelling and the ideal way to lower the swelling and heart attack risk have yet to be clearly decided.

Greeting new Guidelines or should we embrace them and quickly integrate them into practice?

By James Joseph Rybacki, Pharm.D. 1/8/19

You may have noticed that guidelines are updated about every 2-3 years. This gives time for new research to be published, new conferences to reveal the research and of course the busy clinicians who sit on and lead the guideline panels to meet and hash out the facts, levels of evidence and try to anticipate some aspects of what has happened balanced with good clinical approaches.

There are new cholesterol guidelines which were revealed at the November American Heart Association meeting in Chicago. There are a lot of changes. Thresholds where we should take some action, new nomenclature to be sure, yet the changes in the context of the ever-changing studies this make sense.

I plan to try to interview Roger Blumenthal from John’s Hopkins, one of the leaders of the new cholesterol guidelines at the upcoming American College of Cardiology (ACC) meeting in NOLA in March. If it becomes a reality, we will post the video on in late March.

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