Why expensive Zetia. Niacin appears to outperform Zetia.

http://www.webmd.com/cholesterol-management/news/20091116/niacin-tops-zetia-in-cutting-artery-plaque

While in this study the expensive Niaspan was used, you can by Slo-Niacin dirt cheap.

http://www.costco.com/Browse/Product.aspx?Prodid=11118583

Why do insurance companies pay for Lovaza? They are usually very picky and Lovaza would seem an obvious "soak" job?

How did it get on approved drug lists?

Dr. Davis,

Your correspondent should tell his brother to ditch the Zetia too. The research makes it clear it does not prevent heart attack and may worsen health. Statins appear to be helpful because of their impact on inflammation, not because they lower LDL cholesterol. Zetia lowers cholesterol in a mechanical way that has no impact on inflammation.

Why is a 44 year old being subjected to open heart surgery? Quacks.

As an internist not categorically opposed to statins (although I agree with starting with nutrition first, which is why I read this blog), there are generic alternatives for this person's brother. If my patients need Western drugs, I start with cheap generics whenever possible. Zetia has dubious benefits of ANY kind, and costs a fortune. And of course Dr. D is right that there are many cheaper sources of fish oil; I usually point my patients in that direction.

I often feel "standard" American-style medical practice is intended to waste as much money as possible. People need to be able to trust their docs to execute plans that are not only based on the research evidence, but are cost effective. There is no culture of cost-effective medicine in this country, because health care was defined by the Americans as a for-profit arena.

"Prescribe unto others as you would have them prescribe unto you."

Lovaza fills a void created by bad government and insurance policy. According to IRS rules, over the counter supplements cannot be covered by many insurance handlers. My work's HSA is like this. Fish oil / omega-3 is technically considered an over the counter supplement. The folk making Lovaza more than understand the benefits of omega-3 and want to sell it to the folks who want their insurance to pay for it. So they made it into a "drug" and sell it as such. It's a brilliant marketing plan and it seems to be working for them. The sad part is that it is working! It shouldn't! Same thing goes with Lovastatin. Why not take a good red yeast rice? Oh well... you pay for what you don't know.

-- Boris

Your post, Dr Davis, seems more a call for better health care, the kind we here in the United Kingdom get under our National Health Service, than a call for different fish oils or different meds.

The NHS does have it's problems, sure, but they're nothing like the problems this person you describe has.

It's ironic that her brother is trying to be a "good" American by paying his bills and not filing bankruptcy.
If only his doctors, insurance companies, and drug mNUFcturers had a similar ethic.  It seems that for them, being a good American is maximizing their income regardless of who they take it from.
Ordinary Americans have been sold this "good" American concept from birth.  It's propaganda.  Far too many special interests have used it to enrich only themselves.

Your brother should not be paying anything for drugs to lower cholesterol.

Cholesterol is not the enemy, nor is saturated fat.

The real enemy is chronic inflammation that comes from several sources but mainly from a high grain diet (too much omega 6).

Please, read http://www.omega-3-fish-oil-wonders.com/good-fats.html

Best wishes,
Alfredoe

I have read with interest the comments concerning Lovaza. I was put on it in 2008. I have tried numerous times to ask GSK through emails & ph calls the calorie make up in the gelcap. No one seems to know! Not the Doctor who put me on it, the pharmacist, or anyone from GSK!!! As a diabetic who has lost 140 lbs, following my diet plan is very important to me. Any suggestions on who can make them give up the big calorie secret?
Thanks,
Beverly

Had this reader not been aware that her brother could take fish oil as a nutritional supplement, he likely would have been denied the benefit of omega-3 fatty acids in slashing the risk for recurrent cardiovascular events. You and I can buy wonderfully safe and effective fish oil as a nutritional supplement, but there won't be a sexy drug representative to sell it, nor an expensive dinner and payment for a trip to Orlando to hear about it.

Beverly,
A rough estimate for the caloric content of each Lovaza capsule would be approximately 8-10 calories.  Since each capsule contains roughly 1 gram of total fat.

Some thoughts I have about the causality vs. correlation. Those studies that show correlation with increased mortality /disease with sleep times longer than 9 hours per day could suggest that people with deseases sleep longer because of the disease?  Not that longer sleep periods them selfs are the cause of the disease and early death but a sign of troubles in health which need more time for the body to trying to recuperate?

I personally sleep between  7 - 9 hour per day if I can rest up to my taste, but if I'm stressed I sleep less and if I'm sick I sleep more.

(Sorry for possible spelling mistakes, I'm not native english speaker.)

WBR:
JVAS

Anon--

Excellent point.

In fact, I wonder if greater sleep need is, for many, a red flag for hypothyroidism, in addition to other conditions.

Brain study shows differences in night owls, early risers
Last Updated: Tuesday, June 23, 2009 | 5:36 PM MT  
CBC News  

Scientists at the University of Alberta have found there are significant differences in the way our brains function, depending on whether we are early risers or night owls.

Using magnetic resonance imaging-guided brain stimulation, neuroscientists tested muscle torque and the excitability of pathways through the spinal cord and brain.

"We found that the brains of morning people are more excitable in the morning and evening people are completely opposite," neurophysiology researcher David Collins said Tuesday.

"The evening people ... it's almost a perfect storm of excitability in the central nervous system, where the brain is maximal in the evening and the spinal cord is maximal in the evening.... They generate the most force in the evenings," he said.

David Collins, neurophysiology researcher at the University of Alberta (CBC) "Morning people ... their brains are most excitable in the morning, but their spinal cords are most excitable in the evening," Collins said.  

The results may suggest that morning people are performing below their maximum possible level at all times of the day because of this, he said.
Morning person may be steadier

If you could change morning people into evening people, maybe their performance would be best in the evening, he suggested. This doesn't mean it's necessarily better to be an evening person, he said.

"A morning person may be a more consistent, steady plodder over the course of the day," Collins said.

Kaitlin Cleveley, a sports performance researcher at the U of A, likes to begin work around 10 p.m. and go until 3 a.m.

"Anything that starts in the morning is absolutely brutal for me to try and get up and try and function," she said. This study brings new perspective to training, she said.

"It's about trying to peak the athlete.... It can help to set up a sleep program, and it can help to reduce jet lag and sort of help you to determine you know 'When should I book the flight?, When should I get there?'" Cleveley said.

The research has lots of applications, including understanding mental and physical peaks and how people can maximize performance, she said.

Initially the research was to determine if brain function changes over the day, Collins said.

The study evolved with some early findings around two subjects in the study. One proved to be an extreme morning person, the other an extreme evening person, he said.

How does napping fit into this?  Does napping count in the "hours per night" or is it separate?  Any statistics on mortality and napping?

A lot of cultures have an afternoon siesta but Americans tend to frown on napping.

A close family member just underwent double bypass surgery in the past few weeks (doing well now, though it took a blood transfusion to get over a 2 day slump while in the hospital), after more than a year of symptoms with exertion,  poor stress test results, a lot of career stress recently, etc.  None of us were told though until just before the recent angiogram.   I always viewed this situation as a "when", not an "if", because I had a different view than the AHA's, but it's always "too soon", even if expected.

The angiogram revealed multiple sites of stenosis in locations not suitable for stents, so double bypass was performed.

Aside from family history (her father died of CVD at age 50), there were other risk factors, so she faithfully followed most of the AHA guidelines since at least the 80s - regular chol panels (high results), statins, HRT, low fat/high chol, reduced saturated fat, reduced fat dairy, lean meats, lots o' carbs (even lots of whole grains), etc.  

But obviously, this didn't work (I think it's a recipe for a bypass), because  CVD happened anyway despite all this adherence to  "prevention" (I use that word loosely in this context).  

Other risk factors include tendency toward "apple" shape, "strong explosive" personality (sort of Type A), and as I suspected, diabetes (though that was concealed from the family until just before the surgery).  On top of that ...(drum roll)...

and pertinent to this post - 25+ years of working the third shift as a nurse in L & D.  She was *chronically* and noticeably sleep-deficient (very often apparent, even over the phone), not to mention also Vitamin D deficient (her calcium supplement only added a tiny amount).  The coronary calcium scan wasn't done until last year, when there was marked plaque and shortness of breath & fatigue symptoms.  Of course no program such as Track Your Plaque was suggested or undertaken.  It was fate, right? - the family history - nothing could be done to override that, right? Note: if you are reading this with a sarcastic tone, that's about right .

Talk about an AHA failure to prevent. Everything I've  I shared about about the AHA's misguided approach to prevention, low carb and grain restriction to manage BG and diabetes, and all the other ways to prevent CVD fell on deaf ears.  Still does.  Still keeping my fingers crossed that the bypass arteries don't clog up.