Sunday, December 13, 2009

Red Yeast Rice to treat high cholesterol?

From Geriatric Pharmacy Intern Yariagna Rollan Pharm.D(c)
University of Florida College of Pharmacy

Statins (3-hydroxy-3-methylglutaryl coenzyme A or HMG-
CoA reductase inhibitors) are the most effective medications to lower low-density lipoprotein (LDL) cholesterol or bad cholesterol and the risk of cardiovascular events. Although generally well tolerated, many patients taking statins may experience adverse effects including statin-associated myopathy and rhabdomyolysis, elevated liver enzyme levels, and gastrointestinal symptoms. In older adults there is a higher risk of cardiovascular events due to accumulated coronary atherosclerosis and also an increased risk for severe myopathy not only from statins but from fibrates as well.

Statin-associated rhabdomyolysis is a rare, life-threatening condition, with a rapid breakdown of skeletal muscle that leads to the release of muscle fiber contents (myoglobin) into the bloodstream causing weakness and diffuse muscle pain. Myoglobin is a protein that is harmful to the kidneys and may result in Acute Kidney Failure. Rhabdomyolysis is dose related and there is no alternative treatment for patients who still require management for hyperlipidemia.
In some cases is possible to reduce the dose of the statin or completely discontinue the medication. However, each patient needs to be treated as an individual, considering the necessary goals in order to continue to reduce the risk of cardiovascular events.

Red yeast rice is the fermented product of the yeast species Monascus purpureus that grows on rice. It could be used as an alternative treatment for patients with statin associated myopathy. It is a readily available dietary supplement that has been used for centuries in China and helps decrease LDL cholesterol levels. Red yeast rice contains monacolin K, a strong HMG-CoA reductase inhibitor. Recent studies have reviewed the effectiveness, safety, and tolerability of red yeast rice in patients with ages ranging from 21 to 80 years of age and with a history of myopathy related to the use of statins.

The studies have shown reductions of approximately 18% of total cholesterol, 22% of LDL cholesterol, and 7% reduction of serum triglyceride levels. No significant effect was seen on high-density lipoprotein (HDL) cholesterol levels or good cholesterol. Most importantly there was no significant difference found between the red yeast rice and placebo groups in adverse events and muscle pain. Further studies are required in order to recommend this treatment as an alternative. There are still concerns with toxicity and the ability of red yeast rice to lower cardiovascular related events effectively. Consult your pharmacist before starting any supplement.

Thursday, December 3, 2009

Obesity and Risk for Heart Disease

From Geriatrics Student Dana Ross Pharm.D.(c)
Palm Beach Atlantic University School of Pharmacy

Researchers found that obese patients were two times more likely to develop heart disease and related conditions than their normal-weight counterparts. Researchers looked at patients for 5 years in the United States in office visits. They monitored disease progression and onset of obese patients versus normal weight individuals by chart reviews for certain disease states. These disease states included diabetes, hypertension, and dyslipidemia.

The study looked at patients BMI (Body Mass Index) to classify their weight category.
Investigators claim to have confirmed a correlation between obesity and heart disease related diseases. They found patients with obesity to be at greater than double the risk for developing chronic disease states, specifically relating to coronary, or heart conditions and health.

These findings are important for the medical community because obesity is such a growing health problem in the United States, the Centers for Disease Control says obesity is found in greater than 33% of American adults! This will open the publics eyes about obesity and its health risks and hopefully spark some changes.

Fish Oil Supplement Safe to Use with Other Antiplatelets?

From Geriatric Pharmacy Intern Phuong Pham, PharmD(c)
University of Florida College of Pharmacy

Patients with cardiovascular disease typically are prescribed an anti-platelet drug, called Plavix, in combination with aspirin, to prevent the formation of blood clots. However, several studies have shown a small increase in the risk for major and minor bleeding when this combination is used. Omega-3 fatty acid, or fish oil, have been popular among consumers as a dietary supplement to lower triglycerides and as a secondary prevention of heart disease. It also has an anti-platelet property, similar to Plavix and aspirin, which raises concern about the increase risk of bleeding. In a study done by Pauline D. Watson and her colleagues at Drexel University College of Medicine in Philadelphia, they set out to study the effects of taking high-dose fish oil, Plavix, and aspirin to see if the addition of fish oil further contributes to an increase risk of bleeding when taken with the other two antiplatelets. They reviewed the medical records of 182 patients, most with coronary artery disease, being treated with high-dose fish oil (mean dose 3 g), aspirin (mean dose 161 mg), and Plavix (mean dose 75 mg), and 182 patients of similar age and gender being treated with aspirin and Plavix alone. During an average follow-up of 33 months, the researchers found one major bleeding episode in the fish oil group, no major bleeding in the control group, four minor bleeding episodes in the fish oil group, and seven minor bleedings in the control group. However, the results were not significantly different between the fish oil and control group. The authors concluded that high-dose fish oil is safe in combination with aspirin and Plavix and does not increase the risk of bleeding compared with that seen with aspirin and Plavix alone.