Obesity drug Meridia may raise risk of heart attack, stroke, death

The weight-loss drug Meridia may be another example of the treatment being worse than the disease. Early data from a recent study suggests that people taking Meridia (sibutramine) face a higher risk of heart attack, stroke and death than those on a placebo pill. But the Food and Drug Administration isn’t raising a red flag on Meridia just yet. The agency says it is still analyzing the data before drawing any conclusions, but adds that the findings underscore the recommendations on Meridia’s labeling that people with a history of heart problems or stroke should not take it.

In the meantime, we’ve been concerned about the heart risks posed by Meridia for more than a decade, since it was first approved by the FDA in 1997 for the treatment of obesity. We’ve categorized it as a high-risk drug you should avoid if you have heart disease, high blood pressure or other significant health issues that might make you vulnerable.

Ironically, the study in question, which was conducted by Abbott Pharmaceutical, the manufacturer of Meridia, was designed to show that the drug reduced the risk of cardiovascular problems. Approximately 10,000 people who were 55 or older participated in the study. All were overweight or obese and had a history of heart disease or type 2 diabetes, plus one other factor that upped their cardiovascular risk. A preliminary analysis found that 11.4 percent of those on Meridia suffered a heart attack, stroke, or death, compared with just 10 percent of those on placebo.

The FDA said it is conducting an expedited safety review of Meridia and will announce its conclusion when finished. The agency also urged people taking the drug to report any adverse events they’ve experienced to FDA's MedWatch Adverse Event Reporting program.

So if drugs aren’t the answer to losing weight, what are your options? In general, we advise against the use of diet pills because the benefits are often marginal at best and sometimes come with dangerous side effects. Better and safer ways to shed pounds include healthy exercise and diet changes. For more on safe and effective weight loss strategies, compare treatments to see what works best (subscribers only).

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs 

Study adds weight to case against cholesterol drug Zetia

 
Bad news continues to buffet the once-blockbuster cholesterol drug ezetimibe, which is sold under the brand name Zetia. Backing up research released last year, a new study has found that ezetimibe does not reduce fatty build-ups in the arteries, despite lowering levels of "bad" (LDL) cholesterol in the blood. On the other hand, one of the oldest treatments for high cholesterol—the B vitamin niacin—seems to help on both counts, say the researchers.

The study included 363 people with heart disease, or a high risk of the disease, who had been taking drugs called statins for several years to lower their cholesterol. Statins are the usual go-to drug when changes in diet and exercise don't reduce a person's cholesterol enough. But sometimes even statins fall short and people need additional treatment. Ezetimibe was approved by the FDA as a supplemental treatment, and for occasional use on its own, in 2002. Besides Zetia, you can also get a pill called Vytorin that combines ezetimibe with a statin (the earlier research looked at this combined form).

In the new study, half the people took ezetimibe and half took an extended-release version of niacin, in addition to their statin. All had regular ultrasound scans to check the narrowness of the arteries in their necks. The level of build-up in these blood vessels can help predict a person's risk of having a heart attack or stroke.

Q&A: Is an irregular heartbeat dangerous?

I seem to have an irregular heartbeat. Could that be dangerous? —D.S., Lady Lake, Fla. 

It could be. Minor, short-lived variations in heart rate or an occasional "skipped" beat are relatively common and usually completely harmless. But more frequent or sustained irregularities— like a recurrent racing heartbeat, or erratic rhythms that last for more than a few seconds—could indicate several serious problems, including heart disease, an overactive thyroid, or a reaction to certain drugs or dietary supplements. And the irregular rhythms themselves can cause dizziness, fainting, stroke, heart attack, or even sudden death in susceptible people. You should see your doctor right away to determine the cause of the perceived irregularity. If an electrocardiogram doesn’t turn up anything, your doctor will likely have you wear a continuous-recording monitor for at least 24 hours to provide a more complete picture.

Q&A: Co-Q10 supplements for statin safety?

I’ve heard that people on cholesterol-lowering statin drugs should take coenzyme Q10 (Co-Q10) pills to prevent muscle damage. Does any evidence support that? —M.R.V., by e-mail 

Not enough to recommend taking the pills for that purpose. Muscle pain or, rarely, muscle damage is a known side effect of statins, and several studies have found that some of those drugs can reduce natural blood levels of Co-Q10. And extreme deficiencies of the compound can cause similar muscle problems, which then respond to Co-Q10 supplements. But no study has determined whether Co-Q10 reductions actually cause the side effect in statin users. And to our knowledge, only one small, unpublished study has indicated that the pills can relieve that adverse effect. More important, people who experience muscle discomfort while on a statin should talk to their doctor about stopping the drug, reducing the dosage, or switching to a different one rather than taking a supplement to try relieving the symptom, which might signal a more serious problem.

Quit smoking today—and start looking better tomorrow

Fewer wrinkles. Better-smelling breath, hair, and clothing. Healthier teeth and gums. More money in your pocket. An improved sense of taste and smell. A reduced risk of heart disease, stroke, chronic obstructive pulmonary diseases, and cancer of the lungs, cervix, pancreas, throat, intestine, kidneys, and bladder. Most important, up to 10 years added to your life span. Despite these convincing reasons to quit smoking, Americans are not getting the message that smoking can not only shorten your life, but also increase the risk of death in those who come into contact with your secondhand smoke—including your children.

According to a recent study by the Centers for Disease Control, the rate of U.S. smokers in 2008 (20.6 percent) has remained virtually unchanged since 2004, when 20.9 adults reported being smokers. And 20.6 percent translates to 46 million U.S. smokers, 443,000 preventable deaths each year, and $96 billion in annual health-care costs. Hardest hit by the tobacco epidemic are vulnerable populations, including people with lower levels of education.

If you smoke cigarettes, choose to quit today as part of the 34th Great American Smokeout. It’s true that quitting is no simple task—and you may have made several honest attempts before. But considering the damage cigarette smoke does to your looks, on top of your health and the health of those around you, it’s worth another try. Consider these practical ways to help you get started:

Avoid dangerous combination: Blood thinner Plavix with some heartburn drugs

The Food and Drug Administration warned today that people who take the blood thinner clopidogrel (Plavix) should not take the heartburn drugs omeprazole (Prilosec, Prilosec OTC, and generics) and esomeprazole (Nexium) because two new studies confirm that the combination could have dangerous consequences. The studies show that omeprazole and esomeprazole—both members of a class of stomach acid-reducing drugs called proton pump inhibitors, or PPIs—can lower the effectiveness of Plavix , putting people at risk of heart attacks or strokes.

Plavix is given to people after a heart attack to help reduce the risk of blood clots that can trigger another attack. The drug can be hard on the stomach and cause gastrointestinal bleeding, so people are often prescribed a PPI treatment, which reduces the amount of acid in the stomach and lowers the risk of stomach bleeding. But previous studies suggested this drug combination may actually increase the risk of having another heart attack. The FDA’s warning is based on two new studies from the makers of Plavix that show that both omeprazole and esomeprazole reduce the drug’s effectiveness because they block an enzyme in the body called CYP 2C19.

The agency said it does not have enough information to draw a conclusion about whether any other PPIs can be safely used with Plavix, but studies into this issue are being conducted. However, a different type of acid-reducing drug called cimetidine (Tagamet, Tagamet HB, and generics) also inhibits the CYP 2C19 enzyme and should not be taken with Plavix.

What your walking speed can tell your doctor

Doctors are trained fortune-tellers of sorts. But instead of divining the future through tea leaves or Tarot cards, they look to our bodies for clues. If our blood pressure is high, they may warn of heart and circulation problems that could be down the road. Ditto for high cholesterol. But doctors can also draw upon subtler signs — even, for example, our walking speed.

As odd as it may sound, studies show that healthy older adults who walk slowly are at higher risk of falls, disabilities, frequent hospital visits, and other health problems. And, according to a new study, slow walkers also have triple the chance of dying from heart disease, although the reasons aren't yet clear.

The study included 3,208 seniors ages 65 to 85 in France. Each person's walking speed was clocked over 6 meters (almost 20 feet). The researchers then checked on the participants every couple of years. All were in reasonably good health at the start of the study, and didn't have any conditions that could have substantially affected how fast they walked, such as Parkinson disease, dementia, or a disabling stroke.

After five years, 209 people had died, including 99 from cancer, 59 from heart disease, and 51 from other causes (such as infections and respiratory failure). The researchers found that the slowest walkers were three times more likely to have died of heart disease than those who walked at a faster clip. However, they didn't find a link between slow walking and other causes of death, including cancer.

Consumers who took Zetia or Vytorin may get refund

If you took the cholesterol-lowering drugs Zetia or Vytorin in recent years, you may be able to get some of your money back. The manufacturers Merck and Schering-Plough have agreed to a proposed $41.5 million class action settlement over charges they violated consumer protection laws by marketing the drugs as being superior to other cholesterol drugs and selling them at higher prices when, in fact, they are not more effective. Merck and Schering-Plough deny any wrongdoing.

Vytorin has been under fire since last year, when two studies cast doubt on the benefits of the drug, which is a combination of Schering-Plough’s Zetia and Merck’s Zocor. The first was a 2-year study that showed Vytorin was no better than Zocor alone in reducing plaque build-up in arteries. The second was a five year study that showed Vytorin did not reduce strokes or heart attacks compared to placebo, and more alarmingly was associated with a higher incidence of cancer and death from cancer. Earlier this year, the Food and Drug Administration said in a controversial decision that people should continue to take Vytorin because it lowers LDL or "bad" cholesterol more than Zocor alone.

Q&A: Can a low diastolic pressure be harmful?

You recently said that lower-than-normal systolic blood pressure is safe as long as it causes no symptoms. Can a low diastolic pressure be harmful? —C.W., by e-mail

Probably not if your systolic level is normal. But if that level is high, the wide pulse pressure—or the difference between the diastolic and systolic levels— can indicate heart-valve problems, a weakened heart muscle, severe anemia, an overactive thyroid, and other problems. And some research suggests that a low diastolic, by itself, might be dangerous in people with coronary disease. A study of more than 20,000 such people found that a diastolic of 60 millimeters of mercury (mm Hg) or less tripled the risk of death compared with pressures between 71 and 90 mm Hg, independent of the pulse pressure. Diastolics between 60 to 70 mm Hg doubled the risk. If your diastolic is 70 or less, ask your doctor if you should be concerned, especially if you also have a high systolic level or are being treated for coronary disease.

It’s about time for a school lunch makeover

When I read that the Institute of Medicine (IOM) had released new guidelines to improve the nutrition of school lunches, my first reaction was "It’s about time!" The guidelines include setting a maximum number of calories in a meal, lowering the sodium, saturated fat and starchy vegetables, and increasing the amount of fruit, vegetables and whole grains.

Having lived through school lunches of chicken fried steak with cream gravy, mashed potatoes, and a big cup of ketchup as the "vegetable" (thank you Ronald Reagan), I realize that many school cafeterias have made some strides. But placing a largely ignored bowl of apples at the end of the line does little to negate the greasy pizza, and fried chicken patties that usually precede that bowl. And my children have been known to throw at me that a meal of macaroni and cheese with French fries can’t be that bad, since it’s served at the school cafeteria.

One of my brothers tells me that I worry too much. We ate it, and it didn’t kill us. But it is killing us. And it’s setting up our children for a lifetime of poor health. A new national survey released by the Preventive Cardiovascular Nurses Association found that most Americans don’t realize that heart disease risk doesn’t wait until adulthood. The American Heart Association even held a conference this year looking at the dangers of the growing girth of our children. And they are growing—some estimates say that 1 in 3 of our kids are overweight.

Want to quit smoking? Don’t switch to low-tar

It’s amazing the ways in which we sabotage our best intentions. How many bursts of enthusiasm have been lost with the thought "but I’ll just do this first"? If you’ve tried to start an exercise routine, you’ll know how it goes. I’ll start jogging, but I need to buy new running shoes first. I’ll go to the gym, just as soon as I get these chores finished.

Some smokers think that a great first step to quitting smoking is to switch to a lower tar brand first. After all, that means less addictive nicotine, fewer harmful substances, and shows they’re serious about change, right?

Wrong. Studies show that smokers draw more deeply on lower tar cigarettes, so they inhale about the same amount of harmful substances as smokers of higher tar brands. Not only that, but smokers who switch to a lower tar brand are much less successful when they try to quit altogether.

A recent study looked at the smoking behavior of more than 30,000 Americans. The study found that smokers who switched to lower tar brands were more likely to attempt to quit, but less likely to succeed. Only 9 in 100 people managed to quit after switching brands, compared to 17 in 100 who quit without switching first.

Q&A: Can particular foods lower bad cholesterol?

Can particular foods or dietary strategies lower "bad" LDL cholesterol? —A.S., via e-mail

Yes, several. Foods that can help lower LDL include those high in fiber (particularly oat bran, psyllium, and barley) and foods containing added or natural stanols or sterols—plant substances that inhibit the absorption of cholesterol—such as Benecol and Take Control margarines, Minute Maid Premium Heart Wise orange juice, and certain nuts and seeds. Eating two to three servings of soy foods each day may also help. Researchers have found that combining those foods increases their benefits: A diet high in soy protein, fiber, and plant sterols can reduce LDL levels as much as a low-dose statin drug. Other LDL-cutting dietary strategies include reducing saturated fat intake to less than 7 percent of calories, minimizing trans fat, and losing excess weight.

Q&A: Is a noisy heartbeat a sign of something serious?

I’m often awakened by the sound of my own heartbeat. Is that serious? —B.F.S., Niles, Ill.

Probably not. The most likely cause is simply that your mattress is amplifying the sound, especially if you sleep on your left side. If so, try a different position, with your ear not pressed against the pillow or mattress. If that doesn’t help, ask your doctor about anemia or heart-valve disease, both of which can cause an unusually loud pulse as the heart struggles to supply enough blood and oxygen.

Read more on how to keep your heart healthy, and see our information on the benefits and risks of anemia drugs.

8 core reasons to eat more apples

This weekend, I’m headed to the annual apple festival in my city to do my part in honoring this highly-acclaimed fruit. That means tasting as many varieties as my stomach will allow. And that shouldn’t be a problem, since apples are an excellent source of digestion-aiding fiber. Fiber in apples and other fruits provides bulk in the intestinal tract, holding water to cleanse and move food quickly through the digestive system. And just one apple provides as much dietary fiber as a serving of bran cereal.

And the healthful reasons to indulge in this fat-free, tasty fruit don’t end there. Several studies have linked apple nutrients to an impressive range of health benefits. Here are 7 more reasons to bite into an apple this weekend, or whenever:

• Prevent disease. Apples are a natural source of health-promoting phytochemicals that have been found to lower blood pressure and protect against circulatory problems caused by diabetes. Study have also shown the phytochemicals found in apples help keep LDL (bad) cholesterol levels under control.

• Strengthen bones. Apples and apple juice contain the mineral boron, which has been shown to strengthen bones—a good defense against osteoporosis.

• Protect your heart. Apples are a rich source of soluble fiber, such as pectin, which helps to prevent cholesterol buildup in the lining of blood vessel walls, thus reducing the risk of atherosclerosis and heart disease.

Study: Smoking bans cut nonsmokers’ heart attack risk

A new report released this week by the Institute of Medicine confirms that smoking bans do indeed reduce the risk of heart attacks and heart disease associated with exposure to secondhand smoke. In addition, the report, based on data from 11 key studies on heart attack rates, confirms that breathing secondhand smoke increases nonsmokers' risk for heart problems. Those studies found that the incidence of heart attacks dropped anywhere from 6 percent to 47 percent after cities, states, or even whole countries like Italy or Scotland banned indoor smoking.

Exposure to secondhand smoke appears to increase the risk of heart disease by about 25 to 30 percent among nonsmokers, the IOM concluded. And in the United States alone, secondhand smoke is estimated to be responsible for approximately 46,000 deaths from heart disease, 3,400 lung cancer deaths, 150,000 to 300,000 lung infections, including pneumonia and bronchitis in children, an increase in the severity of asthma attacks from about 200,000 to 1 million in children with asthma, and more than 750,000 middle ear infections in children.

Back when Consumer Reports investigated the risks associated with secondhand smoke in 1995, the idea that secondhand smoke could cause heart disease was still under debate. At the time, just five states had outlawed smoking in the workplace. Today, 25 states, plus the District of Columbia have such laws, and the connection between secondhand smoke and heart disease is no longer in doubt--thanks in large part to the ability of researchers to track the incidence of heart attacks and heart disease before and after such bans.