Unsuccessful Fertility Therapy Has Modest Impact on Heart Disease Risk
Women who undergo treatments to help them conceive but who do not become pregnant have a slightly higher risk of heart disease later in life than women who do have a child after fertility treatment, according to a new study. Some media coverage emphasized the increased risk. However, the risk is small and should not cause undue concern, cautioned researchers from the Institute for Clinical Evaluative Sciences (ICES), in Ontario.
The study followed almost 30,000 women under the age of 50 who underwent fertility therapy between 1993 and 2011, with an average number of three treatment cycles. About one-third of the women gave birth within a year of their final treatment. Of the two-thirds who did not give birth, the risk of having a cardiovascular event such as heart attack, stroke or heart failure was about 10 per 1,000 women over the 10 years after fertility treatment. For women who did give birth, the risk was about 6 per 1,000 over the same period of time.
“We don’t want to alarm women who undergo fertility therapy; we are instead suggesting that as women age, they should stay mindful of their health and remind their physician about any fertility therapy years earlier,” said Donald Redelmeier, MD, of ICES in an accompanying press release. “It can be an opportunity for their doctor to review other risk factors for heart disease and discuss ways to protect against future cardiac problems.”
Prescriptions for Walking Boost Activity Levels and Improve Health
A new study is the first to show that providing a prescription for a number of daily steps along with a pedometer to track progress improves patient health. Guidelines recommend that people walk at least 10,000 steps daily for health benefits, but many Canadians find this target difficult to meet. “As physicians, we have to face reality and admit that for many patients, just telling them to be more physically active simply doesn’t work,” said Kaberi Dasgupta, MD, in a press release from the Research Institute of the McGill University Health Centre.
Dr. Dasgupta and her colleagues enrolled 347 patients with type 2 diabetes, high blood pressure, or both into a randomized trial testing prescribed step counts. Half of the participants only received standard advice to move more while the other half received written step-count prescriptions and a pedometer.
After a year, participants who received the written prescriptions walked an average of 1,200 more steps per day than participants in the control group. Among patients with type 2 diabetes, those in the step-count prescription group also had reduced blood sugar levels and improvements in insulin resistance. The results were encouraging, though fell below the researchers’ goal of increasing steps by 3,000 per day. The McGill team is currently planning studies of additional interventions to further increase daily activity.
Mid-life Cardiac Risk Factors Increase Risk of Later Dementia
Risk factors for heart disease—such as smoking, high blood pressure and diabetes—found in middle-aged patients increase their risk of developing dementia later in life. Diabetes in particular was found to increase this risk as much as the strongest known genetic risk factor for Alzheimer’s disease, according to research presented at the American Stroke Association’s 2017 International Stroke Conference.
Researchers from the Johns Hopkins University looked at data collected from more than 15,000 people enrolled in the Atherosclerosis Risk in Communities (ARIC) study, beginning in 1987. Participant ages ranged from 45 to 64 at the start of the study. Over the course of ARIC, 1,516 participants developed dementia. The researchers found that the risk of dementia was 41% higher in people who had smoked in middle age, 39% higher with high-blood pressure at midlife and 77% higher in people with mid-life diabetes.
Since the study only observed people over time, it did not directly test whether treating these risk factors in mid-life could reduce the risk of developing dementia. However, “If you want to protect your brain as you get older, stop smoking, watch your weight, and go to the doctor so diabetes and high blood pressure can be detected and treated,” said Rebecca Gottesman, MD, PhD, lead author of the study, in a press release from the meeting.
New Drug Reduces Risk of Cardiovascular Events
A new drug called evolocumab, given along with statin therapy to patients with existing heart or vascular disease, significantly reduces the risk of a cardiovascular event, including heart attack, stroke, the need for angioplasty or bypass surgery, and death. This finding was presented at the American College of Cardiology’s (ACC) Annual Scientific Session in March.
Evolocumab is one of a new class of drugs called PCSK9 inhibitors. They block the activity of the PCSK9 molecule, which, in turn, increases the body’s natural ability to remove cholesterol from the blood stream. PCSK9 inhibitors work independently of the commonly prescribed statin drugs to reduce LDL cholesterol. Patients from 49 countries who enrolled in the FOURIER clinical trial had blood cholesterol levels that put them at risk for cardiovascular events despite taking an optimal dose of a statin. More than 80% had already experienced a heart attack.
Over an average of about two years, patients who received evolocumab injections plus a statin in the trial had a 15% lower risk of any cardiovascular event compared with patients receiving a statin plus placebo injections. Evolocumab also reduced LDL cholesterol levels by an average of 59% and did not cause additional side effects compared with statin therapy alone.
Although longer-term follow up is needed, “We now have definitive data that by adding evolocumab to a background of statin therapy, we can significantly improve cardiovascular outcomes and do so safely,” said Marc Sabatine, MD, the study’s lead author in a press release from the ACC. This improvement comes at a steep price, however: evolocumab, approved by Health Canada in 2015, costs more than $7,000 to $9,000 per patient per year in Canada, and substantially more in the US.