Does REDUCE-IT Prove the Triglyceride Hypothesis?

We’ve appreciated for many years that lowering levels of LDL cholesterol directly contributes to reduction in the risk of a cardiovascular event.  However, it has been less clear whether (or to what extent), triglyceride lowering may also contribute to reducing the risk of heart attack, stroke or death from cardiovascular disease.   In our editorial just published in Future Cardiology, we would predict that less than 25% of the cardiovascular benefit observed in the REDUCE-IT trial was directly attributable to triglyceride lowering.   This supports other pleotropic effects of Icosapent Ethyl (Vascepa®) that contributed to the large benefits observed in the study.

In fact, a newly published analysis supports the tenet that lowering of LDL cholesterol has a greater impact in reducing cardiovascular risk than lowering of triglycerides.  That is, a 40 mg/dL reduction in LDL cholesterol corresponded to an approximate 20% reduction in cardiovascular risk whereas a 40 mg/dL reduction in triglycerides only correlated to an 8% reduced risk.   In REDUCE-IT, triglycerides were lowered by nearly 45 mg/dL on average . Therefore, triglyceride lowering  would have only played a modest role when compared to the benefits observed.

Bottom Line: While high triglycerides contribute to increased cardiovascular risk, the benefits observed in REDUCE-IT extend well beyond triglyceride lowering.  In other words, REDUCE-IT to some extent supports, but does not prove the triglyceride hypothesis.

Dr. Michael Miller is a Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  HIs most recent book is “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” now published by Penguin Random House.  

Does REDUCE-IT Prove the Triglyceride Hypothesis?

We’ve appreciated for many years that lowering levels of LDL cholesterol directly contributes to reduction in the risk of a cardiovascular event.  However, it has been less clear whether (or to what extent), triglyceride lowering may also contribute to reducing the risk of heart attack, stroke or death from cardiovascular disease.   In our editorial just published in Future Cardiology, we would predict that less than 25% of the cardiovascular benefit observed in the REDUCE-IT trial was directly attributable to triglyceride lowering.   This supports other pleotropic effects of Icosapent Ethyl (Vascepa®) that contributed to the large benefits observed in the study.

In fact, a newly published analysis supports the tenet that lowering of LDL cholesterol has a greater impact in reducing cardiovascular risk than lowering of triglycerides.  That is, a 40 mg/dL reduction in LDL cholesterol corresponded to an approximate 20% reduction in cardiovascular risk whereas a 40 mg/dL reduction in triglycerides only correlated to an 8% reduced risk.   In REDUCE-IT, triglycerides were lowered by nearly 45 mg/dL on average . Therefore, triglyceride lowering  would have only played a modest role when compared to the benefits observed.

Bottom Line: While high triglycerides contribute to increased cardiovascular risk, the benefits observed in REDUCE-IT extend well beyond triglyceride lowering.  In other words, REDUCE-IT to some extent supports, but does not prove the triglyceride hypothesis.

Dr. Michael Miller is a Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  HIs most recent book is “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” now published by Penguin Random House.  

Tips to Increase Sleep & Lose Weight

Did you know that poor sleep habits are associated with average increases in food intake  of ~250 calories per day?    In other words, sleeping less than 6 hours per night (versus 7-9 hours) for 6 months can result in a weight gain of  ~10-12 pounds, notwithstanding weight that may be added if exercise is reduced because of chronic fatigue!

Below are several tips to help you to increase your sleep time and lose weight in the process!  Make sure to also check out the previous blog on ways to “sleep like a baby” (https://wordpress.com/post/healyourheartbook.wordpress.com/2400).

1. Make dinner a light meal:  Concentrate most of your food intake during breakfast & lunch so that ~75% of your calories are consumed before dinner (rather than the other way around).
2. Don’t eat within 2-4 hours of bedtime: Our minds are trying to relax after a long day, so why rev up our body’s metabolic machinery at night?  This means no snacking after dinner (a 250 calorie snack each night + poor sleep habits can produce a 1 pound weight gain each week).
3. Walk after your dinner meal:  Take a 20-30 minute leisurely walk (weather permitting) after dinner to assist in digestion.
4. Stand & stretch every 20-30 minutes.   Once you head to the couch or recliner, make sure to stand up 2-3 times each hour.  All of these measures will help you sleep better and shed some pounds in the process.
5. Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine. He is also a member of the Nutrition Committee for the American Heart Association and American College of Cardiology.  For more weight losing and sleep gaining tips, check out Dr. Miller’s book, “Heal your Heart”.

 

 

Why Music is Magical for Your Heart

After we published a study that found joyful music to dilate blood vessels (as reported by Reuters, the Star, and other media outlets), advances continue to be made toward understanding why music has magical medicinal properties to benefit your heart and overall health.   If you have the opportunity to listen to a favorite artist perform live on stage (as we did when Paul McCartney, as shown above, toured our area), seize it because listening to music that brings you joy a key to good health because:

1. Joyful Music uplifts Mood: Dopamine is a neurotransmitter and hormone that brings feelings of pleasure.  Recent studies have identified specific areas in the brain that are activated to release dopamine not only when joyful music is played, but also in its anticipation.   In other words,  when you anticipate that the song is about to be played or you’re listening to the first few notes, dopamine is activated from one area; as the song is played, the familiarity activates another dopamine center so you can get a double-dose of dopamine!
2. Music may Improve Cognition:  Listening to music may improve mental focus with greater ability to multitask.  A recent study also found that listening to music combined with physical activity was better than physical activity alone for brain processing activities in older men and women.
3. Playing an Instrument Reduces Risk of Dementia: Playing an instrument reduces the risk of vascular dementia by improving neuroplasticity (or flexibility) of the brain enabling increased ability to listen with greater focus and improved ability to perform and engage in new tasks.
4. Bottom Line: Dust off those old LPs, CDs, guitars, etc and play or listen to your favorite songs.  Or better yet, make a playlist of your favorite music (such as on Spotify), shuffle the songs and enjoy!
5. Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland  and author of “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease“.