Coronary Flow Reserve measurements with PET imaging are the gold standard for identifying CAD.

Dr. K Lance Gould weighs in on NIH Niaspan study cancellation

Posted by Scott under Education, Guest Doc Topic, MI:Journal, PET News

The following is an excerpt from the Summer 2011 issue of, “The Weatherhead P.E.T. Imaging Center for Preventing and Reversing Atherosclerosis’s” newsletter called, “P.E.T. News”.

New study about HDL cholesterol Treatment
The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has stopped
a clinical trial studying a blood lipid treatment 18 months earlier than planned. The trial found that adding high
dose, extended-release niacin to statin treatment in people with heart and vascular disease did not reduce
the risk of cardiovascular events, including heart attacks and stroke. This report has prompted lots of calls from patients wondering whether they should continue taking Niaspan.

Before taking any action based on this study alone, we always take a careful look at how the study was conducted and how it compares to other studies looking at the same issue. The results of this study are CONTRARY to several other large randomized trials that show a substantial benefit from raising HDL cholesterol. The data on the recent Niaspan trial has not been published in the medical journals yet so that it cannot be adequately evaluated.

However, several points stand out as follows:
1. The study showed no harm, but was stopped due to a reported lack of benefit without specific data provided
until this fall.
2. The patients selected had weighted average baseline LDL of 74 and HDL of 34. The HDL increased by 20%
to approximately 41 with Niaspan. Thus, the baseline lipids were not as severe as we commonly see in patients
with higher LDL, higher triglycerides and lower HDL. The study failed to achieve our HDL target of 45 to
50mg/dl and also failed to achieve the lipid and weight goals of our program.
3. The randomized, well done, definitive FATS and HATS trials of triple therapy including niacin showed
an 80% to 90% decrease in coronary events, the greatest benefit of any treatment ever reported for coronary artery disease and nearly double the benefit from statins alone.
4. Niaspan also changes the LDL and HDL particle size to the larger fluffier cholesterol particles such that
the larger LDL particles are less atherogenic and the larger HDL particle size provides more effective reverse
cholesterol transport out of atheroma thereby lowering atheromatous risk.
5. No drug therapy is a substitute for healthy food, lean body weight and exercise. The healthy living combined
with drug treatment to correct all lipid abnormalities is more effective than either approach alone, as shown in
the randomized HATS and FATS trial as well as the nonrandomized trial at the University of Texas.
We are not advising our patient to stop Niaspan as a result of these news reports. A large body of scientific data
indicates that Niapsan combined with other medications is beneficial, not contravened by the recent news reports.

Combined medications and healthy living as outlined above provide the best outcomes as we emphasize in our
program. Further analysis of the study will be conducted when it is available.

Read the full issue of P.E.T. News by clicking the following link. PET News Summer 2011

An Introduction to Coronary Artery Disease and The Weatherhead PET Imaging Center

Posted by Scott under PET News

Coronary Heart Disease is the most common form of heart disease in this country and the primary cause of heart attacks. It is the single largest killer of American men and women resulting in more premature deaths than any other illness, more than cancer and accidents combined. In men, the first symptom of heart disease is commonly a heart attack and 50 percent of firsttime heart attacks are fatal causing more than 550,000 deaths each year commonly in the prime of life. Almost everyone has heard a story of some strong vital hardworking man who suddenly drops dead just as he was settling into retirement or finished paying off his mortgage. This man most likely had no symptoms prior to the attack, that was caused by sudden plaque rupture of mild cholesterol deposits in the walls of his coronary arteries.

Women develop coronary artery disease somewhat later in life and “catch up” with men by 65 to 70 years old when deaths due to coronary heart disease are comparable to or greater than men.

The Weatherhead PET Imaging Center for Preventing and Reversing Atherosclerosis is dedicated to the primary prevention of death and disability from heart disease. We accomplish this in two steps: First, detecting heart disease early with PET imaging, the most sensitive and accurate noninvasive test for finding early heart disease. Second, by educating people and implementing lifestyle changes and medications to correct the causes of heart disease in the people at highest risk for it.