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HOUSE CALL WITH DR. SANJAY GUPTA
Is Rimonabant a Miracle Drug for Both Weightloss, Cardiovascular Health?
Aired November 13, 2004 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ELIZABETH COHEN, HOST: Good morning and welcome to HOUSE CALL. I'm Elizabeth Cohen in for Dr. Sanjay Gupta. Checking the headlines, while the CDC says flu season is off to a slow start, New York City is trying to buy doses of flu vaccine from Europe. The Big Apple joins Illinois, which has already secured 200,000 doses from European suppliers.
And the safety of yet another arthritis drug has been called into question. Researchers say early studies show taking the drug Beckstra more than doubles the risk of heart attack and stroke in patients with heart disease. Pfizer, the maker of Beckstra, says the conclusions are unsubstantiated and based on information that's not published in a medical journal.
As winter approaches, researchers are warning people are more likely to have heart problems when the temperature drops suddenly or when air pollution levels are high. Doctors say stress on the heart could be the trigger. This is just one of the stories coming out of the American Heart Association conference this week.
Heart disease is the focus of today's show. This week's conference brought some big news. From vitamins, to new drugs and the foods we eat, lots of studies came out in the hopes of better understanding and fighting this deadly disease.
Our Christy Feig takes a look at just some of this week's big stories.
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): For years, millions of Americans have taken Vitamin E, the anti-oxidant thought to help reduce the risk of heart disease and some cancers. But a new study now says that taking high daily doses of the popular supplement may actually be doing more harm than good.
ELISEO GUALLAR, DR. JOHNS HOPKINS: For people who are taking 400 international units or more per day, we estimated that they have between a 4 to 6 percent increased mortality.
FEIG: Researchers found no adverse affects in daily doses of 200 international units or less. While they are not sure why a high dose increases mortality, the data suggests there is an increased risk of internal bleeding and stroke. And a new combination drug used for the treatment of congestive heart failure may become the first race-based medicine to hit pharmacy shelves. In a clinical trial with 1,050 black patients by deal, a pill that combines medication for both blood pressure and chest pain, proved to be an effective treatment for blacks with heart disease. Researchers found a 43 percent reduction in deaths among blacks taking Bidil. And only 16 percent required hospitalization for heart failure, a reduction of one-third.
Studies have not been done on white patients. And some experts say it's too early to say if Bidil works better on one race than the other.
And one pill that has everyone talking is the experimental weight loss drug Rimonabant. Trial participants taking 20 milligrams of the drug for a year lost an average of 20 pounds and nearly three and a half inches off their waist. And experts say the pill could also help manage other cardiovascular risks.
ALICE JACOBS, DR., AMERICAN HEART ASSOCIATION: Not only was it effective in this study in reducing and maintaining weight loss, but it has a favorable effect on other risk factors, as well, such as blood lipids and glucose.
FEIG (on camera): Still the American Heart Association says a pill is not a substitute for recommended lifestyle changes.
Christy Feig, CNN, Washington.
COHEN: Thanks, Christy.
Heart disease causes one out of every five deaths in this country. That means one person will die every minute from some kind of coronary event.
Here to bring us up-to-date on all the latest treatments and prevention in heart disease is Dr. Mehmet Oz. He's a cardiac surgeon and director of the Cardiovascular Institute at Columbia University.
MEHMET OZ, CARDIAC SURGEON: Great to be here, Elizabeth.
COHEN: Doctor, some people are calling Rimonaband a super pill. Others are saying the weight loss it brings on isn't all that dramatic. Christy talks about 20 pounds, but they started at over 200 pounds. What do you think?
OZ: Well, 20 pounds of weight loss is a lot. But what I like about this drug are two things. First, it works in a very different way from other drugs that try to get you to lose weight. In fact, it works on the same receptor that causes the munchies. For those of you who shouldn't have but did try pot, it's the same principle that if you can block that receptor, you won't be as hungry. You won't eat as much.
I also like the fact that in the studies, it seems to affect not just the obesity, but the side effects of obesity. Remember, it's not being fat that causes heart attacks necessarily. It's the fact that obesity causes high blood pressure, high cholesterol, high blood sugars. And these secondary problems then lead to hardening of the arteries.
COHEN: Now doctor, you founded the complimentary medicine program at New York Presbyterian Medical Center. What do you make of this new Vitamin E study?
OZ: Well, the Vitamin E study shed somewhat light on the problem of vitamin supplements, because they are used quite frequently without adequate data.
But let's be cautious in not over interpreting this data. It's a meta analysis. And that's basically a book report of other studies that have already been done. And in doing this book report, they left out studies in which fewer than 10 people died. So they don't have as comprehensive a list of patients that could have been included.
On the other hand, it is interesting to note that there was no benefit of taking Vitamin E. And although they only generally used vitamin supplements that had synthetic E with only one of the many variants of E, it is important for people watching this program to realize that we shouldn't be encouraging you to take more than 200 international units of Vitamin E with the expectation of health benefits. It may, however, with more appropriate and larger studies be shown to be true.
COHEN: Now doctor, you brought something with you called a heart stocking. This is not something you hang on the fireplace at Christmastime. It is not a fashion accessory. So what exactly is it?
OZ: Well, this heart stocking was actually one of the most exciting things at the American Heart Association. And it looks like a stocking, like a cap, but it fits around the heart. And by doing that, it prevents the heart from over enlarging.
So let me give you a little bit of cocktail conversation. When you blow a balloon up, the reason it gets easier as you keep blowing is because the larger the balloon gets, the easier it is for the balloon, because there's pressure on it so expand.
The same thing happens to the heart. Once the heart starts to get large, which is what happens in heart failure, it just gets -- keeps getting bigger and bigger and bigger.
This stocking restrains the heart and prevents it from getting larger. And when used in a large study, in fact, it was the largest surgical device study done by surgeons, it was clear evidence that it reduces the incidence of the need to get a heart transplant or mechanical heart.
This information is of great value to physicians studying heart failure because it's one additional clue that helps us think differently about the heart.
Remember that most folks grow up thinking the heart empties blood the way that balloon evacuates air. That's not right. The heart twists blood out the same way you'd wring a towel to get water out. So when you lose that mechanism as you do in heart failure, you might be able to reshape the heart to look more like a football, using this stocking, than a basketball.
COHEN: In another development this week, Dr. Oz, there was some evidence that a new drug is showing promise for African-Americans who are suffering from heart disease. The drug reduced death in those studies by more than 40 percent. Now this is the first major drug trial to test a medicine specifically on African-Americans. The pill really sounds like quite a breakthrough. Can you explain to us why would a drug work differently in a black person than perhaps in a white person?
OZ: Well this fascinating story starts 20 years ago when there was a study using the same combination of drugs that showed no benefit. But some very bright researchers went back and looked at the data and said you know what? African-Americans seemed to benefit from this drug, even if the white people in the trial didn't. So they went back and they repeated the study. And this was a little controversial, because they only included African-Americans in the study.
But sure enough, they proved that there was a dramatic reduction in deaths from heart failure, the same problem that the stocking was treating but they could do it with medications. In fact, they estimate there will be about 15,000 lives a year saved by using this drug.
But here's the interesting part to me. We talk a lot about the differences between people. The reality is there are probably some differences between races that we tend to try to ignore because it's not the right thing to talk about. But in science, it's science. And so we got down to nitty gritty and looked at the effect of this drug on black people. It seemed to show a benefit.
This may, in fact, become the first FDA-approved drug to work predominantly in black people. And that's an interesting change because it's one more step on the path of medicine to customize care for each of you individually.
COHEN: And there was another study, doctor, about fiber that showed that it can boost the effects of cholesterol-lowering statin drug. Researchers found that when patients took three fiber supplements a day, their cholesterol went down just as much as if they'd had a double dose of the statin drugs.
Doctor, should everyone be upping their fiber?
OZ: The average American takes between 3 and 10 grams of fiber a day. You should be taking about 25 grams of fiber. And we know that from numerous large studies showing that it helps reduce the instance of heart disease. This is an important brick in that foundation, once again emphasizing that you ought to take three doses of fiber supplement a day or eat lots of food with fiber, which are predominantly the foods that your mother told you to take when you were a child.
COHEN: Well, we've got a lot more news to talk about, including foods that could save your life. That and more coming up.
(BEGIN VIDEO CLIP)
ANNOUNCER: Most women who die suddenly from a heart attack don't recognize their symptoms. Coming up, we'll tell you what to look for.
Plus, looking to jumpstart your exercise program? We'll give you some tips.
First, take today's "daily dose" quiz. True or false, you should start having your cholesterol checked at age 20. The answer when we come back.
ANNOUNCER: Checking the "daily dose" quiz, we asked, true or false, you should start having your cholesterol checked at age 20? The answer, true. Experts recommend cholesterol checks every five years, starting at age 20.
COHEN: Heart disease is the number one killer of men and women in this country. But according to the American Heart Association, only 13 percent of women consider heart disease their greatest health risk.
Making sure we understand all of these risks is Dr. Mehmet Oz, a cardiac surgeon and director of the Cardiovascular Institute at Columbia University.
Let's take an e-mail now, a question from Rhonda in Ontario, who wants to know, "What are the symptoms of an impending heart attack that women should be aware of? If there's absolutely no history of heart disease in the family, what is the likelihood of a woman having a heart attack?"
Doctor, the classic male sign of having a heart attack is crushing chest pain. Do women need to be on the lookout for different signs?
OZ: Women often have very different constellation of symptoms when they have heart problems. And by the way, for men as well, we often think, well, if I don't have crushing substernal chest pain, it's not a heart attack. That's only true in about half the cases.
For both genders, the reality is the heart doesn't have any fibers that cause pain. It's the fibers of the heart crossing those in the spine that make it seem like you have chest, or arm pain, or chin pain. So look for abnormal pains that aren't the kinds that you usually get. For example, pains in your stomach. Also, shortness of breath is a very big sign that people often ignore. It's a very important one for us, because it shows that the heart is not beating that strongly.
But at the end of the day, many folks never have any pain before they have a heart attack, which is why these check-ups are important.
COHEN: So in the movies when the guy collapses clutching his chest, doesn't always happen that way?
OZ: I wish it did, but the reason there's so many lawsuits in emergency rooms is because people come in with weird symptoms that doctors can't figure out.
COHEN: Well, we've got another question now from Richard in Michigan, who writes, "15 months ago, I had a single stent put into the main coronary artery, which was 90 percent blocked. Will this stent have to be replaced someday?"
First, let's explain a few things. A stent is a mesh tube used to prop open an artery that's been clear of plaque.
Doctor, is there any kind of maintenance that's needed once you have that stent put in there?
OZ: Well, for both stents and heart surgery, the most important predictor of how you'll do is how well you reduce your risk factors. The good news for folks who have stents is that now that they are coated, they're less prone to creating the kinds of irritation that would cause them to close in past years.
So coated stents are actually giving quite good results, especially if the stent has been in place for more than six months. But at the end of the day, the best way to make sure that stent stays open, and this is true for bypass surgery patients as well, is to make sure that the risk factors that caused the blockage in the first place are taken care of.
COHEN: We've got time for one more question. Andrea from Indiana wants to know, "Can you please tell me what the deciding factors are in a choice between stenting blocked arteries and doing bypass surgery?"
Dr. Oz, there are really three options out there, as you know. Obviously, stenting, bypass surgery, and angioplasty, which is putting a balloon in to open the artery instead of a stent. How do you choose between the three?
OZ: Well, Elizabeth, I want to add a fourth option. And I'm a surgeon and I like to heal with steel. The reality is that the fourth option is medical management, which is often very effective for a lot of blockages that are not in life threatening areas.
The way we break down which of the interventions we use is based mainly on where the blockages are and what is the chance that we would hurt you badly if our attempt to open the artery failed.
In areas where the stent or the angioplasty can work successfully, it is tried first. If the lesion is in a life threatening place that cannot be safely accessed, then we try to do surgery.
Stents, by the way, work better than angioplasty because that mesh does hold the vessel open, but there's some places where you can't place a stent which is why sometimes folks get angioplasty or ballooning.
COHEN: Let's get to an e-mail now from Gary from Virginia. "As a patient with blocked arteries, I wonder if there's a treatment on the horizon that can eat away the plaque that makes up the blockage in my arteries?"
Well, doctor, wouldn't that be wonderful?
OZ: Well, in fact, although people often come to my office and say doctor, do you have Drano for my arteries so I can clean them out? The reality is we have something similar to that that's in trials. It's developed from an observation made by folks in Italy that there was a family with very low, good cholesterol, or HDL cholesterol. And by cloning that gene and by making a new drug from it, they can now give us a drug that we think will elevate the good cholesterol and that seems to eat away at that plaque.
But essentially, the most important thing you can do is forget about the plaque and focus on the artery. Everyone worries about the blockage within the tube. Make the tube itself bigger. And you can do that with some of the medications that physicians give you, but as well with exercise and diet.
COHEN: Well, we've been talking about battling heart disease. Coming up, we'll talk about ways to prevent it. Plus more of your questions straight ahead.
ANNOUNCER: Coming up on HOUSE CALL, how low should you go with your cholesterol to keep heart disease at bay?
Plus ways to prevent a family history of heart disease from becoming your future.
First, more of this week's medical headlines in "the pulse."
FEIG: The U.S. Surgeon General said this week that tracking your family's history of high blood pressure, diabetes and other conditions can help your doctor predict your future health risk. Dr. Richard Krohmanan (ph), the Department of Health and Human Services declared Thanksgiving 2004 the first annual National Family History Day and released a computer program to help families keep track of medical history.
And if you had a peanut allergy as a kid and had outgrown it, there's a slight chance that it may come back. But a new study from Johns Hopkins University followed 68 children between the ages of 5 and 21 and found that eating peanut products at least once a month can help those people who have overcome their peanut allergies stay allergy-free.
Christy Feig, CNN, Washington.
COHEN: Welcome back to HOUSE CALL. Those are just some of the things you can control to help prevent heart disease, but you also need to check your numbers, your blood pressure, your good cholesterol, your bad cholesterol.
We're talking with heart surgeon Dr. Mehmet Oz, this morning. We have lots of e-mails lined up, so let's just jump right back in. Robert from North Carolina wants to know, "My good cholesterol level is very low. When is low too low? What are the best treatments for low good cholesterol?"
Doctor, what can Robert do to raise his level of good cholesterol?
OZ: Well, you want your good cholesterol to be more than 40. So they're out there pulling the cholesterol out of your arteries and cleansing your body. The best way to elevate your good cholesterol is exercise and niacin, which is a B vitamin that's actually first line therapy for high, bad cholesterol also.
COHEN: Doctor, we should point that people should aim for HDL or good cholesterol, as you said, above 40. And their LDL, or the bad cholesterol, should be less than 100. Now these numbers are going to be different if you're considered to be a high risk patient.
One way to drop that bad cholesterol may be through the foods you eat. New research shows that in increasing certain types of healthy fats not only lowers your cholesterol, but also may decrease C- reactive protein, a measure of inflammation in your blood vessels.
Doctor, tell us about these healthy fats. What are they?
OZ: These healthy fats are called Omega 3 fats. And a good example of them are walnuts, and almonds, and flax seed oil. And they work in several important ways. But most importantly, they help effectively lubricate your arteries. And they prevent some of the irritating fats from creating irritating substances that cause sudden blockages of arteries.
And one more important factor. Don't focus on the cholesterol. That's not where the game is won and lost. It's won and lost by how the cholesterol is carried. That's the so-called good and bad cholesterol you just spoke of. Those are the numbers you should memorize.
COHEN: We have another question now from Jennifer in North Carolina. "What preventative measures can a person with several risk factors take? I'm a 31-year-old woman. Both of my parents had heart attacks in their 40s and my mother's was fatal. Are there any accurate tests that can be done to detect what a person's risk is?"
Doctor, can Jennifer have any kind of DNA test to see if she's headed in her mother's path?
OZ: We have a couple of tests that we're playing with, but we don't really have a great solution to these answers anyway. So there's not a lot of effort that's spent trying to find out whether she has a clear genetic defect.
However, she's a wonderful candidate for some of the large trials that are being done. And I would encourage her specifically to check to see if she has a homocysteine problem, which is a breakdown product of proteins that can be easily taken care of by taking folic acid.
COHEN: We've got to take a quick break now. More HOUSE CALL coming up.
ANNOUNCER: Been putting off getting back to the gym? Our bod squad gives you some pointers to get you moving.
Plus, more ways to find out all about the heart news we've been talking about. That's just ahead.
COHEN: Welcome back to HOUSE CALL. An important part of keeping your heart healthy is exercise. But for many of us, just getting moving can seem overwhelming.
UNIDENTIFIED FEMALE: You guys are so fabulous.
COHEN (voice-over): When it comes to starting an exercise program, one of the biggest obstacles is just getting the motivation to get moving. Health experts recommend at least half an hour of exercise five days a week.
But for the two-thirds of Americans who are overweight or obese, sudden exercise can be more than challenging. It can be potentially dangerous. The heavier you are, the greater your risk of diabetes, asthma, arthritis, high blood pressure and cholesterol. Carrying extra weight around the middle or thighs may also increase the risk of sports injuries because of the stress on the joints.
The American Council on Exercise advises getting into fitness exercise gradually, but consistently. Experts suggest incorporating simple lifestyle changes, like walking more and climbing stairs, instead of taking the elevator to make exercise feel seamless. The key is to start moving in the right direction for your health.
COHEN: As we've said, exercise is a key ingredient in prevention. And another is staying informed. To do that, head to the American Heart Association's Web site at americanheart.org. You can sign up for free newsletters or find information on everything from warning signs to diet. Another site to click on, 4woman.gov. That's the National Women's Health Information Center.
Now that's all the time we have for today.
Dr. Oz, thank you so much for joining us.
OZ: Great to be here.
COHEN: Well, make sure to tune in next week. We're taking an inside look at the craziness of raising multiples, including a family with nine children. How do they do it?
E-mail us your questions at email@example.com. You won't want to miss that show. That's next weekend on HOUSE CALL, 8:30 a.m. Eastern.
Thanks for watching. I'm Elizabeth Cohen. Stay tuned for more news on CNN.
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