NHPs for CVD Flashcards
Which NHPs have CV risk-lowering data from RCTs (2)
Omega-3 fatty acids (fish oil)
Multivitamin
Which NHPs do NOT have CV risk-lowering data from RCTs (3)
Garlic
Soluble fiber
Plant sterols
What are the main fatty acids in omega 3 (2)
EPA (eicosapentaenoic)
DHA (docosahexaenoic)
Which oils have a-linolenic acid (3)
Flaxseed oil
Canola oil
Soybean oil
Which fatty acids family have more thrombotic and inflammatory metabolites? Which oil does it contain?
Linoleic (corn oil, safflower oil, sunflwoer oil)
and arachidonic
(omega-6 family)
MOA of omega-3 for CV risk lowering (3)
- Reduce triglycerides
- Antithrombotic effects
- Mild anti-hypertensive effects
Effects on lipid profile for fish oil (4)
TG
Total cholesterol
HDL
LDL
TG: dec
Total cholesterol: no change
HDL: slight inc
LDL: slight inc
What do older vs newer meta-analyses say for benefit of fish oil to reduce CV risk
Old: benefit
New: no benefit (even in secondary)
- no statistically significant on hard outcomes, stroke or MI
Which trials have “positive” fish oil studies (3)
GISSI-prevenzione (probe)
JELIS
DART
Which trials have “negative” fish oil studies (6)
ORIGIN
OMEGA
Alpha-OMEGA
VITAL (no benefit with VIT D as well)
ASCEND
STRENGTH
GISSI trial
Primary/secondary
Statin/no statin
All secondary
4% on statin
What could be the cause of no benefit for ORIGIN trial
54% on statin
What are cautions to take with fish oil (risks)
- Bleeding with doses greater than 3g/day
- Increased risk of afib
- Increased risk of stroke in primary prevention
What can fish oil be used for?
High triglycerides
(need to take 3-4g/day)
Is multivitamin beneficial in for prevention of CVD in primary and secondary according to Physicians Health Study II
No benefit for primary endpoint
MOA of flaxseed (2)
Reduce total cholesterol
Reduce LDL
MOA of Krill oil (3)
What does it contain
Reduced LDL
Reduced TG
Increased HDL
Contains
- EPA and DHA
- omega-9
- phospholipids
- Vit A & E and other antioxidants
Garlic effects (2)
which drug has the most evidence?
Cholesterol (some show effect, some don’t)
- Dec total cholesterol
- Dec LDL
Blood-pressure lowering (some show effect, some don’t)
- Lower BP by 8/7 mm HG
Most evidence drug: Kwai
Caution with Garlic
May have anti platelet activity
Which extra evidence does soluble fibre have over garlic?
Has observational data in addition to meta-analysis
Soluble fiber MOA
Examples?
Reduced LDL
Reduced total cholesterol
Ex
- psyllium
- beta-glucan
Phytosterols MOA (1)
reduce intestinal cholesterol absorption by displacing cholesterol from mixed micelles
- dec LDL
Mediterranean diet benefit in PREDIMED
Same benefit as statin
- best natural route for decreasing CV disease
What does the GISSI-HF say for fish oil capsule reduction in CV events?
Reduces death and hospitalization
NNT= 50
