West Newsmagazine 4-5-17

44 I HEALTH I
April 5, 2017
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A low level of “good” cholesterol may be a risk factor for having a heart attack
at a younger age, a new study shows.
health
capsules
Bringing doctors’ drug
company payments to light
While a majority of U.S. adults visit
a doctor who receives payments from
drug and medical device companies, few
patients are aware that such payments
exist, according to a new Drexel University
study conducted jointly with Stanford
and Harvard universities. About 65 percent
of those surveyed for the study had
visited a doctor within the last year who
had received payments or gifts from those
companies, while just 5 percent of them
knew that their doctor had received such
payments.
Among respondents who saw certain
types of specialists, the likelihood of those
doctors’ having received payments was
even higher. For example, orthopedic
surgeons visited by 85 percent of those
surveyed had received payments, and
obstetrician/gynecologists seen by 77 percent
of survey respondents had received
payments.
The nationwide study included a representative
sample of more than 3,500 adults
whose doctors were linked to data from
Open Payments, a government website
set up under a “sunshine” provision of the
Affordable Care Act that reports pharmaceutical
and device industry payments to
physicians. Its intent is to make such payment
information publicly available and
transparent to patients.
“These findings tell us that if you thought
that your doctor was not receiving any
money from industry, you’re most likely
mistaken,” said Genevieve Pham-Kanter,
Ph.D., an assistant professor in Drexel’s
Dornsife School of Public Health. “Patients
should be aware of the incentives that their
physicians face that may lead them to not
always act in their patients’ best interest.
And the more informed patients are about
their providers and options for care, the
better decisions they can make.”
Low “good” cholesterol common
in young heart attack patients
A high level of “bad” cholesterol, or LDL-
C, has long been considered a risk factor
for heart attacks and strokes, because it
indicates that arteries may be clogged with
dangerous deposits called plaque. However,
a recent small study found that men
under the age of 45, and women under 50,
who suffer heart attacks are far more likely
to have abnormally low HDL-C, or “good”
cholesterol, than elevated bad cholesterol.
In the bloodstream, HDL-C acts like a
scavenger, scouring the arteries to get rid
of excess fat and bad cholesterol, reduce
inflammation and prevent blood clots.
For that reason, healthy levels of HDL-C
[defined as above 40 mg/dL in men and
above 50 mg/dL in women] may be protective
against heart attacks.
In this study, researchers at Harvard
Medical School reviewed billing data
and medical records at two large medical
centers, and identified 813 younger
men and women who had been treated for
heart attacks over the past 16 years. The
patients’ average age was 48; 38 percent
were women.
“In this study of younger heart attack
patients, low HDL-C was the most
common abnormality, seen in approximately
90 percent of the men and 75 percent
of the women,” said Bradley Collins,
a fourth-year student at Harvard and the
study’s lead author. “This finding suggests
that low HDL-C should be considered a
marker of increased heart attack risk in
younger patients particularly.”
The researchers said their results show
that low HDL-C levels in younger patients
should prompt their physicians to recommend
preventive measures, including
lifestyle changes, improved control of
glucose and blood pressure, and use of
medications to lower LDL-C. Combining
all these measures together can lead
to significant improvement in overall cardiovascular
health, Collins said. HDL-C
is considered a “modifiable” risk factor
for heart disease – meaning adults can
potentially increase their HDL-C by giving
up smoking, maintaining a healthy weight,
being more physically active, and eating
more fruit and vegetables while avoiding
unhealthy fats. The study was presented at
the American College of Cardiology’s 66th
Annual Scientific Session in March.
Opioids and kids
Use of opioids by young people, both
accidental and otherwise, resulted in more
than 188,000 calls to U.S. Poison Control
Centers from January 2000 through
December 2015, averaging one call every
45 minutes, according to a newly published
study.
Overall, most of the opioid exposures
leading to those calls occurred among
children younger than five years of age
[60 percent], followed by teenagers [30
percent]. The medications which prompted
the most calls were hydrocodone [29 percent],
oxycodone [18 percent] and codeine
[17 percent].
The reason for, and the severity of, the
children’s exposures varied by age. Among
young kids, the vast majority of the drugs
were accidentally ingested, tended to have
less serious outcomes and were able to be
managed at home. Among teenagers, on
the other hand, more than two-thirds of
the exposures were intentional. Teens also
were more likely to be admitted to a hospital
and to experience serious outcomes than
younger children. An especially alarming
statistic the researchers noted was the
more than 50 percent increase in the rate
of suspected opioid-related suicides among
teenagers during the 16-year study period.
One piece of good news is that the
number of exposures to most prescription
opioids has been steadily declining
in recent years. However, a notable
exception as far as calls to poison control
centers are concerned is buprenorphine, a
narcotic medication primarily used to treat
people for addiction to heroin and other
opioids. While exposures to most opioids
have declined, pediatric buprenorphine
Calls to U.S. Poison Control Centers involving
kids taking opioids averaged one every 45
minutes between 2000 and 2015.