Cardiologists may one day have a new tool to help prevent heart attacks and strokes in some high-risk patients: a prescription drug that contains large doses of EPA, an omega-3 fatty acid contained in fish oil.
A large clinical trial found that the drug, called Vascepa, sharply reduced the rate of cardiovascular events in people with a history of heart disease or Type 2 diabetes, according to early results that were announced on Sept. 24.
The findings were particularly relevant for people with high triglycerides, a type of fat in the blood that has been linked to an increased risk of heart disease.
The new trial, called Reduce-IT, focused on people whose cholesterol levels were well-controlled with statins but whose triglyceride levels remained very high. Many cardiovascular experts were doubtful that adding fish oil on top of statins would produce much if any benefit because a number of smaller and less rigorous studies over the years had failed.
But the new trial showed that statin-treated adults with elevated triglycerides who were prescribed high doses of the purified EPA had a 25% reduction in their relative risk of heart attacks, strokes and other cardiac events compared to a control group of patients who received placebo.
“I’m very surprised by the magnitude of the results, which quite frankly are large,” said Dr Michael J. Blaha, the director of clinical research at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Medical School, who was not involved in the study. “My expectations were very low. A lot of people are legitimately surprised by this.”
Fish oil has long been a popular supplement to protect against heart disease. It contains high levels of omega-3 fatty acids, primarily EPA and DHA, which reduce inflammation and lower triglyceride levels. Omega-3 fatty acids also have blood-thinning effects similar to those of aspirin.
But until now most of the clinical trials that have looked at fish oil in heart patients had not found convincing evidence that it helps.
Some argued that the trials were deeply flawed, saying they relied on doses that were too small or that they failed to recruit the patients who were most likely to benefit, like those with high triglycerides. Some of the studies were observational, which are less rigorous than clinical trials, in which different groups of patients receive different treatments. They also used various types of fish oil.
The new trial differed from previous ones in a number of ways. It focused specifically on two groups of high-risk patients: people with a history of cardiovascular events, such as heart attacks, strokes and angina; and those with Type 2 diabetes and other risk factors like high blood pressure. The patients also had to have high triglycerides.
The median baseline level of triglycerides among the subjects was 216 milligrams per decilitre — well above the cut-off for what is considered a normal level, which is 150 milligrams per decilitre. In addition, all of the patients were on statins, which lower cholesterol.
The intervention in this trial, which was sponsored by Amarin, was not the typical fish oil supplement that can be purchased at any supermarket or pharmacy.
Vascepa is a prescription drug that contains highly purified EPA. Fish oil supplements, on the other hand, often contain a mixture of both EPA and DHA and in some cases other oils as well.
EPA and DHA are similar but have slightly different effects. Both can lower triglycerides, for example, but DHA also tends to raise LDL cholesterol, the so-called bad kind associated with heart disease.
The trial enrolled 8,179 adults and followed them on average for about five years. In addition to lowering cardiovascular events, the trial found that Vascepa was safe and well-tolerated.
Amarin announced the findings on Sept. 24 and is expected to present the full results and data at an annual American Heart Association conference in November.
Dr Ethan Weiss, a cardiologist and associate professor at the University of California, San Francisco, who was not involved in the study, said that the findings confirm the role that high triglycerides play in heart disease but that they nonetheless came as a shock because so many earlier trials of fish oil found little or no benefits. He pointed to several caveats: He and others need to see all of the data, and the patient population that is likely to benefit from Vascepa is very specific. Diet and exercise can also lower triglycerides — especially very low carbohydrate diets — and whether the outcome on heart risk might be similar to the effect produced by Vascepa should be studied, he said.
“Lots of questions remain,” he said. “But the takeaway is that this is really big and I was wrong. And I am happy I was wrong and am excited we have a new pathway and set of tools to explore for our patients.”
Some experts cautioned that Vascepa is not for everyone who has heart disease or risk factors for it. The drug is currently approved for certain patients with unusually high triglyceride levels.
“The worried well shouldn’t run out and take fish oil,” said Dr Michael Shapiro, a site investigator for the Reduce-IT trial and the director of Oregon Health and Science University’s atherosclerosis imaging program. But the group that is likely to benefit includes a large proportion of patients in heart clinics.
“The amount of people around the world who have atherosclerotic disease or diabetes who take a statin and still have elevated triglycerides is enormous,” he said. “This has huge implications.”
Public officers above 58 years and with pre-existing conditions told to work from home: The Standard
Head of Public Service Joseph Kinyua. [File, Standard]
In a document from Head of Public Service, Joseph Kinyua new measure have been outlined to curb the bulging spread of covid-19. Public officers with underlying health conditions and those who are over 58 years -a group that experts have classified as most vulnerable to the virus will be required to execute their duties from home.
However, the new rule excluded personnel in the security sector and other critical and essential services.
“All State and public officers with pre-existing medical conditions and/or aged 58 years and above serving in CSG5 (job group ‘S’) and below or their equivalents should forthwith work from home,” read the document,” read the document.
To ensure that those working from home deliver, the Public Service directs that there be clear assignments and targets tasked for the period designated and a clear reporting line to monitor and review work done.
SEE ALSO: Thinking inside the cardboard box for post-lockdown work stations
Others measures outlined in the document include the provision of personal protective equipment to staff, provision of sanitizers and access to washing facilities fitted with soap and water, temperature checks for all staff and clients entering public offices regular fumigation of office premises and vehicles and minimizing of visitors except by prior appointments.
Officers who contract the virus and come back to work after quarantine or isolation period will be required to follow specific directives such as obtaining clearance from the isolation facility certified by the designated persons indicating that the public officer is free and safe from Covid-19. The officer will also be required to stay away from duty station for a period of seven days after the date of medical certification.
“The period a public officer spends in quarantine or isolation due to Covid-19, shall be treated as sick leave and shall be subject to the Provisions of the Human Resource Policy and procedures Manual for the Public Service(May,2016),” read the document.
The service has also made discrimination and stigmatization an offence and has guaranteed those affected with the virus to receive adequate access to mental health and psychosocial supported offered by the government.
The new directives targeting the Public Services come at a time when Kenyans have increasingly shown lack of strict observance of the issued guidelines even as the number of positive Covid-19 cases skyrocket to 13,771 and leaving 238 dead as of today.
SEE ALSO: Working from home could be blessing in disguise for persons with disabilities
Principal Secretaries/ Accounting Officers will be personally responsible for effective enforcement and compliance of the current guidelines and any future directives issued to mitigate the spread of Covid-19.
Uhuru convenes summit to review rising Covid-19 cases: The Standard
President Uhuru Kenyatta (pictured) will on Friday, July 24, meet governors following the ballooning Covid-19 infections in recent days.
The session will among other things review the efficacy of the containment measures in place and review the impact of the phased easing of the restrictions, State House said in a statement.
This story is being updated.
SEE ALSO: Sakaja resigns from Covid-19 Senate committee, in court tomorrow
Drastic life changes affecting mental health
Kenya has been ranked 6th among African countries with the highest cases of depression, this has triggered anxiety by the World Health Organization (WHO), with 1.9 million people suffering from a form of mental conditions such as depression, substance abuse.
Globally, one in four people is affected by mental or neurological disorders at some point in their lives, this is according to the WHO.
Currently, around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.
The pandemic has also been known to cause significant distress, mostly affecting the state of one’s mental well-being.
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With the spread of the COVID-19 pandemic attributed to the novel Coronavirus disease, millions have been affected globally with over 14 million infections and half a million deaths as to date. This has brought about uncertainty coupled with difficult situations, including job loss and the risk of contracting the deadly virus.
In Kenya the first Coronavirus case was reported in Nairobi by the Ministry of Health on the 12th March 2020. It was not until the government put in place precautionary measures including a curfew and lockdown (the latter having being lifted) due to an increase in the number of infections that people began feeling its effect both economically and socially.
A study by Dr. Habil Otanga, a Lecturer at the University of Nairobi, Department of Psychology says that such measures can in turn lead to surge in mental related illnesses including depression, feelings of confusion, anger and fear, and even substance abuse. It also brings with it a sense of boredom, loneliness, anger, isolation and frustration. In the post-quarantine/isolation period, loss of employment due to the depressed economy and the stigma around the disease are also likely to lead to mental health problems.
The Kenya National Bureau of Statistics (KNBS) states that at least 300,000 Kenyans have lost their jobs due to the Coronavirus pandemic between the period of January and March this year.
KNBC noted that the number of employed Kenyans plunged to 17.8 million as of March from 18.1 million people as compared to last year in December. The Report states that the unemployment rate in Kenya stands at 13.7 per cent as of March this year while it stood 12.4 per cent in December 2019.
Mama T (not her real name) is among millions of Kenyans who have been affected by containment measures put in place to curb the spread of the virus, either by losing their source of income or having to work under tough guidelines put in place by the MOH.
As young mother and an event organizer, she has found it hard to explain to her children why they cannot go to school or socialize freely with their peers as before.
“Sometimes it gets difficult as they do not understand what is happening due to their age, this at times becomes hard on me as they often think I am punishing them,”
Her contract was put on hold as no event or public gatherings can take place due to the pandemic. This has brought other challenges along with it, as she has to find means of fending for her family expenditures that including rent and food.
“I often wake up in the middle of the night with worries about my next move as the pandemic does not exhibit any signs of easing up,” she says. She adds that she has been forced to sort for manual jobs to keep her family afloat.
Ms. Mary Wahome, a Counseling Psychologist and Programs Director at ‘The Reason to Hope,’ in Karen, Nairobi says that such kind of drastic life changes have an adverse effect on one’s mental status including their family members and if not addressed early can lead to depression among other issues.
“We have had cases of people indulging in substance abuse to deal with the uncertainty and stress brought about by the pandemic, this in turn leads to dependence and also domestic abuse,”
Sam Njoroge , a waiter at a local hotel in Kiambu, has found himself indulging in substance abuse due to challenges he is facing after the hotel he was working in was closed down as it has not yet met the standards required by the MOH to open.
“My day starts at 6am where I go to a local pub, here I can get a drink for as little as Sh30, It makes me suppress the frustration I feel.” he says.
Sam is among the many who have found themselves in the same predicament and resulted to substance abuse finding ways to beat strict measures put in place by the government on the sale of alcohol so as to cope.
Mary says, situations like Sam’s are dangerous and if not addressed early can lead to serious complications, including addiction and dependency, violent behavior and also early death due to health complications.
She has, however, lauded the government for encouraging mental wellness and also launching the Psychological First Aid (PFA) guide in the wake of the virus putting emphasis on the three action principal of look, listen and link. “When we follow this it will be easy to identify an individual in distress and also offer assistance”.
Mary has urged anyone feeling the weight of the virus taking a toll on them not to hesitate but look for someone to talk to.
“You should not only seek help from a specialist but also talk to a friend, let them know what you are undergoing and how you feel, this will help ease their emotional stress and also find ways of dealing with the situation they are facing,” She added
Mary continued to stress on the need to perform frequent body exercises as a form of stress relief, reading and also taking advantage of this unfortunate COVID-19 period to engage in hobbies and talent development.
“Let people take this as an opportunity to kip fit, get in touch with one’s inner self and also engage in reading that would help expand their knowledge.