Canakinumab for prevention future heart attacks

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Submitted by Dr T on November 1, 2013 – 4:52pm

Dear Doctor,
As a heart attack p-t (and having arrhythmia)I’d like to know your opinion about significance of experimental(approved for different problems) canakinumab injections  to fight inflammation in the body;
whether the issue of inflammation for cardiovascular health itself is overstated, and if not, what inflam. levels are considered to be excessive; and,
whether  this drug (its components), may be considered safe enough to warranty its use for heart patients. In other words, is it safe for a reasonably cautious p-t to try these injections?
Thank you very much for your professional opinion!

Hi Vlad,

Canakinumab treatment is in study, to test the hypothesis that it will prevent recurrent cardiovascular events in patients who sustained a heart attack and who had an elevated hsCRP

It works by decreasing the activity of a protein called interleukin-1 beta, which may help to decrease inflammation. There is as yet no evidence that it will have an effect on the inflammatory component of atherosclerosis, the cause of coronary artery disease.

There is as yet no evidence that it should be used in the treatment of heart disease, and i have no opinion whether it will – way too early!

Meanwhile it is better to concentrate on the other cardiac health factors that will influence your chances of having future cardiovascular events such as heart attack or stroke.

Age, hereditary factors, high cholesterolweight, cigarette smoking, blood pressureexercise history, and diabetes are all important in determining your risk for heart disease.  

Blood tests

The lipid profile measures cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C, “good” cholesterol), and low density lipoprotein cholesterol (LDL-C, “bad” cholesterol). Triglycerides are the major form of fat found in the body and their function is to provide energy for the cells. Below are the desirable ranges for the components of the lipid profile:

  • Cholesterol <200 mg/dL (5.18 mmol/L)
  • HDL-cholesterol > 40 mg/dL (1.04 mmol/L)
  • LDL-cholesterol <100 mg/dL* (2.59 mmol/L)
  • Triglycerides <150 mg/dL (1.70 mmol/L)

Some other blood tests that may be used to assess your cardiac risk include :

  • High-sensitivity C-reactive protein (hs-CRP): Studies have shown that measuring CRP with a high sensitivity test can help identify risk of cardiovascular disease (CVD). This test is different from the regular CRP test, which detects elevated levels of CRP in people with infections and inflammatory diseases. 
  • Lipoprotein A: Lp(a) is a lipoprotein  and is similar to LDL-C but does not respond to typical strategies to lower LDL-C such as diet, exercise, or most lipid-lowering drugs. Since the level of Lp(a) appears to be genetically determined and not easily altered, the presence of a high level of Lp(a) may be used to identify individuals who might benefit from more aggressive treatment of other risk factors

Calculate here your risk of developing coronary artery disease (CAD), stroke and cardiovascular disease (CVD)

All of these contribute to information that your doctor needs to make an optimal recommendation for your care.

Apart from these, if a procedure is considered, your doctor will need to order a variety of tests that may include a chest X-ray, an EKG, lung function tests and urinalysis, as well as a variety of blood tests such as a CBC (your blood count), Coagulation profile (how well does your blood clot), Electrolytes (kidney function), ABG (arterial blood gas) and HIV profile.

Remember this:

  • A heart healthy lifestyle is important in reducing blood pressure, cholesterol, and triglycerides, but sometimes even healthy lifestyle is not sufficient. Some conditions involving elevated lipids levels are hereditary and  medications may needed to reach normal cholesterol levels.
  • Some people are more at risk for a heart attack than others. If you are overweight, smoke, have a high blood pressure or diabetes, abnormal risk test results, and/or have a family history of heart disease, you are at a greater risk.

Hope this helps,

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