Monthly Archives: July 2016

Drugs May Work Better Together Than Apart

In a new study of a class of cholesterol lowering drugs called PCSK9 inhibitors—which received much fanfare recently for lowering cholesterol to unprecedented levels —doctors wanted to know how they would work if taken along with statins, the gold standard for treating high LDL cholesterol. Do the drugs, which both work on cholesterol receptors in the liver but in slightly different ways, combine forces to lower LDL even further than either alone? Or do they negate each other’s effects, only producing as much reduction as either one alone?

Dr. Steven Nissen, chair of cardiovascular medicine at Cleveland Clinic, and his colleagues report the answer to those questions in a report in JAMA and in a presentation at the American Heart Association annual meeting. Among nearly 1,000 people with heart disease in six countries, they found that the combined effect of the PCSK9 inhibitor evolocumab and a statin lowered LDL dramatically — more than either drug alone. And that reduction came with a possible heart benefit — the drug combination also shrunk plaques that had been building up in the heart vessel walls of these people.

“The question was, could we do better than giving a statin alone, by giving the combination,” says Nissen. “And at the end of 18 months, we found [among the people taking the combination], there was less plaque than what the patients started with.”

All of the people in the study had at least one partially blocked major heart vessel, as well as other heart disease risk factors including a previous heart attack, unstable angina, type 2 diabetes, hypertension or were smokers. All were being treated with a statin to lower their cholesterol. For 18 months, they continued with their statin but about half were randomly assigned to receive evolobumab, a PCSK9 inhibitor, while the remaining people took a placebo. All also had ultrasound images taken of their heart at the start of the study and again toward the end to measure if and how much their plaque changed.

About 64% of people taking the combination of cholesterol-lowering drugs had their heart plaques shrink during the study, compared to 47% of those taking placebo. That suggests that the two-drug regimen might reverse atherosclerosis and potentially even avert some heart events by dissolving the fatty buildup that causes them.

“This study shows that for people with difficult-to-control cholesterol, we are beginning to accumulate evidence that there are drug options for them to not only lower cholesterol but to improve the health of their arteries,” says Nissen. “That’s new information.”

Survive the Holidays With a Narcissist

Your mother wants to tell you how wrong you are for, well, everythinginvolving your kids. Or your aunt wants to pry into your love life—and insult you about your single status. Maybe it’s a friend who needs to one-up you about everything (you just went away for the weekend? She’s planning on taking a luxurious tropical vacation. And flying first class). Or, your sister needs all the attention on her and throws a fit when she doesn’t get it.

Welcome to the holidays, the time of year when you’re forced to spend quality time with all the narcissists in your life.

While only 6% of the US population is thought to actually have narcissistic personality disorder, narcissism is really on a spectrum. “I think all of us have people in our family that meet some of the criteria for being a narcissist,” says Karyl McBride, PhD, licensed marriage and family therapist and author of Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers. (Learn the signs someone you know—or even you!—might be a narcissist.)

When you’re heading out to all the holiday parties and gatherings this year, you don’t have to run away from your narcissistic mother, uncle, or family friend. Here’s how to face them head on:

Don’t fight back

As hard as it can be, you shouldn’t try to compete with a narcissist. “Remember that they’re usually driven by an unconscious sense of shame or inferiority,” says Joseph Burgo, PhD, author of The Narcissist You Know: Defending Yourself Against Extreme Narcissists in an All-About-Me Age. For that reason, if you fight back, you’ll lose—and may make an enemy, he says. You can’t choose your family members, so it’s best to listen politely, then excuse yourself and join another conversation. But a friend? “You might want to look for different friends who take an interest in you, too,” Burgo says. Now that’s honesty. (Here are the two routes to a friend breakup.)

Remember this one word

Narcissists have a way of surprising you with their meanness. “They’re not in touch with their own feelings, so if they’re having a bad day, they’ll project that onto other people,” explains McBride. Whether they give you a backhanded compliment or deliver an outright insult, don’t get sucked in. Instead, shrug your shoulders and say this one word: “Interesting.” That’s McBride’s favorite go-to response when something comes at you out of the blue and you need time to think without reacting. It shows them that, nope, you’re not taking the bait and they can’t get to you.