TIME Heart Disease

New Class of Cholesterol Drugs Shows Promise For Heart Disease

The experimental drugs show promise, but medical experts remain cautious

Experimental drugs intended to lower cholesterol may also significantly reduce the risk of heart attacks and strokes, according to two new studies.

New research published in The New England Journal of Medicine show that a new class of cholesterol drugs, called PCSK9 inhibitors, may not just lower levels of bad cholesterol, but may also reduce the likelihood of adverse heart events.

The two drugs, evolocumab (under development by Amgen) and alirocumab (under development by Sanofi and Regeneron) appeared to reduce the risk of cardiac events like heart attack by around half, according to new studies.

PCSK9 inhibitors keep levels of low-density lipoprotein (LDL) cholesterol in the blood in check. In some cases they’ve shown to be even more effective than statins, one of the most prescribed drug categories. The experimental drugs are given by injection.

As the New York Times reports, it’s still too early to tell whether the drugs could be used to prevent adverse heart disease events, and the initial studies were only meant to assess the safety of the drugs as cholesterol moderators. Many in the medical community want to see more data.

The drugs have long been shown to be effective at lowering cholesterol, but there may be more widespread use if they also significantly lower heart attack and death risk. Reuters reports that both companies have already submitted their drugs for approval by the U.S. Food and Drug Administration (FDA).

Both studies were presented at the American College of Cardiology annual meeting.

TIME Heart Disease

Statins May Seriously Increase Diabetes Risk

128585544
Getty Images

Statins can lower cholesterol and even tamp down inflammation to keep the risk of heart disease down. But these commonly prescribed drugs may increase the risk of diabetes, and by a considerable amount

Doctors may have to weigh a serious potential risk before prescribing statins, the cholesterol-lowering drugs that are among most prescribed drugs in America. In a study published in Diabetologia, scientists from Finland found that men prescribed statins to lower their cholesterol had a 46% greater chance of developing diabetes after six years compared to those who weren’t taking the drug. What’s more, the statins seemed to make people more resistant to the effects of insulin—which breaks down sugar—and to secrete less insulin. The impact on insulin seemed to be greatest among those who started out with the lowest, and closest to normal, levels of blood glucose. And the higher the dose of the statin, and the longer the patients took them, the greater their risk of diabetes.

Previous studies have suggested that statins can raise blood sugar levels, and increase the risk of diabetes by anywhere from 10% to 20%, but none have documented an effect this large. Doctors often consider statins for patients who are at higher risk of heart disease, and one of the risk factors for future heart trouble is diabetes. So how do these results affect that decision?

“It’s a good news-bad news scenario,” says Dr. Robert Eckel, past president of the American Heart Association and professor of medicine at University of Colorado School of Medicine. “Although there is convincing evidence that patients on statins are at increased risk of new-onset diabetes, the benefit accrued [from statins] in reducing risks of heart attack, stroke and fatal heart disease trumps the effects of being new onset diabetics.”

In other words, the good that statins can do for people who are not yet diabetic but at higher risk of heart problems outweighs the increased risk of diabetes.

MORE New Guidelines for Cholesterol Treatments Represent “Huge Change”

And while the increased risk that the Finnish scientists found — 46% — is noteworthy, Eckel points out that the study involved only white men, and therefore may not be generalizable to a broader population. It’s not clear what the men’s family history or personal history of diabetes was; some may have had other risk factors for the disease that put them at higher risk of developing diabetes anyway, even if they didn’t take a statin.

Those who developed diabetes while taking statins were similar on many metabolic measures to those who developed diabetes but weren’t taking statins, suggesting that “that statin treatment increased the risk of diabetes independently of the risk profile of the background population,” the authors write. In a separate, U.S.-based study on statins, researchers found that those who went on to develop diabetes while taking statins also had risk factors for the disease before they started taking the medications.

MORE Should You Take Statins? Study Says Heart Benefits Outweigh Diabetes Risk

Which means that for confused patients, and their doctors, the current advice about who should take statins doesn’t change. The results, in fact, highlight the need for a discussion rather than just working through a checklist before prescribing statins. For patients who may not yet be diabetic, but are vulnerable to developing the disease and also may need a statin, Dr. Neil Stone, lead author of the 2013 American College of Cardiology and American Heart Association cholesterol guidelines, says he stresses the importance of lifestyle changes in diet and exercise.

“If you have a patient who is prone to developing diabetes, you’re getting into a higher risk group, because they also have risk factors associated with heart disease. So they have the potential to benefit from statins. If they are going to take a statin, I tell them we are going to help you get more fit, and work with your lifestyle. It’s even more important because if you don’t do that, and the patient decides to take the statin and go on with their unhealthy habits, then they are going to be even more prone to developing diabetes,” says Stone.

The patient’s family history of diabetes is another important part of the decision to start someone on a statin. It’s all about making sure that each patient’s risks and benefits are weighed carefully. And the potentially greater risk of diabetes created by statins should be part of that consideration. “Communication here is everything,” says Eckel.

Read next: New Hormone Discovered That Curbs Weight Gain, Diabetes Just Like Exercise

Listen to the most important stories of the day.

TIME Diet/Nutrition

5 Things You Should Know About Cholesterol

butter
Getty Images

Recent research shows no substantial relationship between the consumption of dietary cholesterol and blood cholesterol levels

Cholesterol seems to be one of those words that’s in everyone’s vocabulary, but many of my clients are incredibly confused about what cholesterol is, and how it affects their health. It also happens to be buzzing in the media at the moment, thanks to a new report from the Dietary Guidelines Advisory Committee, a group of top nutrition researchers who advise the government about what and how Americans should be eating.

If you’re feeling a little perplexed by all this cholesterol talk, here’s a simple breakdown of what you really need to know.

Cholesterol is only found in animal-based foods

There are two types: dietary cholesterol and blood cholesterol. Dietary cholesterol is the cholesterol found in foods, and only foods of animal origin contain it, because animals’ bodies naturally produce this waxy, fat-like substance. So when you eat an animal-based food (think eggs, dairy, meat, seafood) you’re ingesting cholesterol that an animal’s body produced. Plant-based foods do not contain any cholesterol, so if you see a jar of nut butter marked “cholesterol free” know that they didn’t remove the cholesterol—it just wasn’t there to begin with.

Read more: 16 Most Misleading Food Labels

Cholesterol is essential for your health

Even if you ate zero animal foods, you’d still have cholesterol in your body. That’s because your liver produces cholesterol and it’s needed for several key functions, including the making of hormones, vitamin D, and substances that help you digest food. While cholesterol is vital, it isn’t considered to be an essential nutrient, meaning something you must obtain from foods, like vitamin C or potassium. That’s because your body produces all of the cholesterol it needs.

Read more: 27 Mistakes Healthy People Make

There are “good” and “bad” types of cholesterol in your blood

The two types of blood cholesterol you hear about most often are HDL (the “good” kind; think happy cholesterol) and LDL (the “bad” kind; think lousy cholesterol). HDL and LDL are actually carriers of cholesterol called lipoproteins. HDL is good because it carries cholesterol away from arteries and back to the liver, where it can be removed from your body. LDL—the bad type—has the opposite effect. Too much LDL can lead to a build-up, which clogs and narrows arteries, and creates inflammation. This chain of events can lead to a sudden rupture, which sends a clot into the bloodstream, causing a heart attack and/or stroke.

Read more: 9 Subtle Signs You Could Have a Heart Problem

Dietary cholesterol may not impact blood cholesterol as much as previously thought

The old thinking was that consuming dietary cholesterol added to the cholesterol that your body naturally produces, thus raising the amount in your blood. This was perceived to be risky, because too much blood cholesterol has been shown to up the risk of heart disease, the top killer of both men and women. One often-cited statistic is that every 1% increase in total blood cholesterol is tied to a 2% increase in the risk of heart disease.

For many years, the Dietary Guidelines for Americans recommended that dietary cholesterol should be limited to no more than 300 mg per day. To put that in perspective, one egg yolk contains about 185 mg, three ounces of shrimp contains about 130 mg, two ounces of 85% lean ground beef about 60 mg, and one tablespoon of butter about 30 mg. The brand new report eliminated this cap, however, because the committee believes that the research shows no substantial relationship between the consumption of dietary cholesterol and blood cholesterol levels. As such, they concluded, “Cholesterol is not a nutrient of concern for overconsumption.”

Read more: 14 Things Heart Doctors Tell Their Friends

The new guidelines aren’t carte blanche to other kinds of animal fat

Nearly every media outlet covered the release of the report from the Dietary Guidelines committee, zeroing in on the omission of cholesterol limits—but that doesn’t mean it’s now healthy to go out and down cheeseburgers and pepperoni pizzas. The committee is still concerned about the relationship between blood cholesterol and saturated fat from foods like cheese.

You may have heard about another recent report, which concluded that a lower intake of saturated fat wasn’t linked to a lower risk of heart disease. That’s true, but it’s not the whole story, because the risk really lies in what you replace the saturated fat-laden foods with. When people curb saturated fat, but eat more carbohydrates, they lower protective levels of “good” HDL cholesterol, and drive up triglycerides (a type of blood fat), a combo that may actually up the risk of heart disease. But numerous studies have shown that replacing foods like butter and cheese with plant-based fats like almond butter, avocado, and olive oil can help lower heart disease risk.

Bottom line: the number one message from the new Dietary Guidelines report is that we all need to be eating less sugar and processed foods, and more plants, including vegetables, fruits, whole grains, beans and lentils. So if you have cholesterol from something like eggs, pair them with other whole, nutrient-rich plant foods, like veggies and avocado, combined with some fruit, black beans, sweet potato, or quinoa. That’s good nutrition.

Cynthia Sass, MPH, RD, is Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Cynthia is currently the sports nutrition consultant to the New York Rangers NHL team and the Tampa Bay Rays MLB team, and is board certified as a specialist in sports dietetics.

This article originally appeared on Health.com.

TIME Heart Disease

Why Your Heart Disease Risk Might Be Lower Than You Think

Stethoscope
Getty Images

Of the five popular tools that doctors rely on to predict whether you’re headed for heart trouble, four of them have a pretty major flaw

For decades, doctors have relied on the undisputed champion of heart disease risk assessment: the Framingham Risk Score. It emerged from a massive study of heart disease risk factors in more than 5,000 men and women and pointed out advanced age, being male, smoking, having diabetes, high total cholesterol, low levels of good cholesterol and high blood pressure. Scoring higher on these factors meant you had a greater chance of developing heart problems in the next 10 years, and most successive models included some version of these core culprits.

Now, scientists led by Dr. Michael Blaha, director of clinical research at the Ciccarone Center for Prevention of Heart Disease at Johns Hopkins Medicine, have published a new study in the Annals of Internal Medicine that finds that those risk calculators—four of which doctors use regularly—tend to overestimate the risk of heart attack in patients.

MORE: New Guidelines for Cholesterol Treatments Represent “Huge Change”

“It’s not that scientists made mistakes when coming up with the [calculators],” says Blaha, “They did the best job they could with the data they had. But there may be inherent problems in using historical data to predict things now.”

The diet and lifestyle of Americans have changed considerably since the Framingham days, when heart attacks occurred more frequently in younger people and more often in men than women. Americans on average now eat more trans fat and salt and have lower exposure to secondhand smoke, which can all affect heart disease rates.

MORE: Cholesterol Whiplash: What to Make of the New Heart-Risk Calculator

But even the most recent guidelines for predicting heart disease risk, released in 2013 by the American Heart Association and the American College of Cardiology, relied on the Framingham Risk factors. In the current analysis, these guidelines overestimated heart attack risk by 86% in men and 67% in women when Blaha and his team compared the predicted risk to actual rates of heart events in a group of more than 4,000 people aged 50 to 74 years, who were followed up for an average of 10 years. The other models overshot the risk by anywhere from 37% to 154% for men, and from 8% to 67% for women.

That’s a lot of extra heart disease that, under current guidelines, doctors may start treating with blood pressure medications, insulin and cholesterol-lowering drugs. All of those come with potential side effects and complications. In fact, the study found that statins to keep cholesterol in check were least effective among those with the lowest risk of having future heart events, meaning the benefits may not outweigh the risks for many.

MORE: Single Gene Responsible for Group of Heart Disease Risk Factors

“We’re getting close to the idea of re-thinking risk,” says Blaha. Instead of relying on decades-old data that draws conclusions and recommendations on a population level, ideally everyone’s risk should be more individualized and based on his own particular history. The Framingham model, for example, includes data collected from a single measurement of blood pressure and cholesterol, and a yes-or-no answer on whether the patient smokes. But someone who has smoked for years and just quit is physiologically different from someone who never lit up at all, just as having blood pressure that’s under control thanks to medication is not the same as never having hypertension to begin with. The most accurate way to predict someone’s risk of having a heart attack is to survey his blood pressure and cholesterol readings over his lifetime, or at least for many years. That may soon be possible with electronic health records and the popularity of medical monitoring bracelets. But until then, any model that relies on population-based data like Framingham may suffer from overestimating someone’s heart danger, Blaha says.

MORE: Eating Fruit Cuts Heart Disease Risk by 40%

“These data point squarely to the idea that we need to be rethinking risk prediction,” he says. That may require not just combing through more data per patient, but also folding in other factors that may be more sensitive to the health of a person’s heart. Imaging techniques, including coronary calcium scores that measure the amount of calcium—a foundation for the plaques that eventually rupture to cause heart attacks—may provide more valuable and accurate information on a person’s risk, for example.

In the meantime, Blaha isn’t advocating for the elimination of current risk predictors or guidelines that help doctors decide when a patient’s risk warrants treatment with a drug. “The guidelines are still useful, but patients and doctors have to understand the caveats and limitations to them,” he says. Whatever score a patient receives from these calculators, that number should be the starting point of a discussion between doctor and patient about that patient’s particular risk factors—including his family history, whether and how much he smoked, and how much exercise he gets on a regular basis. “Patients need to demand, or ask their doctors to go beyond the number and say, ‘Do you really think I need to starting taking medicine?’ or ‘How much risk do I really have of having a heart attack?’” That kind of conversation is far more valuable than a single-risk calculator will ever be.

TIME Diet/Nutrition

Cholesterol Is Not a ‘Nutrient of Concern,’ Report Says

six-eggs-in-carton
Getty Images

New dietary recommendations are due later this year from the U.S. government, and big changes could be coming for cholesterol.

A preliminary document from the Dietary Guidelines Advisory Committee, released in December and reported this week by the Washington Post, states that “cholesterol is not considered a nutrient of concern for overconsumption.” That one sentence could drastically change the way Americans think about cholesterol-containing foods, like eggs, shrimp, butter and cheese. If the stance is adopted in forthcoming recommendations from the USDA and U.S. Department of Health and Human Services, which jointly set national nutrition guidelines, it may mean a vast departure from guidelines set just five years ago. The 2010 dietary guidelines put cholesterol under the “foods and food components to reduce” category, and the guidelines advise that people eat less than 300 mg per day. (Eggs, a source of dietary cholesterol, contain about 164 mg each.)

Experts say this would mean that recommendations are finally catching up with the evidence, which suggests that dietary cholesterol bears little impact on a person’s risk of heart disease.

“There have been multiple analyses and meta-analyses now looking at intake of dietary cholesterol and the risk of heart disease,” says Dr. Dariush Mozaffarian, dean of the School of Nutrition Science and Policy at Tufts University. “In the general population, there’s really not any strong evidence for a link.” However, a few studies have shown that there may be increased risk in people with type-2 diabetes, he says.

Dietary cholesterol isn’t solidly linked to cholesterol levels in the blood, says Dr. David Katz, director of the Yale University Prevention Research Center. “There’s virtually no association,” Katz says; much more profound are the impacts of saturated and trans fats. Several of his own lab’s studies have shown that eggs don’t adversely affect blood cholesterol.

Read more: Should I Eat Eggs?

The final report isn’t yet available. In a statement, the U.S. Department of Health and Human Services says this: “The 2015 Dietary Guidelines Advisory Committee is currently finalizing its report to the federal government detailing its scientific recommendations for the U.S. Department of Health and Human Services (HHS) and U.S. Department of Agriculture’s (USDA) joint development of the Dietary Guidelines for Americans, 2015. We expect the Committee’s advisory report to be released to the public in the coming weeks.”

If cholesterol gets its nutritional exoneration, that doesn’t give you license to swap your steel-cut oatmeal for five-egg, bacon-wrapped omelets. “We do not have evidence that people who eat more eggs have less heart disease,” says Katz. “But we do have evidence that people who eat more whole grains have less heart disease.” Eggs are safe to add to a heart-healthy diet, but don’t count on eggs to be the cornerstone.

“From my perspective, our dietary guidelines should be based on where we have strong evidence for good and where we have strong evidence for harm, and everything else should be kind of left out until we get strong evidence,” says Mozaffarian. “Dietary cholesterol is not in a place, I think, where there’s strong evidence for harm.”

TIME Diet/Nutrition

Where Dietary-Fat Guidelines Went Wrong

A new review argues that there was no evidence to support the low-fat message that has been the mantra for good health since the 1970s

A little fat may not be harmful, while too much of it can be unhealthy, and even fatal. But in the latest review of studies that investigated the link between dietary fat and causes of death, researchers say the guidelines got it all wrong. In fact, recommendations to reduce the amount of fat we eat every day should never have been made.

Reporting in the journal OpenHeart, Zoe Harcombe, a researcher and Ph.D. candidate at University of the West of Scotland, and her colleagues say that the data decisionmakers had in 1977, when the first U.S. guidelines on dietary fat were made, did not provide any support for the idea that eating less fat would translate to fewer cases of heart disease, or that it would save lives.

“The bottom line is that there wasn’t evidence for those guidelines to be introduced,” she says. “One of the most important things that should have underpinned the guidelines is sound nutritional knowledge, and that was distinctly lacking.”

When the recommendations were made, in the 1970s, heart disease claimed more U.S. lives than any other cause of death (and has retained that distinction for most of the ensuing years), so public-health and government officials were eager to get on the low-fat bandwagon. National guidelines, endorsed by health experts and expected to be followed by physicians in doctors’ offices around the country, sent word to the American public — trim fat to about 30% of your total daily calories, and cut saturated fat, from red meat and dairy products like milk, egg and cheese, in particular down to no more than 10% of total calories.

The problem, as Harcombe notes in her study, is that advice was “arbitrary. The 30% wasn’t tested, let alone proven,” she says. In fact, some data even contradicted the idea that the fat we took in from food had anything at all to do with the artery-clogging plaques that caused heart disease. In one study, men who were fed copious amounts of high-fat foods (butter, eggs, portions of cream and the like) did not show higher levels of blood cholesterol, suggesting that the fat from food had little to do with the cholesterol circulating in the body and produced by the liver. In fact, says Judith Wylie-Rosett, a professor of epidemiology and population health at Albert Einstein College of Medicine and a spokesperson for the American Heart Association (AHA), roughly a third of the cholesterol from food becomes part of the circulating cholesterol that can potentially build up in heart vessels — “not a major driver,” she says.

That’s why the AHA, among other groups, has gradually revised its guidelines and moved away from the strict guidance to lower fat intake. Instead, they focus on the types of fats in our foods, and on the diet as a whole. For example, Harcombe argues that the focus on fat, and on cholesterol and saturated fat in particular, has had a boomerang effect on the health of Americans. When we cut the fat, we replaced it with carbohydrates, which are broken down by the body into sugars and into a different form of fat, triglycerides, which may actually do more harm to the heart than cholesterol from animal products like red meat and dairy.

MORE Ending the War on Fat

So the AHA, while still urging people to be aware of how much saturated fat they eat, are not as focused on limiting total fat intake. “The message is still to use lean meats and fish, but the emphasis is not so much on total fat,” says Wylie-Rosett.

Harcombe would argue that even that doesn’t go far enough, according to her results. In her analysis of six trials in which people were randomly assigned to eat higher or lower amounts of dietary fat, she found no difference in heart attacks and mortality rates among the two groups. “What we are saying is that dietary interventions did not provide the evidence that dietary fat is associated with heart disease outcomes,” she says.

MORE Dietary Guidelines Are Not So Sustainable, Study Says

Does that mean a diet of daily steak and eggs won’t harm the heart? Harcombe admits that she also doesn’t have evidence for that position, but says that her findings do expose the shortcomings of current recommendations and the need for more rigorous studies. Given the current state of knowledge, she says “We are not doing our best by the consumer at the moment.” Wylie-Rosett agrees. “We don’t need to restrict fat to below 30% of daily calories, but do we want to allow up to 70%? We don’t know.”

Harcombe’s own solution to the confusion is to stick with the basics. “It’s one message, in three words — eat real food,” she says. The less adulterated and processed your diet is, the more nutrients and healthy fats, proteins and carbohydrates your body will get, and the less you’ll have to worry about meeting specific guidelines or advice that may or may not be based on a solid body of evidence.

MORE Uh Oh, Unsaturated Fats May Not Be as ‘Good’ as We Thought

Read next: Should I Eat Red Meat?

Listen to the most important stories of the day.

TIME heart

High Cholesterol Can Be Dangerous Even If You’re Young

182149101
Lisa Bodvar—Getty Images

High cholesterol levels in older age are a familiar risk factor for heart attacks, and doctors warn that the danger can start much sooner for many. But how soon should you start worrying?

Most of us know that too much cholesterol in the blood can bring on dangerous clots that lead to heart attacks and stroke. And recent studies show that the build up of these fats in the blood vessels doesn’t happen overnight — it takes years of gradual deposits to narrow a vessel. So in 2013, when heart experts expanded the criteria for who over the age of 60 should consider taking cholesterol-lowering statins, Michael Pencina, a professor of biostatistics at the Duke University Clinical Research Institute, began wondering about those, including himself, who were younger. How long should they wait before taking the drugs?

In the latest study of healthy people who were followed for about 15 years on average, researchers report Monday in the journal Circulation that having even mildly elevated cholesterol levels can increase risk of having later heart problems by as much as 40%.

The researchers argue that having high cholesterol for many years—even if it starts when you’re young—should be a new risk factor that doctors and patients consider when discussing their risk of heart disease.

Even people with moderately high levels of lipids, who might not qualify for treatment for high cholesterol levels, could be at higher risk of heart attacks later in life simply because they harbor these elevated lipid levels for a long period of time.

MORE: Should I Take a Statin? What You Need to Know About the New Cholesterol Guidelines

Among a group of 1,478 people aged 55 years old from the Framingham Heart Study’s Offspring Cohort, those who had higher cholesterol levels for 11 to 20 years (beginning when they were about 35 years old) had a 16.5% higher risk of having a heart attack about 15 years later, compared to a 4.4% risk for those whose cholesterol levels never veered beyond the normal range during middle age. That’s an almost fourfold greater risk, and one that Pencina and his colleagues argue might be reason enough to be more aggressive in discussing ways to lower cholesterol with these patients so they can reduce their risk of heart trouble later on.

MORE: New Cholesterol Guidelines May Put 13 Million More on Statin Drugs

“We identified a patient population whom the guidelines might miss,” he says. It’s another dimension of cardiovascular health that needs to be looked at, and yes, I would say that it should be considered a risk factor.” In the study, the researchers considered LDL levels above 130 mg/dL as elevated, which falls into line with previous professional heart organization criteria.

But he stresses that this factor won’t fall easily into a threshold below which patients won’t need to worry about their cholesterol and above which they will. “There are so many components like family history and other factors that go into the decision of what kind of intervention people may need, such as lifestyle, diet or pharmacologic,” says Pencina. “But if you are measuring your cholesterol, even if it’s fine at an early age, it lets you build that history.”

TIME diabetes

How Race Affects Diabetes Care—and Leads to Amputations

High Blood Sugar Test
Getty Images

Black diabetics are much more likely to face amputation

Black type-2 diabetes patients are three times more likely to lose a leg to amputation as non-black patients, finds a new report from the Dartmouth Atlas Project. That’s partly because they’re also far less likely to get preventative care like foot exams, cholesterol testing and blood sugar testing.

Researchers looked at Medicare claims from 2007-2011 from patients diagnosed with diabetes and peripheral arterial disease, a condition in which plaque builds up in the arteries and blocks blood flow, primarily in the legs. They found significant disparities, both racial and regional: black patients and the rural Southeast region of the U.S. both saw elevated amputation rates.

Diabetes-related amputation, a last resort, generally results from wounds on the feet and poor circulation. Foot exams and testing for blood sugar and cholesterol levels can help lower the risk of having to resort to extreme measures. But in 2010, 75% of diagnosed black diabetics received a a blood lipids test, while 82% of non-black patients had the test.

An average of 2.4 leg amputations for every 1,000 Medicare patients with diabetes and peripheral arterial disease happen nationally, but regionally, the situation is much more grim. Mississippi, which currently ties West Virginia for the most obese state, also has some of the highest amputation rates—6.2 per 1,000 patients in the city of Tupelo. It’s not just racial: For every 1,000 black Medicare beneficiaries with diabetes, 14.2 amputations occurred in the Mississippi city of Meridian, but only 2.1 occurred among black patients in San Diego.

“The resources needed to prevent amputation are currently severely misaligned,” says co-author Philip Goodney, MD, director of the Center for the Evaluation of Surgical Care at Dartmouth Hitchcock Medical Center. “While we must look for opportunities to expand education and preventive care for all patients at risk for amputation, it seems clear to us that we can make the greatest gains by focusing on African-American patients in the highest risk regions, typically in the poor rural regions of the Southern United States, where the highest amputation rates remain.”

TIME Research

Here’s Why You May Be Better Off Taking Generic Cholesterol Drugs

Patients with cheaper drugs tended to take their medicine more consistently

A new study in the Annals of Internal Medicine found that the cost difference between generic and brand-name drugs seems to be a big factor when it comes to sticking with a medication–especially when it comes to statins, one of the most-prescribed drugs in the country. People who got the generic versions of the cholesterol-lowering medication were more likely to consistently take it and avoid cardiovascular disorders than those who filled the brand-name kind.

“Initiating a generic versus a brand-name statin seems to be associated with lower out-of-pocket costs, improved adherence to therapy, and improved clinical outcomes,” the study said.

The study, which looked at more than 90,000 patients over age of 65, found that people taking generic drugs were more likely to stick to their medication regimen. Price played a role in this disparity, the study suggests. The average cost to fill a prescription for the consumer was $10 for generic statins versus $48 for brand names.

“Given this substantial cost difference, it is perhaps not surprising that adherence and cardiovascular outcomes were worse among patients receiving brand-name statins,” study authors wrote. Overall, people who took generic drugs had 8% fewer incidents than people who used brand-name drugs.

The study received grant support from drug manufacturer Teva Pharmaceutical (which makes both generic and brand-name drugs) and acknowledges that the results may not be generalizable for certain populations: particularly those with greater incomes or access to insurance plans that provide better coverage for brand-name drugs.

Your browser is out of date. Please update your browser at http://update.microsoft.com