View Full Version : Cardiology Heart Study

Brian M
5th November 2012, 08:37 PM

Interesting and informative read ,any thoughts and coments please .


5th November 2012, 09:10 PM
I think it is fascinating. They provide their analyses and insights into the recent studies of medications and their rationales for their recommended therapies.

Brian M
5th November 2012, 09:35 PM
Hi Rod

I knew you would so, when you have time to digest all or just the part that refers to our CKCS ,near the end ,any thoughts or conclusions pls .It seems to
say the way to go once CHF is then to start with pimobenden which could give an extension of maybe two more years .

5th November 2012, 09:56 PM
It seems to
say the way to go once CHF is then to start with pimobenden which could give an extension of maybe two more years .

I thought that too. I was looking for the use of this before CHF which Rod has a note of caution about but it looks like there is evidence of increasing life once they are in CHF.


As of 2009, the evidence in support of the ability of pimobendan to increase survival and quality of life for patients with CHF due to:

DCM is overwhelmingly supportive. See the University of Guelph DCM trial results below.
Chronic mitral valve insufficiency is also strongly supportive. See the QUEST trial results below.
Studies investigating the use of pimobendan in asymptomatic (occult) CMVI or DCM are currently ongoing or being planned. Thus there is currently no data to support the use of pimobendan in occult (pre-CHF) CMVI or DCM."

I also thought the SVEP Trial was interesting because it was CKCS and the large amount of cavaliers enrolled 229. I am sure this is old news but I thought the conclusions was interesting and how they said

"This study is the most exhaustive cardiovascular clinical study conducted in veterinary medicine to date."

Brian M
5th November 2012, 10:21 PM
Hi Annie

And Daisy's cardio says Quotes

"Sadly, despite several trials(2 and 3) there is no evidence that treatment with an angiotensin converting enzyme (ACE) inhibitor before the onset of heart failure delays the onset of heart failure. No trials have been performed using Pimobendan in this group of dogs and there is little theoretical basis for its use. Interestingly, asymptomatic dogs fed a “heart diet” had a reduction in heart size(4). The “heart diet” included decrease sodium, increased levels of arginine, carnitine and taurine as well as supplementation with omega 3 fatty acids. Whether this translates into a delay before heart failure develops remains to be proven.

Heart failure is characterised by breathing difficulties, poor appetite, weight loss, exercise intolerance and a cough usually at night. Once heart failure develops, diuretics such as frusemide are required to control the oedema in the lungs. The QUEST study confirmed that pimobendan prolongs survival significantly longer than an ACE inhibitor when combined with frusemide(2). However, although there is no data concerning the combination with an ACE inhibitor, most cardiologists would add an ACE inhibitor to frusemide and pimobendan. A recent study indicated that the addition of a mild diuretic, spironolactone, improves quality of life and prolongs life(5). This drug counteracts the effects of a natural hormone, aldosterone, which is

increased in heart failure and has harmful consequences.

Unfortunately, the disease is progressive and many dogs progress to advanced heart failure. Other drugs may be indicated to:

Reduce systemic blood pressure and increase output
Control arrhythmias
Reduce pulmonary hypertension
Increased doses or frequency of diuretics"

So Pimodeben before the onset of CHF there is no proof of benefit but after and when combined with other drugs it seems the one to go for.But am glad he pushes the "heart diet"


5th November 2012, 10:36 PM
Hi Rod

It seems to say the way to go once CHF is then to start with pimobenden which could give an extension of maybe two more years .


This study did not address the important question of whether one should treat such patients with the combination of pimobendan and benazepril (or another ACE inhibitor) and diuretics as is the case in most practices.

Our conclusions:

This study provides the most compelling evidence that pimobendan has an important role in the management of CHF due to CMVI.
This study does not answer the question of the benefit or lack of benefit of triple therapy (pimobendan, an ACE inhibitor, and furosemide) - our current practice in the management of these cases.


5th November 2012, 10:58 PM
I didn't think the argument on pimobendan and CHF was new though? Weren't those studies on waiting til onset of CHF done some time ago?

Also think 2 years is probably a stretch -- the initial study in this area suggested maybe 9 months on average:


It is interesting to read all the arguments on various approaches.

5th November 2012, 11:09 PM
Actually I read a pretty dismissive evaluation of Omega 3s from fish oils today -- quoted numerous studies which said that while there was a benefit in omega 3 and to eating oily fish several times a week to get omega 3s, that fish oil supplements had not been shown to have any clear benefit, especially as the benefit perceived could easily be due to other factors. Think this was in the Guardian -- will try and find it. They said that it seemed likely that the benefits of omega 3s came from a combination with other vitamins etc in the actual food source. It was certainly pretty persuasive -- not dissimilar I suppose to studies that show glucosamine seems to have very little benefit. But there is strong popular belief in both omega 3 supplements and glucosamine so would be very hard to convince people.

5th November 2012, 11:28 PM
I see Time Magazine summed up some of this last month:


If you want to protect your heart, stick to exercise and a healthy diet, and pass on the fish oil pills, says a new study.

For years, doctors and health experts have recommended taking fish oil supplements, rich in omega-3 fatty acids, to lower the risk of heart disease. But the latest study on the issue — an analysis of previous clinical trials on the effects of omega-3s — shows that the supplements don’t lower users’ risks of heart attack, stroke, sudden death or death from heart disease or any cause. Although the rates of these events were lower among those taking omega-3 supplements compared with those not taking them, the differences were not statistically meaningful, the authors said.

It’s not the first time that the cardiovascular benefits of fish oil have been questioned: another recent analysis of previous research found that the supplements didn’t prevent heart attack or stroke in people with heart disease. (Separately, other research has suggested that that pills have little effect on boosting memory in Alzheimer’s patients, reducing symptoms of the disease or improving thinking and verbal skills compared with placebo.)

(MORE: Fish Oil for Heart Attack Prevention: Is It a Myth?)

In the current analysis, published in the Journal of the American Medical Association and led by Dr. Moses Elisaf of the Lipid Disorders Clinic at the University Hospital of Ioannina in Greece, the scientists reviewed 20 studies dating back to 1989 that involved 68,680 participants. Volunteers in the studies, most of whom were heart patients, were randomly assigned to take either 1.5 g of omega-3 supplementation or a placebo every day for about two years. They were followed for heart events, including death, heart attack and stroke.

While the omega-3 users showed a 9% lower rate of heart-related death compared with the controls, and an 11% lower rate of heart attack, these differences were too small to attribute to the omega-3 pills.

The findings may lead to some confusion among people — both heart patients and those who are healthy but trying to avoid heart disease — who may be taking omega-3 supplements daily. While some early studies did show a significant benefit from taking fish oil pills, data from newer clinical trials weakened that effect. That may be because at least one early, important study did not blind participants or researchers, meaning that everyone knew who was taking omega-3s or placebo. Further, inconsistencies between the included trials, such as the dosages of supplement used or preexisting conditions among participants, may have contributed to the discouraging findings.

(MORE: Study: Fish Oil Pills Don’t Stall Alzheimer’s)

Much other past data showing benefits of omega-3s also came from studies that did not randomize participants into fish oil and placebo groups, and instead retrospectively compared heart events in people who chose to consume more omega-3 fats than others.

Another reason the current study failed to find a benefit may be that more people are using better treatments for heart disease these days, including cholesterol-lowering statin drugs. Elisaf says he wasn’t able to eliminate the potential influence of these medications in lowering rates of heart attack and death from heart disease overall. “We need more data in order to have a clear answer about the role of omega-3 fatty acid supplementation in everyday clinical practice,” he says.

The authors acknowledge that additional research may help determine whether omega-3 supplements may still benefit people depending on their individual risk of heart disease, or if their diets are low in foods that are naturally rich in the fatty acids.

(MORE: Fish Oil Fail: Omega-3s May Not Protect Brain Health After All)

Currently the American Heart Association (AHA) advises people with high triglyceride levels to eat more fatty fish — the omega-3s in oily fish help boost good cholesterol and lower triglycerides — but to discuss supplementation with their doctor if they can’t get enough from their diet. The organization does not recommend the pills in general as a way to protect the heart.

Both the AHA and many doctors recommend eating more fish, however: everyone, including healthy people and heart patients, should eat at least two servings of fish per week to benefit from the omega-3 fats. “If people are taking supplements because their physician prescribed them, they should consult with their physician before stopping,” says Dr. Donna Arnett, president of the AHA and professor of epidemiology at the University of Alabama at Birmingham. “But I would tell them they should not stop eating fish. The results of this study are about dietary supplements. So dietary sources of omega-3s may be different than supplements. They should not assume that dietary sources are not useful.”

Which means that the advice you’ve been hearing all along remains the same — eat more fish. It’s good for your heart.

ead more: http://healthland.time.com/2012/09/12/omega-3-supplements-dont-lower-heart-disease-risk-after-all/#ixzz2BOToikze

5th November 2012, 11:34 PM
... But am glad he pushes the "heart diet"

I think the "heart diet" is pretty much a joke. It was conducted mainly by a pet food manufacturer and consisted of dry food, kibble, also/known/as junk food. Heart supplements, like those listed here -- http://cavalierhealth.org/diets.htm#Cardiac_Supplements -- when added to a good canned meat and vegetable product (ideally, however, I prefer home-prepared meat and vegetables), is much preferrable to the kibble "heart diet" mentioned.

You have to be very careful of so-called "prescription diets" marketed by such pet food companies as Hills and Waltham. They skimp at the dog's expense.

5th November 2012, 11:40 PM
....It seems to say the way to go once CHF is then to start with pimobenden which could give an extension of maybe two more years .

According to cardiologist Mark Oyama in a recent talk to a group of GP vets, pimo and an ACE-inhibitor and a diruetic are being combined as soon as the MVD dog enters congestive heart failure.

Using pimo at the start of CHF is relatively new, I think (at least, that is what Dr. Oyama said in his talk). In the past, the pimo was reserved for the last resort, to boost the heart when the ACE-inhibitor, diruetic, and whatever else lost their effectiveness.

5th November 2012, 11:58 PM
I didn't think the argument on pimobendan and CHF was new though? Weren't those studies on waiting til onset of CHF done some time ago?

I was interested in that part for personal reasons. Having read posts in the past and reading the caution on Rods website, I was concerned when a vet prescribed this drug to a friends cavalier. I was with her at the vet and specifically asked that question (since he said kennedy was on the verge of CHF) along with since he is at this stage shouldn't he see a cardiologist. I will not even get into his response but the vet made her feel so bad about getting a referral to cardiologist, that she made me call. I left a message for another vet, but even though he was fine with referral he had never heard of problems with this drug treating prior to CHF.

It may not be new but there still are vets prescribing it before the dog is in CHF.


You are lucky that Daisy is seeing Simon Swift (I believe), because you know she is in good hands.

6th November 2012, 12:02 AM
... It may not be new but there still are vets prescribing it before the dog is in CHF. ...

Unfortunately, I heard of a US cardiologist who very recently prescribed pimo for a cavalier before CHF, and the dog promptly died. Since then, the name of that cardiologist has been removed from the list of board certified veterinary cardiologists on http://www.cavalierhealth.org/Cardiologists.htm