Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Fatty Acids and their role in Cardiometabolic HealthArindam Pande
This document discusses fatty acids and their role in cardiometabolic health. It summarizes that the conventional view of the diet-heart hypothesis, which links saturated fat and cholesterol to heart disease, may be an oversimplification. Different fatty acids, including saturated fatty acids found in dairy, can have varying metabolic effects. Replacing saturated fats with polyunsaturated fats may lower heart disease risk, but replacing them with carbohydrates does not. Ongoing research is exploring the cardiovascular impacts of omega-3 supplements and specific plant oils. In conclusion, the type of fat consumed is important for heart health, not just total fat intake, and dietary patterns rather than single nutrients should be the focus.
Iron deficiency in Heart Failure - Trial evidencePraveen Nagula
1) Iron deficiency is a common but often unrecognized and undertreated comorbidity in patients with heart failure.
2) Iron deficiency is prevalent in around 76% of Indian patients with heart failure and is associated with increased morbidity and mortality as well as worse patient outcomes and quality of life.
3) Intravenous ferric carboxymaltose is recommended for treating iron deficiency in heart failure patients, as it is more effective than oral iron supplements which are poorly absorbed and do not adequately address the underlying causes of restricted iron availability.
The document discusses the paradoxical relationship between obesity and mortality in patients with kidney disease undergoing dialysis. Several studies are reviewed that found higher BMI in dialysis patients was associated with lower risks of death and hospitalization, unlike the general population where obesity increases health risks. The studies accounted for various factors and found even extreme obesity was protective. Weight gain over time was also associated with reduced mortality risk. The reasons for this reverse epidemiology are unclear but proposed mechanisms include increased stores of nutrients and anti-inflammatory proteins in adipose tissue.
Anticoagulation in chronic kidney disease patientsAnderson Sousa
This document discusses anticoagulation in patients with chronic kidney disease and provides practical guidance on the topic. It reviews the increased risk of thrombosis in chronic kidney disease patients and discusses various anticoagulant and antiplatelet options. Key points addressed include the pharmacokinetics and dosing considerations of unfractionated heparin, low-molecular-weight heparins, warfarin, and newer oral anticoagulants in renal impairment. Monitoring and management strategies are also covered.
This study aimed to clarify the relationship between lipid profile, morbidity assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction (AMI). The study found that low-density lipoprotein cholesterol (LDL-C) and triglyceride levels were significantly lower in patients with higher Killip classification (more severe heart failure) and in those who died within 30 days compared to survivors. After adjusting for risk factors, LDL-C less than 62.5 mg/dL and triglycerides less than 110 mg/dL were identified as cutoff values associated with higher 30-day mortality. Patients with both low LDL-C and triglycerides and high Killip classification had a nearly 11-fold
Complete revascularization in patients with multivessel disease undergoing primary PCI was associated with a small increase in additional infarction in non-IRA territories compared to IRA-only revascularization. However, total infarct size and measures of cardiac function were similar between the two groups both before discharge and at 9 month follow up. While complete revascularization led to more type 4a MIs, the increased risk did not negatively impact clinical outcomes.
1) Primary percutaneous coronary interventions (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease can be performed via culprit-only PCI, multivessel (MV) PCI during the same procedure, or staged PCI.
2) Studies have found that MV PCI during STEMI is associated with higher mortality and stent thrombosis compared to culprit-only or staged PCI.
3) The HORIZONS-AMI trial of patients with STEMI and multivessel disease found higher mortality with single/one-time MV PCI compared to staged PCI.
Effects of aspirin for primary prevention in persons with Diabetes mellitusShadab Ahmad
This study evaluated the effects of low-dose aspirin (100 mg daily) for primary prevention of vascular events in 15,480 adults with diabetes but no known cardiovascular disease. It found that aspirin led to a 12% lower risk of serious vascular events but also a 29% higher risk of major bleeding. The number of vascular events prevented was similar to the number of major bleeding events caused. Therefore, the benefits of aspirin did not clearly outweigh the risks for primary prevention among adults with diabetes but no known cardiovascular disease.
Fatty Acids and their role in Cardiometabolic HealthArindam Pande
This document discusses fatty acids and their role in cardiometabolic health. It summarizes that the conventional view of the diet-heart hypothesis, which links saturated fat and cholesterol to heart disease, may be an oversimplification. Different fatty acids, including saturated fatty acids found in dairy, can have varying metabolic effects. Replacing saturated fats with polyunsaturated fats may lower heart disease risk, but replacing them with carbohydrates does not. Ongoing research is exploring the cardiovascular impacts of omega-3 supplements and specific plant oils. In conclusion, the type of fat consumed is important for heart health, not just total fat intake, and dietary patterns rather than single nutrients should be the focus.
Iron deficiency in Heart Failure - Trial evidencePraveen Nagula
1) Iron deficiency is a common but often unrecognized and undertreated comorbidity in patients with heart failure.
2) Iron deficiency is prevalent in around 76% of Indian patients with heart failure and is associated with increased morbidity and mortality as well as worse patient outcomes and quality of life.
3) Intravenous ferric carboxymaltose is recommended for treating iron deficiency in heart failure patients, as it is more effective than oral iron supplements which are poorly absorbed and do not adequately address the underlying causes of restricted iron availability.
The document discusses the paradoxical relationship between obesity and mortality in patients with kidney disease undergoing dialysis. Several studies are reviewed that found higher BMI in dialysis patients was associated with lower risks of death and hospitalization, unlike the general population where obesity increases health risks. The studies accounted for various factors and found even extreme obesity was protective. Weight gain over time was also associated with reduced mortality risk. The reasons for this reverse epidemiology are unclear but proposed mechanisms include increased stores of nutrients and anti-inflammatory proteins in adipose tissue.
Anticoagulation in chronic kidney disease patientsAnderson Sousa
This document discusses anticoagulation in patients with chronic kidney disease and provides practical guidance on the topic. It reviews the increased risk of thrombosis in chronic kidney disease patients and discusses various anticoagulant and antiplatelet options. Key points addressed include the pharmacokinetics and dosing considerations of unfractionated heparin, low-molecular-weight heparins, warfarin, and newer oral anticoagulants in renal impairment. Monitoring and management strategies are also covered.
This study aimed to clarify the relationship between lipid profile, morbidity assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction (AMI). The study found that low-density lipoprotein cholesterol (LDL-C) and triglyceride levels were significantly lower in patients with higher Killip classification (more severe heart failure) and in those who died within 30 days compared to survivors. After adjusting for risk factors, LDL-C less than 62.5 mg/dL and triglycerides less than 110 mg/dL were identified as cutoff values associated with higher 30-day mortality. Patients with both low LDL-C and triglycerides and high Killip classification had a nearly 11-fold
Complete revascularization in patients with multivessel disease undergoing primary PCI was associated with a small increase in additional infarction in non-IRA territories compared to IRA-only revascularization. However, total infarct size and measures of cardiac function were similar between the two groups both before discharge and at 9 month follow up. While complete revascularization led to more type 4a MIs, the increased risk did not negatively impact clinical outcomes.
1) Primary percutaneous coronary interventions (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease can be performed via culprit-only PCI, multivessel (MV) PCI during the same procedure, or staged PCI.
2) Studies have found that MV PCI during STEMI is associated with higher mortality and stent thrombosis compared to culprit-only or staged PCI.
3) The HORIZONS-AMI trial of patients with STEMI and multivessel disease found higher mortality with single/one-time MV PCI compared to staged PCI.
Effects of aspirin for primary prevention in persons with Diabetes mellitusShadab Ahmad
This study evaluated the effects of low-dose aspirin (100 mg daily) for primary prevention of vascular events in 15,480 adults with diabetes but no known cardiovascular disease. It found that aspirin led to a 12% lower risk of serious vascular events but also a 29% higher risk of major bleeding. The number of vascular events prevented was similar to the number of major bleeding events caused. Therefore, the benefits of aspirin did not clearly outweigh the risks for primary prevention among adults with diabetes but no known cardiovascular disease.
This document describes a research study that will compare the clinical outcomes of 20mg and 40mg doses of rosuvastatin in patients with ST elevation acute myocardial infarction (STEMI) who have undergone percutaneous coronary intervention (PCI) over 2 months. The study will enroll 66 patients who will be randomly assigned to receive either 20mg or 40mg of rosuvastatin. The primary outcome will be major adverse cardiovascular events over the 2 month period. Secondary outcomes include cardiac biomarker levels, new onset diabetes, and safety/tolerability. The study aims to determine if the higher 40mg dose provides improved clinical benefits compared to the 20mg dose.
1. Recurrent myocardial infarction (MI) after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) occurs in about 21% of patients and is associated with worse clinical outcomes.
2. Recurrent MI significantly increases the risks of subsequent cardiac mortality, noncardiac mortality, stroke, and bleeding.
3. Early recurrent MIs within 1 day of the initial PPCI are associated with higher unadjusted cardiac mortality compared to later recurrent MIs, but after adjustment, recurrent MIs occurring more than 1 year after PPCI carry the highest risk of cardiac death.
The guidelines provide recommendations for screening, risk assessment, treatment goals, and management of dyslipidemia to prevent cardiovascular disease. Key points include screening adults based on age and risk factors, using LDL-C and other lipid levels to determine risk stratification and treatment goals, and employing lifestyle changes and pharmacologic therapies like statins and fibrates to manage lipid levels and reduce risk. The guidelines aim to optimize dyslipidemia treatment to lower cardiovascular disease risk.
Advancing dialysis: Recasting kidney failure as cardiovascular diseaseAdvancingDialysis.org
The document discusses issues related to end stage renal disease (ESRD) and dialysis treatment in the United States. It notes that ESRD represents 7% of the Medicare budget while only treating 1% of the population. While total Medicare spending and spending per patient on dialysis has stabilized in recent years, the total number of dialysis patients has continued to increase and now exceeds 500,000. The document discusses challenges with the current conventional dialysis treatment approach, including its inability to adequately manage issues like fluid overload, hypertension, and cardiovascular disease - which are the major drivers of mortality in ESRD patients. It suggests alternative home dialysis modalities may help address these issues but barriers need to be addressed to increase their utilization
The PRAMI trial was a randomized controlled trial that compared preventive percutaneous coronary intervention (PCI) to PCI limited to the infarct artery in patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel coronary artery disease. The trial found that preventive PCI of non-infarct arteries with major stenoses significantly reduced the risk of adverse cardiovascular events compared to PCI limited to the infarct artery alone. However, the trial had a small sample size. Guidelines recommend PCI of a non-infarct artery be performed separately from primary PCI, but the optimal timing remains unclear due to varying results from observational studies.
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
The study evaluated the efficacy and safety of combining LDL cholesterol lowering (rosuvastatin 10 mg) and blood pressure lowering (candesartan 16-12.5 mg and hydrochlorothiazide 12.5 mg) therapies versus placebo in 12,705 participants without cardiovascular disease but with risk factors. The combined therapy group experienced significantly fewer cardiovascular events (29% risk reduction) and fewer secondary outcomes (28% risk reduction) compared to the dual placebo group. The number needed to treat over 5.6 years was 72 to prevent one primary outcome and 63 to prevent one secondary outcome. While statistically significant differences were observed, the overall clinical benefit was modest given the event rates in both groups.
Ueda 2016 diabetes mellitus and heart failure - yahia kishkueda2015
Diabetes and heart failure have a bidirectional relationship where each condition can lead to or worsen the other. Over 60% of asymptomatic type 2 diabetes patients have left ventricular diastolic dysfunction. The prevalence of heart failure is higher in diabetics and increases with age. Diabetes increases the risk of heart failure through hypertension, coronary artery disease, diabetic nephropathy and cardiomyopathy. Intensive glucose control can help prevent microvascular complications but does not significantly reduce cardiovascular events. Several diabetes medications need to be used cautiously in heart failure patients. Both conditions are serious with high mortality rates so treatment must target overall improvement.
Aspirin as Prevention Therapy for Cardiovascular Events in patients with Diab...Stefania Dumitrescu
The Role of Aspirin in the primary prevention of cardiovascular disease in patients with diabetes, especially T2DM - current knowledge and recommendations -
Cardiovascular disease is very common in patients with chronic kidney disease.
- CVD is the leading cause of death in patients with CKD, even in early stages of kidney disease and those with low levels of albuminuria. Reduced kidney function and increased albuminuria are associated with higher risk of CVD events and mortality.
- The prevalence of CVD is extremely high in patients on dialysis, with over 70% of dialysis patients having CVD. CVD is responsible for about 40% of all deaths in dialysis patients.
- Both traditional CVD risk factors like hypertension and diabetes as well as nontraditional risk factors related to CKD contribute to the elevated CVD risk in this population. Targeting modifiable
Donor Lymphocyte Infusion in Patients with Hematological Malignancies after T...spa718
1. Donor lymphocyte infusion (DLI) is an effective method for treating relapse after hematopoietic stem cell transplantation. Modified DLI (mDLI) using G-CSF mobilized peripheral blood and short-term immunosuppression can reduce acute GVHD rates while maintaining the graft-versus-leukemia effect.
2. Prophylactic mDLI can significantly decrease relapse rates and increase survival in patients with advanced acute leukemia after HLA-identical or haploidentical transplantation.
3. Risk-stratified mDLI based on minimal residual disease monitoring may further reduce relapse and improve outcomes by targeting high-risk MRD-positive patients.
This randomized controlled trial tested the effects of eicosapentaenoic acid (EPA) supplementation on major coronary events in 18,645 Japanese patients taking statins. Patients received either EPA capsules totaling 1,800 mg daily or a placebo in addition to statin treatment for an average of 4.6 years. The primary endpoint was major coronary events including sudden cardiac death and heart attacks. The EPA group had a 19% lower relative risk of major coronary events compared to the control group. Specifically, EPA reduced non-fatal coronary events such as unstable angina. EPA supplementation showed benefits for both primary and secondary prevention of major coronary events in hypercholesterolemic patients taking statins.
This study compared the effects of levosimendan, dobutamine, and vasodilator therapy on ongoing myocardial injury in patients with acute decompensated heart failure. The study found that while all treatments were associated with decreases in cardiac troponin I levels and improvements in hemodynamic and functional indicators, levosimendan treatment showed the most pronounced improvements, especially in left ventricular ejection fraction and systolic pulmonary artery pressure. However, none of the treatments significantly reduced cardiac troponin I levels compared to each other. The study demonstrated beneficial effects of short-term use of levosimendan, dobutamine, and nitroglycerin on ongoing myocardial injury in acute decompensated heart failure.
Advancing dialysis: Recasting kidney failure as cardiovascular diseaseAdvancingDialysis.org
This document discusses issues related to end-stage renal disease (ESRD) and dialysis treatment in the United States. It notes that ESRD represents 7% of the Medicare budget while only treating 1% of the US population. Total Medicare spending on dialysis has risen steadily to over $35 billion per year. The dialysis patient population has also increased over time and now exceeds 500,000 patients, though the annual growth rate has fallen below 2%. Despite increased spending, health outcomes like mortality and hospitalization rates have stabilized in recent years. The document suggests that the main challenge for dialysis is in managing chronic conditions like hypertension, left ventricular hypertrophy, and heart failure, which are major drivers of morbidity and mortality
Advancing dialysis.org recent findings better management of volume with inten...AdvancingDialysis.org
The document discusses the challenges of managing fluid volume in patients undergoing standard hemodialysis treatment given the constraints of a 3 session per week schedule. Fluid accumulates in the body during the long interdialytic gaps, putting stress on the heart and increasing risks. While ultrafiltration rates have decreased slightly over time, cardiovascular hospitalization rates have risen, suggesting fluid management remains a key issue. Studies link higher fluid overload levels to increased mortality risk, indicating more consistent volume control through increased treatment frequency and/or time could help address remaining unmet needs.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
LDL Cholesterol Target :“ Lower the Better ”Arindam Pande
Lowering LDL cholesterol provides significant cardiovascular benefits and reduces risk, even in those with low baseline LDL levels or who achieve very low LDL levels with treatment. While residual risk remains even with intensive statin therapy to lower LDL well below current target levels, risk continues to decrease as LDL is further lowered. The lower the achieved LDL level, the lower the long-term risk of major cardiovascular events and atherosclerotic progression.
This document summarizes Dr. Chenhua Yan's work establishing and utilizing a modified donor lymphocyte infusion (mDLI) approach for the treatment of relapse after haploidentical hematopoietic stem cell transplantation (HSCT) for hematologic malignancies. The mDLI approach uses G-CSF mobilized peripheral blood stem cells and immunosuppressive agents after infusion to reduce graft-versus-host disease while preserving graft-versus-leukemia effects. Studies showed mDLI improved response rates and survival compared to chemotherapy or standard DLI alone for relapsed disease. Risk-stratified mDLI based on minimal residual disease also reduced relapse rates after transplantation.
A randomized study assigned 465 patients undergoing emergency PCI for acute STEMI to either preventive PCI of stenoses in non-infarct arteries or PCI of the infarct artery only. At a mean follow up of 23 months, the preventive PCI group had lower rates of the primary composite outcome of death from cardiac causes, non-fatal heart attack, or refractory angina (9% vs 23%). Preventive PCI also reduced the risk of subsequent cardiovascular events within the first 6 months after the procedure. Procedure times and contrast usage were increased with preventive PCI, but complication rates were similar between the groups.
Carotid intima-media thickness (CIMT) and carotid plaques in young Nepalese p...Paul Schoenhagen
Abstract
Background: Carotid intima-media thickness (CIMT) and carotid plaques are non-invasive surrogate markers of early evaluation of coronary artery disease (CAD) and sub clinical atherosclerosis. The objective of the study was to evaluate CIMT and carotid plaques in less than 45 years old Nepalese patients with angiographically proven CAD.
Methods: A total of 54 patients with angiographically documented CAD at less than 45 years of age were enrolled. CAD was confirmed by coronary angiography. Demographic profile was obtained. High resolution B-mode ultrasound was used to detect the CIMT and carotid plaques.
Results: The study population included 44 males and 10 females, with a mean ± SD age of 38.4±4.3 years (range, 25-44 years). Cardiovascular risks factors included smoking in 81%, Hypertension in 52%, diabetes in 19% and alcohol consumption in 78% of patients. Lipid profile (mean ± SD) was normal except for elevated triglyceride (TG) levels of 204±130.8 mg/dL. By angiography, 64.8% had single vessel disease, 26% had double vessel disease and 9.2% had triple vessel disease. Ultrasound detected either thickened CIMT or presence of plaques in 46 (85.2%) cases (group-A) and 8 (14.8%) had negative (normal) carotid study (group-B). Among the 46 patients with positive findings 63% had carotid plaques and 37% had thickened CIMT only. The majority (69%) of the carotid plaques were detected at the carotid bulbs. In total population, carotid plaque was detected in 53.7% of cases. There was no statistical significant difference of age, body mass index (BMI) and lipid level between group-A and group-B.
Conclusions: Increased CIMT and carotid plaques are detected in majority of the young Nepalese patients with angiographically documented CAD. The majority of carotid plaques are detected at the carotid bulbs. Routine carotid ultrasound study in young individuals with CAD risk factors appears worthwhile.
This document describes a research study that will compare the clinical outcomes of 20mg and 40mg doses of rosuvastatin in patients with ST elevation acute myocardial infarction (STEMI) who have undergone percutaneous coronary intervention (PCI) over 2 months. The study will enroll 66 patients who will be randomly assigned to receive either 20mg or 40mg of rosuvastatin. The primary outcome will be major adverse cardiovascular events over the 2 month period. Secondary outcomes include cardiac biomarker levels, new onset diabetes, and safety/tolerability. The study aims to determine if the higher 40mg dose provides improved clinical benefits compared to the 20mg dose.
1. Recurrent myocardial infarction (MI) after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) occurs in about 21% of patients and is associated with worse clinical outcomes.
2. Recurrent MI significantly increases the risks of subsequent cardiac mortality, noncardiac mortality, stroke, and bleeding.
3. Early recurrent MIs within 1 day of the initial PPCI are associated with higher unadjusted cardiac mortality compared to later recurrent MIs, but after adjustment, recurrent MIs occurring more than 1 year after PPCI carry the highest risk of cardiac death.
The guidelines provide recommendations for screening, risk assessment, treatment goals, and management of dyslipidemia to prevent cardiovascular disease. Key points include screening adults based on age and risk factors, using LDL-C and other lipid levels to determine risk stratification and treatment goals, and employing lifestyle changes and pharmacologic therapies like statins and fibrates to manage lipid levels and reduce risk. The guidelines aim to optimize dyslipidemia treatment to lower cardiovascular disease risk.
Advancing dialysis: Recasting kidney failure as cardiovascular diseaseAdvancingDialysis.org
The document discusses issues related to end stage renal disease (ESRD) and dialysis treatment in the United States. It notes that ESRD represents 7% of the Medicare budget while only treating 1% of the population. While total Medicare spending and spending per patient on dialysis has stabilized in recent years, the total number of dialysis patients has continued to increase and now exceeds 500,000. The document discusses challenges with the current conventional dialysis treatment approach, including its inability to adequately manage issues like fluid overload, hypertension, and cardiovascular disease - which are the major drivers of mortality in ESRD patients. It suggests alternative home dialysis modalities may help address these issues but barriers need to be addressed to increase their utilization
The PRAMI trial was a randomized controlled trial that compared preventive percutaneous coronary intervention (PCI) to PCI limited to the infarct artery in patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel coronary artery disease. The trial found that preventive PCI of non-infarct arteries with major stenoses significantly reduced the risk of adverse cardiovascular events compared to PCI limited to the infarct artery alone. However, the trial had a small sample size. Guidelines recommend PCI of a non-infarct artery be performed separately from primary PCI, but the optimal timing remains unclear due to varying results from observational studies.
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
The study evaluated the efficacy and safety of combining LDL cholesterol lowering (rosuvastatin 10 mg) and blood pressure lowering (candesartan 16-12.5 mg and hydrochlorothiazide 12.5 mg) therapies versus placebo in 12,705 participants without cardiovascular disease but with risk factors. The combined therapy group experienced significantly fewer cardiovascular events (29% risk reduction) and fewer secondary outcomes (28% risk reduction) compared to the dual placebo group. The number needed to treat over 5.6 years was 72 to prevent one primary outcome and 63 to prevent one secondary outcome. While statistically significant differences were observed, the overall clinical benefit was modest given the event rates in both groups.
Ueda 2016 diabetes mellitus and heart failure - yahia kishkueda2015
Diabetes and heart failure have a bidirectional relationship where each condition can lead to or worsen the other. Over 60% of asymptomatic type 2 diabetes patients have left ventricular diastolic dysfunction. The prevalence of heart failure is higher in diabetics and increases with age. Diabetes increases the risk of heart failure through hypertension, coronary artery disease, diabetic nephropathy and cardiomyopathy. Intensive glucose control can help prevent microvascular complications but does not significantly reduce cardiovascular events. Several diabetes medications need to be used cautiously in heart failure patients. Both conditions are serious with high mortality rates so treatment must target overall improvement.
Aspirin as Prevention Therapy for Cardiovascular Events in patients with Diab...Stefania Dumitrescu
The Role of Aspirin in the primary prevention of cardiovascular disease in patients with diabetes, especially T2DM - current knowledge and recommendations -
Cardiovascular disease is very common in patients with chronic kidney disease.
- CVD is the leading cause of death in patients with CKD, even in early stages of kidney disease and those with low levels of albuminuria. Reduced kidney function and increased albuminuria are associated with higher risk of CVD events and mortality.
- The prevalence of CVD is extremely high in patients on dialysis, with over 70% of dialysis patients having CVD. CVD is responsible for about 40% of all deaths in dialysis patients.
- Both traditional CVD risk factors like hypertension and diabetes as well as nontraditional risk factors related to CKD contribute to the elevated CVD risk in this population. Targeting modifiable
Donor Lymphocyte Infusion in Patients with Hematological Malignancies after T...spa718
1. Donor lymphocyte infusion (DLI) is an effective method for treating relapse after hematopoietic stem cell transplantation. Modified DLI (mDLI) using G-CSF mobilized peripheral blood and short-term immunosuppression can reduce acute GVHD rates while maintaining the graft-versus-leukemia effect.
2. Prophylactic mDLI can significantly decrease relapse rates and increase survival in patients with advanced acute leukemia after HLA-identical or haploidentical transplantation.
3. Risk-stratified mDLI based on minimal residual disease monitoring may further reduce relapse and improve outcomes by targeting high-risk MRD-positive patients.
This randomized controlled trial tested the effects of eicosapentaenoic acid (EPA) supplementation on major coronary events in 18,645 Japanese patients taking statins. Patients received either EPA capsules totaling 1,800 mg daily or a placebo in addition to statin treatment for an average of 4.6 years. The primary endpoint was major coronary events including sudden cardiac death and heart attacks. The EPA group had a 19% lower relative risk of major coronary events compared to the control group. Specifically, EPA reduced non-fatal coronary events such as unstable angina. EPA supplementation showed benefits for both primary and secondary prevention of major coronary events in hypercholesterolemic patients taking statins.
This study compared the effects of levosimendan, dobutamine, and vasodilator therapy on ongoing myocardial injury in patients with acute decompensated heart failure. The study found that while all treatments were associated with decreases in cardiac troponin I levels and improvements in hemodynamic and functional indicators, levosimendan treatment showed the most pronounced improvements, especially in left ventricular ejection fraction and systolic pulmonary artery pressure. However, none of the treatments significantly reduced cardiac troponin I levels compared to each other. The study demonstrated beneficial effects of short-term use of levosimendan, dobutamine, and nitroglycerin on ongoing myocardial injury in acute decompensated heart failure.
Advancing dialysis: Recasting kidney failure as cardiovascular diseaseAdvancingDialysis.org
This document discusses issues related to end-stage renal disease (ESRD) and dialysis treatment in the United States. It notes that ESRD represents 7% of the Medicare budget while only treating 1% of the US population. Total Medicare spending on dialysis has risen steadily to over $35 billion per year. The dialysis patient population has also increased over time and now exceeds 500,000 patients, though the annual growth rate has fallen below 2%. Despite increased spending, health outcomes like mortality and hospitalization rates have stabilized in recent years. The document suggests that the main challenge for dialysis is in managing chronic conditions like hypertension, left ventricular hypertrophy, and heart failure, which are major drivers of morbidity and mortality
Advancing dialysis.org recent findings better management of volume with inten...AdvancingDialysis.org
The document discusses the challenges of managing fluid volume in patients undergoing standard hemodialysis treatment given the constraints of a 3 session per week schedule. Fluid accumulates in the body during the long interdialytic gaps, putting stress on the heart and increasing risks. While ultrafiltration rates have decreased slightly over time, cardiovascular hospitalization rates have risen, suggesting fluid management remains a key issue. Studies link higher fluid overload levels to increased mortality risk, indicating more consistent volume control through increased treatment frequency and/or time could help address remaining unmet needs.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
LDL Cholesterol Target :“ Lower the Better ”Arindam Pande
Lowering LDL cholesterol provides significant cardiovascular benefits and reduces risk, even in those with low baseline LDL levels or who achieve very low LDL levels with treatment. While residual risk remains even with intensive statin therapy to lower LDL well below current target levels, risk continues to decrease as LDL is further lowered. The lower the achieved LDL level, the lower the long-term risk of major cardiovascular events and atherosclerotic progression.
This document summarizes Dr. Chenhua Yan's work establishing and utilizing a modified donor lymphocyte infusion (mDLI) approach for the treatment of relapse after haploidentical hematopoietic stem cell transplantation (HSCT) for hematologic malignancies. The mDLI approach uses G-CSF mobilized peripheral blood stem cells and immunosuppressive agents after infusion to reduce graft-versus-host disease while preserving graft-versus-leukemia effects. Studies showed mDLI improved response rates and survival compared to chemotherapy or standard DLI alone for relapsed disease. Risk-stratified mDLI based on minimal residual disease also reduced relapse rates after transplantation.
A randomized study assigned 465 patients undergoing emergency PCI for acute STEMI to either preventive PCI of stenoses in non-infarct arteries or PCI of the infarct artery only. At a mean follow up of 23 months, the preventive PCI group had lower rates of the primary composite outcome of death from cardiac causes, non-fatal heart attack, or refractory angina (9% vs 23%). Preventive PCI also reduced the risk of subsequent cardiovascular events within the first 6 months after the procedure. Procedure times and contrast usage were increased with preventive PCI, but complication rates were similar between the groups.
Carotid intima-media thickness (CIMT) and carotid plaques in young Nepalese p...Paul Schoenhagen
Abstract
Background: Carotid intima-media thickness (CIMT) and carotid plaques are non-invasive surrogate markers of early evaluation of coronary artery disease (CAD) and sub clinical atherosclerosis. The objective of the study was to evaluate CIMT and carotid plaques in less than 45 years old Nepalese patients with angiographically proven CAD.
Methods: A total of 54 patients with angiographically documented CAD at less than 45 years of age were enrolled. CAD was confirmed by coronary angiography. Demographic profile was obtained. High resolution B-mode ultrasound was used to detect the CIMT and carotid plaques.
Results: The study population included 44 males and 10 females, with a mean ± SD age of 38.4±4.3 years (range, 25-44 years). Cardiovascular risks factors included smoking in 81%, Hypertension in 52%, diabetes in 19% and alcohol consumption in 78% of patients. Lipid profile (mean ± SD) was normal except for elevated triglyceride (TG) levels of 204±130.8 mg/dL. By angiography, 64.8% had single vessel disease, 26% had double vessel disease and 9.2% had triple vessel disease. Ultrasound detected either thickened CIMT or presence of plaques in 46 (85.2%) cases (group-A) and 8 (14.8%) had negative (normal) carotid study (group-B). Among the 46 patients with positive findings 63% had carotid plaques and 37% had thickened CIMT only. The majority (69%) of the carotid plaques were detected at the carotid bulbs. In total population, carotid plaque was detected in 53.7% of cases. There was no statistical significant difference of age, body mass index (BMI) and lipid level between group-A and group-B.
Conclusions: Increased CIMT and carotid plaques are detected in majority of the young Nepalese patients with angiographically documented CAD. The majority of carotid plaques are detected at the carotid bulbs. Routine carotid ultrasound study in young individuals with CAD risk factors appears worthwhile.
Cardiac imaging in prosthetic paravalvular leaksPaul Schoenhagen
This document discusses cardiac imaging techniques used in the diagnosis and treatment of prosthetic paravalvular leaks (PVLs). Echocardiography, especially 3D transoesophageal echocardiography (TEE), plays a key role in initially diagnosing PVLs, guiding percutaneous closure procedures, and evaluating outcomes. While transthoracic echocardiography is often first used, TEE is needed to confirm clinically significant leaks. Additional techniques like CT, MRI, and angiography can provide further detail. Intraprocedural imaging with TEE and fluoroscopy helps interventional cardiologists properly position closure devices and confirm adequate sealing of leaks.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help alleviate symptoms of mental illness and boost overall mental well-being.
microRNA-based diagnostics and therapy in cardiovascular disease—Summing up t...Paul Schoenhagen
This document discusses microRNAs (miRNAs) as potential biomarkers for cardiovascular disease diagnosis and therapy. It summarizes that miRNAs have been found to be specifically up or downregulated in different cardiovascular diseases and animal models. Circulating miRNAs have shown promise as biomarkers for conditions like myocardial infarction and coronary artery disease due to their stability and disease-specific expression patterns. Several miRNAs have been identified as biomarkers for acute myocardial infarction that may complement or improve upon existing protein biomarkers. Research is also exploring the potential of miRNA-based therapies for cardiovascular diseases.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Sodium content in processed foods in Argentina: compliance with the national lawPaul Schoenhagen
Background: Despite the body of evidence that documents the unfavorable effects of excessive sodium
consumption on blood pressure and cardiovascular health, public health efforts to decrease sodium consumption
have been limited to a few countries. Argentina is the first country in Latin America to regulate sodium content of
processed foods by means of a national law. The objective of this cross-sectional quantitative study is to provide a
baseline comparison against the reduction targets set by the national law before its entry into force.
Methods: Data were collected in February 2014 in a leading supermarket chain located in Buenos Aires.
Nutrient data from package labels were analysed for 1,320 products within 14 food groups during the study
period. To compare sodium concentration levels with the established maximum levels we matched the
collected food groups with the food groups included in the law resulting in a total of 292 products. Data
analysis was conducted using SPSS version 20 software.
Results: Food groups with the highest median sodium content were sauces and spreads (866.7 mg/100 g),
meat and meat products (750 mg/100 g) and snack foods (644 mg/100 g). Categories with the highest sodium
content were appetizers (1,415 mg/100 g), sausages (1,050 mg/100 g) and ready-made meals (940.7 mg/100 g).
We also found large variability within products from the same food categories. Products included in the
national law correspond to 22.1% (n=292) of the surveyed foods. From the 18 food groups, 15 showed
median sodium values below the established targets. Products exceeding the established maximum levels
correspond to 15.1% (n=44) of the products included in the analysis.
Conclusions: This study is the first analysis of food labels to determine sodium concentrations of processed
foods in Argentina and to provide a baseline against the national law standards. Upon the completion of
this analysis, maximum levels have been achieved by most of the food groups included in the law. Thus, the
introduction of further reductions for the existing maximum levels and the establishment of sodium targets for
all relevant product categories not included in the law should be considered as the next steps in the process.
Salt intake reduction efforts: advances and challengesPaul Schoenhagen
The articles in this special issue of Cardiovascular Diagnosis and Therapy describe the efforts to reduce salt intake in different parts of the world, including South America, Africa, the Middle East, the Far East (China and Mongolia) and Australia, in addition to an overview of the work of the World Hypertension League in this domain. Sharing experiences from diverse regions and countries, these data will contribute to better understanding the challenges and opportunities encountered by the groups working in the field.
Hemodynamic assessment of partial mechanical circulatory support: data derive...Paul Schoenhagen
Partial mechanical circulatory support represents a new concept for the treatment of advanced heart failure. The Circulite Synergy Micro Pump®, where the inflow cannula is connected to the left atrium and the outflow cannula to the right subclavian artery, was one of the first devices to introduce this concept to the clinic. Using computational fluid dynamics (CFD) simulations, hemodynamics in the aortic tree was visualized and quantified from computed tomography angiographic (CTA) images in two patients. A realistic computational model was created by integrating flow information from the native heart and from the Circulite device. Diastolic flow augmentation in the descending aorta but competing/antagonizing flow patterns in the proximal innominate artery was observed. Velocity time curves in the ascending aorta correlated well with those in the left common carotid, the left subclavian and the descending aorta but poorly with the one in the innominate. Our results demonstrate that CFD may be useful in providing a better understanding of the main flow patterns in mechanical circulatory support devices.
Salt reduction and hypertension in China: a concise state-of-the-art reviewPaul Schoenhagen
Abstract: Hypertension (HTN) and its cardiovascular complications such as stroke and heart failure are a serious public health problem around the world. A growing number of studies confirm that salt plays an important role in the development of HTN. Increasing intake of salt leads to abnormal transport of sodium ions at the cellular level with activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Studies have shown that salt restriction can reduce blood pressure (BP) in patients with HTN, especially salt-sensitive HTN. Public health interventions to reduce salt intake, with the goal of decreasing adverse outcomes have been launched in numerous countries. In this review we will summarize the epidemiology of cardiovascular diseases and their risk factors, the relationship between salt and HTN, the effect of salt restriction on HTN and the current situation of prevention and treatment of HTN by salt reduction in China.
WHO’s supported interventions on salt intake reduction in the sub-Saharan Afr...Paul Schoenhagen
Abstract: Reduction of salt intake is an important and cost-effective way for reducing hypertension and the risk of cardiovascular diseases (CVDs). Current global salt intakes are estimated at around 10 g/day, well above the World Health Organization (WHO) recommended level of <5 g/day. The sub-Saharan Africa (SSA) region has a prevalence of hypertension of 46% among adults aged 25 and over and therefore strategies to reduce salt intake are necessary. This requires an understanding of salt intake behaviors in the population along with government commitment to increase awareness and take actions that would create an enabling environment. It is also important to have the food industry and other key stakeholders on board. A review of the developed WHO’s norms and guidelines, technical support provided to countries by WHO as well as country initiatives shows that countries in the African region are at different stages in the implementation of salt reduction interventions. For example, South Africa has enacted legislation to make the food industry reduce the salt content of a number of its products while Mauritius is requesting bakery owners to reduce salt in bread. A number of countries are currently undertaking studies to measure salt intake in the populations. Overall progress is slow as the region experiences a double burden of communicable and noncommunicable diseases, competing health priorities and limited resources for health.
Keywords: Africa; salt intake; sodium; non-communicable diseases (NCDs); cardiovascular
An overview of salt intake reduction efforts in the Gulf Cooperation Council ...Paul Schoenhagen
Globally, morbidity and mortality from non-communicable diseases (NCDs) are increasing steadily and at an alarming rate. High blood pressure is a major risk factor for cardiovascular disease (CVD) and salt reduction is an effective measure to decrease mortality rates. In the Eastern Mediterranean region, current salt intake is high, with an average intake of >12 g per person per day. Reducing the intake of salt has been identified as a priority intervention to reduce NCDs. Countries of the Gulf Cooperation Council (GCC) are showing a willingness to comply with the World Health Organization (WHO) recommendations and an eagerness to reduce the burden of NCDs. However, they face some challenges, including lack of political commitment, lack of experience, and shortage of qualified human resources. Salt intake reduction efforts
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
A new polymer-free drug-eluting stent with nanocarriers eluting sirolimus fro...Paul Schoenhagen
Background: Permanent polymers in first generation drug-eluting stent (DES) have been imputed to be a possible cause of persistent inflammation, remodeling, malapposition and late stent thrombosis. We aim to describe the in vivo experimental result of a new polymer-free DES eluting sirolimus from stent-plus-balloon (Focus np stent, Envision Scientific) compared with a bare-metal stent (BMS) (Amazonia CroCo, Minvasys) and with a biolimus A9 eluting stent (Biomatrix, Biosensors).
Developing a national salt reduction strategy for MongoliaPaul Schoenhagen
Background: The increase in prevalence of risk factors such as hypertension has contributed to an incremental rise in non-communicable diseases (NCDs) in Mongolia over recent decades, such that they now account for 80% of all deaths in the country. Salt reduction is one of the most cost-effective interventions to reduce the burden of NCDs.
Methods: In 2011, the Ministry of Health (MOH) instigated the development of a national salt reduction strategy for Mongolia. As part of a 2-week national consultation and training program on salt reduction, it established an inter-sectoral working party and organized a series of bilateral meetings and visits to factories. Actions arising included a baseline survey of population salt consumption patterns and the implementation of a series of pilot salt reduction initiatives.
Results: The results of the baseline assessment revealed that average daily intake of salt, based on 24 hour urine samples from a representative national sample (n=1,027), was 11.06±5.99 g in 2011, more than double the World Health Organization (WHO) five grams recommendation. Moreover, while most participants knew that salt was bad for health, few were taking efforts to reduce intake, and many were consuming highly salty meals and tea; salt in tea alone was estimated to contribute 30% of daily salt intake. A pilot Pinch Salt intervention to reduce salt consumption of factory workers was undertaken in Ulaanbaatar (UB) city between 2012 and 2013, and was associated with a reduction of 2.8 g of salt intake. Ongoing food industry initiatives have led to significant reductions in salt levels in bread, and companies producing processed meat have indicated a willingness to reduce salt. Relevant stakeholders have also supported the campaign by participating in annual World Salt Awareness Week events. The activities to date have demonstrated the potential for action and there is now a need scale these up to a national level to ensure that Mongolia is in a strong position to achieve a 30% reduction in population salt intake by 2025. The main goal of the Mongolian national salt reduction strategy is to create a social, economic and legal environment that supports salt reduction, including by influencing food supply, increasing partnerships between government and relevant stakeholders, and creating an enabling environment to support improved consumer choices. The strategy will be implemented from 2015 to 2025, with an interim review of progress in 2020.
Conclusions: Given that Mongolia has one of the highest rates of stroke in the world, which is strongly associated with population-wide blood pressure (BP) levels, the addition of a population-based stroke surveillance program would provide a reliable direct assessment of the impact of these salt reduction initiatives on the health of the Mongolian people. The results from this research would likely be widely generalizable to other populations experiencing similar lifestyle transitional changes.
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Improved non-calcified plaque delineation on coronary CT angiography by sonog...Paul Schoenhagen
Purpose: To prospectively compare non-calcified plaque delineation and image quality of coronary computed tomography angiography (CCTA) obtained with sinogram-affirmed iterative reconstruction (IR) with different filter strengths and filtered back projection (FBP).
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
This document provides a summary of a presentation on statins. It discusses the benefits of statins in reducing cardiovascular events and mortality in both primary and secondary prevention. It addresses several controversies around statins, including their association with diabetes, cognitive impairment, cancer, and hemorrhagic stroke. While some modest risks are noted, the overall benefits of statins in reducing cardiovascular risk are found to outweigh these potential risks. The document emphasizes the importance of statin adherence to achieve optimal outcomes and addresses targets for LDL and non-HDL cholesterol levels according to recent guidelines.
Prognosis and treatment of cardiogenic shock complicating acute myocardial in...drucsamal
This document discusses the prognosis and treatment of cardiogenic shock complicating acute myocardial infarction. It notes that while the mortality rate for cardiogenic shock used to be 80-90%, studies now report in-hospital mortality rates between 42-74%. Several factors predict higher mortality, such as increasing age, prior heart attack, and low blood pressure/cardiac output. The document recommends general measures like aspirin, heparin, and vasopressors to treat cardiogenic shock. It advises against beta blockers and favors early revascularization when possible to improve outcomes for patients experiencing this complication of a heart attack.
This document discusses cardiovascular disease (CAD) in South Asians and a clinical trial on the use of statins. It contains the following key points:
1) South Asians have a higher prevalence of CAD than other ethnicities due to genetic and environmental/lifestyle factors such as metabolic syndrome and central obesity.
2) The JUPITER trial found that treating individuals with low LDL cholesterol but high C-reactive protein with rosuvastatin reduced cardiovascular events like heart attack and stroke by 44% compared to placebo, showing statins can benefit those not currently eligible for treatment.
3) Rosuvastatin was well-tolerated in JUPITER and showed no increase in side effects even when LDL
This document summarizes the key points from a lipidology conference presentation. It discusses recent guidelines and studies on cholesterol treatment, including more aggressive LDL lowering to under 70mg/dl for patients with cardiovascular disease. New tools for general cardiovascular risk prediction were presented. Treatment with high-dose statins was found to significantly reduce stroke recurrence and other outcomes for patients who had a stroke or TIA within the past 1-6 months. Immediate withdrawal of statins after acute stroke was associated with increased risks.
1. A study found that early treatment of a first episode of acute pericarditis with colchicine in addition to standard anti-inflammatory therapy reduced the risk of recurrence compared to anti-inflammatory therapy alone.
2. The STOP-HF trial found that screening high-risk patients for heart failure with BNP and providing further assessment and care for those with elevated BNP resulted in less left ventricular dysfunction, heart failure, and emergency hospitalizations compared to usual care.
3. The EchoCRT trial of CRT in patients with narrow QRS found no benefit of CRT and more deaths with CRT, suggesting CRT is not recommended for patients with narrow QRS.
This document summarizes recent evidence on medical treatments, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) for stable coronary artery disease. Key findings include:
1) Large clinical trials found no significant difference in outcomes between PCI and optimal medical therapy for stable CAD patients.
2) CABG was shown to reduce mortality, myocardial infarction, and repeat revascularization compared to medical therapy or PCI for multi-vessel disease.
3) For left main coronary artery disease, CABG may be preferable to PCI for patients with high anatomical complexity scores.
4) Ongoing trials like ISCHEMIA are further evaluating optimal revascularization strategies for stable CAD patients with ischemia.
1) A study examined 103 heart attack patients treated with high-dose statins and found plaque volume decreased slightly (0.9%) in the arteries not responsible for the heart attack.
2) A randomized study of 296 heart attack patients found that performing revascularization of additional blocked arteries beyond the heart attack artery led to fewer total cardiac events (10% vs 21%) over 12 months compared to only treating the heart attack artery.
3) A study of 738 patients with chronic total blockages and good collateral blood flow found that revascularizing the blockages reduced cardiac death and total cardiac events compared to medical treatment alone, showing benefit of revascularization even in patients with established collateral circulation.
Exercise stress echocardiography in patients with aortic stenosis: impact of baseline diastolic dysfunction and functional capacity on mortality and aortic valve replacement
Authors: Andrew N. Rassi, Wael AlJaroudi, Sahar Naderi, M Chadi Alraies, Venu Menon, Leonardo Rodriguez, Richard Grimm, Brian Griffin, Wael A. Jaber
http://www.thecdt.org/article/view/2855
The SPRINT study compared an intensive blood pressure treatment target of less than 120 mm Hg to a standard target of less than 140 mm Hg in 9,361 patients at high risk for cardiovascular events but without diabetes. At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive group and 136.2 mm Hg in the standard group. After a median follow up of 3.26 years, the primary composite outcome of heart attack, acute coronary syndrome, stroke, heart failure or cardiovascular death occurred less frequently in the intensive group compared to the standard group. All-cause mortality was also lower in the intensive group, though rates of some adverse events were higher.
The HOPE-3 trial found that combining treatment with rosuvastatin, candesartan, and hydrochlorothiazide reduced the risk of cardiovascular events by 29% compared to placebo in a population at intermediate cardiovascular risk. The combination therapy lowered LDL cholesterol by 33.7 mg/dL and systolic blood pressure by 6.2 mmHg on average over 5.6 years. It reduced the risk of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to placebo, with numbers needed to treat of 72 and 63 to prevent an event in the primary outcomes. Subgroup analyses suggested greater benefit for those with higher baseline blood pressure.
This document summarizes recent studies on stroke prevention strategies and risk factors. It discusses advances in neurorehabilitation, drug development, and other therapies. It then reviews major risk factors for stroke like hypertension, dyslipidemia, diabetes, smoking, obesity, lack of physical activity, and prior stroke or TIA. Several studies are highlighted that show treating modifiable risk factors can reduce stroke risk by 82-90%. The document also reviews guidelines for treating hypertension and targets for LDL cholesterol in secondary stroke prevention. It discusses trials comparing antiplatelet therapies like clopidogrel plus aspirin versus aspirin alone for reducing recurrent stroke risk.
- The document discusses recent advances in stroke management including neurorehabilitation, drug development, robotics, cortical stimulation, and stem cell therapies.
- It then discusses various risk factors for ischemic and hemorrhagic stroke, noting that hypertension, diet, physical inactivity, smoking, and abdominal obesity account for the majority of population-attributable risk.
- Specific guidelines and studies are discussed regarding management of hypertension, dyslipidemia, anti-platelet therapy including clopidogrel and aspirin, and LDL cholesterol targets after ischemic stroke to reduce risk of recurrent events.
This study evaluated the efficacy of colchicine in preventing in-stent restenosis in 90 patients undergoing percutaneous coronary intervention with bare-metal stents. Patients were divided into 3 groups: those receiving a bare-metal stent plus colchicine, bare-metal stent alone, or a drug-eluting stent. After 6 months of follow up, the rates of in-stent restenosis and target vessel revascularization were significantly lower in patients receiving colchicine plus bare-metal stent compared to bare-metal stent alone. There was no difference in stent thrombosis rates between groups. The study suggests that colchicine may be useful for reducing restenosis and need for repeat procedures when
This document provides biographical information about Dr. Wei-Chun Huang, including his academic and professional qualifications. It lists his positions, including serving as the director of the Department of Critical Care Medicine at Kaohsiung Veterans General Hospital, as well as his affiliations with professional organizations in Taiwan and internationally. The document also thanks the ICU departments from 14 hospitals across Taiwan for their participation in a conference.
This document discusses the role of statins in secondary prevention after coronary artery bypass graft (CABG) surgery. It finds that only 60% of vein grafts remain patent 10 years after CABG, putting patients at high risk for subsequent cardiac events. Guidelines recommend statin therapy for all CABG patients to achieve an LDL below 100 mg/dl. Studies show preoperative statin use reduces mortality, stroke, and atrial fibrillation after CABG by limiting inflammation and improving endothelial function. Postoperative aggressive statin therapy further limits graft atherosclerosis and decreases recurrent heart attacks and revascularization through its pleiotropic effects. However, statins remain underutilized after CABG according to one study, highlighting the need to
Cardiac risk evaluation: searching for the vulnerable patient FELIX NUNURA
The document discusses screening patients for cardiovascular risk factors and disease. It outlines various risk assessment tools like the Framingham Risk Score and SCORE that estimate risk based on factors like age, cholesterol levels, blood pressure, smoking status. It discusses limitations of risk factor-based screening and emphasizes the importance of directly measuring subclinical disease using tests like coronary artery calcium scoring and carotid intima-media thickness to identify vulnerable patients. The document advocates screening for and treating the underlying atherosclerotic disease rather than just risk factors to improve prevention outcomes.
This document discusses hypertension guidelines and management. It covers the epidemiology of hypertension, guidelines for classification and treatment targets, detection of white coat and masked hypertension, and management of hypertension in patients with comorbidities like chronic kidney disease. Proper control of hypertension is important for reducing cardiovascular and renal risks. Treatment involves lifestyle changes and antihypertensive medications, with certain drugs offering additional organ protective effects. Management is more complex in patients on dialysis or after kidney transplantation.
Rosuvastatin is an effective treatment for cardiovascular disease (CVD) prevention and risk reduction. It provides significant reductions in LDL cholesterol levels with doses as low as 10 mg per day and can reduce LDL by over 50% at higher doses. Multiple studies have shown that rosuvastatin lowers rates of major adverse cardiac events compared to placebo in both primary and secondary prevention populations. Rosuvastatin has also demonstrated plaque regression in coronary arteries and slowed progression of atherosclerosis. It is considered a first-line agent by guidelines for lowering cholesterol and reducing CVD risk.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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