Presented by:
P. Michael Ho, MD, PhD, David J. Magid, MD, MPH, Susan M. Shetterly, MS, Kari L. Olson, PharmD, BCPS, Thomas M. Maddox, MD, MSc, Pamela N. Peterson, MD, MSPH, Frederick A. Masoudi, MD, MSPH, John S. Rumsfeld, MD, PhD
The South African Journal of Diabetes & Vascular Disease presents: Problems and challenges in patients with type 1 diabetes.
Larry A Distiller
Centre for Diabetes and Endocrinology
Johannesburg
http://www.diabetesjournal.co.za
Cardiology 2019 trial and meta analysisFuad Farooq
This document summarizes 15 recent studies on cardiovascular diseases and treatments that were published in major medical journals in 2019, including the New England Journal of Medicine, Journal of the American College of Cardiology, Annals of Internal Medicine, Lancet, and JAMA. The studies covered topics such as the use of smartwatches to detect atrial fibrillation, the efficacy and safety of medications like colchicine and evolocumab in heart disease patients, outcomes of PCI versus CABG for left main coronary artery disease, the effects of dual antiplatelet therapy duration following PCI, and the cardiovascular risks associated with cancer survivorship and sleep duration.
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
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.
This document discusses strategies for preventing stroke in patients with non-valvular atrial fibrillation (AFib). It presents two case studies and provides background on the prevalence and risks of stroke from AFib. It reviews evidence that anticoagulation therapy with warfarin can significantly reduce stroke risk but carries a risk of bleeding. Scoring systems like CHADS2 and CHA2DS2-VASc are discussed to assess stroke risk. Novel oral anticoagulants like dabigatran, rivaroxaban and apixaban are summarized based on major clinical trials demonstrating their efficacy and safety compared to warfarin. Pharmacokinetic properties and dosing guidelines for these drugs are also
This patient is a 37-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a family history of coronary artery disease. Examination found elevated blood pressure and LDL, as well as signs of sympathetic overactivity.
Given the patient's sympathetic overactivity, diabetes, hypertension, and family history of CAD, treatment with a beta-blocker and high-intensity statin is recommended. Metoprolol is preferred as it has a short half-life, is excreted through the liver, and does not accumulate in renal impairment. Intensifying the statin dose is also needed given the patient's multiple risk factors to achieve a target LDL lower than 100 mg/dL.
This is a case of a 74-year-old woman with a history of myocardial infarction who presents for routine follow-up. Her current medications include a statin but her lipid levels are not at goal. The guidelines recommend an LDL goal of <55 mg/dL and at least a 50% reduction for very high risk patients like her. After increasing her statin and adding ezetimibe, her LDL decreased to 53 mg/dL but she had a transient ischemic attack. Additional treatment options to further lower her risk should be considered.
This randomized clinical trial compared adjunctive cilostazol versus double dose clopidogrel after drug-eluting stent implantation. The trial involved 3,755 patients randomized to either triple antiplatelet therapy with cilostazol or double dose clopidogrel dual antiplatelet therapy for 1 month. The primary endpoint of cardiac death, MI, stent thrombosis, stroke, or major bleeding within 1 month occurred in 1.2% of the triple therapy group and 1.4% of the double dose clopidogrel group, demonstrating noninferiority of triple therapy. On treatment platelet reactivity was lower in the triple therapy group. The trial demonstrated that triple antiplatelet therapy was noninferior to double
The South African Journal of Diabetes & Vascular Disease presents: Problems and challenges in patients with type 1 diabetes.
Larry A Distiller
Centre for Diabetes and Endocrinology
Johannesburg
http://www.diabetesjournal.co.za
Cardiology 2019 trial and meta analysisFuad Farooq
This document summarizes 15 recent studies on cardiovascular diseases and treatments that were published in major medical journals in 2019, including the New England Journal of Medicine, Journal of the American College of Cardiology, Annals of Internal Medicine, Lancet, and JAMA. The studies covered topics such as the use of smartwatches to detect atrial fibrillation, the efficacy and safety of medications like colchicine and evolocumab in heart disease patients, outcomes of PCI versus CABG for left main coronary artery disease, the effects of dual antiplatelet therapy duration following PCI, and the cardiovascular risks associated with cancer survivorship and sleep duration.
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
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.
This document discusses strategies for preventing stroke in patients with non-valvular atrial fibrillation (AFib). It presents two case studies and provides background on the prevalence and risks of stroke from AFib. It reviews evidence that anticoagulation therapy with warfarin can significantly reduce stroke risk but carries a risk of bleeding. Scoring systems like CHADS2 and CHA2DS2-VASc are discussed to assess stroke risk. Novel oral anticoagulants like dabigatran, rivaroxaban and apixaban are summarized based on major clinical trials demonstrating their efficacy and safety compared to warfarin. Pharmacokinetic properties and dosing guidelines for these drugs are also
This patient is a 37-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a family history of coronary artery disease. Examination found elevated blood pressure and LDL, as well as signs of sympathetic overactivity.
Given the patient's sympathetic overactivity, diabetes, hypertension, and family history of CAD, treatment with a beta-blocker and high-intensity statin is recommended. Metoprolol is preferred as it has a short half-life, is excreted through the liver, and does not accumulate in renal impairment. Intensifying the statin dose is also needed given the patient's multiple risk factors to achieve a target LDL lower than 100 mg/dL.
This is a case of a 74-year-old woman with a history of myocardial infarction who presents for routine follow-up. Her current medications include a statin but her lipid levels are not at goal. The guidelines recommend an LDL goal of <55 mg/dL and at least a 50% reduction for very high risk patients like her. After increasing her statin and adding ezetimibe, her LDL decreased to 53 mg/dL but she had a transient ischemic attack. Additional treatment options to further lower her risk should be considered.
This randomized clinical trial compared adjunctive cilostazol versus double dose clopidogrel after drug-eluting stent implantation. The trial involved 3,755 patients randomized to either triple antiplatelet therapy with cilostazol or double dose clopidogrel dual antiplatelet therapy for 1 month. The primary endpoint of cardiac death, MI, stent thrombosis, stroke, or major bleeding within 1 month occurred in 1.2% of the triple therapy group and 1.4% of the double dose clopidogrel group, demonstrating noninferiority of triple therapy. On treatment platelet reactivity was lower in the triple therapy group. The trial demonstrated that triple antiplatelet therapy was noninferior to double
Advances in medical management of HF.. building up the pillarsPraveen Nagula
This document discusses advances in the medical management of heart failure. It notes that heart failure prevalence is growing globally and in India. Newer drugs like SGLT2 inhibitors (SGLT2i), specifically dapagliflozin, have shown benefits in reducing cardiovascular risks and hospitalizations for heart failure beyond standard therapies. Two major trials, DECLARE and DAPA-HF, found dapagliflozin reduced risks of cardiovascular death or hospitalization for heart failure compared to placebo in patients with and without diabetes. The document concludes that early recognition and effective management of heart failure with newer drugs can help decrease progression and improve outcomes.
This document provides an overview of heart failure, with a focus on heart failure with preserved ejection fraction (HFpEF). It discusses the pathophysiology, diagnosis, and management of HFpEF. Key points include:
- HFpEF accounts for about 1/3 to 1/2 of heart failure cases and is associated with abnormal diastolic function.
- Diagnosis involves assessing symptoms, imaging like echocardiography to evaluate diastolic dysfunction, and ruling out other potential causes.
- Treatment focuses on controlling risk factors like hypertension, fluid management, and some evidence that ARBs, ARNI, and statins may provide benefits. Prognosis is similar to heart failure with reduced eject
This study evaluated the efficacy and safety of adding ticagrelor to low-dose aspirin in stable patients with a history of myocardial infarction. Over 18,000 patients were randomly assigned to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo twice daily in addition to standard medical therapy including aspirin. The primary outcome was a composite of cardiovascular death, myocardial infarction, and stroke. The results showed that ticagrelor at either dose reduced the risk of the primary outcome compared to placebo by 16-19% with no significant difference between the two ticagrelor doses. Ticagrelor increased the risk of TIMI major bleeding but not fatal bleeding or intracere
New blood products hemorrhagic stroke apr 14 12Ihsaan Peer
This document discusses new blood products and their roles in hemorrhagic stroke. It summarizes a study on Recombinant Factor VIIa (rFVIIa) for treating acute intracerebral hemorrhage. The study found that while rFVIIa reduced hematoma growth, it did not improve survival or functional outcomes. The document also reviews options for reversing the effects of oral anticoagulants in patients who experience hemorrhagic stroke, including prothrombin complex concentrates (PCCs). It provides guidance on appropriate dosing and administration of PCCs based on recommendations from the National Advisory Committee on Blood and Blood Products.
The FDA has decided to require Cardiovascular Outcome Trials (CVOT) for new obesity drugs. Trails may be required either before or after approval and marketing. This 2012 presentation discusses the rationales for such trials and points out that some believe one such previous trial was misinterpreted.
Cardiovascular Medications in Older Adults PASaskatchewan
This document discusses managing cardiovascular medications in older adults. Key points include:
- Medication requirements often change with age due to physiological changes
- Older adults are at higher risk for both cardiovascular events and adverse drug reactions
- Managing medications for older adults presents challenges like multimorbidity, polypharmacy, altered pharmacokinetics, and adherence issues
- The document reviews these considerations for an individual case study patient and his medications for atrial fibrillation, hypertension, and dyslipidemia. Resources for guiding decisions in older adults are also provided.
This study examined racial and gender disparities in achieving target LDL cholesterol levels among hypertensive patients. It found that black women, black men, and white women were less likely to achieve target LDL-C levels within two years compared to white men, even after adjusting for demographic factors, clinical characteristics, healthcare access factors, provider characteristics, and lipid-lowering medication potency. Black women were prescribed the most potent lipid-lowering medications on average. The disparities seen suggest a need for greater focus on patient-level barriers to medication adherence for women and black men.
How to Use Heart Rate Changes to Improve Exercise Test Results How to Use H...MedicineAndFamily
The document discusses using heart rate changes to improve the diagnostic and prognostic value of exercise testing. It argues that functional capacity and heart rate recovery provide stronger prediction of outcomes than ST segment depression alone. The document also warns against several mistakes that can invalidate the use of statistical prediction rules and scores, such as limiting the study population, incomplete follow-up, and using surrogate endpoints rather than clinical outcomes.
The JUPITER trial was a randomized, double-blind, placebo-controlled trial that investigated whether rosuvastatin 20 mg could decrease major cardiovascular events in apparently healthy people with elevated levels of C-reactive protein (hsCRP > 2 mg/L) but normal cholesterol levels (LDL < 130 mg/dL). The trial enrolled 17,802 participants across 26 countries who were randomized to rosuvastatin 20 mg or placebo. Rosuvastatin significantly reduced the primary endpoint of myocardial infarction, stroke, hospitalization for unstable angina, arterial revascularization procedures, or cardiovascular death by 44% compared to placebo. Rosuvastatin also significantly lowered levels of LDL cholesterol, hsCRP, and triglycerides
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.
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
Statin use was associated with a statistically significant increased risk of developing diabetes in postmenopausal women according to a study using data from the Women's Health Initiative. The risk was found across all subgroups tested and persisted even after adjusting for potential confounding factors. However, the study did not prove causation and a subset analysis using fasting glucose did not replicate the increased risk finding. The authors conclude statins have cardiovascular benefits but more research is needed to establish if they causally increase diabetes risk.
JUPITER (Justification for the Use of Statins in Primary Prevention: An Inter...theheart.org
- 4-year, double-blind, placebo-controlled, randomized clinical trial
- Population and treatment:
17 802 patients with normal LDL-C (median 108 mg/dL) and elevated CRP (>2.0 mg/L) randomized to rosuvastatin 20 mg/d or placebo
- Primary outcome:
Composite of nonfatal MI, nonfatal stroke, hospitalization for unstable angina, revascularization, and confirmed death from CV causes
See the article at http://www.theheart.org/article/917181.do
Guidelines and beyond new drug therapy for heart failure with reduced ejectio...ahvc0858
This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies
This document summarizes guidelines for cholesterol treatment and clinical trials evaluating lipid targets. It discusses the ATP III guidelines, major trials after ATP III including TNT, JUPITER, ACCORD-LIPID, and AIM-HIGH. It then reviews the 2013 ACC/AHA cholesterol treatment guidelines, including the 4 groups that benefit from statins, ASCVD risk assessment, and future directions. Clinical cases are used to illustrate guideline recommendations for statin treatment based on a patient's risk factors.
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.
1) Statins are highly effective in reducing LDL-C and cardiovascular risk, playing a cornerstone role in lipid management. They work by inhibiting HMG-CoA reductase.
2) Atorvastatin has been extensively studied in large trials and shown to significantly reduce major cardiovascular events when doses are increased from 10 mg to 80 mg.
3) Studies in India found that high dose atorvastatin (80 mg) was well tolerated and more effective at reducing LDL-C and hs-CRP than lower doses in ACS patients. However, many ACS patients in India were not receiving statins as recommended.
Rivaroxaban has shown benefits beyond antiplatelet therapy alone in reducing cardiovascular events. The COMPASS trial found that in patients with chronic coronary artery disease or peripheral artery disease, rivaroxaban plus aspirin reduced the composite of cardiovascular death, stroke, and myocardial infarction by 24% compared to aspirin alone. It also reduced mortality by 18% and ischemic stroke by 42%. Patients with multiple risk factors such as diabetes, chronic kidney disease, or heart failure derived the greatest benefits. However, use of anticoagulants remains lower than guidelines recommend due to overestimation of bleeding risks and underestimation of thrombotic risk.
Hypertension is a major risk factor for cardiovascular disease. Hypertension is more difficult to control in patients with diabetes due to various pathophysiological factors. This document discusses hypertension in diabetes in depth, including definitions, types, causes, management goals, refractory hypertension, and treatment approaches. Treatment involves optimizing drug regimens, addressing medication non-adherence, and considering secondary causes of hypertension such as kidney disease or obstructive sleep apnea.
- The current medication adherence program at The Client pharmacy is ineffective and expensive, with only a 3.75% increase in adherence for non-adherent patients. This results in lost revenue and costs the company approximately $290 billion annually.
- Accenture proposes developing a gamification platform to increase patient engagement and medication adherence in a more cost-effective manner. Game mechanics would appeal to different patient motivations and provide feedback to customize the experience.
- Key benefits would include increased prescription sales, lower program costs, and more patient data to continue improving the platform over time based on measuring various success metrics like adherence rates and time spent on the program.
Advances in medical management of HF.. building up the pillarsPraveen Nagula
This document discusses advances in the medical management of heart failure. It notes that heart failure prevalence is growing globally and in India. Newer drugs like SGLT2 inhibitors (SGLT2i), specifically dapagliflozin, have shown benefits in reducing cardiovascular risks and hospitalizations for heart failure beyond standard therapies. Two major trials, DECLARE and DAPA-HF, found dapagliflozin reduced risks of cardiovascular death or hospitalization for heart failure compared to placebo in patients with and without diabetes. The document concludes that early recognition and effective management of heart failure with newer drugs can help decrease progression and improve outcomes.
This document provides an overview of heart failure, with a focus on heart failure with preserved ejection fraction (HFpEF). It discusses the pathophysiology, diagnosis, and management of HFpEF. Key points include:
- HFpEF accounts for about 1/3 to 1/2 of heart failure cases and is associated with abnormal diastolic function.
- Diagnosis involves assessing symptoms, imaging like echocardiography to evaluate diastolic dysfunction, and ruling out other potential causes.
- Treatment focuses on controlling risk factors like hypertension, fluid management, and some evidence that ARBs, ARNI, and statins may provide benefits. Prognosis is similar to heart failure with reduced eject
This study evaluated the efficacy and safety of adding ticagrelor to low-dose aspirin in stable patients with a history of myocardial infarction. Over 18,000 patients were randomly assigned to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo twice daily in addition to standard medical therapy including aspirin. The primary outcome was a composite of cardiovascular death, myocardial infarction, and stroke. The results showed that ticagrelor at either dose reduced the risk of the primary outcome compared to placebo by 16-19% with no significant difference between the two ticagrelor doses. Ticagrelor increased the risk of TIMI major bleeding but not fatal bleeding or intracere
New blood products hemorrhagic stroke apr 14 12Ihsaan Peer
This document discusses new blood products and their roles in hemorrhagic stroke. It summarizes a study on Recombinant Factor VIIa (rFVIIa) for treating acute intracerebral hemorrhage. The study found that while rFVIIa reduced hematoma growth, it did not improve survival or functional outcomes. The document also reviews options for reversing the effects of oral anticoagulants in patients who experience hemorrhagic stroke, including prothrombin complex concentrates (PCCs). It provides guidance on appropriate dosing and administration of PCCs based on recommendations from the National Advisory Committee on Blood and Blood Products.
The FDA has decided to require Cardiovascular Outcome Trials (CVOT) for new obesity drugs. Trails may be required either before or after approval and marketing. This 2012 presentation discusses the rationales for such trials and points out that some believe one such previous trial was misinterpreted.
Cardiovascular Medications in Older Adults PASaskatchewan
This document discusses managing cardiovascular medications in older adults. Key points include:
- Medication requirements often change with age due to physiological changes
- Older adults are at higher risk for both cardiovascular events and adverse drug reactions
- Managing medications for older adults presents challenges like multimorbidity, polypharmacy, altered pharmacokinetics, and adherence issues
- The document reviews these considerations for an individual case study patient and his medications for atrial fibrillation, hypertension, and dyslipidemia. Resources for guiding decisions in older adults are also provided.
This study examined racial and gender disparities in achieving target LDL cholesterol levels among hypertensive patients. It found that black women, black men, and white women were less likely to achieve target LDL-C levels within two years compared to white men, even after adjusting for demographic factors, clinical characteristics, healthcare access factors, provider characteristics, and lipid-lowering medication potency. Black women were prescribed the most potent lipid-lowering medications on average. The disparities seen suggest a need for greater focus on patient-level barriers to medication adherence for women and black men.
How to Use Heart Rate Changes to Improve Exercise Test Results How to Use H...MedicineAndFamily
The document discusses using heart rate changes to improve the diagnostic and prognostic value of exercise testing. It argues that functional capacity and heart rate recovery provide stronger prediction of outcomes than ST segment depression alone. The document also warns against several mistakes that can invalidate the use of statistical prediction rules and scores, such as limiting the study population, incomplete follow-up, and using surrogate endpoints rather than clinical outcomes.
The JUPITER trial was a randomized, double-blind, placebo-controlled trial that investigated whether rosuvastatin 20 mg could decrease major cardiovascular events in apparently healthy people with elevated levels of C-reactive protein (hsCRP > 2 mg/L) but normal cholesterol levels (LDL < 130 mg/dL). The trial enrolled 17,802 participants across 26 countries who were randomized to rosuvastatin 20 mg or placebo. Rosuvastatin significantly reduced the primary endpoint of myocardial infarction, stroke, hospitalization for unstable angina, arterial revascularization procedures, or cardiovascular death by 44% compared to placebo. Rosuvastatin also significantly lowered levels of LDL cholesterol, hsCRP, and triglycerides
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.
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
Statin use was associated with a statistically significant increased risk of developing diabetes in postmenopausal women according to a study using data from the Women's Health Initiative. The risk was found across all subgroups tested and persisted even after adjusting for potential confounding factors. However, the study did not prove causation and a subset analysis using fasting glucose did not replicate the increased risk finding. The authors conclude statins have cardiovascular benefits but more research is needed to establish if they causally increase diabetes risk.
JUPITER (Justification for the Use of Statins in Primary Prevention: An Inter...theheart.org
- 4-year, double-blind, placebo-controlled, randomized clinical trial
- Population and treatment:
17 802 patients with normal LDL-C (median 108 mg/dL) and elevated CRP (>2.0 mg/L) randomized to rosuvastatin 20 mg/d or placebo
- Primary outcome:
Composite of nonfatal MI, nonfatal stroke, hospitalization for unstable angina, revascularization, and confirmed death from CV causes
See the article at http://www.theheart.org/article/917181.do
Guidelines and beyond new drug therapy for heart failure with reduced ejectio...ahvc0858
This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies
This document summarizes guidelines for cholesterol treatment and clinical trials evaluating lipid targets. It discusses the ATP III guidelines, major trials after ATP III including TNT, JUPITER, ACCORD-LIPID, and AIM-HIGH. It then reviews the 2013 ACC/AHA cholesterol treatment guidelines, including the 4 groups that benefit from statins, ASCVD risk assessment, and future directions. Clinical cases are used to illustrate guideline recommendations for statin treatment based on a patient's risk factors.
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.
1) Statins are highly effective in reducing LDL-C and cardiovascular risk, playing a cornerstone role in lipid management. They work by inhibiting HMG-CoA reductase.
2) Atorvastatin has been extensively studied in large trials and shown to significantly reduce major cardiovascular events when doses are increased from 10 mg to 80 mg.
3) Studies in India found that high dose atorvastatin (80 mg) was well tolerated and more effective at reducing LDL-C and hs-CRP than lower doses in ACS patients. However, many ACS patients in India were not receiving statins as recommended.
Rivaroxaban has shown benefits beyond antiplatelet therapy alone in reducing cardiovascular events. The COMPASS trial found that in patients with chronic coronary artery disease or peripheral artery disease, rivaroxaban plus aspirin reduced the composite of cardiovascular death, stroke, and myocardial infarction by 24% compared to aspirin alone. It also reduced mortality by 18% and ischemic stroke by 42%. Patients with multiple risk factors such as diabetes, chronic kidney disease, or heart failure derived the greatest benefits. However, use of anticoagulants remains lower than guidelines recommend due to overestimation of bleeding risks and underestimation of thrombotic risk.
Hypertension is a major risk factor for cardiovascular disease. Hypertension is more difficult to control in patients with diabetes due to various pathophysiological factors. This document discusses hypertension in diabetes in depth, including definitions, types, causes, management goals, refractory hypertension, and treatment approaches. Treatment involves optimizing drug regimens, addressing medication non-adherence, and considering secondary causes of hypertension such as kidney disease or obstructive sleep apnea.
- The current medication adherence program at The Client pharmacy is ineffective and expensive, with only a 3.75% increase in adherence for non-adherent patients. This results in lost revenue and costs the company approximately $290 billion annually.
- Accenture proposes developing a gamification platform to increase patient engagement and medication adherence in a more cost-effective manner. Game mechanics would appeal to different patient motivations and provide feedback to customize the experience.
- Key benefits would include increased prescription sales, lower program costs, and more patient data to continue improving the platform over time based on measuring various success metrics like adherence rates and time spent on the program.
This document discusses medication adherence and strategies to improve it. Key points:
- Medication non-adherence leads to 125,000 deaths annually and costs $300 billion per year.
- Goals of adherence include establishing trusting patient relationships, engaging patients in their therapy, and providing follow-up care.
- Causes of non-adherence include not filling prescriptions, not refilling on time, missing doses, or stopping medication early.
- Pharmacists should communicate simply with patients, reinforce benefits, educate on medications, confirm understanding, and follow-up after therapy starts to achieve therapeutic success.
Near-infrared spectroscopy can discriminate lipid-rich plaques in ex vivo human aorta specimens through variable depths of blood with high sensitivity (91%) and specificity (88%). The study demonstrated the potential for NIR spectroscopy, combined with chemometrics, to detect vulnerable plaques in coronary arteries by identifying chemical composition regardless of blood depth. Ongoing work aims to reproduce the results in coronary tissue and develop a catheter-based system for human studies to discriminate disrupted plaques from normal tissue through blood in patients.
This document discusses a non-invasive technique using superparamagnetic iron oxide (SPIO) enhanced MRI to detect vulnerable plaque. SPIO particles are phagocytosed by macrophages and can thus be used to image inflammation. Studies in mice showed SPIO accumulation in atherosclerotic plaques after intravenous injection, indicating macrophage infiltration. MRI of abdominal aortas of mice after SPIO injection demonstrated higher signal in plaques compared to normal vessel walls, corresponding to greater iron uptake in inflamed plaques. This suggests SPIO enhanced MRI may non-invasively detect vulnerable plaque by imaging macrophage-mediated inflammation.
Thermography is a new technique for detecting atherosclerotic plaque vulnerability. A new catheter-based system called the Epiphany Thermography System can precisely measure plaque temperature and has shown higher temperatures in proximal versus distal plaque segments. Studies have found that greater temperature differences between segments predicts future cardiovascular events, with 86% sensitivity and 79% specificity. Preliminary research also indicates thermography may help identify vulnerable patients by measuring inflammation levels in coronary sinus blood draining the heart.
065 association for eradication of heart attackSHAPE Society
This document summarizes a scientific paper published in Circulation in 2003 about vulnerable plaques and patients. It discusses what has been learned since prior conferences on this topic, including defining major and minor criteria for vulnerable plaques based on culprit plaques. It outlines markers of vulnerability at the plaque/artery level relating to plaque morphology/structure, activity/function, and pan-arterial assessments. Conditions and markers associated with myocardial vulnerability both with and without atherosclerosis-derived ischemia are also summarized. The challenges of terminology and techniques for risk stratification of vulnerable myocardium are briefly discussed.
This document summarizes research on the effectiveness and cost-effectiveness of influenza vaccination, statin drugs, and aspirin for preventing cardiovascular events. It finds that influenza vaccination has been shown to reduce hospitalizations for cardiovascular disease by 6-12% and lower mortality by 48-50% based on observational studies. The cost per life saved from influenza vaccination is estimated to be $13,200, much lower than the $198,000 per life saved by statin drugs. While statins and aspirin are effective therapies, influenza vaccination provides benefits to cardiovascular health at the population level due to its low cost and ability to prevent thousands of events each year. More research is still needed to understand the mechanisms by which influenza increases cardiovascular risk
1. Isolated-low HDL levels in ABCA1 heterozygotes is associated with impaired basal and stimulated endothelial nitric oxide synthase activity.
2. A single rapid infusion of reconstituted HDL completely restored both basal and stimulated endothelial nitric oxide synthase activity in ABCA1 heterozygotes.
3. Impaired lipid trafficking and caveolar disruption caused by dysfunctional ABCA1 profoundly affects endothelial nitric oxide synthase activity.
117 mr images of human carotid arteriesSHAPE Society
Magnetic resonance (MR) images were taken of human carotid arteries from both a normal subject and a patient with carotid artery disease. The images show the carotid arteries of a healthy individual for comparison with those of a person suffering from carotid artery disease. The diseased arteries likely demonstrate abnormalities that indicate a restriction of blood flow.
134 mr contrast agents for vulnerable plaque imagingSHAPE Society
1. MS-325 is an albumin-targeted gadolinium contrast agent that highlights inflamed vessel walls and facilitates plaque imaging. It provides prolonged enhancement of the vessel wall and lumen, allowing for high resolution detection of plaque burden.
2. Studies show MS-325 provides strong enhancement of vessel walls adjacent to plaques due to increased capillary volume and binding to extravasated albumin in the vessel wall. This allows for detection and potential quantification of atherosclerotic plaques.
3. Experimental fibrin-targeted contrast agents EP-1242 and EP-1873 rapidly enhance arterial and venous blood clots in animal models, demonstrating potential for assessing thromboembolic risk and monitoring clot resolution with
This document summarizes research on C-reactive protein (CRP) and its relationship to atherosclerosis and coronary death. It finds that CRP levels are elevated in patients with unstable angina and predict future cardiovascular risk. A study of sudden coronary deaths found higher CRP levels in those who died from plaque rupture compared to controls or those who died from stable plaques or erosion. The study also observed a positive correlation between CRP staining in atherosclerotic plaques and serum CRP levels, independent of the death mechanism. However, questions remain about how well postmortem CRP correlates with pre-death levels and the extent to which elevated CRP results from cardiac injury rather than reflecting the plaque vulnerability.
This study investigated the role of hydrogen peroxide as an endogenous EDHF in coronary autoregulation of canine subepicardial microvessels in vivo. The researchers found that after NO inhibition, vasodilator responses were attenuated mainly in small arteries (>100 μm), whereas combined infusion of NO inhibition plus catalase abolished the autoregulatory vasodilation in both small arteries and arterioles (<100 μm). They concluded that hydrogen peroxide, an endogenous EDHF, plays an important role in coronary autoregulation of canine subepicardial microvessels in vivo.
A patient presented with unstable angina and stenosis of the left anterior descending artery. Angiography and thermography were performed, which identified the site of stenosis. A stent was implanted in the left anterior descending artery, after which thermography and angiography were repeated and showed improvement. Additional thermography and angiography were done for a circumflex lesion, which also identified the site of stenosis.
3rd vulnerable plaque rumberger 3 16-02 3SHAPE Society
1) Clinical data confirms that coronary calcium detected by electron beam computed tomography (EBT) is found in 96% of patients presenting with or developing acute coronary syndromes, and that these patients have significantly greater coronary artery calcium scores at baseline compared to asymptomatic matched individuals.
2) Histologic studies show that coronary artery calcium occurs in all types of plaques, including stable (43%), rupture-prone (54%), and erosion-prone (77%) plaques.
3) Therefore, coronary artery calcium detected by imaging is a marker of atherosclerotic plaque burden but not necessarily a marker of stable or unstable plaque, as there is considerable overlap in calcium presence between different plaque types.
167 plaque p h heterogeneity in physiological mediaSHAPE Society
- The study measured pH, pCO2, and pO2 levels in human atherosclerotic plaque tissue over 4 hours using sensor wires placed in the plaque while submerged in oxygenated media.
- Sensor A, placed deeper in thicker plaque tissue, recorded lower pH and higher pCO2 levels compared to Sensor B, which was located closer to the vessel wall in thinner tissue.
- Strong correlations between pH and pCO2 for both sensors suggest the sensors were firmly placed in living plaque tissue. Physiologic readings that tracked changes in oxygen levels provide evidence that plaque remains in a living state when exposed to conditions resembling the in vivo environment.
SPIO particles coated with different materials were tested for their effects on nitric oxide production in macrophages. Dextran coated SPIO particles (SPIO-2) produced the lowest level of nitric oxide, while lipid coated particles (SPIO-3) produced higher levels and uncoated particles (SPIO-4) produced the highest levels. Fluorescently labeled SPIO particles were found inside macrophages harvested from mice injected with the particles, and iron particles were also seen inside circulating monocytes of injected mice. Aortic walls from Apo E deficient mice appeared darker after injection of SPIO particles and contained many iron particles, but aortic walls from control mice did not show this change and had few iron particles.
This document announces an industry roundtable event on vulnerable plaque to be held on March 29, 2003 in Chicago. The roundtable aims to bring together cardiologists, researchers, and industry executives to discuss regulatory challenges, reimbursement issues, and identifying areas of common interest in developing and regulating new products for detecting and treating vulnerable plaque. The program will highlight emerging trends in treating heart disease caused by vulnerable plaque and the current regulatory climate for alternative clinical strategies. A panel of experts from academia, industry and government agencies will discuss these issues.
This document provides an overview of the new VP.org website and its goals of sharing research on vulnerable plaque (VP) to help eradicate heart attacks. Key features include an online library called Atheroline with medical literature and multimedia, a toolbar for easy access, and personalized alerts. The site aims to recycle scientific findings to build on past work and speed discovery. It also announces an upcoming VP symposium and lists new members joining the VP.org team. Long-term visions include widespread home screening tests for VP, over-the-counter treatments, and ultimately eliminating heart attacks.
Dr. Maureen McMahon Presents "“Heart Disease and Preventive Measures” at Lupu...LupusNY
Pro-inflammatory HDL (piHDL) may help predict risk of atherosclerosis (ATH) in patients with systemic lupus erythematosus (SLE). The study found 45% of SLE patients and none of the healthy controls had piHDL. PiHDL was significantly associated with carotid plaque and greatly increased the risk of plaque in SLE patients. Traditional risk factors did not fully explain the risk of ATH in SLE. PiHDL could be a useful marker for predicting ATH risk in SLE patients. Further research is needed to develop new treatments targeting piHDL and risk profiles including piHDL.
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.
Dyslipidemia -Assessment and management based on evidence SYEDRAZA56411
This document provides a summary of a presentation on dyslipidemia assessment and management. It discusses several key points:
1. International guidelines recommend intensive statin therapy to manage cardiovascular disease risk in patients with dyslipidemia.
2. Randomized trials like JUPITER showed that rosuvastatin reduced major cardiovascular events in individuals with elevated CRP levels despite normal lipid levels, supporting early prevention.
3. Guidelines worldwide advise lowering LDL-C based on cardiovascular risk, with intensive statin therapy recommended for high-risk patients to achieve LDL-C reduction of 50% or more.
1) ARBs may increase the risk of myocardial infarction (MI) compared to other antihypertensive drugs due to their unique mechanism of action. While ARBs block the AT1 receptor, they increase angiotensin II levels which can stimulate inflammatory AT2 receptors, destabilizing atherosclerotic plaques and increasing the risk of rupture.
2) Clinical trials have shown ACE inhibitors reduce mortality more than ARBs, especially in patients with diabetes or heart failure. The mortality benefit of ACE inhibitors is also greater with longer-term use.
3) Guidelines recommend ACE inhibitors for high-risk MI patients to reduce mortality based on clear evidence from numerous randomized controlled trials.
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
ueda2012 do we still need high doses-d.mohammedueda2015
This document discusses hypertension and the need for high doses of antihypertensive medications. It provides data showing that over half of adults with hypertension still have uncontrolled blood pressure despite improvements. It also summarizes trials showing residual cardiovascular risk even when blood pressure is controlled. The document advocates for early use of combination antihypertensive therapy, especially those targeting the renin-angiotensin-aldosterone system, to improve control and reduce organ damage. It highlights valsartan specifically as a well-studied angiotensin receptor blocker with strong evidence from numerous trials across cardiovascular conditions.
Slides to Guide Reducing Cardiovascular Risk in Type 2 Diabetes: What I Do an...hivlifeinfo
This document provides an overview of a presentation on reducing cardiovascular risk in type 2 diabetes. It includes:
- Information about the program directors and faculty for the presentation and their disclosures of financial relationships.
- An outline of the presentation which will cover four case studies on reducing CV risk in type 2 diabetes patients with different established comorbidities.
- Details of the first case which involves a new onset type 2 diabetes patient and the treatment plan implemented, including medication adjustments and results after 14 weeks of treatment.
Newer Approach in management of Angina & CHF: Heart rate modulation and beyond..Arindam Pande
1) A study evaluated the addition of ivabradine to metoprolol in patients with stable angina pectoris and found that it significantly reduced mean resting heart rate, weekly angina attacks, and use of short-acting nitrates over 4 months compared to baseline.
2) The mean heart rate fell by 19.7 bpm, weekly angina attacks decreased 8-fold, and quality of life scores increased with the combination therapy.
3) Heart rate reductions and clinical benefits were greater in patients who had higher baseline heart rates of 70 bpm or more.
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
National reports point towards disparities in the utilization of preventive care services but sparse literature exists regarding predicting utilization pattern of preventive care services.
METHODS: The 2007 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was analyzed to determine demographic patterns of utilization. Recommendations by JNC-VII and NCEP were used to determine guideline adherence to blood pressure and cholesterol checkup respectively. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable while age, gender, race, ethnicity, insurance status, perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, chi-square analysis was used to determine the group differences for the categorical variables. Multivariate logistic regression model was built to predict odds of utilizing appropriate preventive se!
rvices. All analysis was carried out using SAS v9.1.
RESULTS: Total number of adult respondents was 20,434 of which data was available for blood pressure checkup for 20,187 respondents and 15,784 respondents for cholesterol checkup. Overall, respondents were found to adhere to guideline recommendations for getting the blood pressure (n=17,959, 89.0%) and cholesterol (n=14,956, 94.7%) check-up done. A univariate chi-square analysis showed statistically significant differences across all independent variables between people who utilized the preventive care service and those who didn t for blood pressure checkup (p<0><0>65) had much higher odds of using the blood pressure (OR=2.815, CI=2.317-3.420 ) and cholesterol (OR=3.190, CI=2.396-4.!
249 ) preventive services. Males had much lower odds of getting blood pressure (OR=0.350, CI=0.318-0.384) and cholesterol (OR=0.597, CI=0.516-0.692) checks done compared to females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR=0.282, CI=0.253-0.315) and cholesterol (OR=0.314, CI=0.262-0.376) use compared to privately insured people.
CONCLUSIONS: Overall MEPS respondents adhered to blood pressure and cholesterol check up guidelines. The study was however successful in identifying existing age, race, income, insurance status related disparities in US population.
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
This study aimed to characterize patterns of preventive care service utilization for cardiovascular disease and predict trends in a U.S. population using national health survey data. Descriptive analyses found high utilization of blood pressure and cholesterol screening across populations. Logistic regression identified factors associated with screening, such as women and Asians being less likely than men and other races to receive screenings. The results can help guide policies to reinforce screening guidelines for underserved groups.
1) Gliptins like vildagliptin have less risk of hypoglycemia and weight gain compared to sulfonylureas.
2) Vildagliptin has shown beneficial effects on blood pressure and lipid levels.
3) Meta-analyses of clinical trials show that gliptins like vildagliptin have no increased cardiovascular risk compared to other antidiabetic drugs, and may have cardio-protective effects.
The document summarizes guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). It outlines classifications for blood pressure levels, risk factors, treatment goals, lifestyle modifications, and drug therapy recommendations. The guidelines emphasize individualizing treatment based on a patient's specific cardiovascular risks and medical conditions.
The document summarizes the key recommendations from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). It introduces new classifications for blood pressure levels, emphasizes the importance of lifestyle modifications and use of thiazide-type diuretics as initial treatment, and recommends treating to lower blood pressure targets to reduce cardiovascular disease risk. It also provides guidance on proper blood pressure measurement techniques, evaluating patient risk factors, and conducting follow-up assessments.
The document summarizes key information about acute heart failure, including epidemiology, pathophysiology, treatment approaches, and trial data. It describes the ASCEND-HF trial which investigated the effects of nesiritide vs placebo on outcomes in over 7,000 patients hospitalized for acute decompensated heart failure. The trial found no significant differences between nesiritide and placebo for its co-primary endpoints of 30-day mortality or heart failure rehospitalization and dyspnea relief at 6 and 24 hours.
DRUG PROFILE IN MYOCARDIAL INFARCTION WITH MONITORING OF POSTLYSIS COMPLICATI...Sameer Shete
This document presents a retrospective observational study on drug profiles and post-lysis complications in patients with myocardial infarction. The study analyzed 100 patients admitted with ST elevation myocardial infarction. The most common drugs administered were streptokinase, aspirin, clopidogrel, and atorvastatin. The most frequent post-lysis complications observed were bleeding (68% of patients) and hypotension (53% of patients). The study aims to evaluate treatment efficacy and risks associated with myocardial infarction by analyzing patient drug regimens and complications.
Acute Heart Failure: Current Standards and Evolution of Care.2015hivlifeinfo
This document provides an overview of the current standards and evolution of care for acute heart failure (AHF). It summarizes the use of biomarkers like natriuretic peptides and troponins in the diagnosis and risk stratification of AHF. It discusses the clinical considerations in stratifying AHF patients, including systolic blood pressure, worsening renal function, and the distribution of left ventricular ejection fraction. The document reviews current treatment options for AHF such as diuretics, vasodilators like nitroglycerin, and nesiritide based on clinical trials and guidelines.
This document summarizes key information about chronic kidney disease (CKD) and cardiovascular disease (CVD). It notes that patients with CKD should be considered at the highest risk for CVD. Lower estimated glomerular filtration rate (eGFR) is associated with higher risks of coronary disease and CVD mortality. The risks of all-cause mortality are significantly higher across all levels of eGFR and proteinuria for patients with early diabetic kidney disease compared to those without. Heart failure hospitalization risk increases as kidney function declines. The development of macroalbuminuria in diabetes patients heralds a rapid decline in glomerular filtration rate. Timely protection and maintenance of kidney function can reduce CVD risks.
Similar to Medication non-adherence is associated with a broad range of adverse outcomes in patients with coronary artery disease (20)
This document provides background on Jacques Barth, an expert in cardiovascular imaging and risk assessment. It discusses the evolution of ultrasound technology for measuring intima-media thickness (IMT) from 1986 to 2005. IMT is an early marker of atherosclerosis and cardiovascular risk. The document also addresses issues around vulnerable plaques, reporting IMT measurements, and assessing cardiovascular risk in children and adolescents.
This document outlines an approach to identifying and managing coronary risk. It recommends that prevention must be the primary goal through intensive global risk factor reduction for all patients with clinically apparent heart disease. It also recommends identifying asymptomatic high-risk individuals through testing like the Framingham Risk Score so they can receive prevention. It proposes a risk stratification approach from low to very high risk based on annual risk levels and corresponding testing and treatments, with very high risk patients receiving the most intensive treatments like invasive detection of unstable plaques and procedures like CABG or multiple drug-eluting stents.
This document describes a study that uses intravascular ultrasound (IVUS), biplane coronary angiography, and blood flow measurements to characterize endothelial shear stress (ESS) in coronary arteries. It found that over 6 months, areas of low ESS demonstrated plaque progression, areas of normal ESS remained stable, and areas of high ESS developed outward remodeling. The technology allows in vivo determination of intracoronary flow velocity and ESS, which has not previously been possible. This provides a method to predict progression of atherosclerosis and vascular remodeling. A pilot study applied this technique in 8 patients at baseline and 6 months to analyze changes in native coronary artery disease and in-stent restenosis while taking candesartan vs fel
Zahi A. Fayad is an Associate Professor who studies molecular imaging of atherosclerosis using MRI. His research focuses on developing targeted contrast agents to noninvasively detect unstable plaque. Some agents under investigation include annexin A5 labeled with a radioisotope to detect apoptosis, FDG-PET to assess plaque activity, and fibrin-targeted and MMP-targeting Gd-based contrasts. Additional work involves lipid-based particulate agents using reconstituted HDL or iron oxide nanoparticles. The goal is to improve MRI detection sensitivity and specificity for high-risk plaque characterization.
This document discusses the use of coronary CT angiography (CTA) to detect and characterize coronary atherosclerosis beyond just detecting coronary stenoses. CTA can identify calcified plaques, non-calcified plaques, mixed plaques, atheromas, thrombi, and myocardial infarction scars. CTA provides information on plaque composition and distribution that can help understand coronary artery disease and be used to follow patients under therapy. The limitations of CTA include artifacts from cardiac motion, breathing, blooming effect, and poor contrast opacification of small vessels. Advances in multislice CT technology are helping to address some of these limitations.
This document discusses approaches to cardiovascular disease (CVD) and the need for new approaches. It summarizes that the emphasis is shifting from high risk plaques to high risk symptomatic patients, and from high risk asymptomatic to intermediate and low risk patients. It discusses diagnostic tools like magnetic resonance imaging to identify high risk asymptomatic patients and computed tomography to identify intermediate risk patients using coronary artery calcium scoring and CRP biomarkers. It also discusses prevention and treatment strategies like a polypill for acute coronary syndrome patients and those with chronic atherothrombosis.
This document proposes a non-invasive method using SPIO (super paramagnetic iron oxide) nanoparticles to image macrophage infiltration and inflammation in vulnerable atherosclerotic plaques. Rabbits and mice were injected with SPIO, which accumulated in inflamed plaque areas correlated with macrophage density. SPIO-enhanced MRI then successfully identified these inflamed plaques non-invasively in vivo. This technique could provide a way to detect rupture-prone plaques and better understand plaque vulnerability.
This document discusses the use of coronary CT angiography (CTA) to detect and characterize coronary atherosclerosis beyond just detecting coronary stenoses. CTA can identify calcified plaques, non-calcified plaques, and mixed plaques. It can detect atheromas and characterize plaque density. CTA can also identify intracoronary thrombi and myocardial infarction scars. The document outlines the CTA scanning parameters and techniques used to minimize motion artifacts and optimize image quality for plaque detection and characterization.
This document describes a study that introduces a non-invasive method for imaging macrophage infiltration in inflamed atherosclerotic plaques using superparamagnetic iron oxide (SPIO) nanoparticles and MRI. The researchers injected SPIO into hypercholesterolemic and normal rabbits and found that SPIO profoundly accumulated in areas of macrophage infiltration in the atherosclerotic plaques, as confirmed by histology. SPIO-enhanced MRI was able to identify these inflamed plaques non-invasively. The results suggest SPIO-enhanced MRI can be a novel method for detecting rupture-prone inflamed plaques associated with heart attacks and strokes.
The document discusses several factors that are considered predictors of plaque vulnerability, including luminal narrowing, plaque volume and composition, fibrous cap thickness, and plaque inflammation. It reviews studies that show myocardial infarction can develop from previously non-severe lesions and that lipid content, cap thickness, inflammation, and stress factors like circumferential stress are correlated with plaque stability and vulnerability. In conclusion, the size and composition of the lipid core, thickness and composition of the fibrous cap, and inflammation are well-established predictors of plaque rupture.
This document discusses a novel tracer for MRI imaging of macrophage infiltration in atherosclerotic plaque. It summarizes research into lipid-coated superparamagnetic iron oxide nanoparticles (SPIOs) that are phagocytosed by macrophages. The researchers tested various SPIO coatings and sizes to maximize macrophage uptake while minimizing oxidative stress. Lipid-coated SPIOs combined with certain aminoglycans showed the highest uptake and lowest induction of reactive oxygen species. The goal is to develop an MRI contrast agent that can noninvasively image vulnerable, inflamed plaques by detecting macrophage presence.
This document discusses the use of DNA microarrays in vulnerable plaque research. It provides background on atherosclerosis and identifies DNA microarrays as a tool that can be used to investigate the molecular mechanisms underlying plaque vulnerability. The document outlines the basic steps of a DNA microarray experiment and discusses considerations for experimental design, data analysis, and validation of results. It also summarizes several studies that have used DNA microarrays or related techniques to examine gene expression in atherosclerosis.
The document provides details about AEHA's booth at the ACC/AEHA Exhibition from March 30 to April 1, 2003. It lists the booth equipment and inventory, proposed activities like an Ecode on Friday morning and a VP Symposium. Giveaways include Magellan GPS devices in a raffle and Dove chocolates. It also discusses the need for an immediate membership sign-up page on the AEHA website and a vision for the future of AEHA.
This document discusses approaches to identifying and managing coronary risk. It states that the primary goal should be preventing acute cardiac events through intensive risk factor reduction for all patients with clinically apparent heart disease. Additionally, it notes that one third of sudden cardiac deaths and heart attacks occur in previously asymptomatic individuals with undiagnosed risk factors or pre-clinical disease. The document proposes identifying high-risk asymptomatic individuals through testing to provide prevention. It presents a risk stratification approach using testing like CRP, cholesterol, glucose and imaging to guide different levels of risk factor reduction and management.
This document discusses the use of DNA microarrays in studying vulnerable atherosclerotic plaques. It provides background on atherosclerosis and plaque rupture. DNA microarrays allow high-throughput analysis of gene and protein expression, which can provide insights into molecular mechanisms underlying plaque vulnerability. One study used microarrays to analyze gene expression differences between ruptured and stable plaques, identifying perilipin as upregulated in ruptured plaques. However, microarray analysis of atherosclerosis is still in its early stages with many technical challenges to address.
Vulnerable plaques are prone to rupture and cause heart attacks. This document proposes criteria for defining vulnerable plaques based on histopathology and clinical factors. It also explores using infrared thermography to identify vulnerable plaques by detecting heat from macrophage inflammation. Studies in animal models and humans found temperature heterogeneity in atherosclerotic arteries that correlated with plaque vulnerability features. Further research aims to develop non-invasive thermography techniques to accurately detect vulnerable plaques and help predict heart attack risk.
The document presents findings on the A20 gene, which encodes a zinc finger protein that inhibits NF-kB activity and TNF-induced apoptosis. The study found that C57 and FVB mouse strains have a coding difference in A20 that generates a phosphorylation site in C57 mice. C57-A20 was less effective at shutting down TNF-induced NF-kB activity and C57 cells were less susceptible to TNF-induced apoptosis compared to FVB cells. This suggests less active A20 in C57 mice leads to increased inflammation and reduced apoptosis, while more active A20 in FVB mice decreases inflammation and increases apoptosis, contributing to differences in atherosclerosis susceptibility between the strains.
#1 killer of human beings in the 21st centurySHAPE Society
Vulnerable plaque refers to dangerous forms of atherosclerotic plaques that can rupture or induce thrombosis, disrupting blood flow. The document discusses the history and research around vulnerable plaque, including pioneers in the field and emerging techniques to detect vulnerable plaque such as intravascular ultrasound, optical coherence tomography, and magnetic resonance imaging. It summarizes that vulnerable plaques are typically characterized by a thin fibrous cap, large lipid core, and presence of macrophages.
The document presents findings on the A20 gene, which encodes a zinc finger protein that inhibits NF-kB activity and TNF-induced apoptosis. The study found that C57 and FVB mouse strains have a coding difference in A20 that generates a putative phosphorylation site in C57 mice. Experiments showed the C57 version of A20 is less effective at shutting down NF-kB activity and C57 cells are less susceptible to TNF-induced apoptosis. This suggests the A20 variation could contribute to differences in atherosclerosis susceptibility between C57 and FVB strains by affecting inflammation and apoptosis.
This progress report discusses ongoing near-infrared (NIR) spectroscopy studies. It notes that a new probe design is being developed to improve signal detection in the NIR range. Characterization of a new light source and additional tissue phantom studies are needed. The report identifies ongoing difficulties with depth penetration studies and experimental setup issues. Priorities include analyzing existing data to inform probe redesign, characterizing the new light source, conducting depth penetration and tissue phantom studies, and addressing experimental setup challenges.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
6. Rates of non-adherence Non-adherent patients were younger and more likely to have COPD and depression n=10,021 n=13,596 n=11,865
7. Non-adherence to cardioprotective medications is associated with adverse outcomes 0.5 All-cause mortality n=1,889 CV mortality n=372 CV Hospitalization* n=2,008 Coronary Revascularization # n=2,117 B-blockers Statins ACE-inhibitors Hazards Ratio 1.0 2.0 *Hospitalization for AMI or heart failure #PCI or CABG
8. Non-adherence to H2 antagonists or proton pump inhibitors not associated with adverse outcomes 1.14 (0.97-1.33) All-cause mortality 1.10 (0.78-1.57) CV mortality 1.02 (0.87-1.18) CV hospitalization 1.07 (0.92-1.23) Coronary revascularization Hazard ratio (95% confidence interval) Outcome