Coronary heart disease is the leading cause of death in the United States. Four clinical trials examined the effects of garlic in treating and preventing coronary heart disease. The trials found that garlic reduced platelet aggregation, lowered LDL and raised HDL cholesterol, reduced inflammatory biomarkers associated with coronary artery disease, and decreased the risk of future cardiovascular events. Specifically, garlic intake was shown to inhibit blood clotting, lower levels of lipids that cause plaque buildup, and reduce progression of calcium deposits in coronary arteries.
Primary Prevention of Cardiovascular Disease: The Role of Aspirin and StatinsCTSI at UCSF
Presented by Michael Pignone, MD, MPH, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
Primary Prevention of Cardiovascular Disease: The Role of Aspirin and StatinsCTSI at UCSF
Presented by Michael Pignone, MD, MPH, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
Background and Aim: Many studies have found association between Red Cell Distribution Width (RDW) values and hypertension, dipping pattern, and end-organ damage. RDW values are affected by blood vitamin B12, iron, and folic acid levels, parameters that were not assessed in the previous studies. The aim of our study was to evaluate the relation between RDW and hypertension, dipper pattern, and end-organ damage independently from vitamin B12, folic acid, and ferritin levels in newly diagnosed hypertensive patients.
Potential role of uric acid in correlation with epidemics of hypertension and...Apollo Hospitals
Diabetic nephropathy (DN) is a microvascular complication of Type 2 diabetes mellitus. Uric acid (UA) is the end product of purine nucleotide metabolism and its primary mode of clearance is by renal excretion. Modifiable factors such as blood pressure, albuminuria, glycemic control, etc., play an important role in the progression of DN and none of them are curative. Hence, there is a pressing interest to identify other potentially modifiable factors such as UA in the progression of DN.
Serum uric acid as a marker of left ventricular failure in acute myocardial i...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Erectile dysfunction (ED) is a serious health problem these days which is prevalent in men. It is reported that 1 in 10 adult men suffer from erectile dysfunction. It originates due to various reasons such as stress, depression, hormonal deficiency, etc. Under severe conditions, erectile dysfunction causes many health co-morbidities. In some cases, it has been seen that erectile dysfunction is one of the indicator of other health consequences such as endothelial dysfunction.
Managing CV risk in Inflammatory Arthritis (Focusing on Gout)Sidney Erwin Manahan
Presentation made during the 1st Inter-Hospital Rheumatology Fellows' Case Discussion on 9 June 2018 at the Speaker Feliciano Belmonte Auditorium, 7/F East Avenue Medical Center. Presentation highlights the needs to recognize gout as one of the rheumatic conditions that put patients at risk for developing CV disease.
Hyperphosphatemia in CKD patients; The Magnitude of The Problem - Prof. Alaa ...MNDU net
Hyperphosphatemia in CKD patients; The Magnitude of The Problem
Prof. Alaa Sabry - Professor of Nephrology
Mansoura Nephrology and Dialysis Unit (MNDU) Course
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
Background and Aim: Many studies have found association between Red Cell Distribution Width (RDW) values and hypertension, dipping pattern, and end-organ damage. RDW values are affected by blood vitamin B12, iron, and folic acid levels, parameters that were not assessed in the previous studies. The aim of our study was to evaluate the relation between RDW and hypertension, dipper pattern, and end-organ damage independently from vitamin B12, folic acid, and ferritin levels in newly diagnosed hypertensive patients.
Potential role of uric acid in correlation with epidemics of hypertension and...Apollo Hospitals
Diabetic nephropathy (DN) is a microvascular complication of Type 2 diabetes mellitus. Uric acid (UA) is the end product of purine nucleotide metabolism and its primary mode of clearance is by renal excretion. Modifiable factors such as blood pressure, albuminuria, glycemic control, etc., play an important role in the progression of DN and none of them are curative. Hence, there is a pressing interest to identify other potentially modifiable factors such as UA in the progression of DN.
Serum uric acid as a marker of left ventricular failure in acute myocardial i...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Erectile dysfunction (ED) is a serious health problem these days which is prevalent in men. It is reported that 1 in 10 adult men suffer from erectile dysfunction. It originates due to various reasons such as stress, depression, hormonal deficiency, etc. Under severe conditions, erectile dysfunction causes many health co-morbidities. In some cases, it has been seen that erectile dysfunction is one of the indicator of other health consequences such as endothelial dysfunction.
Managing CV risk in Inflammatory Arthritis (Focusing on Gout)Sidney Erwin Manahan
Presentation made during the 1st Inter-Hospital Rheumatology Fellows' Case Discussion on 9 June 2018 at the Speaker Feliciano Belmonte Auditorium, 7/F East Avenue Medical Center. Presentation highlights the needs to recognize gout as one of the rheumatic conditions that put patients at risk for developing CV disease.
Hyperphosphatemia in CKD patients; The Magnitude of The Problem - Prof. Alaa ...MNDU net
Hyperphosphatemia in CKD patients; The Magnitude of The Problem
Prof. Alaa Sabry - Professor of Nephrology
Mansoura Nephrology and Dialysis Unit (MNDU) Course
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
Running head CASE STUDY 2 13CASE STUDY .docxsusanschei
Running head: CASE STUDY 2 1
3
CASE STUDY 2
Congestive Heart Failure
Case Study 2
This case study is about Mr. P, a 76 year old male, hospitalized usually to treat cardiomyopathy and congestive heart failure (CHF). The author describes the approach to care, treatment plan, method to provide education and a teaching plan about the CHF. Congestive heart failure is defined as “the state in which the heart is unable to pump blood at a rate adequate for satisfying the requirements of the tissues with function parameters remaining within normal limits usually accompanied by effort intolerance, fluid retention, and reduced longevity” (Denolin, 1983, p. 445).
Approach to care
· Assessment of patient: Physical examination of the patient (at each visit), with particular attention to assessment of their vital signs, cardiovascular system (including volume status), signs of deterioration and co-morbid conditions.
· Assessment and management of the patient’s cardiovascular risk factors (e.g. hypertension, dyslipidaemia, diabetes, smoking and obesity).
· Assessment of the patient’s nutritional status.
· Assessment of the patient’s potential for adverse effects of medicines
· Regular reassessment of the patient’s biochemistry (including urea and creatinine) and haematology (including haemoglobin) parameters.
· Assessment of the patient’s daily fluid and salt intake from food and drink.
· Ongoing monitoring of the patient’s electrolytes (particularly serum sodium and potassium levels) and renal function.
· Monitor intake and output strictly and take daily weight.
Treatment Plan
CHF is a complex clinical syndrome; therefore, treatment plan includes the focus on the fundamental causes. Appropriate combination of medicines, control over lifestyle with careful monitoring is the basic treatment for CHF.
· An Angiotensin-Converting Enzyme (ACE) inhibitor (captopril, enalapril etc) or an Angiotensin II receptor blocker (ARB) helps to relax the blood vessels and enhance the blood flow.
· Beta-blockers (bisoprolol, carvedilol etc) reduce the blood pressure and stabilize the heart beat rate.
· Diuretics (lasix, bumex etc) remove more sodium and water from the body, which helps in lowering blood pressure. Also, spironolactone and eplerenone called as potassium-sparing diuretics help to retain potassium.
· Other drugs include anticoagulant, statin and digoxin as per doctor’s recommendation.
Besides medication and diet alteration, devices and surgical procedures are available for the treatment of heart failure. An implantable cardiac defibrillator (ICD), coronary artery repair and valve repair or replacement (as appropriate) can be done (Heart.org, 2016).
Education method
Heart failure patients and their family members should acquire the education, problem solving abilities and motivation regarding the treatment plan, medications and effective participation in self-care. “Patient education and post discharge management have demonstrated be ...
Behavior Modification for Cardiovascular risk factor reductionnihal Ashraf
There is little controversy over the benefits to cardiovascular health of not smoking, eating a well balanced diet, maintaining mental well-being, taking regular exercise and keeping active, as demonstrated in large cohort studies.
These health behaviours also play an etiological role in other noncommunicable diseases, such as cancer, respiratory disease, diabetes, osteoporosis and liver disease (WHO., 2003), which makes interventions to promote them potentially very cost-effective.
However, there is considerable uncertainty about the best ways of helping people at high CVD risk to modify their behaviour.
Drug Consult ExampleDate and time requested September 23, 2013 .docxmadlynplamondon
Drug Consult Example
Date and time requested: September 23, 2013 at 10:00 AM
Date and time answered: September 27, 2013 at 5:00 PM
Pharmacy has been consulted re: Are calcium supplements associated with coronary heart disease in adult patients?
Background:
Calcium supplementation has long been recommended for promoting bone health and is often utilized for the prevention and treatment of osteoporosis.1 It has been reported that in the older population close to 50% of men and 70% of women are users of calcium supplements.1 In most adult patients, the recommended daily allowance (RDA) of elemental calcium is 1000 mg. In females aged 51 and greater, the RDA is slightly increased at 1200 mg.2 Calcium administration is generally well tolerated with the most commonly occurring adverse effects being gastrointestinal discomfort, constipation, flatulence and nausea.3 Recently, there has been speculation about a correlation between calcium supplementation and cardiovascular risk. While some studies have reported cardiovascular benefits such as improvements in blood pressure and lipid panels, some concerning data linking calcium supplementation to increased risk of stroke, myocardial infarction and cardiovascular death has also been published.1 It has been hypothesized that excess calcium intake via supplementation may lead to cardiac calcium phosphate deposits which are correlated with risk of atherosclerosis, coronary heart disease and death.1
Literature Search Strategy:
A search was conducted using Ovid MEDLINE (2009 to September week 2 2013). Terms searched included supplemental calcium, calcium supplement, coronary heart disease and cardiovascular disease. The Boolean operator OR was first used to combine the terms supplemental calcium and calcium supplement and then used again to combine the terms coronary heart disease and cardiovascular disease. The Boolean operator AND was subsequently utilized to combine the results from supplemental calcium, OR calcium supplement, with coronary heart disease OR cardiovascular disease. The search was limited to the English language and humans and yielded 13 results. Of the 13 articles, 9 were excluded for being review articles, 2 were excluded because they focused on dietary rather than supplemental calcium intake and 1 was excluded for being focused specifically on myocardial infarction and stroke. The article to be discussed was chosen because it is relevant to the topic as it looks specifically at cardiovascular risk related to calcium supplementation in both men and women.
Results/Literature Analysis:
A prospective study was conducted to determine if calcium intake was associated with risk of death from heart disease, cerebrovascular disease or cardiovascular disease.1 Included participants were male and female AARP members with ages ranging from 50 to 71 years. Participants were geographically located in 6 states (California, Florida, Louisiana, New
Jersey, North Carolina, and Pennsylvania) ...
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.
1. The Use of Garlic Against Coronary Heart Disease
Michael Kamnikar
FTEC 496B-001
4/12/2016
2. Cardiovascular diseases are the number one cause of death in the United States (1).
Coronary heart disease is a cardiovascular disease in which plaque builds up inside of the
arteries in which supply oxygen-rich blood to your heart (2). As the plaque builds up, it makes
the arteries narrower and reduces the amount of blood that can travel through to the heart. If
there is not enough blood traveling to the heart, or if there is a blockage, a heart attack can
occur. Over time, coronary heart disease weakens the muscles in the heart which can leave to
heart failure and death (2). Dietary factors play a role in some human diseases including
cardiovascular disease. Diets rich in fruits, vegetables, and spices are associated with lower risk
of all-cause, cancer, and cardiovascular disease (3). These foods contain phytochemicals which
are known for the prevention and treatment of cardiovascular disease (3). One spice that
contains these phytochemicals is garlic.
As stated, coronary heart disease is the leading cause of death in men and women in the
United States. Each year, about 370,000 Americans die because of it. There are many risk
factors that make people more susceptible to coronary heart disease including unhealthy blood
cholesterol levels, high blood pressure, smoking, insulin resistance, diabetes, obesity, lack of
physical activity, older age, and family history (2).
Coronary heart disease is diagnosed by your doctor based on medical and family history,
risk factors, a physical exam, and results from tests and procedures. If your doctor thinks you
may have coronary heart disease they can use a multitude of tests. First, an electrocardiogram
can be used to detect your heart’s electrical activity. The test records how fast the heart is
beating, its rhythm, and the strength of beating. Second, stress testing can be used to make
your heart work harder and beat faster. By doing this, the heart needs more oxygen enriched
blood. If your heart isn’t getting enough oxygen as it needs, you will not be able to exercise as
long as someone with a normal heart. In conjunction with stress tests, pictures are taken while
you exercise to see how well blood is flowing in and out your heart. Other tests can also be
used, such as an echocardiograph test, blood tests, coronary angiograph, cardiac
catheterization, and chest x-rays (2).
If you are diagnosed with coronary heart disease, there are some treatments that can
be put in place. The goals of treatment are lowering the risk of blood clots forming, preventing
complications of the disease, reducing risk factors, relieving symptoms, and widening or
bypassing clogged arteries. The main treatments put in place are heart-healthy eating,
maintaining a healthy weight, managing stress, quitting smoking, and introducing physical
activity (2). For this topic of discussion, a diet enriched with garlic aids in the prevention,
treatment and management of coronary heart disease.
Garlic has been around for a long time and has been used for flavoring, traditional
medicine, and as a functional food that enhances physical and mental health (3). It is even cited
in the Egyptian Codex Ebers, a 35-century-old document, as useful in the treatment of heart
disorders, tumors, worms, bites and other ailments (3). Today, garlic has gained attention
3. because of its role in treating cardiovascular disease and many studies have been made to
assess this role.
The first clinical trial assessed the effects of a garlic pill on platelet aggregation and
bleeding time. Platelet aggregation is known to play a role in the pathophysiology of coronary
heart disease. Many studies have already shown that garlic can inhibit platelet aggregation so
this clinical trial also compared the use of garlic with the use of Plavix, a medication that helps
prevent platelets from forming a blood clot. The idea behind the study was that Plavix is a
medication that helps prevent blood clotting, but it is expensive and can have side effects. If
garlic proved to be as helpful or better, it would make sense to use garlic pills instead.
The clinical trial study was conducted on 36 healthy adult males between the ages of 19
and 24. Before garlic or Plavix was given to the volunteers, blood samples had to be collected in
order to go through a platelet aggregation test. This was done so a baseline could be
established. There was also a bleeding time test performed before any garlic or medications
were given for a baseline. After baselines were established, the men were randomly divided
into four groups. The groups either received 600, 1200, or 2400 mg of garlic pill, or a 75 mg
Plavix pill. The pills were ingested daily for three weeks. After the three weeks, blood samples
were collected for platelet aggregation testing and the bleeding time test was performed on
each subject.
The results showed that there was no difference between the samples collected before
and after the subjects used the 600 mg. There was also no difference in some parameters for
the group who took 1200 mg of garlic, but there were differences in the activity of ADP and
ristocetin. However, there was significant results in the groups that took the 2400 mg garlic pills
and the Plavix, although there was not much difference in ristocetin for the Plavix users. This
shows that there was a meaningful difference before and after for the group that took 2400 mg
of garlic pill which showed that platelet aggregation decreased.
In conclusion, the authors that conducted this experiment stated that the results of this
study show that garlic has an anti-clotting nature which can prevent platelet aggregation. So,
everyone should use garlic as a part of their daily diets in order to treat or prevent coronary
heart disease (4).
The second clinical trial used high doses of garlic extract in rats to investigate the
antihyperlipidemic effects of garlic because hypercholesterolemia is associated with an
increased risk of coronary heart disease. It has been shown that elevated concentrations of
total or LDL cholesterol in the blood are powerful risk factors for CHD, whereas high
concentrations of HDL cholesterol or a low LDL to HDL cholesterol ratio may protect against
coronary heart disease (5). The main focus of this study was to analyze the anti-hyperlipidemic
and anti-hypercholesterolemic activities of garlic.
In order to analyze the properties of garlic, 40 healthy male rats weighing from 200 to
250 grams were obtained. Garlic extracts were also prepared. By distillation processes to
4. different strengths of extract were created; 200 mg/kg and 400 mg/kg. The rats were divided
into four groups of ten. The control group was fed a normal diet and group two was fed a
normal diet with 10% cholesterol enriched high fat. Groups three and four were given the 200
mg/kg and 400 mg/kg, respectively. Blood was then extracted from the heart by cardiac
puncture to be tested for the amount of LDL and HDL present.
After two and four weeks of treatment, LDL decreased significantly and HDL increased
significantly in groups three and four as compared to the control group and group two. This
significant reduction of the HDL to LDL ratio suggests health benefits in conjunction to the
reduction of coronary heart disease. This shows that garlic extracts may lower cardiovascular
disease potential (5).
Next, the conductors of a clinical trial hypothesized that garlic extract along with
coenzyme Q10 would have a favorable effect on inflammatory markers and coronary
atherosclerosis progression. Coenzyme Q10 is present in all cellular membranes and has shown
to have antioxidant properties by preventing oxidative modification of LDL. When
concentrated, coenzyme Q10 has shown to be lower in patients with coronary heart disease.
Along with aged garlic extract, coronary heart disease may be prevented or treated.
This study used an available aged garlic extract and coenzyme Q10 supplement called
Kyolic 110 and investigated plaque burden and inflammatory biomarkers. 65 firefighters were
used in the double blind study. Some were placed on Kyolic 110 while others were placed on
the placebo. The pills were given to the firefighters every day for a year. All participants had
coronary artery calciumand c-reactive protein assessments before and after using the pills for a
year.
The results showed that aged garlic extract, along with coenzyme Q10, reduced the
progression of coronary artery calciumwhich tracks progression of coronary heart disease over
time. The c-reactive protein content was also lower. This data suggests that the participants
who used Kyolic have had significant improvements in cardiovascular health (6).
Another article showed that garlic is a great functional food that can help treat
secondary coronary heart disease. Garlic powder tablets under the name of Allicor were used
as the drug that was known for reducing risk factors of cardiovascular disease. Patients with
coronary heart disease that were men and women between the ages of 40 and 65 were used.
One group received Allicor while the other received a placebo twice a day for twelve months.
Many tests were conducted in order to look at total cholesterol, triglyceride content,
HDL, and LDL. Family history, smoking and diabetes were also taken into account. After twelve
months tests showed that the people who took Allicor had significant changes in total and LDL
cholesterol levels. Total cholesterol decreased by 12.4% while LDL decreased by 16.3%. Serum
triglyceride levels were lowered by 11.8% as well.
5. To take the study even further, the authors made a risk analysis for the ten years for the
patients. This data showed prognostic risk of fatal and non-fatal myocardial infarction and
sudden death. Women treated by Allicor had a reduced risk by 1.3 fold and men had a reduced
risk by 1.5 fold (7).
All in all, these four clinical trials show that garlic is a functional food that can prevent or
treat coronary heart disease. However, it would be advantageous to find out how garlic does
this. There was not a study found that explained the mechanism of action in which garlic
worked. If the compound or compounds in garlic that help prevent or treat this disease were
found, then there could be a big movement towards knocking out coronary disease.
To conclude, coronary heart disease is an important disease to be aware about because
it is leading killer in the United States. There are many risk factors and most of them can be
avoided. Maintaining a healthy diet, exercising, and not smoking can help tremendously. Along
with a healthy diet, garlic may be a great way to help prevent cardiovascular disease. Garlic can
inhibit platelet aggregation or blood clotting, lower LDL levels, raise HDL levels, reduce coronary
artery calciumand other inflammatory biomarkers, reduce plaque, and can contribute to
antihypertension.
6. References
(1) National Center for Complementary and Integrative Health. (2015). Cardiovascular
disease. Retrieved April 9, 2016.
(2) National Heart, Lung, and Blood Institute. (2015). Coronary heart disease. Retrieved
April 9, 2016.
(3) Rahman, K., Lowe, G. (2006). Garlic and cardiovascular disease: a critical review. J Nutr.
136(3): 7365-7405. Retrieved April 9, 2016.
(4) Fakhar, H., Hashemi Tayer, A. (2012). Effect of the garlic pill in comparison with Plavix on
platelet aggregation and bleeding time. Iran J Ped Hematol Oncol. 2(4): 146-152.
Retrieved April 11, 2016.
(5) Ebrahimi, T. Behdad, B., Agha Abbasi, M., Ghaffarzadegan Rabati R., Farshid Fayyaz, A.,
Behnod, V., Asgari, A. (2015). High doses of garlic extract significantly attenuated
the ratio of serum LDL to HDL level in rat-fed with hypercholesterolemia diet.
Diagn Pathol. 10: 74. Retrieved April 11, 2016.
(6) Zeb, I.,, Ahmadi, N., Nasir, K., Kadakia, J., Nabavi Larijani, V., Flores, F., Budoff, M. (2012).
Aged garlic extract and coenzyme Q10 have favorable effect on inflammatory
markers and coronary atherosclerosis progression: a randomized clinical trial. J
Cardiovasc Dis Res. 3(3): 185-190. Retrieved April 12, 2016.
(7) Sobenin, I., Pryanishnikov, V., Kunnova, L., Rabinovich, Y., Martirosyan, D., Orekhov, A.
(2010). The effects of time-released garlic powder tablets on multifunctional
cardiovascular risk in patients with coronary artery disease. Lipids Health Dis. 9:
119. Retrieved April 12, 2016.