The document summarizes research on diet and lifestyle modification trials for reducing blood pressure and preventing cardiovascular disease. It outlines completed trials such as DASH and DASH-Sodium that demonstrated reducing sodium and following dietary patterns high in fruits and vegetables lowers blood pressure. Ongoing trials continue exploring optimal macronutrient balances and how lifestyle changes can help control blood pressure, especially in older individuals and reducing racial disparities.
This document discusses approaches to managing type 2 diabetes. It presents two case studies. For the first case of a newly diagnosed patient, it recommends assessing lifestyle factors, conducting a physical exam and lab tests, and setting an A1c target. Metformin is the first-line medication due to its efficacy, safety profile and cost. For the second case of an uncontrolled patient already on metformin, it analyzes adding a second agent. Common add-on options are discussed, including their mechanisms of action, dosing, efficacy, side effects, costs and disadvantages to help determine the best individualized treatment approach.
A 62-year old man presented with cerebrovascular accident secondary to hypertension. He had a history of non-compliance with antihypertensive medications and alcohol and tobacco use. He was initially unresponsive but regained consciousness after treatment. His blood pressure fluctuated above normal levels during treatment. He received nutritional counseling and was placed on an oral fluid diet, which along with medications helped control his blood pressure and recovery. At follow-up two weeks later, his health status was satisfactory with normal vital signs and anthropometric measurements. Medical nutrition therapy played an important role in his recovery from cerebrovascular accident.
The document discusses lipid abnormalities and cardiovascular risk in patients with insulin resistance and diabetes. It notes that lipid abnormalities affect all lipid fractions, characterized by elevated triglycerides, remnant lipoproteins, small dense LDL, and low HDL. Lifestyle modifications and medical therapies can help treat diabetic dyslipidemia and reduce cardiovascular risk. The guidelines recommend statin therapy along with lifestyle changes to lower LDL and reduce risk, and address other lipid abnormalities as needed.
Mary, a 52-year-old diabetic woman, has been feeling weak, fatigued, and confused with frequent urination and thirst. Tests show high levels of ketones in her urine and blood, indicating diabetic ketoacidosis (DKA). The doctor diagnoses DKA based on her symptoms and test results. Treatment involves fluid replenishment, electrolyte replacement, and insulin therapy to reverse the metabolic imbalances causing DKA. If left untreated, DKA can lead to serious complications or death, but with treatment the prognosis is generally good.
Hypertension and Cardiovascular Disease Clinical Nutrition Case StudyDawnAnderson14
This document provides information on a case study involving hypertension and cardiovascular disease. It begins with objectives to better understand hypertension, dyslipidemia, and associated nutritional problems and therapies. An introduction defines hypertension, dyslipidemia, and their relationship to cardiovascular disease. Background literature on studies related to reducing blood pressure through diet is presented. Finally, the document describes a 54-year-old African American woman's medical diagnosis of stage 2 hypertension, medications, lab values, anthropometrics, estimated nutrient needs, and proposed nutritional interventions focused on reducing calorie, sodium, and saturated fat intake.
1. Advise lifestyle modifications like a heart-healthy diet, exercise, weight control, and smoking cessation.
2. Reassess risk factors and calculate 10-year ASCVD risk in 5 years.
3. Consider a moderate-intensity statin if additional risk factors emerge or 10-year risk reaches 7.5% at the next assessment.
1) Patients with diabetes have more than double the risk of major adverse cardiovascular events like myocardial infarction, stroke, and heart failure compared to those without diabetes.
2) Lifestyle changes like diet, exercise, and not smoking along with controlling blood pressure and lipids through medication are more important for reducing cardiovascular risk than glycemic control alone.
3) Cardiovascular disease risk is significantly increased in those with diabetes, with women seeing higher relative risks than men. Multiple factors contribute to diabetes being a major risk factor for cardiovascular disease.
This document discusses approaches to managing type 2 diabetes. It presents two case studies. For the first case of a newly diagnosed patient, it recommends assessing lifestyle factors, conducting a physical exam and lab tests, and setting an A1c target. Metformin is the first-line medication due to its efficacy, safety profile and cost. For the second case of an uncontrolled patient already on metformin, it analyzes adding a second agent. Common add-on options are discussed, including their mechanisms of action, dosing, efficacy, side effects, costs and disadvantages to help determine the best individualized treatment approach.
A 62-year old man presented with cerebrovascular accident secondary to hypertension. He had a history of non-compliance with antihypertensive medications and alcohol and tobacco use. He was initially unresponsive but regained consciousness after treatment. His blood pressure fluctuated above normal levels during treatment. He received nutritional counseling and was placed on an oral fluid diet, which along with medications helped control his blood pressure and recovery. At follow-up two weeks later, his health status was satisfactory with normal vital signs and anthropometric measurements. Medical nutrition therapy played an important role in his recovery from cerebrovascular accident.
The document discusses lipid abnormalities and cardiovascular risk in patients with insulin resistance and diabetes. It notes that lipid abnormalities affect all lipid fractions, characterized by elevated triglycerides, remnant lipoproteins, small dense LDL, and low HDL. Lifestyle modifications and medical therapies can help treat diabetic dyslipidemia and reduce cardiovascular risk. The guidelines recommend statin therapy along with lifestyle changes to lower LDL and reduce risk, and address other lipid abnormalities as needed.
Mary, a 52-year-old diabetic woman, has been feeling weak, fatigued, and confused with frequent urination and thirst. Tests show high levels of ketones in her urine and blood, indicating diabetic ketoacidosis (DKA). The doctor diagnoses DKA based on her symptoms and test results. Treatment involves fluid replenishment, electrolyte replacement, and insulin therapy to reverse the metabolic imbalances causing DKA. If left untreated, DKA can lead to serious complications or death, but with treatment the prognosis is generally good.
Hypertension and Cardiovascular Disease Clinical Nutrition Case StudyDawnAnderson14
This document provides information on a case study involving hypertension and cardiovascular disease. It begins with objectives to better understand hypertension, dyslipidemia, and associated nutritional problems and therapies. An introduction defines hypertension, dyslipidemia, and their relationship to cardiovascular disease. Background literature on studies related to reducing blood pressure through diet is presented. Finally, the document describes a 54-year-old African American woman's medical diagnosis of stage 2 hypertension, medications, lab values, anthropometrics, estimated nutrient needs, and proposed nutritional interventions focused on reducing calorie, sodium, and saturated fat intake.
1. Advise lifestyle modifications like a heart-healthy diet, exercise, weight control, and smoking cessation.
2. Reassess risk factors and calculate 10-year ASCVD risk in 5 years.
3. Consider a moderate-intensity statin if additional risk factors emerge or 10-year risk reaches 7.5% at the next assessment.
1) Patients with diabetes have more than double the risk of major adverse cardiovascular events like myocardial infarction, stroke, and heart failure compared to those without diabetes.
2) Lifestyle changes like diet, exercise, and not smoking along with controlling blood pressure and lipids through medication are more important for reducing cardiovascular risk than glycemic control alone.
3) Cardiovascular disease risk is significantly increased in those with diabetes, with women seeing higher relative risks than men. Multiple factors contribute to diabetes being a major risk factor for cardiovascular disease.
1) The document discusses the approach to managing dyslipidemia in patients with diabetes, including lifestyle modifications and statin therapy based on risk factors and guidelines from the American Diabetes Association.
2) It provides examples of managing specific patient cases, such as addressing high liver enzymes before starting a statin, managing statin side effects like muscle pain, and treating very high triglycerides.
3) The key points are categorizing patients based on risk, using statin intensity based on risk level, monitoring for side effects, addressing secondary causes of lipid abnormalities, and following guideline recommendations.
This case study describes a 60-year-old male patient, Mr. Abdul Hamid Shah Jummah Shah, who presented with frequent urination, feeling tired, and blurred vision. Laboratory tests found elevated blood glucose, cholesterol, and triglyceride levels. The patient was diagnosed with diabetes and prescribed metformin and atenolol. A diet schedule avoiding sugar was also provided, along with counseling on maintaining the diet and using sugar-free products.
Dyslipidemia 'from guidelines to practice' prof.alaa wafaaalaa wafa
This document discusses guidelines for the treatment of dyslipidemia. It begins by comparing hypertension treatment to lipid lowering, noting that lipid lowering has fewer drug classes, mechanisms of action, and side effects compared to hypertension treatment. It then discusses how many patients do not reach lipid goals even after dose adjustments of statin medications. The document emphasizes the need for more effective cholesterol lowering to meet lipid goals. It reviews various studies demonstrating the relationship between cholesterol levels, cardiovascular risk, and mortality. It discusses the benefits of different statin medications and doses at lowering cholesterol. The document provides an overview of guideline recommendations for cholesterol goals and treatment intensities based on patient risk levels.
1) The patient has a 10.8% 10-year ASCVD risk, placing him in the intermediate risk category.
2) For patients in this category, guidelines recommend evaluating additional risk enhancers such as family history of premature CVD, metabolic syndrome, inflammation, and coronary artery calcium score.
3) Based on the assessment of risk enhancers, the guidelines recommend either moderate or high-intensity statin therapy.
The document presents the case of a 63-year-old male patient with end-stage renal disease secondary to diabetes who has been on dialysis for three years. He was recently hospitalized multiple times for various issues and experienced significant weight loss and decreased nutritional status. The case examines his medical history and diet during hospitalizations in order to assess his current protein-energy wasting status and recommend treatment.
The document presents a case study of a 51-year-old Filipino woman diagnosed with type 2 diabetes mellitus and hypertension. Her lab results and physical exam are provided. She is currently taking medications including Glimeperide, Metformin, Pioglitazone, and Nifedepine to manage her conditions. The document also provides general information on diabetes mellitus, including diagnostic criteria, treatment goals, glucose-lowering therapies and nutritional recommendations.
Nutrition therapy work shop dawly second part 2017FarragBahbah
This document provides information on nutrition for patients with chronic kidney disease (CKD) and those undergoing dialysis. It discusses recommendations for calories, protein, carbohydrates, fat, sodium, fluids, phosphorus, calcium, potassium and micronutrients. It notes that dialysis can impact nutrition by causing losses of certain nutrients and affecting appetite and food intake. Dietary goals for patients on dialysis include managing blood pressure and glucose as well as intake of minerals and fluids.
This document discusses dietary guidelines for kidney health. It notes that kidneys play a key role in nutrient homeostasis and that loss of kidney function disrupts this. For chronic kidney disease (CKD) patients, guidelines recommend a daily protein intake of 0.6-0.8g/kg, limiting fat intake to 30% of calories, and restricting sodium and phosphorus intake. While protein restriction may slow CKD progression, large trials like MDRD found little overall benefit. A plant-based, low-protein diet that is low in phosphorus and sodium may be most suitable for CKD patients. Focusing on overall dietary patterns like the DASH diet may be more practical than individual nutrient restrictions.
This document provides an overview of diabetic dyslipidemia and lipid management recommendations for patients with diabetes. It discusses that excess fat contributes to atherosclerosis and mortality in diabetes. It outlines traditional and non-traditional risk factors for cardiovascular disease. The spectrum of diabetic dyslipidemia includes quantitative changes like high triglycerides and qualitative changes in lipoprotein composition. Lifestyle modifications and statin therapy are recommended to improve lipid profiles and reduce cardiovascular risk according to guidelines. The appropriate screening, interpretation of results, and intensity of statin therapy depends on individual patient risk factors and characteristics.
This document provides an overview of integrated renal care and the role of renal diet and nutritional counseling. It discusses the stages of chronic kidney disease and care processes. Key points include:
- Nutritional assessment and counseling are important parts of renal care provided by a renal dietitian.
- Diet must be individualized based on a patient's kidney disease stage, lab results, nutrition status and other factors.
- Diet focuses on managing calories, protein, carbohydrates, fat, sodium, fluids, phosphorus and other minerals.
- Malnutrition is common in kidney disease and dialysis, so nutritional monitoring and counseling are essential.
- The patient is a 50-year-old male smoker with hypertension for 6 years. His lipid profile shows a total cholesterol of 210 mg/dL, triglycerides of 180 mg/dL, LDL of 119 mg/dL, and HDL of 30 mg/dL.
- According to guidelines, he is at high cardiovascular risk due to smoking, hypertension, and lipid levels. Egypt is also considered a very high risk country.
- The appropriate measures for this high risk patient include lifestyle modifications plus high-intensity statin therapy, with an LDL cholesterol goal of less than 70 mg/dL. Monitoring is also needed.
The document discusses cardiovascular risk and management in patients with diabetes, including treating cardiovascular risk factors as aggressively in diabetic patients as in non-diabetic patients with prior heart attacks, aiming for tighter glycemic control to reduce cardiovascular events and mortality, and considering individual patient factors and comorbidities when setting glycemic targets and selecting antihyperglycemic therapies, particularly in acute care settings where basal insulin regimens are preferred over sliding scales.
Nutrition of patients undergoing dialysisManiz Joshi
This document discusses nutritional assessment and dietary recommendations for dialysis patients. It outlines several methods for assessing nutritional status, including physical exams, body composition measurements, functional tests, and biochemical markers like serum albumin and prealbumin. Optimal intake levels are provided for proteins, sodium, fluids, potassium, phosphorus, and various vitamins. Maintaining adequate nutrition through diet and supplements is important for dialysis patients given losses during treatment and high risk of malnutrition.
Nutrition is important for patients undergoing peritoneal dialysis due to high risk of protein-energy malnutrition. The kidney regulates various body functions and end stage renal disease results in metabolic and nutritional abnormalities. Protein-energy malnutrition is highly prevalent in peritoneal dialysis and associated with increased mortality. Early nutritional assessment is important to diagnose and treat malnutrition through dietary modifications. Assessment involves measurements of serum albumin, weight changes, dietary intake and anthropometric measurements. The nutritional management focuses on adequate protein, energy, fluid and electrolyte intake tailored to the individual needs.
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.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Trajectories of lipids profile and incident cvd riskPraveen Nagula
The document discusses lipids and cardiovascular disease risk. It describes how the phenotype of acute coronary syndrome patients has changed from thin anxious executives to overweight sedentary individuals with diabetes or metabolic syndrome. Various lipid biomarkers are examined, including LDL, HDL, triglycerides, apoB, apoA-1, and Lp(a). Studies found these biomarkers provide better prediction of cardiovascular risk than LDL alone. Advanced lipid testing is recommended to better assess risk and treatment effectiveness beyond conventional lipids. Biomarkers like non-HDL-C, apoB, and Lp(a) show promise but more research is needed to understand their clinical utility.
1. Diabetic nephropathy is a leading cause of end-stage renal disease. It is defined by progressive albuminuria coupled with increasing blood pressure and declining kidney function.
2. The prevalence and incidence of diabetic nephropathy is increasing worldwide due to rising rates of diabetes. Optimizing blood glucose and blood pressure control can reduce the risk or slow the progression of nephropathy.
3. Standard treatment involves angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to control blood pressure and slow kidney function decline, though current therapies only slow progression and do not halt it. Additional research is still needed to develop more effective treatments.
1) The document discusses guidelines for statin use in Indians and highlights several non-traditional cardiovascular risk factors for Indians.
2) It notes Indians are more likely to have atherogenic dyslipidemia characterized by high triglycerides and low HDL rather than high LDL.
3) The document advocates estimating lifetime cardiovascular risk for Indians based on traditional and non-traditional factors rather than 10-year risk to better guide statin therapy.
Dyslipdemia and Rosuvastatin by prof taj jamshaidTAJ JAMSHAD
This document discusses the role of rosuvastatin in treating dyslipidemia. It summarizes that rosuvastatin is effective at lowering LDL cholesterol and raising HDL cholesterol levels. Several studies showed that rosuvastatin was more effective than other statins at reducing LDL cholesterol levels. The document also notes that rosuvastatin is approved by the FDA for reducing atherosclerosis based on evidence from studies showing it can regress atherosclerotic plaque buildup in arteries.
The document provides information about several Native American tribes that lived in Florida, including their locations, diets, customs, clothing, tools, housing, present status, and languages. The Timucua lived in northeast Florida and were heavily tattooed. They built houses out of palm fronds and wood. The Calusa were the most powerful tribe in Florida and gained wealth through trade and tribute. Sadly, all of the tribes described are now extinct.
1) The document discusses the approach to managing dyslipidemia in patients with diabetes, including lifestyle modifications and statin therapy based on risk factors and guidelines from the American Diabetes Association.
2) It provides examples of managing specific patient cases, such as addressing high liver enzymes before starting a statin, managing statin side effects like muscle pain, and treating very high triglycerides.
3) The key points are categorizing patients based on risk, using statin intensity based on risk level, monitoring for side effects, addressing secondary causes of lipid abnormalities, and following guideline recommendations.
This case study describes a 60-year-old male patient, Mr. Abdul Hamid Shah Jummah Shah, who presented with frequent urination, feeling tired, and blurred vision. Laboratory tests found elevated blood glucose, cholesterol, and triglyceride levels. The patient was diagnosed with diabetes and prescribed metformin and atenolol. A diet schedule avoiding sugar was also provided, along with counseling on maintaining the diet and using sugar-free products.
Dyslipidemia 'from guidelines to practice' prof.alaa wafaaalaa wafa
This document discusses guidelines for the treatment of dyslipidemia. It begins by comparing hypertension treatment to lipid lowering, noting that lipid lowering has fewer drug classes, mechanisms of action, and side effects compared to hypertension treatment. It then discusses how many patients do not reach lipid goals even after dose adjustments of statin medications. The document emphasizes the need for more effective cholesterol lowering to meet lipid goals. It reviews various studies demonstrating the relationship between cholesterol levels, cardiovascular risk, and mortality. It discusses the benefits of different statin medications and doses at lowering cholesterol. The document provides an overview of guideline recommendations for cholesterol goals and treatment intensities based on patient risk levels.
1) The patient has a 10.8% 10-year ASCVD risk, placing him in the intermediate risk category.
2) For patients in this category, guidelines recommend evaluating additional risk enhancers such as family history of premature CVD, metabolic syndrome, inflammation, and coronary artery calcium score.
3) Based on the assessment of risk enhancers, the guidelines recommend either moderate or high-intensity statin therapy.
The document presents the case of a 63-year-old male patient with end-stage renal disease secondary to diabetes who has been on dialysis for three years. He was recently hospitalized multiple times for various issues and experienced significant weight loss and decreased nutritional status. The case examines his medical history and diet during hospitalizations in order to assess his current protein-energy wasting status and recommend treatment.
The document presents a case study of a 51-year-old Filipino woman diagnosed with type 2 diabetes mellitus and hypertension. Her lab results and physical exam are provided. She is currently taking medications including Glimeperide, Metformin, Pioglitazone, and Nifedepine to manage her conditions. The document also provides general information on diabetes mellitus, including diagnostic criteria, treatment goals, glucose-lowering therapies and nutritional recommendations.
Nutrition therapy work shop dawly second part 2017FarragBahbah
This document provides information on nutrition for patients with chronic kidney disease (CKD) and those undergoing dialysis. It discusses recommendations for calories, protein, carbohydrates, fat, sodium, fluids, phosphorus, calcium, potassium and micronutrients. It notes that dialysis can impact nutrition by causing losses of certain nutrients and affecting appetite and food intake. Dietary goals for patients on dialysis include managing blood pressure and glucose as well as intake of minerals and fluids.
This document discusses dietary guidelines for kidney health. It notes that kidneys play a key role in nutrient homeostasis and that loss of kidney function disrupts this. For chronic kidney disease (CKD) patients, guidelines recommend a daily protein intake of 0.6-0.8g/kg, limiting fat intake to 30% of calories, and restricting sodium and phosphorus intake. While protein restriction may slow CKD progression, large trials like MDRD found little overall benefit. A plant-based, low-protein diet that is low in phosphorus and sodium may be most suitable for CKD patients. Focusing on overall dietary patterns like the DASH diet may be more practical than individual nutrient restrictions.
This document provides an overview of diabetic dyslipidemia and lipid management recommendations for patients with diabetes. It discusses that excess fat contributes to atherosclerosis and mortality in diabetes. It outlines traditional and non-traditional risk factors for cardiovascular disease. The spectrum of diabetic dyslipidemia includes quantitative changes like high triglycerides and qualitative changes in lipoprotein composition. Lifestyle modifications and statin therapy are recommended to improve lipid profiles and reduce cardiovascular risk according to guidelines. The appropriate screening, interpretation of results, and intensity of statin therapy depends on individual patient risk factors and characteristics.
This document provides an overview of integrated renal care and the role of renal diet and nutritional counseling. It discusses the stages of chronic kidney disease and care processes. Key points include:
- Nutritional assessment and counseling are important parts of renal care provided by a renal dietitian.
- Diet must be individualized based on a patient's kidney disease stage, lab results, nutrition status and other factors.
- Diet focuses on managing calories, protein, carbohydrates, fat, sodium, fluids, phosphorus and other minerals.
- Malnutrition is common in kidney disease and dialysis, so nutritional monitoring and counseling are essential.
- The patient is a 50-year-old male smoker with hypertension for 6 years. His lipid profile shows a total cholesterol of 210 mg/dL, triglycerides of 180 mg/dL, LDL of 119 mg/dL, and HDL of 30 mg/dL.
- According to guidelines, he is at high cardiovascular risk due to smoking, hypertension, and lipid levels. Egypt is also considered a very high risk country.
- The appropriate measures for this high risk patient include lifestyle modifications plus high-intensity statin therapy, with an LDL cholesterol goal of less than 70 mg/dL. Monitoring is also needed.
The document discusses cardiovascular risk and management in patients with diabetes, including treating cardiovascular risk factors as aggressively in diabetic patients as in non-diabetic patients with prior heart attacks, aiming for tighter glycemic control to reduce cardiovascular events and mortality, and considering individual patient factors and comorbidities when setting glycemic targets and selecting antihyperglycemic therapies, particularly in acute care settings where basal insulin regimens are preferred over sliding scales.
Nutrition of patients undergoing dialysisManiz Joshi
This document discusses nutritional assessment and dietary recommendations for dialysis patients. It outlines several methods for assessing nutritional status, including physical exams, body composition measurements, functional tests, and biochemical markers like serum albumin and prealbumin. Optimal intake levels are provided for proteins, sodium, fluids, potassium, phosphorus, and various vitamins. Maintaining adequate nutrition through diet and supplements is important for dialysis patients given losses during treatment and high risk of malnutrition.
Nutrition is important for patients undergoing peritoneal dialysis due to high risk of protein-energy malnutrition. The kidney regulates various body functions and end stage renal disease results in metabolic and nutritional abnormalities. Protein-energy malnutrition is highly prevalent in peritoneal dialysis and associated with increased mortality. Early nutritional assessment is important to diagnose and treat malnutrition through dietary modifications. Assessment involves measurements of serum albumin, weight changes, dietary intake and anthropometric measurements. The nutritional management focuses on adequate protein, energy, fluid and electrolyte intake tailored to the individual needs.
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.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Trajectories of lipids profile and incident cvd riskPraveen Nagula
The document discusses lipids and cardiovascular disease risk. It describes how the phenotype of acute coronary syndrome patients has changed from thin anxious executives to overweight sedentary individuals with diabetes or metabolic syndrome. Various lipid biomarkers are examined, including LDL, HDL, triglycerides, apoB, apoA-1, and Lp(a). Studies found these biomarkers provide better prediction of cardiovascular risk than LDL alone. Advanced lipid testing is recommended to better assess risk and treatment effectiveness beyond conventional lipids. Biomarkers like non-HDL-C, apoB, and Lp(a) show promise but more research is needed to understand their clinical utility.
1. Diabetic nephropathy is a leading cause of end-stage renal disease. It is defined by progressive albuminuria coupled with increasing blood pressure and declining kidney function.
2. The prevalence and incidence of diabetic nephropathy is increasing worldwide due to rising rates of diabetes. Optimizing blood glucose and blood pressure control can reduce the risk or slow the progression of nephropathy.
3. Standard treatment involves angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to control blood pressure and slow kidney function decline, though current therapies only slow progression and do not halt it. Additional research is still needed to develop more effective treatments.
1) The document discusses guidelines for statin use in Indians and highlights several non-traditional cardiovascular risk factors for Indians.
2) It notes Indians are more likely to have atherogenic dyslipidemia characterized by high triglycerides and low HDL rather than high LDL.
3) The document advocates estimating lifetime cardiovascular risk for Indians based on traditional and non-traditional factors rather than 10-year risk to better guide statin therapy.
Dyslipdemia and Rosuvastatin by prof taj jamshaidTAJ JAMSHAD
This document discusses the role of rosuvastatin in treating dyslipidemia. It summarizes that rosuvastatin is effective at lowering LDL cholesterol and raising HDL cholesterol levels. Several studies showed that rosuvastatin was more effective than other statins at reducing LDL cholesterol levels. The document also notes that rosuvastatin is approved by the FDA for reducing atherosclerosis based on evidence from studies showing it can regress atherosclerotic plaque buildup in arteries.
The document provides information about several Native American tribes that lived in Florida, including their locations, diets, customs, clothing, tools, housing, present status, and languages. The Timucua lived in northeast Florida and were heavily tattooed. They built houses out of palm fronds and wood. The Calusa were the most powerful tribe in Florida and gained wealth through trade and tribute. Sadly, all of the tribes described are now extinct.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise boosts blood flow, releases endorphins, and promotes changes in the brain which help regulate emotions and stress levels.
Guide for de mystifying law of trade mark litigation in IndiaVijay Dalmia
The document provides an overview of trademark law in India. It discusses that trademark registration is not required for protection, and that rights can be acquired through registration, first use, or assignment. It also outlines threats like cancellation, opposition, and litigation for infringement or passing off. Key principles of Indian trademark law include first adoption taking priority over registration, and volume of business not being a relevant consideration in litigation. Defences for infringement or passing off include delay, acquiescence, and differences in goods/sales channels.
20 начина да си убиеш блога, без да се усетишVeselin Nikolov
Презентацията е посветена на това да ви накара да се замислите, преди да "подобрите" нещо. Подобренията често имат фатални тъмни страни, които могат да загробят вашия блог или сайт.
IPR Enforcement in India through Criminal Measures - By Vijay Pal DalmiaVijay Dalmia
This document summarizes Indian laws relating to intellectual property including trademarks, copyrights, patents, industrial designs, geographical indications, and internet/information technology. It outlines the criminal statutes and procedures for IP infringement cases, noting that infringement is a cognizable offense allowing police to directly file cases. Upon conviction, penalties include imprisonment up to 3 years and fines up to Rs. 200,000 for trademarks, and minimum 6 month imprisonment and Rs. 50,000 fine for copyright. Special provisions also address copyright enforcement authorities in various states.
This document discusses how acquiring top talent is important for startups and ventures to succeed. It argues that people are the most important ingredient for any venture to become an "adventure" or great success. The document promotes an outsourcing company called Idealpeople that helps clients attract and recruit top talent, especially in high-tech industries, in order to reduce risks and deliver faster returns on investment. It provides testimonials from clients who were satisfied with Idealpeople's services.
Saint Valentine's Day originated from a 5th century Roman festival where young men would draw girls' names from a box to be their partner for the year. Pope Gelasius replaced this pagan festival with having people draw saints' names to emulate. Valentine, a Catholic bishop, secretly married couples against the emperor's orders and was executed. He healed his jailer's daughter before his death, signing a message to her that started the tradition of exchanging love messages on Valentine's Day.
Determining Your Community's Competitive Advantage For The Creative SectorEmily Robson
Michael Florio, from OMAFRA’s rural community development branch will provide an overview of a ‘new’ practical economic analysis tool being developed to help communities identify their competitive advantages in the creative/cultural sector. As part of this overview, Michael will explain, how the information can systematically be used by a community/region to inform the development of a local strategy/action plans to grow the creative/cultural sector in a community/region.
This document discusses various aspects of software development processes. It begins with an overview of traditional waterfall software development processes versus more modern agile processes. It then covers source code management tools and how they have evolved from centralized version control to distributed version control. Next, it discusses important software development processes such as determining origin of code, export controls, licensing, and copyright. Finally, it briefly outlines different levels of software support and how client self-assist is evolving to provide more automated support capabilities.
Presentation about learning English in the virtual world of Second Life. A proven way to help motivate learners and create immersive learning opportunities.
The document outlines a school health and nutrition strategy in 3 sentences:
The strategy promotes safe, adequate, and healthy learning environments; integrates health and nutrition interventions into the curriculum; and has community nurses visit schools to assess, diagnose, treat, and refer students, while also distributing vitamin supplements and deworming medication.
Law Of Industrial Patent Design In India by Vijay DalmiaVijay Dalmia
This document discusses India's design laws and registration process. It provides an overview of the key aspects of industrial designs as a category of intellectual property rights in India, including definitions, eligibility, registration procedures, fees, rights conferred, and infringement. The document also shares statistics on design registrations in India and globally. In summary, it outlines the legal framework for design protection in India and relevant considerations for registering and enforcing industrial designs.
The document discusses the shift in marketing from marketer-controlled to consumer-driven. It advocates connecting with consumers through ongoing dialogue and embracing conversations. The consulting firm believes research must take conversations and the multi-faceted consumer into account. They have developed methods and communities to help clients connect with consumers and be conversation-ready.
Several diets are associated with improved health outcomes, including reduced risk of cardiovascular disease. The traditional Okinawan diet, Mediterranean diet, and DASH diet all emphasize fruits, vegetables, and whole grains while limiting red meat, saturated fat, and sodium. Following these overall dietary patterns is linked to lower mortality, better blood pressure control, and reduced risk of chronic diseases.
This document summarizes the evidence on the relationship between sodium intake and cardiovascular disease and mortality outcomes. While higher sodium intake is generally associated with higher blood pressure, a risk factor for cardiovascular disease, the evidence suggests the relationship between sodium and blood pressure, as well as between sodium and clinical outcomes, is modest. Large cohort studies using NHANES data found no significant associations between sodium intake and cardiovascular or all-cause mortality. Overall, the evidence does not strongly support recommendations for universal sodium restriction due to lack of evidence for meaningful health benefits.
This document discusses management of hypertension through lifestyle factors like nutrition and physical activity. It provides guidelines on dietary approaches such as limiting salt, alcohol and red meat intake while increasing consumption of fruits, vegetables, whole grains, fish and unsaturated fats. Regular physical activity of at least 30 minutes per day is recommended. Diets high in quality carbohydrates and plant proteins like the DASH diet have been shown to lower blood pressure and reduce cardiovascular risk.
1. The document discusses guidelines and strategies for the prevention, treatment, and control of hypertension.
2. It outlines 4 stages of intervention for hypertension: preventive, primary, secondary, and resistant hypertension. Treatment approaches differ depending on the stage.
3. The challenges of controlling hypertension include special patient populations, factors influencing drug choice, and issues related to resistant hypertension when blood pressure remains high despite treatment with 3 drug classes.
This document discusses the role of ACE inhibitors (ACEIs) and calcium channel blockers (CCBs) in combination for optimizing hypertension treatment in patients with diabetes, chronic kidney disease, or left ventricular hypertrophy. It highlights that combination therapy is often required to achieve blood pressure goals in diabetic hypertension patients. The combinations of ACEIs or ARBs with CCBs provide renoprotective benefits in type 2 diabetes patients and treatment should be initiated early for those with high-normal blood pressure. The document emphasizes that even small reductions in blood pressure of 2 mmHg can lower cardiovascular risk by up to 10% according to various studies and guidelines.
This document discusses non-pharmacologic management of hypertension. It recommends lifestyle modifications including weight loss, following the DASH diet which emphasizes fruits/vegetables, reducing sodium intake, regular exercise, limiting alcohol, and patient education. Other non-drug therapies mentioned are vitamin D and potassium supplementation, smoking cessation, and limiting NSAIDs and acetaminophen. The DASH diet was shown to lower blood pressure comparable to medication, especially when combined with low-fat dairy.
Hypertension, or high blood pressure, is defined as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. Around 90% of hypertension cases are considered "essential" or "primary" hypertension, which likely has a genetic component. Risk factors for hypertension include obesity, physical inactivity, stress, excessive salt intake, alcohol consumption, and smoking. Left uncontrolled, hypertension can increase the risk of heart disease, stroke, kidney disease, and other health issues. Treatment involves lifestyle changes like losing weight, exercising, and reducing salt intake, as well as medication if needed.
Hypertension frequently occurs with diabetes and amplifies cardiovascular risk. Aggressive blood pressure control below 130/80 mmHg prevents more cardiovascular events in diabetics. Treatment requires multiple drugs like ACE inhibitors, ARBs, thiazide diuretics, and calcium channel blockers to control blood pressure and protect organs. Lifestyle changes like weight loss, exercise, smoking cessation, and moderation of alcohol and sodium also help lower blood pressure.
The DASH eating plan was developed based on two studies that found lowering sodium intake and following a diet rich in fruits, vegetables, and low-fat dairy can significantly reduce blood pressure. The DASH plan focuses on these foods while limiting saturated fat, cholesterol, and red meat. One study found the largest blood pressure reductions when following the DASH plan along with reducing sodium to 1,500mg per day. The document provides details on implementing the DASH eating plan, including recommended daily servings and tips for modifying it based on calorie needs or for weight loss.
Hypertension, or high blood pressure, is a global health problem that affects nearly 1 billion people worldwide. It is poorly controlled, with less than 25% of cases controlled in developed countries and less than 10% in developing countries. If left untreated, hypertension can lead to heart attacks, heart failure, strokes and kidney disease.
The goals of hypertension treatment are to reduce cardiovascular and renal morbidity and mortality by achieving blood pressure targets. Lifestyle modifications such as weight loss, following a diet low in sodium and high in fruits/vegetables, engaging in physical activity, and quitting smoking can help lower blood pressure. When lifestyle changes are not enough, antihypertensive medications including diuretics, ACE inhibitors,
Epidemiology , diagnosis and treatment of Hypertension Toufiqur Rahman
Hypertension, Blood pressure, Systolic Hypertension, Diastolic Hypertension, Epidemiology, Classification of hypertention, Type of hypertension, aetiology of hypertension, Clinical features, complications of hypertension, ambulatory blood pressure monitoring, Resistant hypertension, anti hypertensives,
Diabetes and hypertension frequently occur together and amplify cardiovascular risk. Aggressive blood pressure control is especially important for diabetics to prevent events like heart disease and stroke. The document discusses the history of diabetes and hypertension, complications, diagnosis criteria, treatment goals, and pharmacological and lifestyle approaches to managing hypertension in diabetes. The key goals are achieving a blood pressure under 130/80 mmHg through lifestyle changes and often multiple drug classes like ACE inhibitors or ARBs to protect the kidneys and reduce cardiovascular risk.
The document summarizes guidelines from JNC 8 (2014) on the management of hypertension. It provides 3 key recommendations from JNC 8:
1) Treatment should begin for general population aged ≥60 years with SBP ≥150 mmHg or DBP ≥90 mmHg, and for those <60 years with SBP ≥140 mmHg or DBP ≥90 mmHg.
2) The treatment goal for non-diabetic, non-CKD patients is SBP <150 mmHg and DBP <90 mmHg. Lower goals may apply if no adverse effects.
3) Initial treatment should include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers or thiaz
This study investigated associations between habitual dietary fatty acid intake and blood pressure measurements in post-menopausal women. 31 non-smoking post-menopausal women recorded their diets using food diaries, which were analyzed to calculate intake of total fat and fatty acids. Blood pressure, including systolic, diastolic, and pulse pressure, was measured. A significant correlation was found between higher trans fat intake and increased pulse pressure, providing evidence to support guidelines limiting trans fat intake to less than 2% of total energy. However, no other significant correlations between fatty acids and blood pressure were observed. Larger studies using ambulatory blood pressure monitoring are needed to further understand relationships between diet and blood pressure in post-menopausal
This document summarizes the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). It outlines recommendations for classifying and treating hypertension based on blood pressure levels. Key points include classifying blood pressure into normal, prehypertension, and stages 1 and 2 of hypertension, and recommending lifestyle modifications and drug treatments to lower blood pressure to reduce cardiovascular risks. Compelling indications for certain drug classes are noted for conditions like heart disease, diabetes, and chronic kidney disease.
Hypertension is very common in patients with type 2 diabetes, affecting around half of patients at diagnosis. Strict control of blood pressure, with a target of below 130/80 mmHg, is important for reducing cardiovascular risks in diabetic patients. Several classes of antihypertensive drugs can be used effectively for this purpose, including diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers. Aggressive treatment of hypertension is recommended for diabetic patients, especially those with kidney disease, in order to prevent complications and disease progression.
In this slide deck, I describe the up-to-date evidence on Low Carbs and heart health. The evidence is based mainly on two recent meta-analyses (Hession et al. & Kodama et al.) and prospective cohort studies. Limited evidence on renal aspects is also demonstrated.
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Trials of diet and lifestyle modifications: Food fights and other battles
1. Trials of diet and lifestyle modification: Food fights and other battles Lawrence J. Appel, MD, MPH Professor of Medicine, Epidemiology and International Health (Human Nutrition) Johns Hopkins Medical Institutions Sept 2, 2009
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8. Stroke Mortality by Level of Usual Systolic BP* *Source: Prospective Studies Collaboration, Lancet, 2002: Meta-analysis of 61 prospective studies with 2.7m person-yrs, 11.9k deaths Definition of Hypertension
9. Blood Pressure Classification (JNC VII) Category Systolic BP Diastolic BP Normal < 120 and < 80 Pre-hypertension 120-139 or 80–89 Hypertension Stage 1 Stage 2 140–159 > 160 or or 90–99 > 100
10. Distribution of BP Levels in US Adults, Ages 18 and Older (NHANESIII) “ Normal” <120/80 Prehypertension SBP 120-39 or DBP 80-89 Hypertension SBP > 140 or DBP > 90 Source: Wang, Hypertension, 2004 42% 27% 31%
11. Prevalence of High Blood Pressure by Age and Race/Ethnicity, Women, Age 18 and Older * Extimate is based on sample size not meeting requirement of NHANES III design or relative standard error is greater than 30 percent. 100 30 20 10 0 Percent 40 Black (excludes Hispanic Blacks) 80 70 60 50 90 White (excludes Hispanic Whites) Mexican American 18-29 2.0* 1.0* 0.6* 30-39 11.3 6.2 4.6* 40-49 30.5 10.6 12.7 50-59 47.9 33.5 36.8 60-69 77.8 59.3 50.9 70-79 72.6 67.0 66.9 80 + 80.5* 71.0* 74.3 Source: Burt V, et al. Hypertension, 1995
12. Mean SBP and DBP by Age and Race/Ethnicity for Women, Age 18 Years and Older 150 140 130 120 110 100 90 80 70 mm Hg 18-29 30-39 40-49 50-59 60-69 70-79 80+ Diastolic Systolic Source: Burt V, et al. Hypertension, 1995 SBP Rise with Age = ~0.6 mmHg per year Age Black White Mexican-American
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14. Effects of Population-Based BP Reduction (Shifting SBP Distribution Downward) Stamler R. Hypertension 1991;17:I-16–I-20. % Reduction in Mortality Reduction in BP After Intervention Before Intervention Stroke CHD Total -6 -4 -3 -8 -5 -4 -14 -9 -7 Reduction in SBP mmHg 2 3 5
16. Types of Trials Type of Trial Research Question Examples Feeding Studies Effects of Diet Change on Blood Pressure and Other Risk Factors DASH DASH-Na OmniHeart Behavioral Intervention Studies Feasibility and Effects of Lifestyle Change in Free-Living Individuals TOHP1 TOHP2 TONE PREMIER Wt Loss Maintenance
29. Participant Flow Period 1 6 weeks Period 2 6 weeks Period 3 6 weeks Randomization to 1 of 6 sequences Washout Period 2–4 wk Washout Period 2-4 wk BP, Lipids: Run-In 6 days Participants Ate Study Food Screening / Baseline Participants Ate Their Own Food
37. Key Studies Supporting the Role of Sodium Reduction as a Means to Lower BP Non-Hypertensives Study Reduce BP DASH-Na Prevent hypertension TOHP 2 Prevent age-related rise in BP INTERSALT Prevent CVD events TOHP 3 Hypertensives Initial therapy DASH-Na Adjunct to drug therapy TONE Substitute for medication TONE
39. Percent Reduction in Incident Hypertension over 36-48 Months from Weight Loss and Sodium Reduction Interventions in TOHP2 6 Months 18 Months End of Study * * * * * * * * * P <0.05
40. Control Diet Randomization Run-in: (11-14 days) Intervention (Three 30-day periods, random order) Intermediate Sodium Higher Sodium Lower Sodium Higher Sodium Intermediate Sodium Lower Sodium Study Design Control Diet, N = 204 DASH Diet, N = 208 N = 412
42. Systolic Blood Pressure Control Diet DASH Diet Higher Intermed Lower Sodium Level Effect of DASH Diet on Systolic Blood Pressure -2.2 p=.02 -5.0 p=.0003 -5.9 p<0.0001
43. Interactive Effects of Reduced Na and DASH Diet on Systolic BP Systolic Blood Pressure Higher Lower Sodium Level Na Effect in Control Diet = - 6.7 DASH Effect - 5.7 Combined* Effects Actual = - 8.9 Predicted = - 12.4 * P < 0.001, Strict Additivity
44. Effects of Reduced Na on CVD Events: Results from 3 Randomized Trials INTERVENTION OUTCOME FU TONE (2001) 639 Elderly ↓ Na 21% ↓ CVD events 2.3 yrs Taiwan Veterans (2006) 1,981 Elderly ↓ Na /↑ K Salt 41%* ↓ CVD Mortality 2.6 yrs TOHP Follow-up [abs] 3,126 Prehypertensives ↓ Na 30%* ↓ CVD events 10-15 yrs *p<0.05
45. Effects of Reduced Na Intake on CVD: Longterm Results from the Trials of Hypertension Prevention (Cook et al, BMJ, 2007) Adj RR = 0.70 p=0.02
64. Design Self-Directed (SD) – comparison group Call-Center Directed (CCD) In-Person Directed (IPD) Randomization Last visits: 24 – 36 m after randomization = Data Collection Points, every 6 months during follow-up
65. Description of Groups Randomized Groups Self-Directed (SD) Call-Center Directed (CCD) In-Person Directed (IPD) Counselor: None Healthways Coach Hopkins Coach Static Website: √ Interactive Web-site: √ √ Sessions: Telephone Only Group Mtgs Individual Telephone PCP Reinforcement √ √
66. CCD and IPD Intervention Goals Weight Goal Minimum 5% weight loss, individually tailored Behaviors Calories 1200 kcal/d if ≤ 170 lb; 1500 kcal/d if > 170 lb and < 220 lb; 1800 kcal/d if > 220 lb and < 270 lb; 2200 kcal/d if > 270 lb Diet DASH diet 7-12 services of fruits/vegetables 2-3 servings of low fat dairy low sodium ≤ 25% of calories from fat Exercise Build to ≥ 180 minutes/wk of moderate intensity physical activity in bouts ≥ 10 minutes in length
78. Costs of Lifestyle Intervention Trials Sample Size Duration of Intervention Total Costs Per Participant Costs POWER 415 2 yr $5.9 m $14.2k
79. Costs of Feeding Studies Sample Size Duration of Feeding Total Costs Per Participant Costs DASH 459 11wk $7.8 m $17k DASH-Sodium 412 14 wk $11.8 m $29k Omni Heart 160 19 wk $6.2 m $39k Omni Carb 160 21 wk $10.3 m $64k
80. Costs of Mass Mailing in Feeding Studies DASH DASH-Sodium OmniHeart # Brochures Sent 115,000 265,000 393,000 # Enrolled from Mass Mailing 90 69 72 Yield/ 10k Brochures 7.8 2.6 1.8 Mailing Costs Per Enrolled $486 $1,459 $2,074 Total Mailing Costs $43,700 $100,700 $149,340
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90. MI, CHD Death, or Revascularization (all participants) Stroke Effects of WHI Dietary Modification Intervention on Total CVD and Stroke Time, y HR, 0.97 (95% CI, 0.90-1.06) Comparison Intervention Time, y HR,1.02 (95% CI, 0.90-1.15) Comparison Intervention
SLIDE 5 These are the centers that were involved in DASH. The Center for Health Research in Portland, Oregon was our coordinating center. The NHLBI, although they did not recruit subjects, served as a full partner in all of the study planning. The four clinical centers which were involved in recruiting and studying subjects were the Brigham and Woman’s Hospital in Boston, Johns Hopkins University in Baltimore, Duke in Durham and the Pennington Center in Baton Rouge, Louisiana. 3:18
SLIDE 3 So the goal of DASH was to identify a dietary pattern that captures and reproduces the blood pressure lowering effect of a vegetarian diet but which contains enough meat and other food products to be palatable and acceptable to the general population.
SLIDE 7 This is a diagrammatic presentation of the 11 week feeding period. Not shown on this slide, there were three screening visits to assure that blood pressure was in the proper range and that there were no important concomitant medical conditions. Subjects who passed the screening visits entered the run-in phase of feeding. Run-in was a three week period of time when all subjects received our control diet. At the end of run-in, subjects were randomized to one of three diets for the next eight weeks: either a continuation of the CONTROL diet, a diet high in fruits and vegetables, or our combination diet. During this entire 11 weeks, subjects ate their main meal of the day Monday through Friday in the Clinic site dining area. On Friday, they received their food for Saturday and Sunday, which they ate on their own at home over the weekend. To monitor urinary electrolyte excretion, we collected a 24 hour urine sample at the end of the run-in phase and at the end of the intervention diet. The change in blood pressure from the beginning to end of the 8 weeks’ intervention feeding was our endpoint.
SLIDE 12 We randomized 459 subjects, equally divided between men and women. 60% of subjects were minorities, with 90% of those being African-American. Average age was 45 years. The Pre-study BP for the overall group was 132/85, and 29% of subjects had hypertension, defined as sys >140 and/or dias >90. On average, the subjects were modestly overweight: the body mass index was 28.7 for women and 27.7 for men.
IOM Recommendations: 45-65% Carb 20-35% fat 10-35% protein **The rest of the nutrient profile is the same between the diets
IOM Recommendations: 45-65% Carb 20-35% fat 10-35% protein **The rest of the nutrient profile is the same between the diets
IOM Recommendations: 45-65% Carb 20-35% fat 10-35% protein **The rest of the nutrient profile is the same between the diets