Cardiology

Risk factors for heart disease

In a study that will be published in The Lancet shortly, comes the most definitive look at risk factors causing heart disease. Some key observations:

* 90% of the risk factors can be prevented

* risk factors are similar across different regions and race

So, what are the risk factors? Here they are, in order of importance:

1) poor HDL/LDL ratio

2) smoking

3) diabetes

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Not what Merck wants to hear . . .

I’m sure that they’re in damage control mode after reading about how Vioxx increases heart attack risk.

Patients taking Merck & Co. Inc.’s Vioxx arthritis drug had a 50 percent greater chance of heart attacks and sudden cardiac death than individuals using Pfizer Inc.’s rival Celebrex medicine, according to a large study financed by the U.S. Food and Drug Administration. . .

The study also found patients taking the …

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More coronary artery disease screening and EBCT

Galen has bluntly chimed in on the study comparing exercise stress testing and calcium scores from electron beam computed tomography (EBCT) that the lay press has been reporting.

As we brace ourselves for patients demanding EBCT, let’s consider the data and recommendations. Again, UptoDate comes in handy:

Coronary calcification detected by EBCT is found in individuals who have significant angiographic CHD, with a sensitivity ranging from …

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Exercise stress testing

The lay press is all over this study, blaring out this headline: Stress Test May Miss Early Heart Disease. Here were the participants in the study:

Most were men over 45 or women over 55, smokers, people with high cholesterol or high blood pressure, diabetes or a close relative with early heart disease, they reported in this week’s issue of the Journal of the American College of Cardiology.


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Hyperkalemia from the RALES study

The RALES study, published in 1999, concluded that spironolactone reduce mortality in those with severe heart failure (i.e. Class IV failure). Today’s NEJM comes out with a study showing that due to the RALES study, rates of hyperkalemia and mortality from this complication increased. Taking this into account, there were no significant decreases in death from all causes.

The reason for this is that most …

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A study showing . . .

. . . that triptans do not increase the rate of heart attack and stroke. Reassuring for migraine sufferers.

The myth of antioxidant supplements

As I have been continually telling my patients, antioxidant supplements do not have the appropriate evidence to support their use. Today, the American Heart Association agreed.

Interesting study . . .

. . . from Finland. It is suggested that the rate of stroke was lowest on Sunday, and highest on Monday. I wonder if the next step would be to see if the same applies to heart attacks.

Time is money

Interesting study from Vanderbilt University.  Paying physicians to take more time with patients.  I guess it would make sense if there was a correlation between improved patient outcomes and the length of the visit.  

A small number of physicians at Vanderbilt University Medical Center, Nashville, are taking part in a study to find out if it’s more cost effective in the long run to pay doctors to take more …

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A recent conversation . . .

. . . with a Pfizer rep yesterday led to their new medication, Caduet.  This is simply a combination of Pfizer’s best-selling medications, Norvasc and Lipitor.  I was commenting on how this medication is convenient for those concurrently taking the two medications separately.  Then, to my surprise the rep suggested that I use this first-line for hypertension, saying that “people with hypertension have high cholesterol anyways”. 

 

Pretty …

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Don’t delay calling 911 for a suspected cardiac arrest

Our second winning entry is a story from a paramedic:

A late-fifties male gets up in the morning [wife’s still sleeping] to go to the bathroom. He’s overweight, smokes like a chimney, and is now grunting away – trying to push out the pound of steak he ate for dinner last night. While he’s doing that, the pressure he places on his bowels produces a sudden drop in his …

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Speaking english a disease?

Here’s a nice joke from the BMJ:

For those of you who watch what you eat and drink, and worry about heart disease, here is the truth””according to a joke currently doing the rounds. The Japanese eat very little fat, while people in Mexico eat lots. Both groups suffer fewer heart attacks than the British or Americans. Africans drink very little red wine, while the Italians drink large volumes …

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More on OTC statins

Graham from Gross Anatomy, agreed with previous assertions that the motive for OTC statins is all about the money. I continue to have mixed feelings about it, but still believe there are too many driving forces (i.e. drug company profits, insurance savings) to prevent it from happening in the US.

In the May 22nd issue of The Lancet, the editorial slams the recent UK OTC decision, …

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Should statin cholesterol drugs be over the counter?

Associated Press:

Some of the world’s biggest drug companies are working behind the scenes to convince regulators to let older cholesterol-lowering drugs be sold without a prescription in low doses, as Britain has just done.

While doctors say the drugs are safe, less than one-half of Americans who could benefit take them, mostly those at highest risk of heart disease, other complications and death, experts say. Most of the …

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Zocor OTC in the United Kingdom

The UK is the first country to allow statins to be sold over-the-counter. It’s inevitable that statins will be OTC in the United States when the US patent for Zocor expires in 2006. With the success of OTC Claritin and Prilosec, pushing medications to OTC status will allow drug companies to continue reaping profits after patent expiration.

Risks of elevated liver enzymes, muscle aches, as well as …

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How to prevent blood clots when going on airplanes

I’m flying soon, and thought this would be a relevant article to share.

Prescriber’s Letter:

Practical Tips for Avoiding “Economy Class Syndrome”

What Is Economy Class Syndrome?

Economy class syndrome is a condition that can happen after sitting in a cramped space, such as the economy class section of an airplane. This can lead to blood clots in the legs and sometimes the …

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Final data for estrogen-only hormone replacement

AMNews:

Final data from WHI’s estrogen-only arm published

Estrogen-only hormone therapy for postmenopausal women does not affect coronary heart disease but increases the risk of stroke by 39% while decreasing the risk of hip fracture by 39%, according to a study published in the April 7 Journal of the American Medical Association.

Therapy was also associated with an increased risk of breast cancer, although this was not statistically …

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