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Sifting Social Media for Early Signs of Adverse Drug Reactions

Sifting Social Media for Early Signs of Adverse Drug Reactions | Heart and Vascular Health | Scoop.it

Collaborators at University of Virginia will analyze social media to identify adverse drug reactions much faster than existing methods.

The promise of social media as an early-warning system for adverse drug reactions. They analyzed four types of public online media (websites, blogs, Web forums and social networking sites) posted from 2000 to early 2012 and were able to identify hundreds of thousands of documents containing adverse drug reaction-related information. The preliminary results suggest that these documents can accurately provide warnings earlier – in some cases, years earlier – than existing channels.

Online medical information is plagued by medical Web spam: countless pages of medical misinformation designed to exploit consumer fears and sell unregulated remedies ranging from herbal remedies for arthritis to anti-aging skin creams. Experts estimate that more than 20% of all medical information on the Web is spam.

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Gastrointestinal Pearls for the Cardiovascular Clinician

Gastrointestinal Pearls for the Cardiovascular Clinician | Heart and Vascular Health | Scoop.it
Gastrointestinal Pearls for the Cardiovascular Clinician
Seth Bilazarian, MD's insight:

Ten excellent pearls of wisdom for cardiovascular clinicians and their patients from a gastroenterologist.

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Moving Beyond Aspirin for Atrial Fibrillation

Moving Beyond Aspirin for Atrial Fibrillation | Heart and Vascular Health | Scoop.it
In this segment of the Peer Exchange, the panelists discuss the use of warfarin, aspirin, and newer anticoagulants in patients with valvular disease, atrial fibrillation, and venous thromboembolic disease.
Seth Bilazarian, MD's insight:

Excellent review of adoption issues for the newest class of anticoagulants or blood thinners from HCPLive from the perspective of 4 different physicians.

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Eight Current Controversies in Interventional Cardiology - the decline of the IABP

Eight Current Controversies in Interventional Cardiology - the decline of the IABP | Heart and Vascular Health | Scoop.it

The IABP-SHOCK II randomized 600 acute MI patients with cardiogenic shock to IABP or no IABP after early PCI or CABG.14

At 30 days, only slightly fewer patients receiving counterpulsation had survived (39.7% vs. 41.3%; p = 0.69) and there was no difference in terms of major bleeding, sepsis, stroke, hemodynamic stabilization, and other measures. In the short term, IABP added no net benefit to patient survival—and this finding didn’t change at 12 months either.

These results contributed to a downgrading in both sets of guidelines, such that IABP is now a Class II recommendation in this setting; the ACCF/AHA guidelines further award a Class IIb recommendation to the statement “Alternative LV assist devices for circulatory support may be considered in patients with refractory cardiogenic shock such as Tandem Heart and Impella.

Seth Bilazarian, MD's insight:

The intraaortic balloon pump has been used for a long time because it is simple to use but it is does not work for patients who are in shock.  The availability of devices now that support the heart most notably the Impella device need greater adoption in community hospital catheterization labs to bridge patients through the critical early period of shock.

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FDA Strengthens Warning of Heart Attack and Stroke Risk for Non-Steroidal Anti-Inflammatory Drugs

FDA Strengthens Warning of Heart Attack and Stroke Risk for Non-Steroidal Anti-Inflammatory Drugs | Heart and Vascular Health | Scoop.it
FDA is strengthening the existing prescription and Drug Facts labels warning that nonsteroidal anti-inflammatory drugs (NSAIDs) – a group of drugs used for the temporary relief of pain and fever – can increase the chance of a heart attack or stroke, either of which can lead to death.
Seth Bilazarian, MD's insight:

NSAIDs (like ibuprofen and Alleve) are effective treatments for pain, inflammation and fever. Consumers can still take them but should be aware of this increased risk of heart attack or stroke, especially at higher doses.

I often have patients tell me they take these medicines every day and they don't help that much.

If they are not providing good benefit definitely stop using these medications since the risk is important and avoiding the risk if the medications are not helping the pain being treated is strongly recommended

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Are You at Risk for a Heart Attack After Exercise?

Are You at Risk for a Heart Attack After Exercise? | Heart and Vascular Health | Scoop.it

Dying during or immediately after physical activity occurs rarely.  Regular exercise is a cornerstone of good health, and its long-term benefits for both longevity and protection against heart attacks, cancer and other ailments are supported in many studies. Doctors say there are strategies to reduce the already low likelihood of a workout turning into a tragedy.

The majority of sports-related sudden cardiac arrests occur among people above 35 years old. Most victims are men and most already have heart disease whether they know it or not.

“The risk is much greater for people who don’t exercise on a regular basis,. The weekend warrior who goes out to crush it once a week” or less often is much more vulnerable than the person who gets three to five cardio workouts a week.

For a sedentary middle-age person who wakes up one morning and suddenly decides to become a “lean, mean fighting machine in a month, that’s a bad idea,”  “You should make fitness a goal, but a gradual goal,” slowly increasing intensity over several weeks or more.


Seth Bilazarian, MD's insight:

“You can’t really use the risk of sudden death as an excuse not to exercise.”

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Time Is Muscle: Understanding Heart Attacks

Time Is Muscle: Understanding Heart Attacks | Heart and Vascular Health | Scoop.it
In treating heart attacks, doctors often say that
Seth Bilazarian, MD's insight:
Nice graphic from New York Times on how a heart attack occurs and how doctors treat it with an angioplasty and stent placement
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Early CPR doubles survival

Early CPR doubles survival | Heart and Vascular Health | Scoop.it
Three million people in Sweden are trained in cardiopulmonary resuscitation (CPR). Whether this training increases the frequency of bystander CPR or the survival rate among persons who have out-of-hospital cardiac arrests has been questioned.We analyzed a total of 30,381 out-of-hospital cardiac arrests witnessed in Sweden from 1990, to 2011, to determine whether CPR was performed before the arrival of emergency medical services (EMS) and whether early CPR was correlated with survival. 

CPR was performed before the arrival of EMS in 15,512 cases (51.1%) and was not performed before the arrival of EMS in 14,869 cases (48.9%). The 30-day survival rate was 10.5% when CPR was performed before EMS arrival versus 4.0% when CPR was not performed before EMS arrival (P<0.001). When adjustment was made for a propensity score (which included the variables of age, sex, location of cardiac arrest, cause of cardiac arrest, initial cardiac rhythm, EMS response time, time from collapse to call for EMS, and year of event), CPR before the arrival of EMS was associated with an increased 30-day survival rate (odds ratio, 2.15; 95% confidence interval, 1.88 to 2.45). When the time to defibrillation in patients who were found to be in ventricular fibrillation was included in the propensity score, the results were similar. The positive correlation between early CPR and survival rate remained stable over the course of the study period. An association was also observed between the time from collapse to the start of CPR and the 30-day survival rate.

Seth Bilazarian, MD's insight:

CPR performed before EMS arrival was associated with a 30-day survival rate after an out-of-hospital cardiac arrest that was more than twice as high as that associated with no CPR before EMS arrival.

The absolute increase in survival was 6.5%.  Using this inforamtion it can be said that every 15 out of hospital cardiac arrests that are treated early will save a life.

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Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction

Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction | Heart and Vascular Health | Scoop.it

Supplemental oxygen therapy in patients with STEMI but without hypoxia may increase early myocardial injury and was associated with larger myocardial infarct size assessed at six months.

Seth Bilazarian, MD's insight:

The teaching and conventional wisdom for many years has been that oxygen is a critical treatment for patients having myocardial infarction (heart attack). Like many things in medicine this makes a lot of theoretical sense, but  there has not been very good data to support it.

In myocardial infarction or heart attack, part of the heart muscle is suffering from lack of oxygen. What has been thought now for decades is that giving the patient more oxygen must be beneficial.

Doctors & nurses are taught the pneumonic MONA for (morphine, oxygen, nitrates, aspirin)

Fortunately, with better clinical trial data these recommendations and conventional wisdoms are falling. The MONA recommendations have almost been completed discredited, except for aspirin. Use of morphine may actually increase harm because its use delays absorption of medications that are given early in the patient's course and can cause nausea and vomiting.

Unfortunately, changing the habit of placing all patients with chest pain on oxygen will be a challenge.  MONA should be retired.

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Cardiology 1995: The Rise of Stents and Statins

Cardiology 1995: The Rise of Stents and Statins | Heart and Vascular Health | Scoop.it
The Golden Era of Innovation

Twenty years ago, Bill Clinton was President, Newt Gingrich was TIME magazine's man of the year, and interventional cardiology was in its infancy. In celebration of the 20th anniversary of Medscape, we perused the cardiovascular literature from 1995 and canvassed some experts by email for their reflections on the time and how far the field has come.

 

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Seth Bilazarian, MD's insight:

Great perspective piece on how far we've come in cardiology over the last 20 years by Tricia Ward Editorial Director of theheart.org on Medscape Cardiology.  It's a great read.

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Exploring Why Some People Get Fitter Than Others

Exploring Why Some People Get Fitter Than Others | Heart and Vascular Health | Scoop.it
A new study in rats adds to a growing body of data about how and why bodies respond so differently to exercise.

The interplay of genes and exercise is extremely complex, and scientists are only in the earliest stages of understanding the effects of heredity, environment, nutrition and even psychology in affecting different people’s responses to exercise.

But the potential lesson of the new study would seem to be, that we should closely monitor our body’s response to exercise. If after months of training, someone is not able to run any farther than he or she could before, maybe it is time to change the intensity or frequency of the workouts or try something else, like weight training. The genes that control the body’s responses to that activity are likely to be very different than those involved in responses to aerobic exercise.

Seth Bilazarian, MD's insight:

I think the article is very interesting and is expanding on the direction of all healthcare and medicine. Personalized or as the president calls it "precision medicine"  is something that just makes intuitive sense.  People respond differently to different foods or different exercises and it will be fantastic in the future when were able to have a genetic profile that guides us and allows us to say “you're better off running” or “you’re better off restricting carbohydrates” or “you're at high risk for statin muscle aches” or  some other clear strategy rather than trial and error.  For now trial & error is all we have.

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What is PCSK9?

What is PCSK9? | Heart and Vascular Health | Scoop.it
Watch a video to learn more about the PCSK9 pathway
Seth Bilazarian, MD's insight:

The current best cholesterol lowering medicine we have are the statins.  These medicines like Lipitor (atorvastatin), Crestor (rosuvastatin) and sImvastatin lower LDL (bad cholesterol) by 30 - 50%.  For some patients with very high levels of LDL this is not low enough.  For other patients the statin medicines cannot be tolerated most commonly because of the side effect of muscle aches.  In both situations an alternative to statins is needed.

The PCSK9 inhibitors are an exciting next step that MIGHT prove to be the next big thing.   Studies are now ongoing in the US to test whether these medicines are safe over the long term AND whether the lowering of LDL that they provide (about 50%) also results in lower cardiovascular event rates for patients (less heart attacks and strokes).  The FDA is considering whether to approve these drugs this year before these trials are completed.

This is an excellent video explaining our current understanding of how these medicines lower the LDL level measured in patient's blood.  Stay tuned!

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Appropriate Use Criteria: Questions for the Task Force Chair

Appropriate Use Criteria: Questions for the Task Force Chair | Heart and Vascular Health | Scoop.it
Seth Bilazarian corners Manesh Patel on the challenges that the AUC for coronary revascularization present to the practicing cardiologist.
Seth Bilazarian, MD's insight:

I had the good fortune to sit down with Dr. Mahesh Patel who Is chairman of the appropriate use criteria for the American College of Cardiology and American Heart Association Task force on appropriate use and got his take on the inappropriate use of the word "inappropriate" and communicating the new "rarely appropriate" with payers and the patient's.

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Nutrition Panel Calls for Less Sugar and Eases Cholesterol and Fat Restrictions

Nutrition Panel Calls for Less Sugar and Eases Cholesterol and Fat Restrictions | Heart and Vascular Health | Scoop.it
A nutrition advisory panel that helps shape the country’s official dietary guidelines eased some of its previous restrictions on fat and cholesterol and recommended new limits on the amount of added sugars that Americans should consume.
Seth Bilazarian, MD's insight:

The Dietary Guidelines Advisory Committee, which convenes every five years, followed the lead of other major health groups like the American Heart Association that in recent years have backed away from dietary cholesterol restrictions and urged people to cut back on added sugars.

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Inappropriate Cath, Appropriate Revascularization

Inappropriate Cath, Appropriate Revascularization | Heart and Vascular Health | Scoop.it
Two cases prompt Dr Bilazarian to suggest a new category for the appropriate use criteria for coronary revascularization.
Seth Bilazarian, MD's insight:

The appropriate use criteria are a well intended effort to reduce unnecessary testing or treatments for patients.  Unfortunately, the criteria used to determine whether a procedure such as a heart catheterization is appropriate are far from perfect.  The accuracy of a stress test used to determine whether a catheterization is appropriate is 75 - 85% meaning that it misleads us a significant amount of time.  Physicians are held to a standard through reporting mechanisms that discourage inappropriate use.  But what about when an inappropriate catheterization proves that the prior testing was wrong?

Two recent cases highlight this concern and a need to put these cases in another category rather than just categorizing them as inappropriate.

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Preventing Stroke in People With Atrial Fibrillation

Preventing Stroke in People With Atrial Fibrillation | Heart and Vascular Health | Scoop.it
When blood does not flow smoothly, there is a chance that the blood can form clots. If a blood clot has formed in the heart, it can be carried by the bloodstream to other areas of the body (thromboembolism). This is dangerous because the clot can become wedged in a smaller blood vessel and decrease the flow of blood to the area that blood vessel supplies.

A blood clot that travels to the small blood vessels in the brain can decrease or block blood flow to the brain, causing injury to the brain (ischemic stroke).

The chance of forming blood clots is different from person to person. Atrial fibrillation is not the only factor that creates blood clots; some people may have other medical problems that can increase the chance of forming blood clots or having a stroke. Your doctor will consider your situation to decide whether you have a low or high risk of blood clots or stroke.
Seth Bilazarian, MD's insight:

Atrial fibrillation can increase the risk of thromboembolism and ischemic stroke. Treatment for atrial fibrillation might require anticoagulation, but each patient should be considered individually. The risk of stroke needs to be considered with other medical details, such as the risk of bleeding, to determine the best plan for each patient.

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Shyam Kumar Chaturvedi's curator insight, July 31, 12:32 AM

Atrial fibrillation can increase the risk of thromboembolism and ischemic stroke. Treatment for atrial fibrillation might require anticoagulation, but each patient should be considered individually. The risk of stroke needs to be considered with other medical details, such as the risk of bleeding, to determine the best plan for each patient.

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Mediterranean Diet & Cognitive Decline

Mediterranean Diet & Cognitive Decline | Heart and Vascular Health | Scoop.it

Importance  Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline, a strong risk factor for development of dementia. Epidemiologic studies suggest that a Mediterranean diet, an antioxidant-rich cardioprotective dietary pattern, delays cognitive decline, but clinical trial evidence is lacking.

 Design, Setting, and Participants  Parallel-group randomized clinical trial of 447 cognitively healthy volunteers from Barcelona, Spain (233 women [52.1%]; mean age, 66.9 years), at high cardiovascular risk were enrolled into the Prevención con Dieta Mediterránea nutrition intervention trial from October 1, 2003, through December 31, 2009. All patients underwent neuropsychological assessment at inclusion and were offered retesting at the end of the study.

Interventions  Participants were randomly assigned to a Mediterranean diet supplemented with extravirgin olive oil (1 L/wk), a Mediterranean diet supplemented with mixed nuts (30 g/d), or a control diet (advice to reduce dietary fat).

Results  Follow-up cognitive tests were available in 334 participants after intervention (median, 4.1 years). In multivariate analyses adjusted for confounders, participants allocated to a Mediterranean diet plus olive oil scored better on the RAVLT (P = .049) and Color Trail Test part 2 (P = .04) compared with controls; no between-group differences were observed for the other cognitive tests. Similarly adjusted cognitive composites (mean z scores with 95% CIs) for changes above baseline of the memory composite were 0.04 (−0.09 to 0.18) for the Mediterranean diet plus olive oil, 0.09 (−0.05 to 0.23; P = .04 vs controls) for the Mediterranean diet plus nuts, and −0.17 (−0.32 to −0.01) for the control diet. Respective changes from baseline of the frontal cognition composite were 0.23 (0.03 to 0.43; P = .003 vs controls), 0.03 (−0.25 to 0.31), and −0.33 (−0.57 to −0.09). Changes from baseline of the global cognition composite were 0.05 (−0.11 to 0.21; P = .005 vs controls) for the Mediterranean diet plus olive oil, −0.05 (−0.27 to 0.18) for the Mediterranean diet plus nuts, and −0.38 (−0.57 to −0.18) for the control diet. All cognitive composites significantly (P < .05) decreased from baseline in controls.

Conclusions and Relevance  In an older population, a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognitive function.

Seth Bilazarian, MD's insight:

This randomized clinical trial found that a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognitive function in older people.

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Heart Valve Disease

Seth Bilazarian, MD's insight:

Very nice basic infographic on heart valve disease from CardioSmart by ACC.  See others at:

www.CardioSmart.org/posters

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Deep Vein Thrombosis

Deep Vein Thrombosis | Heart and Vascular Health | Scoop.it
Deep vein thrombosis (DVT) is the formation of a blood clot in a vein deep under the skin. The most common sites of deep vein clots are the lower leg and thigh. They can also occur in the pelvis and arm. Causes of a thrombus (blood clot) include slow blood flow, an injury to the lining of a...
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Guidelines for Intracerebral Hemorrhage

Guidelines for Intracerebral Hemorrhage | Heart and Vascular Health | Scoop.it

Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted. These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

Seth Bilazarian, MD's insight:

ACC Cardiosource has 10 points to remember on ICH 

http://goo.gl/rpTNS6

(Iv'e abridged the list)

 

1. Neuroimaging is required to distinguish ICH from ischemic stroke. Imaging with CT or MRI is acceptable. 

2. Active bleeding can occur for hours after symptoms. More than 20% of patients will have a clinical decline between EMS & ED

3. Protocols should be in place so ICH patients receive rapid treatment and  should be admitted to an ICU or stroke expertise in stroke care.

4. New oral anticoagulants (NOACs) are associated with a lower rate of ICH than warfarin. For warfarin patients INR should be rapidly corrected vitamin K (5-10 mg IV) & FFP

5. Elevated blood pressure (BP) is common after ICH and is associated with poor outcomes. BP lowering to a systolic BP of <140 mm Hg is safe, and may be effective in patients presenting with systolic BP of 150-220 mm Hg.

6. Seizures occur in about 15% of ICH patients, and are associated with a cortical hemorrhage location and should be treated with an anticonvulsant agent

7. Dysphagia is common after ICH, and is a risk factor for pneumonia; all ICH patients should have a formal swallow screen before taking food, drink, or medication by mouth.

8. Surgical treatment of cerebellar ICH is recommended for patients with brainstem compression or hydrocephalus.

9. In patients without existing DNR orders, it is reasonable to provide aggressive care and postpone new DNR orders until the second hospital day

10. Risk factors for recurrent ICH include:

           older age

           location of the index ICH (deep versus lobar)

           antithrombotic drug use

          hypertension

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Powerful new cholesterol drugs (PCSK9 inhibitors) offer hope - Should FDA approve?

Powerful new cholesterol drugs (PCSK9 inhibitors) offer hope - Should FDA approve? | Heart and Vascular Health | Scoop.it

More than 30 million Americans take statins to lower their cholesterol, according to estimates. But these popular drugs don't work for everyone. Now the FDA may be poised to approve two drugs in this new class.

Seth Bilazarian, MD's insight:

Drs. Harlan Krumholz and Steven Nissen do a good job summarizing the difficult task the FDA faces, regarding whether to approve these new drugs called PCSK9 inhibitors.

These powerful cholesterol lowering drugs have been shown to be safe in trials of 1 -2 years duration and can lower cholesterol by 50 -60% (compared to statins that lower cholesterol by 35 - 50%) without the side effect of muscle aches seen with statins.

Should the FDA wait 2 - 3 more years for trials to be completed or allow use earlier for patients with marked cholesterol elevation?

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20 Years of Healthcare Advances

20 Years of Healthcare Advances | Heart and Vascular Health | Scoop.it

What has changed over the past 20 years in healthcare?  Experts nominate the advances that they believe have most changed medicine.

 

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Seth Bilazarian, MD's insight:

I nominated Statins for secondary Prevention

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Patient Guide for Bood Thinners for Atrial Fibrillation

Patient Guide for Bood Thinners for Atrial Fibrillation | Heart and Vascular Health | Scoop.it

Having atrial fibrillation, an irregular heart rhythm, increases your risk of having a stroke. This irregular beating of the heart affects blood flow in the top chambers of the heart and can cause blood cells to collect and stick together, which increases the risk of a blood clot forming. These blood clots may then be carried in the bloodstream to the brain and, if large enough, can block an artery in the brain, resulting in a stroke. Oral anticoagulant drugs (commonly called blood thinners) are used to help prevent strokes by causing the blood to take longer to clot. Two groups of oral anticoagulant drugs are used, vitamin K antagonists (warfarin/Coumadin) and non–vitamin K antagonist oral anticoagulants (NOACs). This Cardiology Patient Page focuses on NOACs.

Seth Bilazarian, MD's insight:

These four new drugs called NOACs  (novel oral anticoagulants) or now being called DOACs (direct oral anticoagulants) or TSOACs (Target Specific Oral Anticoagulants) are alternatives to the older anticoagulant warfarin or Coumadin.  The use of blood thinners is recommended for atrial fibrillation and this patient page from circulation is a great resource.

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Genetic risk, coronary heart disease events & benefit of statins

Genetic risk, coronary heart disease events & benefit of statins | Heart and Vascular Health | Scoop.it

Genetic variants have been associated with the risk of coronary heart disease. In this study, we tested whether or not a composite of these variants could ascertain the risk of both incident and recurrent coronary heart disease events and identify those individuals who derive greater clinical benefit from statin therapy.Specifically, in the primary prevention trials, the number needed to treat to prevent one such event in 10 years was 66 in people at low genetic risk, 42 in those at intermediate genetic risk, and 25 in those at high genetic risk in JUPITER, and 57, 47, and 20, respectively, in ASCOT.A genetic risk score identified individuals at increased risk for both incident and recurrent coronary heart disease events. People with the highest burden of genetic risk derived the largest relative and absolute clinical benefit from statin therapy.

Seth Bilazarian, MD's insight:

There has been much enthusiasm about the potential for genetic testing to predict disease. Unfortunately, this has not yet found practical utility for practicing physicians and their patients. This analysis from investigators @BrighamWomens may be a major breakthrough to permit a reasoned approach to help decide which patients should get statin therapy ( drugs like Lipitor, Crestor and simvastatin ) for cholesterol lowering.

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Michel KHRONIS, MD's curator insight, March 5, 4:46 AM

Statine & gènes

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The entire egg

The entire egg | Heart and Vascular Health | Scoop.it
Harvard Professor Walter Willett underlined the distinction between dietary and blood cholesterol, and stressed whole foods rather than any single nutrient as key to a healthy diet.
Seth Bilazarian, MD's insight:

This question and answer about dietary cholesterol and the changes in the new government advisory committee's revised stance on dietary cholesterol including eggs is well done and helpful.  The final sentence in the  interview " It is a little sobering how long things take, but it’s good to have reached that point" Is certainly appropriate, but does not go far enough. In this era of evolving science and rapid dissemination to the public, we need guideline updates more frequently than every 5 years by both government agencies and professional health and medical societies.

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PocketCPR

PocketCPR | Heart and Vascular Health | Scoop.it

PocketCPR for iPhone:
• Actively utilizes the accelerometer hardware in the iPhone for real-time coaching and actual feedback on CPR while you are learning and practicing.
• Measures the actual depth and rate of your compressions and lets you know if you need to push faster or slower, and whether you should push harder or softer. The patented algorithm also measures the recoil or release of each compression to help ensure full decompression during CPR. A Perfusion Performance Indicator (PPI) graphical display "fills" as compression quality is optimal and remains optimal, providing the user an indication that all the elements of excellent, high quality compressions have been achieved.

Seth Bilazarian, MD's insight:

I have now used this app with three consecutive cardiac arrest patients.  I found the feedback it provides both for the rate of compression AND the depth of compression AND the rate of compression release to be a valuable tool to aid in effective chest compressions.  

There's also a CPR guide with step by step instructions for first responders.

It's free.  Sponsored by Zoll.

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