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The Deadly Threat of Silent Heart Attacks

The Deadly Threat of Silent Heart Attacks | Heart and Vascular Health | Scoop.it
Silent heart attacks are even more common in older adults than heart attacks that immediately come to the attention of doctors and patients, according to recent study in The Journal of the American Medical Association.
The research underscores the importance of paying attention to lingering, hard-to-pin-down symptoms in older adults, experts say. Many elderly men and women tend to dismiss these; caregivers shouldn’t let that happen.
The JAMA report is based on data from 936 men and women ages 67 to 93 from Iceland who agreed to undergo EKGs and magnetic resonance imaging exams to detect whether heart attacks had occurred. EKGs assess the heart’s electrical activity, while M.R.I.’s look at its mechanical pumping activity.
When results were tallied, silent heart attacks were twice as common (22 percent) among older patients as recognized heart attacks (10 percent). Five years after tests were administered, death rates for patients with both recognized and silent heart attacks were 23 percent, almost double the 12 percent death rate for older adults who’d never experienced a myocardial infarction, the technical name for heart attack.
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Average time to get 5 kinds of appointments for new patients

Average time to get 5 kinds of appointments for new patients | Heart and Vascular Health | Scoop.it
A look at the average time to get five kinds of appointments for new patients in 2013, from a survey of 15 metropolitan areas.
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Global Girth Grows to 2.1 billion

Global Girth Grows to 2.1 billion | Heart and Vascular Health | Scoop.it
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Undetectable Troponin T Level in ED & Risk of Myocardial Infarction

Undetectable Troponin T Level in ED & Risk of Myocardial Infarction | Heart and Vascular Health | Scoop.it

Study to evaluate if an undetectable (<5 ng/l) high-sensitivity cardiac troponin T (hs-cTnT) level & ECG without signs of ischemia can rule out myocardial infarction (MI) in the emergency department (ED).

Background  Chest pain is a common symptom often associated with benign conditions, but may be a sign of MI. Because there is no rapid way to rule out MI, many patients are admitted to the hospital.

Methods  All patients who sought medical attention for chest pain and had at least 1 hs-cTnT analyzed during 2 years at the Karolinska University Hospital, Stockholm, Sweden, were included.

Results  14,636 patients. 8,907 (61%) had an initial hs-cTnT of <5 ng/l.

Among patients with a first hs-cTnT level of <5 ng/l, 1,704 (89%) had a second hs-cTnT level measured, which was <5 ng/l in 1,362 (90%) patients. Patients with a first hs-cTnT level of <5 ng/l and no MI within 30 days were admitted to the hospital for a total of 3,262 days, with a mean duration of hospital stay of 1.5 ± 3.0 days; 1,482 (77%) of these patients were discharged on the same or next day. The most common discharge diagnoses in patients with a first hs-cTnT level of <5 ng/l were nonspecific chest pain (50%), atrial fibrillation or supraventricular tachycardia (5.6%), and angina (5.1%).

Conclusions  All patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on an ECG have a minimal risk of MI or death within 30 days, and can be safely discharged directly from the ED.

Seth Bilazarian, MD's insight:

The evaluation of chest pain in the emergency department and ability to rapidly evaluate patients, so low risk patients can be released for their comfort &  convenience and for health care cost savings is the "holy grail".  This paper does allot to get us closer. If patients had low level of troponin and a normal EKG there was no heart attack at 30 days in 99.8% and 100% of patients were alive.  Changing protocols in emergency departments will be difficult but achievable.

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Paul Ridker on Inflammation and Residual CV Risk

Paul Ridker on Inflammation and Residual CV Risk | Heart and Vascular Health | Scoop.it

Dr. Bilazarian interviews Dr. Paul Ridker on the inflammation hypothesis and 2 ongoing trials in this area: the National Heart, Lung, and Blood Institute (NHLBI)-funded Cardiovascular Inflammation Reduction Trial (CIRT),[1] which is testing whether taking low-dose methotrexate reduces myocardial infarction (MI), stroke, or death in people with type 2 diabetes or metabolic syndrome who have had a heart attack or have stable coronary artery disease; and the Novartis-sponsored Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS),[2] which is assessing whether blocking the proinflammatory cytokine interleukin (IL)-1β with canakinumab, as compared with placebo, can reduce rates of recurrent MI, stroke, and cardiovascular death in patients post-MI with elevated high-sensitivity C-reactive protein (CRP; ≥ 2 mg/L).

Seth Bilazarian, MD's insight:

Paul Ridker provides a great primer for clinicians & patients on the status of trials investigating the links between inflammation and cardiovascular disease. He reviews the background and status of the two large randomized clinical outcomes trials he leads: CANTOS & CIRT.

 

Other resources:

1.  slides from Dr. Ridker at  https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_426676.pdf

 

2. CIRT trial http://www.thecirt.org/

 

3,  CANTOS trial http://www.thecantos.org/

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Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke

Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke | Heart and Vascular Health | Scoop.it

Observational studies suggest that we often fail to detect paroxysmal atrial fibrillation as the cause of ischemic stroke. However, owing to the limitations of existing studies, guidelines have yet to endorse specific strategies for detecting atrial fibrillation in patients with a new stroke. The results of two studies published in this issue of the Journal indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic stroke.leaving it unclear whether monitoring improves diagnosis as compared with routine follow-up. 

Seth Bilazarian, MD's insight:

Our patients want to avoid stroke because of the debilitating effects it can have on functional status and quality of life.  Efforts to prevent a second stroke are enthusiastically embraced by patients.

Cryptogenic is stroke that a cause cannot be determined (about 1/3 of strokes).  Treatment with anticoagulants in this patient population is not recommended UNLESS the cause of the stroke is from the common irregular heart rhythm atrial fibrillation (AF).  

On the other hand if atrial fibrillation is NOT detected treatment with aspirin or other anti-platelet drugs are used and these drugs are inferior to anticoagulants if AF is the cause.

Two studies in NEJM showed that prolonged monitoring (30 days or 6 months)  increased the detection of AF and allowed more patients to be started on anticoagulants for stroke prevention.

In the trial of 30 days of recording with an external (carried) monitor was 16.1%.

In the trial of the implanted recorder detection of AF was 

at 6 months 8.9%

at 12 months 12%

at 36 months 36%

 The strategy of prolonged monitoring with an external device  for 1 month or 6 months with an implanted device is an unresolved question and adoption of the small subcutaneous device pictured above, will be limited by its cost, until further studies showing stroke reduction can be completed justifying its cost.

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Sex differences in symptoms of Acute Coronary Syndromes (ACS)

Sex differences in symptoms of Acute Coronary Syndromes (ACS) | Heart and Vascular Health | Scoop.it

DeVon et al. evaluated the diagnostic performance of 13 symptoms of ACS by sex in 736 patients admitted to four EDs with suspected acute coronary syndrome. Overall they found there were more similarities than differences between the sexes in the performance of the symptom predictors evaluated. To learn more read their complete report in JAHA http://goo.gl/s6AQro.

Seth Bilazarian, MD's insight:

Shoulder pain, arm pain and shortness of breath are more frequent in females who present with acute coronary syndromes.

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Medscape: Practioner's Corner - Low Value Care in Medicine - a misnomer?

Medscape: Practioner's Corner - Low Value Care in Medicine - a misnomer? | Heart and Vascular Health | Scoop.it

Hi. Seth Bilazarian on theheart.org on Medscape, for my Private Practice blog. I want to comment on a paper called "Measuring Low-Value Care in Medicare" that was published in JAMA Internal Medicine on May 12.[1]

I want to give some comments. As a community-based clinical cardiologist, I work in a cardiac cath lab. Those are essentially my disclosures.

I want to comment about what I think is a pendulum swinging from physicians being an integral part of healthcare delivery, and problem-solving in that delivery, to being seen as a major impediment and cost-driver, which I think is a significant detriment. This paper concerns me as a clinical cardiologist in several ways. I am a retail deliverer of cardiology. I don't look at healthcare policy; that is not my profession. I am a practitioner. The discussion in this paper was at a higher level than where I practice, but I think it has important implications and I want to share with the Medscape community and get other physicians to weigh in.

I see this in context with many other initiatives which I will mention. Of course there is (1) appropriate-use criteria, largely directed at physicians; (2) Choosing Wisely®, largely directed at patients, with the idea that physicians discuss these issues with patients; (3) comparative effectiveness, discussing healthcare policy, and then (4) low-value care, which is the topic of this paper.

Seth Bilazarian, MD's insight:

My blog on low value care and the complexity of defining that term as we go forward especially as we move toward "patient-centric" or shared decision models of care and are faced with patient satisfaction as a metric of quality.  Comments welcome on the Medscape site 

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Chief Science Officer ‘sets record straight’ about diet, science, AHA | blog.heart.org

Chief Science Officer ‘sets record straight’ about diet, science, AHA | blog.heart.org | Heart and Vascular Health | Scoop.it

At the American Heart Association, everything we do is based on science. Simply put, we examine the evidence that comes from scientific studies and use it to provide advice to help people get healthier and prevent heart disease and stroke.

That’s why I was so alarmed by the many inaccuracies and misrepresentations of scientific facts in a recent article about our dietary recommendations – and why as the American Heart Association’s Chief Science and Medical Officer I need to set the record straight.

Seth Bilazarian, MD's insight:

For those who want to seriously understand the state of the science on dietary saturated fats this is an excellent refutation of the bad journalism that is being propagated.. I'm personally appreciative of the strong statement by Dr. Robertson denouncing the Daily Beast article's contention that being a Christian disqualifies someone from "thinking scientifically".

"Enlightened scientific discourse can improve our world. But arguments based in falsehoods, questionable allegations and personal attacks serve no purpose but to confuse people. And that is irresponsible."

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Subrata Chakravarty's curator insight, May 31, 10:00 AM

This interview of the Chief Science and Medical Officer of the American Heart Association reveals the deep misconceptions of past nutritional recommendations that have shaped our society today (to its detriment!).  


A whole generation's frustration at being misinformed about their health has led to a nutritional awareness movement that has poked massive holes in the medical interpretation of what good nutrition actually means.  The world of nutrition is being redefined, and hopefully that will lead this world to be a better place.

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1 in 5 older Americans take Drugs that compete with one another

1 in 5 older Americans take Drugs that compete with one another | Heart and Vascular Health | Scoop.it

1 in 5  older Americans with multiple chronic medical conditions are on medications that work at odds with each other; meaning the therapy being used for one condition can actually make the other condition worse. 

Graphic is from

http://www.joomag.com/magazine/cardiosource-worldnews-april-2014/0842627001398192120

 

Seth Bilazarian, MD's insight:

One fifth of older Americans receive medications that may adversely affect coexisting conditions. Effects on coexisting conditions should be considered when prescribing medications.  Many of these interactions are known and we discuss these with patients such as the potential interaction of clopidogrel and warfarin in patients who have a coronary stent and atrial fibrillation.  Another example is the use of NSAIDS including COX-2 inhibitors in patients with CHF and hypertension.  The important discussion to asses the benefits of these arthritis and pain medications and engage the patient in shared decision making of the benefit of pain relief vs. the hazard of cardiovascular issues is critical.

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Dorothy M Neddermeyer, PhD's curator insight, May 26, 9:15 AM

Drugs are not only fight with each other...they are fighting against your immune system.....pharmaceuticals are foreign to the human body and therefore the body rejects them until the immune system is totally exhausted and the drugs take over.

Subrata Chakravarty's curator insight, June 1, 9:30 PM

Combine this information with the fact that 7.0 million people use (read: abuse) psychotherapeutic prescription drugs non-medically, reveals the extent of our dependence on drugs. There are better ways.  Stay in touch with us to keep learning, join our mailing list.

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A Patient’s Guide to Recovery After Deep Vein Thrombosis or Pulmonary Embolism

A Patient’s Guide to Recovery After Deep Vein Thrombosis or Pulmonary Embolism | Heart and Vascular Health | Scoop.it

When a blood clot forms in the deep veins of the body, it is called deep vein thrombosis (DVT). DVT occurs most commonly in the leg; however, it can occur anywhere in the body, such as the veins in the arm, abdomen, pelvis, and around the brain. A complication of DVT in legs and arms is pulmonary embolism (PE). A PE occurs when a blood clot breaks off from a DVT and travels through the blood stream, traversing the right atrium and right ventricle, and lodging in the lung.

Seth Bilazarian, MD's insight:

Nice summary for patients wanting to have more information about PE and DVT.   The FAQs adressed are:

How Long Will I Need Treatment With an Anticoagulant? Which Anticoagulant Will I Receive? When Will My Clot and Pain Go Away? How Soon Can I Be Physically Active? What Kind of Doctor Do I Need?

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TAVR for the Referring Physician

TAVR for the Referring Physician | Heart and Vascular Health | Scoop.it
Dr. Bilazarian interviews Dr. Popma about the nuts and bolts of caring for patients after transcatheter aortic valve replacement.
Seth Bilazarian, MD's insight:

I sit down with Jeff Popma at #ACC14 to discuss the critical question for referring physicians with the approval of CoreValve for TAVR for symptomatic AS: Now what?

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Rethinking Warfarin for Atrial Fibrillation

Rethinking Warfarin for Atrial Fibrillation | Heart and Vascular Health | Scoop.it

Full-page newspaper advertisements and a series of television commercials have urged patients with atrial fibrillation to “rethink warfarin” in favor of Eliquis (apixaban – Bristol-Myers Squibb). Apixaban is the latest of 3 new oral anticoagulants now competing with warfarin (Coumadin, and others) for the oral anticoagulant market.

Seth Bilazarian, MD's insight:

The authors of the medical letter have rightly urged clinicians to consider warfarin as a good alternative in patients who are clinically stable on warfarin and doing well. I certainly agree with this. However it accounts for only a minority of patients. My estimate is that only about 10% of patients have stable warfarin therapy.

For myself, I created mnemonic to try to help me quickly go through the important issues for determining whether a patient was a good candidate for one of the novel oral anticoagulants (Praqdaxa, Xarelto, Eliquis). CRABI is the one I use and the "I"is for instability on warfarin. To viewer download the slides from my blog checkout.

 http://news.theheart.org/static/drop/Private-practive-theheartorg-Dr-Seth-Bilazarian-KISS-CRABI.ppt

 

 

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Confessions of a SYMPLICITY HTN-3 Trialist

Confessions of a SYMPLICITY HTN-3 Trialist | Heart and Vascular Health | Scoop.it

 Seth Bilazarian from theheart.org on Medscape, reporting from the American College of Cardiology (ACC) meeting in Washington, DC.

I want to make a few comments on the SYMPLICITY HTN-3 trial.[1,2] Briefly, SYMPLICITY is the name of a series of trials sponsored by the Medtronic company that are evaluating the efficacy and safety of therapy with a renal denervation catheter for a variety of problems, but most importantly for hypertension.

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E-Cigarettes: What to Tell Patients

E-Cigarettes: What to Tell Patients | Heart and Vascular Health | Scoop.it
Channeling Donald Rumsfeld, Dr. Bilazarian outlines both the known and unknown unknowns about e-cigarettes.
Seth Bilazarian, MD's insight:

E-cigarette use has really grown pretty significantly. It does an estimated $1.7 billion in sales and it's currently expected that it will exceed revenue from cigarettes in about 10 years. They're marketed as healthier, as potential quitting aids, and they allow smoking anywhere. The marketing is briefly summarized as "e-cigarettes are healthier, cleaner, and cheaper." Much is not known about these new nicotine delivery devices, but counseling of patients about the hazards is important.

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Average Emergency Department Wait Time

Average Emergency Department Wait Time | Heart and Vascular Health | Scoop.it

30 minutes is the national median wait time to be treated in the emergency department, according to the National Hospital Ambulatory Medical Care Survey in 2010-11. The shortest median wait time: 12 minutes for patients with an immediate need to be seen. As for median treatment time, the clock ticked to slightly more than 90 minutes. 

Source: McCraig LF, et al. MMWR. 2014;63:439

Seth Bilazarian, MD's insight:

For cardiology patients, long wait times in the ED are a hazard because patients with chest pain sometimes say they don't want to go for emergency evaluation because it will take many hours to be evaluated and discharged.  Not going to the ED delays diagnosis for heart attack and delays treatment that can be life saving.

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Trends in Atrial Fibrillation in US, 2000-10

Trends in Atrial Fibrillation in US, 2000-10 | Heart and Vascular Health | Scoop.it

Atrial fibrillation (AF) is one of the most frequently encountered arrhythmias in the hospital. A multidisciplinary approach is required to recognize and treat AF appropriately; to limit the catastrophic consequences such as stroke, heart failure, and dementia; and to decrease the burden on the healthcare system. Hospitalization related to AF is the single largest contributor to overall cost of care in managing AF patients. In this study, we examined the trends of AF hospitalizations in the United States and assessed the effects of patient demographics and comorbid diagnoses on in-hospital mortality, length of stay, and total cost of care. Understanding these factors helps us understand the health economics of AF better. There has been a significant increase in AF hospitalizations over the last decade, with a large contribution from patients >65 years of age, especially among those >80 years of age. The overall length of hospital stay has remained unchanged; however, the cost of inpatient care has increased tremendously, from approximately $2.15 billion in 2001 to $3.46 billion in 2010. To the best of our knowledge, this is the first study to assess the trends of AF-related inpatient care at a national level from the actual hospital discharge database. Such data, although they have inherent limitations, tend to provide more accurate financial trajectory of the problem.

Seth Bilazarian, MD's insight:

Atrial fibrillation or AF is the most common heart rhythm abnormality and it is consistently the first or second most common reason for admission at community hospitals.  We have new therapies such as novel oral anticoagulants (Pradaxa, Xarelto, Eliquis) that should increase the ability to manage this problem as an outpatient but changing the practice of physicians & emergency departments will be difficult.

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Testosterone Replacement Therapy

Testosterone Replacement Therapy | Heart and Vascular Health | Scoop.it
Pentucket Medical cardiologist Seth Bilazarian, MD discusses testosterone replacement therapy in men with "low T." What is the risk of heart attack or stroke?
Seth Bilazarian, MD's insight:

Putting the testosterone replacement for "low T" into perspective for our patients.

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Aspirin for Primary Prevention | Pentucket Medical Associates

Aspirin for Primary Prevention | Pentucket Medical Associates | Heart and Vascular Health | Scoop.it
Aspirin is used to prevent cardiac events like heart attack & stroke. Cardiologist Seth Bilazarian, MD explains aspirin use for primary & secondary prevention.
Seth Bilazarian, MD's insight:

The FDA no longer recommends aspirin for primary prevention

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Electronic Cigarettes

Electronic Cigarettes | Heart and Vascular Health | Scoop.it

Electronic cigarettes (E-cigarettes) are devices that deliver nicotine to a user by heating and converting to an aerosol a liquid mixture typically composed of propylene glycol, vegetable glycerin, flavoring chemicals, and nicotine. E-cigarette use doubled in just 1 year among both adults and children, from 3.4% to 6.2% in adults (2010–2011) and 3.3% to 6.8% in youth (2011–2012), with high levels of dual use with tobacco cigarettes.  Although most youth using e-cigarettes are dual users, up to one third of adolescents who tried an e-cigarette have never smoked a conventional cigarette, indicating that some youth are initiating use of the addictive drug nicotine with e-cigarettes.

Smoke-free policies are a critical intervention both to protect nonsmokers and to support smoking cessation attempts. To avoid reversing the effectiveness of these policies, e-cigarettes should not be used anyplace where smoking cigarettes is not allowed (including in homes that are smoke-free). There is no reason to reintroduce toxins into clean indoor air environments.

Seth Bilazarian, MD's insight:

I tell patients who want to use  E-cigarettes that we don't have adequate information to say that these new nicotine drug delivery devices are safer than cigarettes.  For patients who are motivated to quit smoking, use of  E-cigarettes has not been shown to be an effective  aid to end the addiction of smoking.

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Managing Anticoagulation Interruptions

Managing Anticoagulation Interruptions | Heart and Vascular Health | Scoop.it

On the ClotBlog with Dr. Samuel Z. Goldhaber, at theheart.org on Medscape speaking to you from the American College of Cardiology Scientific Symposium in Washington, DC. Today, I have a special guest and a special friend, Dr. Seth Bilazarian. Seth, welcome to the ClotBlog.

Today I wanted to discuss with you a problem that you and I get calls and emails about over and over again, and that is how to safely interrupt anticoagulation. There are several different levels that we can quickly talk about, including cataract surgery and colonoscopy, but then we can go into the more nitty gritty area of what do we do with patients who have mechanical heart valves. Let's start with cataract surgery. Do you ever instruct your patients to interrupt their anticoagulation?

Seth Bilazarian, MD's insight:

Discussion between a leading academic on thrombosis (Dr Goldhaber) and a community based practitioner (me) on the complexity of managing anti-coagulation around the time of a procedure or surgery.

=================

Thanks for the great plug on twitter : John Mandrola, MD ‏@drjohnm 

Grt discussion on interrupting anticoagulation w/@DrSethdb & Dr Goldhaber http://www.medscape.com/viewarticle/824855?utm_source=twitterfeed&utm_medium=twitter&nbsp;… < Like this topic b/c #judgement critical.

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Overuse of Herbal and Dietary Supplements

Overuse of Herbal and Dietary Supplements | Heart and Vascular Health | Scoop.it

Herbal and dietary supplement use is prevalent. Medication reconciliation should include a careful review of herbal and dietary supplements, including medical and nonmedical harms and benefits. The use of shared decision-making is recommended to integrate these findings into a patient-centered treatment plan. A case of an 80 year old man taking 50 supplements (over $35,000 annually) is reviewed and a teaching point about herbal and dietary supplements is discussed.

Seth Bilazarian, MD's insight:

This case study presents an example of the excessive and inappropriate use of dietary supplements, which can present challenges akin to those recognized in polypharmacy. The strategy highlighted for the physician to review the literature and then present the case regarding risk & benefits and costs to the patient regarding supplements is certainly reasonable but frequently ineffective since patients often are committed to "natural" therapies and believe they are safe and effective.  Furthermore, patients often think physicians are inclined to discredit these therapies.  In my practice, the use of fish oil supplements is the best example of a therapy with no demonstrated cardiovascular benefit and possible harm, There is $12 billion spent annually on fish oil alone.

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New Cholesterol Guidelines => Statin Nation

New Cholesterol Guidelines => Statin Nation | Heart and Vascular Health | Scoop.it

12.8 Million more adults are eligible for statin therapy based on a new study
attempting to determine the effect of new ACC/AHA guidelines
for the management of cholesterol, with the increase seen mostly
among older adults without cardiovascular disease. Among adults
60 and 75 years without cardiovascular disease, the percentage
eligible for such therapy would increase from 30.4% to 87.4%
among men and from 21.2% to 53.6% among women.

Statin Nation - graphic is from Cardiosource  World News at http://www.joomag.com/magazine/cardiosource-worldnews-april-2014/0842627001398192120

Seth Bilazarian, MD's insight:

Are you among the 12.8 million Americans for whom statin is now recommended?

The new atherosclerotic cardiovascular risk calculator (ASCVD) is available as a smartphone app at 

https://itunes.apple.com/us/app/ascvd-risk-estimator/id808875968?mt=8

or

online at:

 http://tools.cardiosource.org/ASCVD-Risk-Estimator/


Use the risk calculator and the current guidelines recommend treatment with statin cholesterol lowering medication  if the 10 year risk of stroke MI or other vascular disease is greater than 7.5% based on this calculator.

 

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askdrmaxwell's curator insight, May 26, 2:17 PM

Cholesterol guidelines have gotten so low, few people can meet them, thus they are prescribed statin drugs. 

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Salt in the Diet

Salt in the Diet | Heart and Vascular Health | Scoop.it

Table salt is made up of a chemical compound called sodium chloride. The sodium portion of salt is responsible for its health concerns. High sodium intake is linked to high blood pressure, which is known to cause strokes and heart attacks. The Dietary Guidelines for Americans from the US government recommend that adults eat no more than 2300 milligrams (mg) of sodium a day—about 1 teaspoon of salt. Furthermore, for about half of all Americans—those aged 51 years or older, African Americans of any age, and people with high blood pressure, diabetes, or chronic kidney disease—the recommended maximum intake of sodium is 1500 mg a day. Currently, in spite of these recommendations, US adults consume an average of 3400 mg of sodium a day.

Seth Bilazarian, MD's insight:
WHAT SHOULD YOU DO? Eat salt in moderation. Most salt in the diet is “invisible” and is contained in processed and restaurant foods. Therefore, salt intake can be decreased by eating out less often (especially at fast-food restaurants) and eating less prepared or packaged foods. If you do eat out, you can ask to have your meal prepared with less salt. Reading labels on prepared foods to look for sodium content per serving also helps. It is generally healthier to cook using fresh foods rather than buying already prepared or packaged foods.
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Blood Thinners: JAMA patient page

Blood Thinners: JAMA patient page | Heart and Vascular Health | Scoop.it

There are 2 types of blood thinners, anticoagulants and antiplatelet drugs. Blood clots can cause problems when they prevent blood from flowing freely, especially to the heart and brain. Sometimes a doctor may not want a patient’s blood to clot as easily and will prescribe a blood thinner.

Seth Bilazarian, MD's insight:

Nice graphic that helps patients understand the differences between antiplatelet & anticoagulant therapy. This is an important source of confusion for patient's who believe that aspirin is an effective therapy for stroke prevention in atrial fibrillation (it is not).  Another potential confusion is why blood thinners or anticoagulants like warfarin or the newer agents (Pradaxa, Xarelto, Eliquis) are not effective treatments after placement of a stent in the coronary artery. Antiplatelet therapies like Plavix, Effient, or Brilinta are needed.

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Deborah Verran's curator insight, May 17, 10:56 PM

This is a good example of the type of reliable factual online information that is available to patients. Some transplant recipients will end up having to take these types of medications (for the appropriate indications). Hence the importance of this particular information.

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New Drug lowers LDL: PCSK9i might be the next stains

New Drug lowers LDL: PCSK9i might be the next stains | Heart and Vascular Health | Scoop.it

A new injectable drug can further knock down cholesterol levels in people who take cholesterol-busting statin medications, according to the results of a global trial.

People taking the new therapy alongside statins enjoyed a 63 - 75% decrease in their "bad" (LDL) cholesterol levels, on top of the reduction caused by the traditional statin medications. This drug enhances the body's natural way of reducing LDL levels in the bloodstream. Cells primarily located in the liver contain receptors that target LDL cholesterol and remove it from the bloodstream. But the liver also produces a regulatory protein called PCSK9 that binds to and breaks down these receptors, The antibodies in the tested drug, evolocumab are designed to intercept PCSK9, preventing the protein from breaking down the cells' LDL receptors, which allows them to stay in circulation longer to remove LDL cholesterol.

Seth Bilazarian, MD's insight:

We have good evidence of this drugs safety and effectiveness in lowering LDL for short term, but we do not yet have data on longer term safety or the more important effectiveness measurement of preventing heart attack, strokes and death.  The large triail called FOURIER is enrolling to assess this.  Check out http://fourierstudy.com for info.

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