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Dental Prophylaxis Protective to Ischemic Stroke

Dental Prophylaxis Protective to Ischemic Stroke | Heart and Vascular Health | Scoop.it

 Correlation has been found between periodontal disease (PD) and stroke. This study was conducted to investigate whether dental prophylaxis and periodontal treatment reduce the incidence of ischemic stroke.

Stroke rate of non-PD subjects was 0.32%/year. In the PD group, subjects who received dental prophylaxis had the lowest stroke IR (0.14%/year); subjects with intensive treatment or tooth extraction had a higher stroke IR (0.39%/year); and subjects without PD treatment had the highest stroke IR (0.48%/year; P<0.001).

Maintaining periodontal health by receiving dental prophylaxis and PD treatment can help reduce the incidence of ischemic stroke.

Seth Bilazarian, MD's insight:

The results of this study show that periodontal disease increases the incidence of ischemic stroke, especially among the younger population. Because it can be prevented and treated with improved oral hygiene, those who already have periodontal should seek treatment to alleviate tissue inflammation and thereby reduce the incidence of ischemic stroke.

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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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DASH: the Best Diet With the Least Buzz - US News

DASH: the Best Diet With the Least Buzz - US News | Heart and Vascular Health | Scoop.it

The aim is healthy blood pressure – the bonus is weight loss.

The name DASH, which stands for Dietary Approaches to Stop Hypertension, was coined in the 1997 New England Journal of Medicine study that started it all. Until then, dietary approaches had mainly focused on cutting salt and alcohol – and weight loss. 

Besides reducing blood pressure, other studies show DASH helps the heart by promoting healthier cholesterol and triglyceride levels. And the DASH approach is in line with American Diabetes Association guidelines. But there’s been one drawback: Few people follow it. A 2008 study  suggests less than one-fifth of Americans with high blood pressure adhere to DASH-style eating.

Because DASH isn’t a commercial diet, there’s no industry marketing behind it. And since it involves an overall dietary pattern, Appel says, “It’s hard to get somebody particularly engaged when it’s not patentable.” On the other hand, he adds, “If this was a pill, there’d be people making billions.”

 


Seth Bilazarian, MD's insight:

There are allot of diet options: Atkins, South Beach, Zone, Weight Watchers, Ornish, Mediterranean, Dash

Despite millions of dollars spent in the weight loss industry, available data are conflicting and insufficient to identify one diet as more beneficial than another.  The Pounds Lost Study (Sacks NEJM 2/26/2009) showed no significant differences in weight loss or satiety scores with several different options of high or low carbohydrate or fat components.

A recent systemic review of Head to Head RCTs concluded that on average they all show modest and similar long term weight loss.  (Attallah et al Circ Cardiovasc Qual Outcomes 2014;7:815-27)


  Best advice  “have a diet you’ll stick with”.

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Top Blood pressure monitors from Consumer Reports

Top Blood pressure monitors from Consumer Reports | Heart and Vascular Health | Scoop.it

Recommended blood pressure monitors are standout choices with high scores. They include CR Best Buys, which offer exceptional value. When narrowing your choices, weigh features, price, and attributes that matter to you.

Seth Bilazarian, MD's insight:

Consumer reports ratings for blood pressure monitors - Best Buys and which ones to avoid.

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How to : Measure your own blood pressure

http://www.bhf.org.uk We talk you through the basics of taking your blood pressure yourself. Its simple and we show you what to do.
Seth Bilazarian, MD's insight:

Simple, but comprehensive resource for accurate blood pressure measurement at home.  The only thing I would add is to bring your cuff &  blood pressure measurement instrument to a doctor to see if the measurements you get are consistent with the values obtained by a trained and certified health professional . This can be done in your doctors office or by a community program that does blood pressure measurements performed by a nurse or other trained professional.

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Sleepless in America

National Geographic Channel’s Sleepless in America exposes the crucial need for sleep and the shocking life-threatening consequences of its absence.
Seth Bilazarian, MD's insight:

Biologically speaking, sleep loss has been shown to increase inflammatory responses, which may underlie pathological sleepiness in sleep apnea & narcolepsy disturb our metabolism, increase the risk of cardiovascular problems and decrease our life span. Sleep is critical to health and disease avoidance.

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Super Bowl outcome associated with cardiovascular death

Super Bowl outcome associated with cardiovascular death | Heart and Vascular Health | Scoop.it

A previous analysis from Los Angeles showed that death rates increased among hometown fans after losing the Super Bowl in 1980 and decreased after a win in 1984. D

Two high drama and intense Super Bowls were analyzed: New York beat New England (Massachusetts) in 2008 and Pittsburgh defeated Arizona in 2009. Daily death certificate data were obtained. The case period included eight consecutive days beginning Super Bowl day. The control period included eight consecutive days beginning Super Bowl day in non-case period Super Bowls from 2005 to 2009.

After Massachusetts’ defeat, circulatory deaths increased by 20 % (p = 0.0004) and ischemic heart disease deaths increased by 24 % (p = 0.01) in Massachusetts. After Pittsburgh’s victory circulatory deaths decreased by 25 % (p = 0.046), ischemic heart disease deaths decreased by 31 % (p = 0.03), and myocardial infarction deaths decreased by 46 % (p = 0.01) in Pittsburgh. Cardiovascular death rates did not change in Arizona (all p > 0.19). Massachusetts and Pittsburgh show stronger support for their home teams compared with Arizona.

Conclusions A Super Bowl with high drama/intensity can be associated with changes in cardiovascular death rates among a fan base with a strong attachment to the team even in the contemporary era. An increase in death rates can be associated with a loss and a decrease in death rates can be associated with a win.

Seth Bilazarian, MD's insight:

Looks like hospitals and cardiac catheterization labs in either Seattle or Boston are going to be busier at the beginning of next week.

Should Seahawk & Patriots fans take aspirin and betalocker before the game?  This might theoretically reduce the risk of CAD events and Takotsubo cardiomyopathy.

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Drinking from BPA-lined cans may increase Blood Pressure

Drinking from BPA-lined cans may increase Blood Pressure | Heart and Vascular Health | Scoop.it

Consuming food and drinks from cans or plastic bottles coated with bisphenol A may cause increases in blood pressure, according to research published in Hypertension.
Researchers demonstrated that concentrations of bisphenol A (BPA) in urine were higher in participants who drank from cans lined with material containing the chemical vs. from glass bottles.

The investigators measured individuals’ urinary BPA concentration, blood pressure (BP) 2 hours after consuming each beverage; 

Urinary BPA concentrations were >1,600% higher after drinking from cans compared with drinking from glass bottles. Systolic BP, adjusted for daily variance, rose approximately 4.5 mm Hg after consuming two canned beverages vs. two glass-bottled beverages (P=.02).  A 5 mm Hg increase in systolic [BP] by drinking two canned beverages may cause clinically significant problems, 

Seth Bilazarian, MD's insight:

The FDA says that BPA is safe http://goo.gl/4vV0w and says "Consumers may use the resin code appearing on plastic containers as a guide to the possible presence of BPA. A resin code of 7 indicates that the container may be made of a BPA-containing plastic. " But the NRDC.org says "A number of canned foods and plastic bottle manufacturers have stopped using BPA, though because there is no labeling requirement, consumers do not know which products contain BPA and which don't."

In our home there are no cans with resin code 7.  Whether this represents accurate labeling or not is unclear.  The nearly 5 mm Hg increase in BP could be meaningful over many years.  The importance of this will need continued study. The practical recommendation for grocery shoppers is that this is another reason to opt for fresh or frozen foods rather than canned.

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Risk of Developing Coronary Artery Disease Following a Normal Coronary Angiogram in Middle-Age

Risk of Developing Coronary Artery Disease Following a Normal Coronary Angiogram in Middle-Age | Heart and Vascular Health | Scoop.it

Atherosclerosis begins in the teenage years & progresses over time. It is unknown, however, whether coronary angiography in middle-aged adults showing no evidence of atherosclerosis identifies individuals at low risk for coronary artery disease (CAD).

In 4068 patients ≥40 years of age who had at least two coronary angiograms, 227 patients (5.8%) had no CAD and 251 patients (6.4%) had mild atherosclerotic disease (stenosis <30%) on the initial angiogram.

Patients in the normal-angiogram group were younger, more often female, and less likely to use tobacco than patients in the mild-atherosclerosis group, while rates of diabetes and hypertension were the same. Angiographic evidence of any CAD and obstructive CAD was apparent in 26% and 4.8%, respectively of the normal-angiogram group on subsequent angiography performed 75 ± 46 months later. Myocardial infarction and revascularization occurred in 4.8% and 3.5%, respectively.

In summary, 26% of middle-aged adults with a normal coronary angiogram who had subsequent angiography for clinical reasons developed CAD, although the annual rates of myocardial infarction or revascularization were very low. Even mild atherosclerosis on the initial angiogram increased the rate of progression of CAD by 10-fold and the rate of revascularization by 8-fold. 

Seth Bilazarian, MD's insight:

This paper has very practical implications for patients.  If there is no or minimal CAD at the time of a coronary angiogram (catheterization), the chance of progression to significant stenosis or heart attack is around 5%.  This rate is generally categorized as low risk by lipid guidelines over 10 years.  However there is an important value in noting (and showing patients) minimal coronary disease that are areas of coronary plaques, since these plaques identify patients at higher risk for progression and warrant a continued aggressive risk reduction approach with life style modification and statin use.

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Atorvastatin Effect on Fibrous Cap Thickness in Coronary Artery Plaque

Atorvastatin Effect on Fibrous Cap Thickness in Coronary Artery Plaque | Heart and Vascular Health | Scoop.it

More intensive statin therapy reduces cardiovascular morbidity and mortality. However, the mechanism of the dose-dependent effect on plaque stabilization by statin therapy is not fully elucidated.

Micron resolution of optical coherence tomography allows detailed assessment of fibrous cap thickness, which contributes to plaque instability.

Increase in fibrous cap thickness in coronary atherosclerotic plaque benefits from higher dose atorvastatin compared with a lower regimen in patients with unstable angina pectoris.

Larger and longer term studies are needed to determine the direct relationship between an increase in fibrous cap thickness and coronary event risk reduction.

Seth Bilazarian, MD's insight:

This study used imaging called Optical Coherence Tomography (OCT) to assess plaques in the coronary arteries.  Use of statin medications like Atorvastatin (Lipitor) reduces the amount of cholesterol in the blood but this study adds direct evidence that in addition to reducing the plaque size it also thickened the overlying cover of the plaque called the fibrous cap.  When this cap becomes disrupted (erodes or ruptures) clot forms and a heart attack can ensue.  This mechanism of benefit through plaque stabilization is a critical contributor to the benefits of statin therapy in patients with coronary plaques.

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Adrenal Masses & Surgically Correctable Hypertension

Adrenal Masses & Surgically Correctable Hypertension | Heart and Vascular Health | Scoop.it

Many patients have a surgically correctable cause for their high blood pressure: a hormonally active adrenal tumor. Three conditions associated with hormonally active adrenal masses—pheochromocytomas, Cushing’s disease and Conn’s syndrome—all can cause uncontrollable hypertension, among other symptoms.

Approximately 8% of  U.S. population has an adrenal tumor. Only one in 4,000 adrenal tumors is malignant, and most benign tumors are inactive. However, about 25%—much more than previously thought—are hormonally active. The effect of this abnormal activity depends on the hormone.

The most effective therapy for hormonally active adrenal tumors, a laparoscopic procedure to remove the adrenal tumor, often cures patients of hypertension and related problems. Yet the clinical symptoms indicating hormonally active tumors are often unrecognized. Most adrenal tumors are detected during imaging for unrelated issues, yet these patients are infrequently referred for follow-up testing. Better awareness of symptoms, and increased testing of incidentally found tumors, could benefit at-risk patients.

Seth Bilazarian, MD's insight:

Although some patients with adrenal tumors can be effectively treated with medications, most patients should have surgery. Excising hormonally active adrenal masses through a relatively low-risk, minimally invasive operation (laparoscopic adrenalectomy) can resolve hypertension and other health problems, including the obesity, diabetes, hypertension and osteoporosis associated with Cushing‘s syndrome.

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Cytisine vs. Nicotine for Smoking Cessation

Cytisine vs. Nicotine for Smoking Cessation | Heart and Vascular Health | Scoop.it

Motivation, it’s often said, is half the battle of behavior change.  In the battle against nicotine addiction, however, motivation alone may not be enough.  Mass media campaigns have helped to raise awareness about the dangers of smoking.  But for the majority of smokers who already want to quit, the question remains: how? 

A study published this week in NEJM compared the effectiveness of cytisine versus nicotine replacement therapy for smoking cessation.  1300 adult smokers in New Zealand were randomized to receive either cytisine for 25 days or nicotine replacement therapy for 8 weeks.  Participants also received behavioral support. At one month, 40% of participants in the cytisine group reported continuous abstinence, as compared to 31% of those on nicotine replacement therapy (absolute difference of 9.3 percentage points; 95% confidence interval 4.2 to 14.5; number needed to treat = 11).  Abstinence was also higher with cytisine than with nicotine replacement therapy at two and six months.  

Seth Bilazarian, MD's insight:

Today, cytisine use is mostly limited to Eastern Europe.  Considering it is much less expensive than Chantix ($20-$30 for the recommended 25 day treatment course of cytisine versus $500 for 12 weeks of Chantix), if cytisine is indeed more effective than nicotine replacement therapy, as the findings of this study suggests, then introducing it to the US market could yield tremendous value.

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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.

Requires Log in - but it's free

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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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ACA Premium Changes in 2014-2015

ACA Premium Changes in 2014-2015 | Heart and Vascular Health | Scoop.it
This Visualizing Health Policy infographic illustrates the change in monthly premiums by county, and select cities, from 2014 to 2015 for a 40-year-old person covered by the second-lowest-cost silver “benchmark” plan in the Affordable Care Act’s insurance marketplaces. Premium changes were greatest...
Seth Bilazarian, MD's insight:

More of the US is experiencing increases in premiums with the #ACA.  I'm surprised that the states with the biggest decreases (>10%) are not regionally concentrated but well dispersed. A new meaning for "blue states"?

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Radial Access: Get Onboard or Get Left Behind

Radial Access: Get Onboard or Get Left Behind | Heart and Vascular Health | Scoop.it
Converting Holdouts to Transradial Access: This is Seth Bilazarian from theheart.org on Medscape, at the Transcatheter Cardiovascular Therapeutics (TCT) 2014 meeting in Washington, DC. I am here with Dr Sunil Rao, from Duke University and section chief at the Durham Veterans Affairs Medical Center.
Seth Bilazarian, MD's insight:

My interview with Dr. Sunil Rao on transradial (from the wrist) catheterization.  His expertise on uptake and "how - to" tips on a catheterization technique that is increasing in the US but still lags behind other parts of the world.  Requires free registration at Medscape.

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Deputy Heart Attack - Learn Early Heart Attack Care!

Deputy Heart Attack - Learn Early Heart Attack Care! | Heart and Vascular Health | Scoop.it
Early Heart Attack Care (EHAC) is dedicated to saving lives by detecting the early signs of a heart attack

Take the short quiz to learn the basics of recognizing a heart attack in the early stage in a family, friend or co-worker:  Here's a sample question

 

 What questions should you ask the person experiencing early heart attack symptoms?
A.    Is the discomfort, tightness, pressure, or pain located in the center of the chest? 
B.    Are the symptoms present in the chest, throat, jaw, upper back or inside of the left arm? 
C.    Did these symptoms come on with exertion and do they go away with rest?
D.    All of the above

Seth Bilazarian, MD's insight:

Great educational quiz from @EHAC_Deputy a resource from @SCPCP an organization that certifies hospitals as centers of chest pain excellence.  Part of the problem with care of the heart attack patient is that it cannot start until emergency services are notified.  This big problem results in much of the problem and lasting effects including death and disability.  Early Heart Attack Care (EHAC) can greatly reduce and sometimes eliminate the long term hazard of a heart attack.  

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Can This Treatment Help Me? There’s a Statistic for That

Can This Treatment Help Me? There’s a Statistic for That | Heart and Vascular Health | Scoop.it

Medical care is often far less effective than most believe. Just because you took some medicine for an illness and became well again, it doesn’t necessarily mean that the treatment provided the cure.

This fundamental lesson is conveyed by a metric known as the number needed to treat, or N.N.T. Developed in the 1980s, the N.N.T. tells us how many people must be treated for one person to derive benefit. An N.N.T. of one would mean every person treated improves and every person not treated fails to, which is how we tend to think most therapies work.  What may surprise you is that N.N.T.s are often much higher than one. Double- and even triple-digit N.N.T.s are common.

Seth Bilazarian, MD's insight:

The number needed to treat (NNT) or the number needed to harm (NNH) are easy ways to quantify the benefit.  The calculation is done by dividing 100 by the difference in the rate of the problem in the two groups (called the absolute risk reduction (ARR)).  If one group has an event rate of 20% and the other group has a rate of 15% the ARR is 5% so the NNT is 100/5 or 20.  Simply put then 20 people need to be treated to prevent one of the bad outcomes.  This is a very helpful context but only part of shared decision making sensible for patients. See also http://www.thennt.com/

 

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Cardiovascular and Cerebrovascular Effects of Red Bull & Mental Stress

Cardiovascular and Cerebrovascular Effects of Red Bull & Mental Stress | Heart and Vascular Health | Scoop.it

The sale of energy drinks is often accompanied by a comprehensive and intense marketing with claims of benefits during periods of mental stress. As it has been shown that Red Bull negatively impacts human hemodynamics at rest, we investigated the cardiovascular and cerebrovascular consequences when Red Bull is combined with mental stress. In a randomized cross-over study, 20 young healthy humans ingested either 355 ml of a can Red Bull or water and underwent 80 minutes after the respective drink a mental arithmetic test for 5 minutes. Continuous cardiovascular and cerebrovascular recordings were performed for 20 minutes before and up to 90 minutes after drink ingestion. Measurements included beat-to-beat blood pressure (BP), heart rate, stroke volume, and cerebral blood flow velocity. Red Bull increased systolic BP (+7 mm Hg), diastolic BP (+4 mm Hg), and heart rate (+7 beats/min), whereas water drinking had no significant effects. Cerebral blood flow velocity decreased more in response to Red Bull than to water (−9 vs −3 cm/s, p <0.005). Additional mental stress further increased both systolic BP and diastolic BP (+3 mm Hg, p <0.05) and heart rate (+13 beats/min, p <0.005) in response to Red Bull; similar increases were also observed after water ingestion. In combination, Red Bull and mental stress increased systolic BP by about 10 mm Hg, diastolic BP by 7 mm Hg, and heart rate by 20 beats/min and decreased cerebral blood flow velocity by −7 cm/s. In conclusion, the combination of Red Bull and mental stress impose a cumulative cardiovascular load and reduces cerebral blood flow even under a mental challenge.

Seth Bilazarian, MD's insight:

Blood pressure increase of 7/3 and reduced mental acuity.  This data certainly adds to the plausibility that these energy drinks can sometimes cause serious cardiovascular consequences.

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Healthy Weight Loss

Healthy Weight Loss | Heart and Vascular Health | Scoop.it

A useful approach is to select the best diet that works for you. This
is the eating plan you can live with.
What You Need to Know About Weight Loss
A total of 3500 calories equals 1 pound of body weight. This means if you decrease (or increase) your intake by 500 calories daily, you will lose (or gain) 1 pound per week. (500 calories per day × 7 days = 3500 calories.)
All foods have carbohydrate, protein, and fat.

Carbohydrates provide 4 calories per gram.

Proteins provide 4 calories per gram.
Fats provide 9 calories per gram.
Carbohydrates are either simple or complex. Simple carbohydrates cause more  weight gain than complex carbohydrates. Simple carbohydrates include sugar and starches (potatoes, pasta,and rice). Complex carbohydrates include fruits, vegetables, and whole grains.

Seth Bilazarian, MD's insight:

A 500 calorie reduction every day is a good basic rule to begin to have an understanding how to move weight down by about a pound per week - its a good start.  Slightly more advanced calculators are more accurate and can help understand how to move weight to a goal or ideal weight.  For those motivated to change habits on caloric intake these calculators can be very helpful.  See the Pennington Biomedial caculators at

 http://www.pbrc.edu/research-and-faculty/calculators/weight-loss-predictor/

 

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Triglycerides on the rise: should we swap seats on the seesaw?

Triglycerides on the rise: should we swap seats on the seesaw? | Heart and Vascular Health | Scoop.it

For decades, cardiovascular risk attributed to lipids beyond LDL has focused on HDL.  Observational data show a consistent inverse relationship between HDL & cardiovascular risk. However, multiple strategies to raise HDL levels have thus far failed to forestall events in clinical trials [e.g. currently available fibrates, niacin, &  cholesteryl ester transfer protein (CETP) inhibitors. 

Apolipoprotein C3 regulates triglyceride-rich lipoprotein can promote inflammation and the preponderance of current genetic evidence sways the seesaw surely to the triglyceride side.

Recent genetic studies show that a lifetime of lower exposure to APOC3 reduced cardiovascular risk. 

Seth Bilazarian, MD's insight:

From author Peter Libby:

In the meantime, what should clinicians do to manage patients who present with hypertriglyceridemia? These new data regarding a causal role for triglycerides in increasing cardiovascular risk should prompt us today to redouble our efforts to reduce hypertriglyceridemia in our patients using non-pharmacological approaches. We should examine the medication list for agents that might raise triglyceride levels such as estrogens and retinoic acid products.  We should consider whether alcohol consumption or thyroid disease contributes to dyslipidemia in individual patients. We should strive to achieve optimum control in diabetic patients. We can discourage excessive carbohydrate consumption in those with hypertriglyceridemia.

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Bypass Surgery Vs. Drug-Eluting Stents for Patients With Proximal Left Anterior Descending Stenosis

Bypass Surgery Vs. Drug-Eluting Stents for Patients With Proximal Left Anterior Descending Stenosis | Heart and Vascular Health | Scoop.it

Although clinical practice guidelines carry a higher class of recommendation for CABG surgery (Class IIa) than for catheter-based deployment of drug eluting stents (DES) (Class IIb), when revascularization is indicated for patients with ischemia due to significant stenosis in CAD isolated to the PLAD, a comprehensive registry in the state of New York found no differences between these approaches in either mortality rates or the combined rates of mortality, MI, and/or stroke, although CABG was associated with lower rates of repeated revascularization.

Seth Bilazarian, MD's insight:

For many years we have had good evidence that there is not a significant difference in death or other major hazard between bypass surgery or angioplasty with stents.  This information from the New York State registry adds important information because of its size and the use of drug eluting stents.  The one significant difference is that the angioplasty group needed more repeat procedures over 3 years; Repeat procedures were needed in 1 in 17 of the bypass patients and 1 in 9 of the stent patients.  This information is welcome addition to help our patients make an informed decision about whiich option is best for them.

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Resolving the Paradox of Vitamin D Deficiency in Black Populations

Resolving the Paradox of Vitamin D Deficiency in Black Populations | Heart and Vascular Health | Scoop.it
Researchers at Massachusetts General Hospital demonstrated that the historic deficiencies in Vitamin D observed in African American populations are a result of conventional assays that neglect bioavailability.
Seth Bilazarian, MD's insight:

Thadhani at MGH and others are developing assays to measure bioavailable vitamin D that could help guide recommendations for vitamin D supplements. Until then, he suggests considering whether the individual has indications of poor bone health, and also other measures linked to vitamin D deficiency, such as low calcium and high parathyroid hormone levels. This can help put total vitamin D levels into the context of other clinical risk factors for a more informed decision about whether to recommend supplementation.

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