Coronary Artery Calcium Scan Embraced By New AHA/ACC Cholesterol Guidelines: Will Insurance Coverage Follow?

Thank you Dr. Pearson.

The Skeptical Cardiologist

The skeptical cardiologist has been utilizing coronary artery calcium (CAC) scans to help decide which patients are at high risk for heart attacks, and sudden cardiac death for the last decade. As I first described in 2014, (see here) those with higher than expected calcium scores warrant more aggressive treatment and those with lower scores less aggrressive treatment.

Although , as I have discussed previously, CAC is not the “mammography of the heart” it is incredibly helpful in sorting out personalized cardiovascular risk. We use standard risk factors like lipids, smoking, age, gender and diabetes to stratify individuals according to their 10 year risk of atherosclerotic cardiovascular disease (ASCVD) but many apparent low risk individuals (often due to inherited familial risk) drop dead from ASCVD and many apparent high risk individuals don’t need statin therapy.

Previously, major guidelines from organizations like the AHA and the ACC did not recommend…

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Revisiting Who Should Take Aspirin

The Skeptical Cardiologist weighs in on the aspirin debate.
Thank you Dr. Pearson.

The Skeptical Cardiologist

Four years ago the skeptical cardiologist wrote the (in his extremely humble  and biased opinion) the definitive post on aspirin and cardiovascular disease.  Entitled “Should I take aspirin to prevent stroke or heart attack“,  it pointed out that although Dr. Oz had recently told almost all middle-aged women to take a baby aspirin and fish oil, there was, in fact no evidence to support that practice.

The publication of the ASPREE (Aspirin in Reducing Events in the Elderly) trial results in the latest issue of the New England Journal of Medicine further strengthens the points I made in 2014.

Between 2010 and 2014 the ASPREE investigators enrolled over 19,000 community-dwelling persons in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability.

(It’s important…

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Researchers Figure Out Why Coffee Is Good For The Heart

The team focused on a protein called p27, which is known among other things to influence the cell cycle. The team found that caffeine triggered the movement of p27 into the mitochondria of heart cells in mice, and in particular, the migration of the heart’s endothelial cells, which line the blood vessels. How well the endothelial cells were able to migrate, they found, relied strongly on the presence of p27, which again is bolstered by caffeine. 

Read the Forbes article here.

Sleep Apnea Raises Your Risk of Sudden Cardiac Death

In a five-year study of nearly 11,000 people, those with obstructive sleep apnea had a higher risk of sudden cardiac death. At greatest risk were those aged 60 and older with moderate to severe apnea (20 episodes an hour).

When their oxygen saturation levels dipped below 78 percent — preventing air from flowing into the lungs — their risk increased by 80 percent.

Memo to Underwriters:

In case anyone asks why we are so harsh on untreated OSA quote this study.

Article link here.

Link to the study abstract here.

RESULTS:

During an average follow-up of 5.3 years, 142 patients had resuscitated or fatal SCD (annual rate 0.27%). In multivariate analysis, independent risk factors for SCD were age, hypertension, coronary artery disease, cardiomyopathy or heart failure, ventricular ectopy or nonsustained ventricular tachycardia, and lowest nocturnal O2sat (per 10% decrease, hazard ratio [HR]: 1.14; p = 0.029). SCD was best predicted by age >60 years (HR: 5.53), apnea-hypopnea index >20 (HR: 1.60), mean nocturnal O2sat <93% (HR: 2.93), and lowest nocturnal O2sat <78% (HR: 2.60; all p < 0.0001).

CONCLUSIONS:

In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD.

Vitamin D and Mortality Risk in People With CVD

Summary:     A normal intake of vitamin D can reduce the risk of early death substantially in people with cardiovascular disease, a new study shows. The study concludes that people who have suffered from cardiovascular disease, and have a normal intake of vitamin D, reduce their risk of morality as a consequence of the disease by 30 per cent.

Source article can be found here.

Eat Yogurt

Higher intakes of yogurt were associated with a 30 percent reduction in risk of myocardial infarction among the Nurses’ Health Study women and a 19 percent reduction in the Health Professionals Follow-Up Study men.

In both groups, participants consuming more than two servings a week of yogurt had an approximately 20 percent lower risks of major coronary heart disease or stroke during the follow-up period. When revascularization was added to the total cardiovascular disease outcome variable, the risk estimates were reduced for both men and women, but remained significant.

Higher yogurt intake in combination with an overall heart-healthy diet was associated with greater reductions in cardiovascular disease risk among hypertensive men and women.

Read the source article here.

 

Eat More Cashews

Conclusion

Cashew nut supplementation in Asian Indians with T2DM reduced systolic blood pressure and increased HDL cholesterol concentrations with no deleterious effects on body weight, glycemia, or other lipid variables. This study was registered at the clinical trial registry of India as CTRI/2017/07/009022.

Cashew Nut Consumption Increases HDL Cholesterol and Reduces Systolic Blood Pressure in Asian Indians with Type 2 Diabetes: A 12-Week Randomized Controlled Trial

This explains why cashews are my favorite nut.

I’m the guy who picks out all of the cashews in a bowl of mixed nuts.