CHD

Cardiac Catheterization: A New Route – Johns Hopkins Health Alerts

/ SupremeCmdr / Leave a comment

Cardiac Catheterization: A New Route: Johns Hopkins Health Alerts.

Cardiac Catheterization: A New Route

Doctors use cardiac catheterization to diagnose and treat heart conditions. The technique involves threading a thin tube called a catheter through an artery (usually the femoral artery in the upper thigh or groin) to the heart. Serious complications during cardiac catheterization are rare. But the procedure comes with risks of bleeding and damage to arteries.

Increasingly, cardiologists perform cardiac catheterization from an alternate site — the radial artery in the wrist — an equally effective tactic that’s linked to fewer bleeding and vascular complications, according to a review published in Circulation.

Why the wrist? After patients undergo cardiac catheterization through the femoral artery, they must remain flat on their back with their leg immobile for two to six hours to allow the artery to heal and help prevent both internal and external bleeding. Because the radial artery is smaller and closer to the skin’s surface, there’s no risk of internal bleeding, and external bleeding is easier to stop or prevent, an advantage for obese patients or those taking blood thinners.

Patients who undergo cardiac catheterization through the wrist can sit up, walk and eat immediately after the procedure — good news for people with back problems who find it difficult to lie still. A compression device is worn around the wrist for two hours. Patients must refrain from heavy lifting with the hand for a few days.

Radial cardiac catheterization most benefits patients in the highest risk groups — women, patients 75 and older and people with acute coronary syndrome. Yet doctors have been less likely to use the wrist site for these groups.

The decision to use radial versus femoral artery cardiac catheterization is largely based on the abilities and the experience of the cardiologist who’ll perform the procedure. The radial procedure is more technically challenging, and a greater number of U.S. doctors have more experience with the femoral approach — something that’s likely to change in the near future.

Testosterone Treatment and MI Risk

/ SupremeCmdr / Leave a comment

Filling a prescription for testosterone therapy was associated with a greater risk of having a nonfatal myocardial infarction (MI) in the next 3 months, a large observational study showed.

The risk after a prescription was filled was more than doubled in men 65 and older overall compared with that in the year before the prescription (rate ratio 2.19, 95% CI 1.27-3.77), according to Robert Hoover, MD, ScD, of the National Cancer Institute in Bethesda, Md., and colleagues.

The study was limited, however, by the observational design, the use of administrative data that lacked information on indications for treatment, and the inclusion of nonfatal MIs only.

via Study Feeds Concerns About MI Risk With Testosterone Tx.

Cardiologists Should Mind Radiation Doses, ESC Says

/ SupremeCmdr / Leave a comment

Because radiation used in imaging tests is proven to cause cancer, they wrote, “cardiologists should make every effort to give ‘the right imaging exam, with the right dose, to the right patient.’

via Cardiologists Should Mind Radiation Doses, ESC Says.

We are seeing more applicant/patient initiated cardiac scans.  I recently became aware of a life insurance application where the underwriter requested a repeat cardiac CT scan.  The applicant’s cardiologist flatly rejected this course of action in an a asymptomatic patient with a correspondingly low CHD risk score.

Now you understand the cardiologist’s thinking.

Did I hear someone say “litigation risk”?

MI Admissions on Upswing in Younger Women

/ SupremeCmdr / Leave a comment

Bucking the trend in other groups, younger women in that province experienced an increase in the hospitalization rate of 1.7% per year from 2000 through 2009 (P=0.04), according to Karin Humphries, MBA, DSc, of the University of British Columbia in Vancouver, and colleagues.

In addition, in that younger group, women had a greater risk of dying within 30 days of hospital discharge compared with men, a difference that persisted through the end of the study period (OR 1.61, 95% CI 1.25-2.08), the researchers reported online in the Journal of Women\’s Health.

via MI Admissions on Upswing in Younger Women.

Testosterone Treatment Tied to Worse Cardiac Outcomes

/ SupremeCmdr / Leave a comment

After adjustment for the presence of coronary artery disease, testosterone therapy was associated with a greater risk of all-cause mortality, myocardial infarction, and ischemic stroke 3 years after angiography (25.7% versus 19.9%; HR 1.29, 95% CI 1.04-1.58), according to P. Michael Ho, MD, PhD, of the Department of Veterans Affairs (VA) Eastern Colorado Health Care System in Denver, and colleagues.

via Testosterone Tx Tied to Worse Cardiac Outcomes.

How come the television commercials don’t tell you this information when they try to make you think you have a disease called Low T?

Annual prescriptions for testosterone increased more than five-fold from 2000 to 2011. In 2011, the total number of prescriptions numbered 5.3 million and make up a market of 1.6 billion, the authors wrote.

Never mind.

Calcium Score Beats Lipids for Telling CVD Risk

/ SupremeCmdr / Leave a comment

Measurement of coronary artery calcium stratified patient risk for cardiovascular disease regardless of dyslipidemia burden or definition, researchers found.

When measured across lipid abnormality categories, patients with a coronary artery calcium score of 100 or more had a 22.2 to 29.2 incidents of cardiovascular disease per 1,000 person-years versus 2.4 to 6.2 events per 1,000 person-years among those with arterial calcium scores of 0, according to Khurram Nasir, MD, MPH, of Baptist Health South Florida in Miami Beach, and colleagues.

via Calcium Score Beats Lipids for Telling CVD Risk.

N-Terminal Probrain Natriuretic Peptide Is a Stronger Predictor of Cardiovascular Mortality Than C-Reactive Protein and Albumin Excretion Rate in Elderly Patients With Type 2 Diabetes

/ SupremeCmdr / Leave a comment

NT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER.

via N-Terminal Probrain Natriuretic Peptide Is a Stronger Predictor of Cardiovascular Mortality Than C-Reactive Protein and Albumin Excretion Rate in Elderly Patients With Type 2 Diabetes.

Race Has Role in Vitamin D Link to Heart Risk

/ SupremeCmdr / Leave a comment

A 10-ng/mL decrease in 25(OH)D levels was associated with an increased risk of coronary heart disease events in whites (HR 1.26, 95% CI 1.06-1.49) and those with Chinese ancestry (HR 1.67, 95% CI 1.07-2.61), according to Ian de Boer, MD, of the University of Washington in Seattle, and colleagues.

But a similar relationship was not seen among blacks (HR 0.93, 95% CI 0.73-1.20) and Hispanics (HR 1.01, 95% CI 0.77-1.33), the investigators reported in the July 10 issue of the Journal of the American Medical Association.

via Race Has Role in Vitamin D Link to Heart Risk.

A couple of years ago I asked my primary care physician to check my Vitamin D level.  We were both surprised to discover the fact I was Vitamin D deficient.  Since then I’ve been on daily Vitamin D supplementation of 5000iu.

Simple blood test.  Just do it.

The researchers advised caution in interpreting the results in the Chinese and Hispanic participants because of the low sample sizes.

I’m still going to take my supplement.