CHD

Apnea Treatment Gets Heart Back in Shape

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Several studies have suggested that obstructive sleep apnea contributes to the development of left ventricular systolic and diastolic dysfunction and, possibly, heart failure. Note that this study indicates that moderate-to-severe sleep apnea can cause structural and functional changes in left ventricular function comparable to that seen in hypertension and, further, these abnormalities significantly improve following CPAP therapy.

via Medical News:Apnea Treatment Gets Heart Back in Shape – in Cardiovascular, CHF from MedPage Today.

FDA Adds Diabetes Warning to Statin Labels

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The diabetes warning has been rumored as a possibility since the findings from the JUPITER trial of rosuvastatin revealed an unexpected 27% increase in new onset diabetes among patients randomized to the statin.That finding was especially perplexing because JUPITER was a study of statins in patients who had no history of cardiovascular disease, the so-called healthy patient trial. Moreover, based on the JUPITER results, the FDA approved rosuvastatin for primary prevention.The FDA said hyperglycemia was also observed among patients treated with 40-mg atorvastatin in a substudy of PROVE-IT TIMI 22, and a meta-analysis of data from 13 statin trials “reported that statin therapy was associated with a 9% increased risk for incident diabetes.”

via Medical News:FDA Adds Diabetes Warning to Statin Label – in Cardiovascular, Dyslipidemia from MedPage Today.

Effect of Aspirin on Vascular and Nonvascular Outcomes Meta-analysis

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Conclusion: Despite important reductions in nonfatal MI, aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis.

via Arch Intern Med — Abstract: Effect of Aspirin on Vascular and Nonvascular Outcomes: Meta-analysis of Randomized Controlled Trials, February 13, 2012, Seshasai et al. 172 3: 209.

Biomarkers May Help Heart Failure Risk Prediction

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After accounting for the clinical risk score, several echocardiographic findings were independently associated with incident heart failure HRs 1.11 to 2.91, P≤0.001 for all:

  • Reduced left ventricular ejection fraction
  • Abnormal mitral inflow E/A peak velocity ratio a measure of diastolic function
  • Enlarged left atrium Increased left ventricular mass

These variables were used to create an echocardiographic score.Elevated levels of NT-proBNP also were independently associated with heart failure risk HR 1.61 as a continuous variable and HR 2.7 for values greater than 190 pg/mL, P

via Medical News:Biomarkers May Help Heart Failure Risk Prediction – in Cardiovascular, CHF from MedPage Today.

Meaningful Treatments

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Thankfully, we’ve learned from our mistakes. Opening blocked vessels is useful in really only two general areas:

Heart attack, where the rule of thumb is to open the tightest blockage (we refer to it as the “infarct-related artery”) and leave the rest as is.

Symptomatic blockages such as the 99% plug that caused my patient his troubles. If, on the other hand, a person has no chest pain or breathing difficulty associated with the disease, we provide no benefit by uncorking it—even if the blockage is 100%.

via Meaningful treatments in the battle against coronary disease.

Declining GFR Linked to Mortality Risk After MI

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Patients with chronic kidney disease had a significantly increased risk of death after myocardial infarction, and the risk increased as glomerular filtration rate (GFR) declined, a review of 103,000 myocardial infarction patients showed.

The excess mortality risk ranged from 17% to as much as 500% as the severity of chronic kidney disease (CKD) increased. CKD predicted heightened mortality regardless of the presence or absence of ST-segment elevation.

via Medical News: ASN: Declining GFR Linked to Mortality Risk After MI – in Meeting Coverage, ASN from MedPage Today.

Watch that GFR.

ADHD Drugs and CV Events

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ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults — NEJM

In conclusion, in our study involving children and young adults with 2.5 million person-years of follow-up, there were 3.1 serious cardiovascular events per 100,000 person-years. Although the point estimates of the relative risks for ADHD drugs did not indicate increased risk, the upper limit of the 95% confidence interval suggested that a doubling in the risk could not be ruled out. However, the absolute magnitude of any increased risk would be low.

The entire article is worth reading given the potential serious side effects of the drugs in question.