by admin | Nov 21, 2013
According to the American Diabetes Association, cardiovascular disease (CVD) is the major cause of morbidity and mortality for people living with diabetes. “The common conditions that coexist with type 2 diabetes, such as hypertension and dyslipidemia, are clearly risk factors for CVD,” explains Robert H. Eckel, MD. “Diabetes itself confers additional risk for CVD, including coronary heart disease, stroke, peripheral vascular disease, and heart failure. Obesity, metabolic syndrome, and inflammation are other key components to the link between diabetes and CVD.” “Large benefits are seen when multiple CVD risk factors are addressed globally.” Published analyses have shown that controlling individual CVD risk factors helps to prevent or slow CVD in people with diabetes. “Large benefits are seen when multiple CVD risk factors are addressed globally,” says Dr. Eckel. “Clinical trials have shown that lowering glucose aggressively can further help reduce CVD risk, but an individualized approach is necessary for most patients with diabetes.” Individualizing Care for Diabetes The American Diabetes Association recommends an A1C of less than 7% for most patients, but Dr. Eckel notes that A1C goals may differ from patient to patient, depending on their individual characteristics (Table 1). “There are several aspects to consider when selecting a target A1C level, including age, duration of diabetes, the extent of diabetes complications, psychosocial support, physical activity limitations, and risks of hypoglycemia. All of these factors—and other cardiometabolic components—will play a role in guiding how aggressively diabetes should be treated.” Blood Pressure & Cholesterol In addition to glycemic control, the management of blood pressure and cholesterol is important to helping prevent or slow CVD in patients with diabetes (Table...
by admin | Nov 14, 2013
For patients with coronary heart disease (CHD), current performance measures recommend annual lipid testing, followed by treatment intensification in cases when abnormal lipid levels are spotted. Little is known, however, about the frequency and correlates of repeat lipid testing in patients with CHD who have already attained guideline–recommended LDL-cholesterol (LDL-C) treatment targets and receive no treatment intensification. “In these patients, repeat lipid testing may represent health resource overuse and possible waste of healthcare resources,” says Salim S. Virani, MD, PhD. Intriguing New Findings on Repeat Lipid Testing In JAMA Internal Medicine, Dr. Virani and colleagues had an analysis published that sought to determine the frequency and correlates of repeat lipid testing in patients with CHD who have already attained the guideline-recommended LDL-C target of less than 100 mg/dL and received no further treatment intensification. Among 27,947 patients with LDL-C less than 100 mg/dL, the data showed that 9,200 patients (32.9%) had another repeat lipid panel performed at 11 months from their first lipid panel in the absence of any treatment intensification. “Overall, about one-third of patients with CHD continued to undergo lipid testing after they achieved their LDL-C goal without treatment intensification,” says Dr. Virani. “More than 9,000 patients had additional lipid panels in the 11 months after they achieved an LDL-C target of less than 100 mg/dL in the absence of any further treatment intensification (which could be performed to attain the optional treatment target of LDL-C less than 70 mg/dL). About two-thirds of patients in our analysis who also met the optional LDL-C treatment target of less than 70 mg/dL had repeat lipid testing within 11 months...
by admin | Oct 17, 2013
Cardiovascular disease (CVD) and cancer are the most prevalent diseases in the current era, and the rates of these diseases continue to rise. More than 2 million breast cancer survivors in the United States are at risk for cardiotoxicity. Pediatric cancer survivors are two to five times more likely than the general population to develop heart disease. Treatment for cancer has become more effective, but cardiac disease in these patients has in turn become increasingly common. CVD can affect their quality of life as well as the course of cancer treatment. Preventing CVD in Cancer Patients Preventing CVD in cancer patients is important because aggressive cancer therapies are being used in older patients who may have cardiac problems or cardiovascular risk factors. Furthermore, researchers are identifying cardiac toxicities with new cancer therapies. Cardiotoxicity from cancer treatments include heart failure, hypertension, hypotension, arrhythmias, pericarditis, and myocardial ischemia. Radiation to the chest, leukemias, and chest tumors can lead to pericarditis, myocarditis, valve disease, and coronary artery disease. Diagnosing cardiotoxicity during cancer treatment can be challenging. Symptoms like fatigue, shortness of breath, and edema are common to cardiac problems but are also adverse effects of cancer therapy. When patients present with these symptoms, they should be referred to cardio-oncology programs for further evaluation. Collaborative Care Among Cardiologists & Oncologists At the University of Michigan, cardiologists are collaborating with oncologists to tailor cardiac and cancer therapy to minimize cardiotoxicity. We stratify risk in patients with cardiac disease or CVD risk factors in an effort to optimize these conditions prior to cancer treatment. Cardio-oncology programs: • Provide prevention and early detection of cardiac complications....
by JonN | Jul 22, 2013
When the ankle-brachial index (ABI) emerged in 1950, it was initially proposed for use as a noninvasive diagnostic tool for lower-extremity peripheral artery disease (PAD). Since then, studies have shown that the ABI is an indicator of atherosclerosis at other vascular sites, making it a useful prognostic marker for cardiovascular events and functional impairment, even in the absence of symptoms of PAD. In an issue of Circulation, the American Heart Association (AHA) released a scientific statement with standardized recommendations for measuring and monitoring the ABI. The recommendations provide protocols and thresholds for use in PAD and cardiovascular risk prediction, according to Michael H. Criqui, MD, MPH, FAHA, who co-chaired the writing committee that developed the scientific statement. “A lack of standards for measuring and calculating the ABI can lead to discrepancies that can significantly impact both prevention and treatment of cardiovascular disease,” he says. “The estimated prevalence of PAD may vary substantially according to the mode of ABI calculation.” Reducing Variation in ABI Technique Recent studies have revealed that techniques for performing the ABI vary from clinician to clinician. Several variables have been identified, including the position of patients during measurement, the sizes of the arm and leg cuffs, and the method of pulse detection over the brachial artery and at the ankles. Other variables include whether the arm and ankle pressures were measured bilaterally, which ankle pulses were used, and whether a single measure or replicate measures were obtained. Several recommendations have been endorsed by the AHA for measuring the ABI (Table 1). “These recommendations can serve as a guide to ensure that clinicians are measuring the ABI...
by admin | May 30, 2013
Nearly 10 million Americans have stable ischemic heart disease (SIHD), which ranks among the leading causes of death among adults in the United States. According to study data, SIHD was the cause of nearly 380,000 deaths in the U.S. in 2010. The total costs associated with caring for heart disease has been estimated at $316.4 billion, while the total cost for coronary heart disease accounts for about $177.1 billion (Figure 1). More than 5 years have passed since guidelines were released on the management of patients with SIHD. In an effort to revisit those recommendations, the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines and five other medical societies collaborated to release a 2012 guideline update for these patients that was published in Circulation. Influential Studies Shaping Revascularization The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial helped shape the revascularization section of the guidelines update, according to James C. Blankenship, MD, FSCAI, who was on the task force that revised the recommendations. “For the COURAGE trial, stable patients in whom catheterization demonstrated a need for revascularization were randomized to medical therapy or coronary intervention. The researchers concluded that neither showed a benefit with regard to death or heart attack. Stenting showed a benefit in angina control for 3 years. This finding, along with data from other studies, indicates that every lesion doesn’t necessarily need to be fixed and that the strongest indication for coronary stenting in stable patients is relief of symptoms.” Revisions in the revascularization section were also shaped by results of the Synergy Between Percutaneous Coronary Intervention With Taxus...
