1. ONE OF THE BIG STORIES THIS YEAR WAS THE “COUMADIN NO MORE” BLOOD THINNING AGENTS TO PREVENT STROKE FROM THE DREADED IRREGULAR RHYTHM, ATRIAL FIBRILLATION.  PRADAXA(DABIGATRAN), WAS  FIRST APPROVED AND HAS THE MOST USAGE TO DATE. ONE OTHER AGENT, XARELTO (RIVAROXABAN), WAS RECENTLY APPROVED AND WE LOOK FORWARD TO UTILIZING IT AS WELL.  2. MAINSTREAM MEDIA TOOK HOLD OF  T.A.V.I. (TRANS CATHETER AORTIC VALVE IMPLANTATION) WHERE VIA THE LARGE ARTERY IN THE GROIN, A NEW REPLACEMENT VALVE COULD BE PLACED FOR THOSE WHO HAVE SEVERE AORTIC STENOSIS (SIGNIFICANT CALCIFIED/THICKENED VALVE OBSTRUCTING OUTWARD BLOOD FLOW). THE CRITERIA AT THIS POINT ARE STRICT, AND THERE ARE SIDE EFFECTS (STROKE) THAT ARE BEING ADDRESSED, BUT THIS IS THE FUTURE UNFOLDING BEFORE OUR EYES. 3. EXCITING AND BEING PERFORMED EVERY DAY NOW IN CATH LABS ARE RADIAL (WRIST) CATHETERIZATIONS (ANGIOGRAMS) AND ANGIOPLASTIES (BALLOON AND STENT DEPLOYMENT). IT IS NOT FOR EVERYONE, BUT MANY ARE ELECTING TO USE THEIR WRIST INSTEAD OF THEIR GROINS ACROSS THE NATION. 

MAY YOU AND YOUR FAMILIES BE BLESSED WITH HEALTH AND JOY FOR THE COMING YEAR. STAY TUNED FOR DAILY BLOGS AND OUR YEAR END REVIEW OF WHAT WAS HOT AND WHAT WAS NOT FOR YOUR HEART IN 2011!

GOOD NEWS: OVER PAST DECADE, THERE HAS BEEN 30% LESS CARDIOVASCULAR DEATH. BAD NEWS: WE ARE MORE OVERWEIGHT AND DIABETIC THAN EVER!  17% OF OUR TEENS ARE OBESE, AND THERE IS A 15% INCREASE IN CHILDHOOD OBESITY. NEARLY 40% OF U.S. ADULTS ARE DITS (DIABETIC IN TRAINING SYNDROME), 1/3 ADULTS HAVE HYPERTENSION AND 50% OF THEN ARE NOT CONTROLLED! CONCLUSION: WE MAY DIE LESS, BUT ALL SIGNS INDICATE A CONTINUED LARGE BURDEN OF VASCULAR DISEASE UNLESS WE CONTROL OUR RISK FACTORS. “GET TO IT, BEFORE IT GETS TO YOU!”

A RECENT AUSTRALIAN REVIEW EXAMINED NUTRITION AND PREVENTING STROKE. IT FOUND: ANTIOXIDANT VITAMINS C AND E, B VITAMINS, AND CALCIUM DO NOT PREVENT STROKE. (EXCEPTION-TREATING FOLIC ACID AND D DEFICIENCIES MAY BE PREVENTATIVE) THE MEDITERRANEAN DIET, DUE TO ITS FISH AND FRUIT CONTENT REDUCES STROKE, LIKEWISE THE DASH DIET WITH LOWER SALT INTAKE IS EFFECTIVE. FOR YOU CHOCOHOLICS, >70% COCOA IN MODERATION MAY BE PREVENTATIVE.  http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(11)70265-4/fulltext

AFTER 4 CASES FOR US THIS YEAR (MOST RECENTLY SUNDAY) OF TAKO SUBO CARDIOMYOPATHY AKA “BROKEN HEART” SYNDROME, A RECENT REPORT IS TIMELY. TAKO SUBO IS STRESS INDUCED (UP TO 30X HIGHER ADRENALINE LEVELS IN THE BODY) WITH RESULTING WEAKENING AND ENLARGING OF THE HEART THAT OCCURS SUDDENLY. THERE ARE NO CORONARY BLOCKAGES PRESENT. WITH SUPPORTIVE CARE AND CARDIAC MEDS, THE MAJORITY WILL RECOVER COMPLETELY. A RECENT STUDY OF 6,800 CASES FOUND THE MAJORITY WERE WOMEN (6200) WITH THOSE OVER 55YRS HAVING  5 TIMES THE INCREASED LIKELIHOOD TO DEVELOP A “BROKEN HEART”!

ONCOLOGISTS AND CARDIOLOGISTS HAVE LONG BATTLED THE DEVELOPMENT OF CARDIOMYOPATHY (WEAK HEART MUSCLE) DURING OR AFTER TREATMENT OF CANCER WITH CHEMOTHERAPY. (ESPECIALLY FOR BREAST CANCER) RECENTLY, 2 STUDIES USING ECHOCARDIOGRAMS (ULTRASOUND OF THE HEART), WERE ABLE TO DETECT AN ABNORMAL RELAXATION PATTERN OF THE HEART MUSCLE (DIASTOLIC DYSFUNCTION) PRIOR TO ANY SIGNIFICANT MUSCLE DAMAGE OR WEAKNESS OCCURS (SYSTOLIC DYSFUNCTION). THEY SHOWED THAT USING THE BLOOD PRESSURE MEDICATION ACE INHIBITORS AND CHOLESTEROL LOWERING STATIN MEDICATIONS THIS ABNORMAL RELAXATION PATTERN COULD BE LESSENED. FURTHER LARGE STUDIES WILL BE PERFORMED.

A. A RECENT CONSUMER REPORTS STUDY OF AT LEAST 15 MAJOR BRANDS, DETERMINED THAT OVERALL THEY CONTAINED THE STATED MILLIGRAM LABEL DOSE,

BUT SOME MAY POSSIBLY CONTAIN PCB CONTAMINANTS OR FAIL TO HAVE STABLE STOMACH COATINGS DESIGNED TO PREVENT THE “FISHY” AFTERTASTE.

 B. A STUDY OF NEARLY 50,000WOMEN (AVE AGE 30) AND FISH CONSUMPTION FOUND THAT OVER A TEN YEAR PERIOD, THE LOWEST INTAKE PRODUCED THE HIGHEST RISK FOR CARDIOVASCULAR DISEASE.

 (http://hyper.ahajournals.org/content/early/2011/12/04/HYPERTENSIONAHA.111.179382.abstract) FOR MORE INFO, LISTEN TO OUR GREAT SHOW “WE MAKE YOU SLEEP WITH DA FISHES”,

ONE OF OVER 70 SHOWS IN OUR ARCHIVES!

I SAY BIG DEAL. WITH THE ONSET OF HEALTH CARE REFORM AND SUBSEQUENT DAY TO DAY RULE CHANGES BY INSURANCE COMPANIES, A STATIN DISCREPANCY EMERGED. OVER THE PAST SEVERAL YEARS, PATIENTS WERE TOLD THAT THEIR LIPITOR AND CRESTOR PRESCRIPTIONS WOULD NOT BE FILLED AND INSTEAD THE EQUIVALENT GENERIC STATIN (PRAVASTATIN, SIMVASTATIN etc) WOULD BE COVERED.  THAT WAS AN ACCIDENT WAITING TO HAPPEN. AS I TELL MY PATIENTS, IF CRESTOR AND LIPTOR ARE THE EMPIRE STATE BUILDING, ALL THE OTHERS ARE  STUDIO APARTMENTS, REGARDLESS OF THEIR DOSAGES.  IT WAS OBSERVED IF WE FOLLOWED THEIR METHODS, A 6% INCREASE IN HEART ATTACK AND DEATH COULD OCCUR. SO, LIPITOR IS NOW ATORVASTATIN, A GENERIC SKYSCARAPER FOR THOSE WHO NEED ITS POWERFUL RISK REDUCTION.  AS ALWAYS, LEARN ALL THE FACTS, GOOD OR BAD ABOUT STATINS BY DISCUSSING THEM WITH YOUR HEALTH CARE PROVIDER. FOR HELP, PUT THE KEY WORD “STATIN” IN OUR SEARCH BAR FOR ALL OF OUR POSTS OVER THE PAST 2 YEARS.

A RECENT ANALYSIS OF 6 STUDIES SHOWED THAT EITHER LIFESTYLE MODIFICATIONS (EXERCISE, DIET, WEIGHT LOSS) OF CARDIAC RISK FACTORS (HYPERTENSION, DIABETES, SMOKING, ELEVATED CHOLESTEROL) OR MEDICAL THERAPY (BP OR DIABETES MEDS, STATINS) ALSO SHOWED STATISTICALLY SIGNIFICANT IMPROVEMENT IN ERECTILE DYSFUNCTION. TAKE THAT LITTLE BLUE PILL! FOR MORE INFO ON WHY E.D. MARKS THE COMING OF VASCULAR DISEASE, LISTEN TO “ITS BETTER TO BE IMPORTANT THAN IMPOTENT” FROM SHU ARCHIVES!

RECENTLY, NEWS THAT TAKING PRESCRIPTION EXTENDED RELEASE NIACIN MAY NOT BE BENEFICIAL IN HEART DISEASE PREVENTION, AND IN FACT, MAY BE HARMFUL. THIS WAS GENERATED FROM A TRIAL OF HEART DISEASE PATIENTS ALREADY ON A STATIN WITH VERY LOW LDL (BAD) LEVELS, BUT ALSO LOW HDL (GOOD) CHOLESTEROL. HISTORICALLY NIACIN BENEFITS BY RAISING HDL LEVELS. HERE IS WHAT YOU NEED TO KNOW FROM THE EXPERTS AT THE NATIONAL LIPID ASSN: 1. THIS WAS A SMALL TRIAL, STOPPED PREMATURELY DUE TO FEAR OF INCREASED STROKE IN THE NIACIN ARM–WHEN DUST SETTLED, MOST BELIEVE STROKE RISK WAS “CHANCE” WITH NO DIFFERENCE VS. PLACEBO. MOST TRIALS CONTINUE TO 5 YEARS WITH CLINICAL BENEFITS SEEN 2-3 YRS INTO THE TRIAL. 2. NIACIN IS TRADITIONALLY USED TO BE AN ADJUNCT TO OTHER MEDS/SUPPLEMENTS TO LOWER LDL OR RAISE HDL (OR BOTH), THIS WAS NOT  THIS TRIAL’S DESIGN! 3. A LARGER, BETTER CONSTRUCTED TRIAL WITH VARIABLE LDL AND HDL LEVELS WILL ANSWER THE NIACIN ISSUE FOR THE “REAL WORLD”, BY 2013. UNTIL THEN, I AM CONTINUING MY NIACIN AND SO SHOULD YOU!