Women under age 55 are significantly less likely to be on optimal therapy 1 year after a heart attack compared with male heart attack survivors of the same age, according to a study published online October 13, 2015 in Circulation: Cardiovascular Quality and Outcomes.
After heart attack, women under age 55 take fewer cardiovascular meds than men—perhaps in part because heart disease is still considered a “man’s disease,” researchers said.(Photo: American Heart Association) “There are two possible reasons why women take fewer cardiovascular medications than men in an outpatient setting,” said lead author of the study Kate Smolina, PhD, postdoctoral fellow in pharmacoepidemiology and pharmaceutical policy at the Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada. “It is either a consequence of physicians’ prescribing behavior, or patients not taking their prescribed medication, or both.” In this retrospective population-based study, researchers analyzed data on more than 12,000 patients who were admitted to hospitals for acute myocardial infarction (AMI) between 2007 and 2009 in British Colombia, Canada, and survived for at least 1 year. Researchers determined whether patients initiated and then filled prescriptions for angiotensin converting enzyme inhibitors, beta blockers, and statins. Numerous other studies have consistently demonstrated that women are less likely than men to receive appropriate pharmacotherapy during hospitalization for AMI or at discharge. This study, which was focused on outpatient settings, found that 65% of women under age 55 initiated their treatment on all appropriate drugs after a heart attack, compared with 75% of same-aged men. “The gender gap in treatment initiation among younger women is an important finding because younger women have much worse outcomes after suffering a heart attack than do men of the same age,” said study co-author Karin Humphries, MBA, DSc, associate professor of Cardiology at the University of British Columbia. “This finding suggests that younger women should be treated aggressively, especially when we have medications that work.” Researchers could not clearly determine whether gender-based differences in treatment initiation were driven by physician prescribing practices or by patient behavior. But, either way, more focus is needed on treating young women after a heart attack, they said. “It is important for both physicians and patients to move away from the traditional thinking that heart disease is a man’s disease,” Dr. Smolina said. “Heart disease in young women has only recently received research attention, so it is possible that physicians and patients still have the incorrect perception that these heart medications pose risks to younger women.” Another important finding from this study: Only one third of all heart attack survivors (both men and women) filled all of the appropriate prescriptions for at least 80% of the year. “Overall, the majority of AMI survivors either discontinue treatment or do not refill their prescriptions consistently, suggesting that further improvements in post-AMI therapy management are necessary,” the authors concluded. Read Entire Article: https://www.mdlinx.com/cardiology/article/199?cid=15 Takeaway
Read Article: https://www.univadis.com/viewarticle/improving-health-literacy-improves-bp-reductions-454696 John Paul Runyon, MD, FACC, FSCAI, FCCP, cardiologist at Ohio Heart And Vascular Center, and affiliated with Adams County Regional Medical Center and The Christ Hospital, has been named a 2016 Top Doctor in Cincinnati, Ohio. Top Doctor Awards is dedicated to selecting and honoring those healthcare practitioners who have demonstrated clinical excellence while delivering the highest standards of patient care.
Dr. John Paul Runyon is a highly experienced cardiologist, having been in practice for more than 33 years. His long and successful career in medicine began in 1983, when he graduated from the University of Kentucky in Lexington. Since entering private practice, Dr. Runyon has also served in a number of senior academic and research positions, including as Associate Professor of Medicine at the University of Cincinnati. Dr. Runyon is dual board certified in Internal Medicine and in Cardiovascular Disease, and with his wealth of experience he treats a wide range of conditions relating to the heart and vascular system, from cardiomyopathy to arrhythmias and acute myocardial infarction. Expert procedures undertaken by Dr. Runyon include cardiac catheterization and cardiac MRI, and coronary angioplasty. Dr. Runyon is renowned across Ohio and beyond as an innovator in the field of cardiology. He is noted for his use of minimally invasive techniques, and for lower limb preservation, and has led clinical trials and research in this area. He is now using his experience and expertise in his role as a physician executive. His dedication and commitment makes Dr. John Paul Runyon a very worthy winner of a 2016 Top Doctor Award. About Top Doctor Awards Top Doctor Awards specializes in recognizing and commemorating the achievements of today’s most influential and respected doctors in medicine. Our selection process considers education, research contributions, patient reviews, and other quality measures to identify top doctors. What if a blood test could reveal that your child is at high risk for early heart disease years in the future, giving you a chance to prevent it now? A big study in England did that—screening thousands of babies for inherited risk—and found it was twice as common as has been thought.
The study also revealed parents who had the condition but didn't know it, and had passed it on to their children. Ninety percent of them started taking preventive medicines after finding out. Researchers say the two-generation benefits may convince more parents to agree to cholesterol testing for their kids. An expert panel in the United States recommends this test between the ages of 9 and 11, but many aren't tested now unless they are obese or have other heart risk factors such as diabetes or high blood pressure. For every 1,000 people screened in the study, four children and four parents were identified as being at risk for early heart disease. That's nearly twice as many as most studies in the past have suggested. "We really need to pay attention to this," said Dr. Elaine Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center and a member of the U.S. expert panel. "It's reasonable to screen for something that's common, dangerous and has a treatment that's effective and safe." Dr. William Cooper, a pediatrics and preventive medicine professor at Vanderbilt University, called it "an innovative approach" that finds not just kids at risk but also parents while they're still young enough to benefit from preventive treatment, such as cholesterol-lowering statin drugs. Statins aren't recommended until around age 10, but certain dietary supplements such as plant sterols and stanols could help younger kids, Urbina said. "We're not talking about putting all these kids on statins," she said. The study was led by Dr. David Wald at Queen Mary University of London. He and another author founded a company that makes a combination pill to prevent heart disease. The work was funded by the Medical Research Council, the British government's health research agency. Results were published Wednesday by the New England Journal of Medicine. Researchers were testing for familial hypercholesterolemia, a genetic disorder that, untreated, raises the risk of a heart attack by age 40 tenfold. They did a heel-stick blood test on 10,059 children ages 1 to 2 during routine immunization visits to check for high cholesterol and 48 gene mutations that can cause the disorder. If a child was found with the disorder, parents were tested. One in 270 children had the gene mutations; others were identified through cholesterol levels alone. "That's a pretty common genetic defect," said Dr. Stephen Daniels, chairman of pediatrics at the University of Colorado School of Medicine and a member of the U.S. expert panel. But many parents balk at the idea of testing children for a disorder associated with middle age, experts say. Karen Teber, a media relations specialist in Madison, Wisconsin, was surprised when a doctor wanted to test her 12-year-old stepson. "My reluctance was really born out of lack of information," she said. "I hadn't heard of it before." The study did not address whether screening is cost-effective. In the U.S., cholesterol tests cost around $80 and usually are covered by health insurance, though much lower prices often are negotiated. The study authors in England estimated that if cholesterol testing costs $7 and gene testing costs $300, it would cost $2,900 for every person identified as having the disorder. Read Article: medicalxpress.com/news/2016-10-cholesterol-one-year-olds.html By how much does sitting for 8 hours a day increase your risk of death? This risk is NOT possible to estimate as it depends on a number of factors including physical activity levels. Can you please outline your recent study analyzing the impact of exercise on the risk of death for people who sit for prolonged periods of time? Compelling evidence from many observational studies shows that lack of physical activity increases the risks of many non-communicable diseases such as type 2 diabetes, cardiovascular disease, stroke, some cancers, and premature mortality. Sedentary behavior, on the other hand, has emerged as a potential risk factor for many chronic conditions and mortality during the last decade. However, it was unknown whether physical activity may attenuate, or even eliminate, the detrimental association between sitting time with death. Our study was a systematic review including a meta-analysis, which is considered the strongest proof of evidence. We systematically searched the literature for studies including data on sitting time, physical activity and mortality from cardio-vascular diseases, cancers, and all-causes. We identified 16 studies and contacted all principal investigators of these studies and asked whether they were willing to reanalyze their data according to a harmonized protocol. All but one, agreed to participate in the project. We then also included two studies where pertinent data were available but not published. In a second step, we performed a meta-analysis taking into account all individual study results. We examined the joint association between sitting time, in four groups, and physical activity, also stratified in four groups (i.e. in total 16 groups) where the most active group in combination with the lowest amount of sitting was the reference group. Thus, the risk of death in all other groups were compared with this reference group. This primary analysis included more than 1 million healthy men and women who were followed between 2 and 18 years. The reference group reported between 60 and 75 minutes of moderate intensity activity (e.g. brisk walking or cycling) every day in combination with less than four hours of sitting every day. We thereafter repeated all analyses where we substituted sitting time with time spent viewing TV in those study where this variable was available (465,000 men and women). We also estimated the risk of death from cancer and cardio-vascular diseases in those studies where these data were available. What were your main findings? Was the increased risk of death in people who sit for 8 hours a day eliminated by exercise?Our results clearly suggested that 60 to 75 minutes of physical activity such as brisk walking or cycling eliminated the association between sitting time and death. In other words, there was no increased risk in those who were active at this level regardless if they sat for more than 8 hours per day. This high activity level was reported by about 25% of the participants. We then performed additional analyses in a sub-sample where we also estimated whether the risk was increased in those who reported more than 10 hours of sitting per day and the results were unchanged. The results for TV viewing were similar, however, watching TV for more than three hours every day was associated with increased risk of mortality regardless of the amount of physical activity except in the most active 25% of the participants where mortality risk was increased only in those who watched TV for more than five hours per day. Your research looked at “moderate intensity” exercise – how is this defined? So do we need to go to the gym in order to eliminate the risks or are other forms of physical activity such as walking sufficient?We defined moderate intensity physical activity as activities that increase energy expenditure about three to four times resting energy expenditure. Common examples of such activities are walking at 5.5 km/h or cycling at 16 km/h. This means that you do not have to go to the gym or participate in vigorous sport activities rather everyday activities than most people can undertake, as part of their everyday life is sufficient to reduce the risk. Is it necessary to get at least 1 hour of exercise a day to have an impact or would a shorter amount of exercise still have an effect?Every minute counts. Our data showed that the risk was reduced also in those who participated in less amounts of activity every day compared with those who were almost completely physically inactive. Many studies have shown that also lower amounts of physical activity of about 15 minutes per day reduces the risk for mortality and chronic diseases compared with those who are completely inactive. How much evidence is there for high intensity exercise?We did not specifically examine high intensity activity but it is suffice to assume that high intensity activity provides even further benefits provided the amount of time spent in high intensity activity is similar. This is also in line with the current physical activity recommendations for public health suggesting that all adults should be active for at least 150 minutes of moderate intensity per week, or 75 minutes of vigorous intensity, or a combination of both. Importantly, some recommendations also suggest that the optimal dose is one hour of moderate intensity activity every day. What advice would you give to people that have desk-based jobs and can’t escape sitting for long periods?Take every opportunity to stand up and walk for a few minutes. Try to find opportunities to be physically active as part of your journey to work, during breaks at work and during lunch time. Why not introduce walking meetings at your job and be as active as you can during leisure time. Take a brisk walk in the evening rather than watching TV and walk the dog even if you don’t have a dog. Read Entire Article: http://www.news-medical.net/news/20160929/Does-exercise-eliminate-the-ill-effects-of-sitting-An-interview-with-Prof-Ulf-Ekelund.aspx John Paul Runyon, MD, FACC, FSCAI, FCCP, cardiologist at Ohio Heart And Vascular Center, and affiliated with Adams County Regional Medical Center and The Christ Hospital, has been named a 2016 Top Doctor in Cincinnati, Ohio. Top Doctor Awards is dedicated to selecting and honoring those healthcare practitioners who have demonstrated clinical excellence while delivering the highest standards of patient care.
Dr. John Paul Runyon is a highly experienced cardiologist, having been in practice for more than 33 years. His long and successful career in medicine began in 1983, when he graduated from the University of Kentucky in Lexington. Since entering private practice, Dr. Runyon has also served in a number of senior academic and research positions, including as Associate Professor of Medicine at the University of Cincinnati. Dr. Runyon is dual board certified in Internal Medicine and in Cardiovascular Disease, and with his wealth of experience he treats a wide range of conditions relating to the heart and vascular system, from cardiomyopathy to arrhythmias and acute myocardial infarction. Expert procedures undertaken by Dr. Runyon include cardiac catheterization and cardiac MRI, and coronary angioplasty. Dr. Runyon is renowned across Ohio and beyond as an innovator in the field of cardiology. He is noted for his use of minimally invasive techniques, and for lower limb preservation, and has led clinical trials and research in this area. He is now using his experience and expertise in his role as a physician executive. His dedication and commitment makes Dr. John Paul Runyon a very worthy winner of a 2016 Top Doctor Award. About Top Doctor Awards Top Doctor Awards specializes in recognizing and commemorating the achievements of today’s most influential and respected doctors in medicine. Our selection process considers education, research contributions, patient reviews, and other quality measures to identify top doctors. A recent report discusses the best way to predict sudden cardiac death in young athletes.10/20/2016
Although rare, sudden cardiac death in young athletes raises serious concerns, especially because most victims report no warning symptoms. Pre-participation screening aims to identify children, adolescents, and young adults at risk, but there is not yet consensus regarding the best way to accomplish this. A new report in the Canadian Journal of Cardiology sheds light on this controversial topic by describing a new screening protocol that offers advantages over American Heart Association (AHA) recommendations and shows that the electrocardiogram (ECG) is the best single screening method.
Cardiologists from the University of British Columbia Vancouver Coastal Health, Vancouver, BC, Canada, compared their own innovative screening protocol to that recommended by the AHA. Both protocols use 12-lead ECGs and questionnaires. However, one problem associated with the AHA questionnaire is the high rate of false positives (identifying someone as having a serious condition when he does not). A false-positive result requires extensive further testing and consultation with a cardiologist, leading to worry, secondary testing, and higher costs. The researchers' new evidence-based questionnaire was designed to better differentiate between symptoms indicative of serious cardiac disease and those related to more benign conditions. The AHA method also involves a physical exam conducted by a physician that includes listening to the heart (auscultation). Investigators screened more than 1400 young competitive athletes ages 12-35 years. Approximately half underwent the AHA recommended screening, and the other half the experimental protocol. Seven participants were found to have serious heart conditions, and six were identified by ECG. Only two of the seven would have been detected as the result of a medical history and physical exam. "The current study provides further evidence to support the use of the ECG as an important tool in the screening of young competitive athletes," explained lead investigator James McKinney, MD, MSc, of the Division of Cardiology of the University of British Columbia. "The ECG is more sensitive in detecting heart muscle problems (cardiomyopathies) and potentially life-threatening electrical disorders such as Wolff-Parkinson-White and long QT syndrome." "An Achilles heel of pre-participation screening has long been the unacceptably high false-positive rate and the costs associated with screening large numbers of athletes," noted co-investigator Saul Isserow, MBBCh, of the Division of Cardiology of the University of British Columbia. In the study, the false-positive rate of the new protocol was less than half that of the AHA protocol (3.7% vs. 8.1%). Investigators found that the physical examination was unhelpful and costly. The physical exam prompted further evaluation in 10 athletes without identifying any of the athletes who actually had heart disease and contributed to higher false-positive rates. "This is not surprising because cardiac auscultation requires years of experience and conditions during mass screening are not ideal for meticulous cardiac auscultation," commented Michael Papadakis, MBBS, MD, and Sanjay Sharma, MBChB, MD, of St. George's University of London in an accompanying editorial. The research indicates that a screening protocol that includes a more specific questionnaire and ECG, but excludes a physical examination, eliminating the need for an on-site physician, would be desirable to optimize efficiency and produce important cost savings. The researchers calculate that eliminating physician costs would result in huge reductions in per person screening costs ($14.42 for new protocol vs. $97.50 for AHA protocol) and costs per diagnosis ($3,822.70 vs. $41,320.49, respectively). "A large proportion of sudden cardiac deaths in young athletes are secondary to inherited or congenital cardiac diseases that are detectable during life and for which several therapeutic options are available to minimize the risk of death. Pre-participation screening is widely used to detect athletes at risk of exercise-related sudden cardiac death, but the optimal approach remains elusive," added Dr. Papadakis and Dr. Sharma. The results of this study indicate the need to harmonize the results of research findings with current practice. Still to be determined is the important question of whether screening saves lives. Read Article: http://www.news-medical.net/news/20160930/New-report-reveals-optimal-way-to-detect-young-athletes-at-risk-of-sudden-cardiac-death.aspx Study evaluates outcomes of hypothermia treatment among patients with in-hospital cardiac arrest10/19/2016
In a study appearing in the October 4 issue of JAMA, Paul S. Chan, M.D., of Saint Luke's Mid America Heart Institute, Kansas City, and colleagues evaluated the association of hypothermia treatment with survival to hospital discharge and with favorable neurological survival at hospital discharge among patients with in-hospital cardiac arrest.
Therapeutic hypothermia, or targeted temperature management, is recommended for comatose patients following both out-of-hospital and in-hospital cardiac arrest. Nevertheless, therapeutic hypothermia has only been shown to improve overall survival and rates of favorable neurological survival in patients with out-of-hospital cardiac arrest due to ventricular fibrillation. Whether this treatment improves survival for patients with in-hospital cardiac arrest is unknown. As in-hospital cardiac arrest affects approximately 200,000 individuals annually in the United States, there is a need to understand whether therapeutic hypothermia is associated with improved survival for these patients. With the use of the national Get With the Guidelines-Resuscitation registry, the researchers identified 26,183 patients successfully resuscitated from an in-hospital cardiac arrest between March 2002 and December 2014, and either treated or not treated with hypothermia at 355 U.S. hospitals. Overall, 1,568 of 26,183 patients with in-hospital cardiac arrest (6 percent) were treated with therapeutic hypothermia; 1,524 of these patients were matched to 3,714 non-hypothermia-treated patients. After adjustment, therapeutic hypothermia was associated with lower in-hospital survival (27.4 percent vs 29.2 percent), and this association was similar for nonshockable cardiac arrest rhythms (22.2 percent vs 24.5 percent) and shockable cardiac arrest rhythms (41.3 percent vs 44.1 percent). Therapeutic hypothermia was also associated with lower rates of favorable neurological survival for the overall study group (hypothermia-treated group, 17 percent; non-hypothermia-treated group, 20.5 percent) and for both rhythm types. When follow-up was extended to 1 year, there remained no survival advantage with therapeutic hypothermia treatment. "Collectively, these findings do not support current use of therapeutic hypothermia for patients with in-hospital cardiac arrest," the authors write. "These observational findings warrant a randomized clinical trial to assess efficacy of therapeutic hypothermia for in-hospital cardiac arrest." Read Article: http://www.news-medical.net/news/20161004/Study-evaluates-outcomes-of-hypothermia-treatment-among-patients-with-in-hospital-cardiac-arrest.aspx Both heredity and environmental factors influence our risk of cardiovascular disease. A new study, by researches at Uppsala University, shows now that the memory of a heart attack can be stored in our genes through epigenetic changes. The results have been published in the journal Human Molecular Genetics
We inherit our genes from our parents at birth. During our lifetime, chemical modifications of DNA that turn off or on our genes, so-called epigenetic changes, occur. These changes can lead to the development of various diseases. In the current study, the researchers examined epigenetic changes in people who have had a previous heart attack. 'During a heart attack the body signals by activating certain genes. This mechanism protects the tissue during the acute phase of the disease, and restores the body after the heart attack. It is therefore likely that it also occurs epigenetic changes associated a heart attack', says Åsa Johansson, a researcher at the Department of Immunology, Genetics and Pathology, who led the study. The results of the study showed that there are many epigenetic changes in individuals who had experienced a heart attack. Several of these changes are in genes that are linked to cardiovascular disease. However it was not possible to determine whether these differences had contributed to the development of the disease, or if they live on as a memory of gene activation associated with the heart attack. 'We hope that our new results should contribute to increasing the knowledge of the importance of epigenetic in the clinical picture of a heart attack, which in the long run could lead to better drugs and treatments', says Åsa Johansson. Read Article: http://www.news-medical.net/news/20160919/Memory-of-heart-attack-can-be-stored-in-genes-through-epigenetic-changes-study-shows.aspx A cardiologist is a doctor with special training and skill in finding, treating and preventing diseases of the heart and blood vessels.
How are Cardiologists Trained? Cardiologists receive extensive education, including four years of medical school and three years of training in general internal medicine. After this, a cardiologist spends three or more years in specialized training. That’s ten or more years of training! How Does a Cardiologist Become Certified? In order to become certified, doctors who have completed a minimum of ten years of clinical and educational preparation must pass a rigorous two-day exam given by the American Board of Internal Medicine. This exam tests not only their knowledge and judgment, but also their ability to provide superior care. When Would I See a Cardiologist? If your general medical doctor feels that you might have a significant heart or related condition, he or she will often call on a cardiologist for help. Symptoms like shortness of breath, chest pains, or dizzy spells often require special testing. Sometimes heart murmurs or ECG changes need the evaluation of a cardiologist. Cardiologists help victims of heart disease return to a full and useful life and also counsel patients about the risks and prevention of heart disease. Most importantly, cardiologists are involved in the treatment of heart attacks, heart failure, and serious heart rhythm disturbances. Their skills and training are required whenever decisions are made about procedures such as cardiac catheterization, balloon angioplasty, or heart surgery. What Does a Cardiologist Do? Whether the cardiologist sees you in the office or in the hospital, he or she will review your medical history and perform a physical examination which may include checking your blood pressure, weight, heart, lungs, and blood vessels. Some problems may be diagnosed by your symptoms and the doctor’s findings when you are examined. You may need additional tests such as an ECG, x-ray, or blood test. Other problems will require more specialized testing. Your cardiologist may recommend lifestyle changes or medicine. Each patient’s case is unique. Via our Patient Stories videos, you can experience real-life stories of heart patients, and how they have worked closely with their cardiologists, families and health care team to achieve the best heart health possible. What Kinds of Tests May the Cardiologist Recommend or Perform? Examples include:
No, however, many cardiologists do tests such as cardiac catheterizations that require small skin punctures or incisions, and some put in pacemakers. Do All Cardiologists Perform Cardiac Catheterizations? No. Many cardiologists are specially trained in this technique, but others specialize in office diagnosis, the performance and interpretation of echocardiograms, ECGs, and exercise tests. Still others have special skill in cholesterol management or cardiac rehabilitation and fitness. All cardiologists know how and when these tests are needed and how to manage cardiac emergencies. How Does the Cardiologist Work with Other Doctors in My Care? A cardiologist usually serves as a consultant to other doctors. Your physician may recommend a cardiologist or you may choose one yourself. As your cardiac care proceeds, your cardiologist will guide your care and plan tests and treatment with the doctors and nurses who are looking after you. Where Do Cardiologists Work? They may work in single or group private practices. Many cardiologists with special teaching interests work in universities where their duties also include research and patient care. There are cardiologists on staff in the Veterans Administration hospitals and in the Armed Forces. Will My Insurance Cover the Services of a Cardiologist? Yes, in most cases. However, insurance plans vary and each case is handled individually. Your doctor and office staff will be glad to discuss your insurance plan and billing with you. What Questions Should I Ask My Cardiologist? There are basic questions to remember to ask, in addition to whatever questions are on your mind. For instance, if you have had a coronary angiogram, you may ask to see the pictures of your heart and have your cardiologist explain what they mean. Your heart and health are, of course, vitally important to you. Remember, your cardiologist wants you to understand your illness and be an active participant in your own care. Read Entire Article: https://www.cardiosmart.org/heart-basics/what-is-a-cardiologist |
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