Tag Archives: cardiovascular

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Mobile Cardiovascular Screening Packages Come Underneath Fire

It seems like a no brainer. Cardiovascular screening is the #1 killer in the world so broad screening of the general population must be a good idea, right? Wrong, says the consumer group Public Citizen, at least when such screening is performed indiscriminately. Somewhat surprisingly, Public Citizen, which is often held at arm’s length by mainstream medicine, gained some support for its position from a major cardiology organization.

In its statement Public Citizen urged 20 hospitals to sever their involvement in a mobile cardiovascular screening program. The HealthFair Cardiovascular Screening Packages are unethical, mislead consumers, and do more harm than good, said Public Citizen.

In a blog post, the president of the American College of Cardiology. Patrick O’Gara, said that “the questions raised about screening have some merit…. we do not recommend broad and untargeted screening.”

The program, says Public Citizen, “peddles inexpensive cardiovascular disease screening packages to people living near the hospitals and institutions without identifying who has relevant risk factors that would make each of the screening tests medically appropriate. HealthFair’s basic cardiovascular screening packages include six tests that, among other things, take pictures of the heart, measure its electrical activity and look for blockages in arteries.”

“The promotions rely on fearmongering and erroneously suggest that for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular illnesses – including heart attacks, strokes and ruptured abdominal aortic aneurysms – and make them sound like an appealing bargain,” according to Public Citizen. Among the harms cited by Public Citizen are false-positive results or the discovery of inconsequential abnormalities. ”Both circumstances can lead to additional unnecessary and risky tests and treatments that will harm some people, cause unfounded anxiety, and cost patients and insurance companies.”

Here is O’Gara’s statement about the issues raised by Public Citizen:

“The questions raised about screening have some merit. The American College of Cardiology and American Heart Association have joint guidelines that offer recommendations to guide physicians in making decisions with individual patients about their risk for heart attack and stroke. Other than assessing blood pressure and serum cholesterol, being attentive to diabetes and promoting a healthy weight with regular exercise, we do not recommend broad and untargeted screening. Decisions about the need for additional testing should be based on each patient’s circumstances.

“The American College of Cardiology participates in the Choosing Wisely campaign, which encourages physicians and patients to discuss the costs and benefits of often overused tests and procedures.”

Ethan Weiss, a cardiologist at the University of California at San Francisco, sent the following explanation for the counter-intuitive perspective on the dangers of screening:

Conceptually, people (including many doctors) believe that we should do everything we can to discover occult disease like heart disease. The assumption is that if we look hard enough, we can find disease and intervene to change the outcome in a positive way. People may ask, “What’s the harm?” However, for cardiology at least, there is no evidence to support this assumption outside of screening for hypertension, lipid abnormalities and diabetes. This situation is worsened when options such as executive physicals are offered, which harden the perception that there must be some health benefit, but you just need money to access it. Again, sadly, this is not supported by evidence.

There can be serious consequences to false positive results. Usually the harm is limited to unnecessary anxiety caused by false-positive tests, but there are also costs (many of these tests are not reimbursed) and the rare cases where false positives result in more tests that lead to complications and very serious medical consequences.

Here is another anecdote: I once had a symptomatic patient with well-managed risk factors who insisted on having a nuclear stress test annually. It had been something started by a colleague of mine who had seen him before me — a very senior and respected doctor — and it was hard for me as a young doctor to overcome the perception that I did not know what I was talking about.

I kept doing the stress tests for a few years, but all the while I tried to convince him it was a mistake. I finally resorted to telling him that I was concerned about all the radiation he was getting. He continued to insist on the tests because he believed (firmly) that this was helping him and could not harm him.

One summer, I got an urgent call from him from the U.S./Canada border where he was being detained —he had set off the Geiger counter crossing the border a few days after his stress test. He was shaken. I reassured him and convinced the border patrol that he was not a terrorist. The next time he came to see me, he agreed to stop having stress tests and has not had one since.

I do believe that we can and will eventually improve our prediction tools. Right now blood pressure, lipids, and diabetes are the only validated — and thus, recommended — things to screen. This does not mean that we don¹t talk about other factors such as
weight, body composition, nutrition, and exercise with our patients. The truth is that the evidence basis for these factors are pretty flimsy too, but we make the assumption that it can’t hurt, and I try to remind patients where we have strong evidence and where we do not.

The bottom line for me is to be honest with patients about what prediction and prevention tools we have and what the evidence basis is for each of them. Going forward, we need to work on more robust and careful studies from which we can learn how to better identify at-risk individuals and also validate whether the new tools do what they should. Finally, we should work to show that the information we learn from these tools can help improve clinical outcomes.

Screen Shot 2014-06-23 at 11.44.12 AM

Screen-Shot-2014-06-23-at-11.44.12-AM

Mobile Cardiovascular Screening Plans Come Underneath Fire

It seems like a no brainer. Cardiovascular screening is the #1 killer in the world so broad screening of the general population must be a good idea, right? Wrong, says the consumer group Public Citizen, at least when such screening is performed indiscriminately. Somewhat surprisingly, Public Citizen, which is often held at arm’s length by mainstream medicine, gained some support for its position from a major cardiology organization.

In its statement Public Citizen urged 20 hospitals to sever their involvement in a mobile cardiovascular screening program. The HealthFair Cardiovascular Screening Packages are unethical, mislead consumers, and do more harm than good, said Public Citizen.

In a blog post, the president of the American College of Cardiology. Patrick O’Gara, said that “the questions raised about screening have some merit…. we do not recommend broad and untargeted screening.”

The program, says Public Citizen, “peddles inexpensive cardiovascular disease screening packages to people living near the hospitals and institutions without identifying who has relevant risk factors that would make each of the screening tests medically appropriate. HealthFair’s basic cardiovascular screening packages include six tests that, among other things, take pictures of the heart, measure its electrical activity and look for blockages in arteries.”

“The promotions rely on fearmongering and erroneously suggest that for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular illnesses – including heart attacks, strokes and ruptured abdominal aortic aneurysms – and make them sound like an appealing bargain,” according to Public Citizen. Among the harms cited by Public Citizen are false-positive results or the discovery of inconsequential abnormalities. ”Both circumstances can lead to additional unnecessary and risky tests and treatments that will harm some people, cause unfounded anxiety, and cost patients and insurance companies.”

Here is O’Gara’s statement about the issues raised by Public Citizen:

“The questions raised about screening have some merit. The American College of Cardiology and American Heart Association have joint guidelines that offer recommendations to guide physicians in making decisions with individual patients about their risk for heart attack and stroke. Other than assessing blood pressure and serum cholesterol, being attentive to diabetes and promoting a healthy weight with regular exercise, we do not recommend broad and untargeted screening. Decisions about the need for additional testing should be based on each patient’s circumstances.

“The American College of Cardiology participates in the Choosing Wisely campaign, which encourages physicians and patients to discuss the costs and benefits of often overused tests and procedures.”

Ethan Weiss, a cardiologist at the University of California at San Francisco, sent the following explanation for the counter-intuitive perspective on the dangers of screening:

Conceptually, people (including many doctors) believe that we should do everything we can to discover occult disease like heart disease. The assumption is that if we look hard enough, we can find disease and intervene to change the outcome in a positive way. People may ask, “What’s the harm?” However, for cardiology at least, there is no evidence to support this assumption outside of screening for hypertension, lipid abnormalities and diabetes. This situation is worsened when options such as executive physicals are offered, which harden the perception that there must be some health benefit, but you just need money to access it. Again, sadly, this is not supported by evidence.

There can be serious consequences to false positive results. Usually the harm is limited to unnecessary anxiety caused by false-positive tests, but there are also costs (many of these tests are not reimbursed) and the rare cases where false positives result in more tests that lead to complications and very serious medical consequences.

Here is another anecdote: I once had a symptomatic patient with well-managed risk factors who insisted on having a nuclear stress test annually. It had been something started by a colleague of mine who had seen him before me — a very senior and respected doctor — and it was hard for me as a young doctor to overcome the perception that I did not know what I was talking about.

I kept doing the stress tests for a few years, but all the while I tried to convince him it was a mistake. I finally resorted to telling him that I was concerned about all the radiation he was getting. He continued to insist on the tests because he believed (firmly) that this was helping him and could not harm him.

One summer, I got an urgent call from him from the U.S./Canada border where he was being detained —he had set off the Geiger counter crossing the border a few days after his stress test. He was shaken. I reassured him and convinced the border patrol that he was not a terrorist. The next time he came to see me, he agreed to stop having stress tests and has not had one since.

I do believe that we can and will eventually improve our prediction tools. Right now blood pressure, lipids, and diabetes are the only validated — and thus, recommended — things to screen. This does not mean that we don¹t talk about other factors such as
weight, body composition, nutrition, and exercise with our patients. The truth is that the evidence basis for these factors are pretty flimsy too, but we make the assumption that it can’t hurt, and I try to remind patients where we have strong evidence and where we do not.

The bottom line for me is to be honest with patients about what prediction and prevention tools we have and what the evidence basis is for each of them. Going forward, we need to work on more robust and careful studies from which we can learn how to better identify at-risk individuals and also validate whether the new tools do what they should. Finally, we should work to show that the information we learn from these tools can help improve clinical outcomes.

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European Regulators Investigate Cardiovascular Safety Of Ibuprofen

The European Medicines Agency announced on Friday that it had initiated a overview of the cardiovascular safety of ibuprofen when taken in high doses over  an extended period of time. The review will be carried out by the Pharmacovigilance Risk Assessment Committee (PRAC).

The EMA explained that people taking ibuprofen ought to proceed to take it as extended as they follow the package deal label or the guidelines of their doctor or pharmacist.

The cardiovascular threat of all non-steroidal anti-inflammatory medicines (NSAIDs) have been below near scrutiny for a amount of years. The enhanced danger connected with a single group of NSAIDs, the COX-two inhibitors, has been acknowledged for much more than a decade. Researchers have also located evidence for cardiovascular difficulties with the NSAID diclofenac.

The agency mentioned it had located no proof for a problem in men and women taking doses significantly less than two,400 mg/day or for quick periods of time. ”Ibuprofen is one of the most broadly employed medicines for soreness and inflammation and has a properly-known safety profile, specifically at normal doses,” the EMA explained.

English: Air pollution

Air Pollution and Cardiovascular Disease: It’s Complex

Epidemiology research have supplied powerful proof linking air pollution to cardiovascular condition, specifically heart attacks (MI) and stroke. By some estimates, air pollution could be accountable for 3.two million deaths every single year, most from cardiovascular leads to.

At 1st glance, a new examine published in Heart seems to cast doubt on this association. Analyzing U.K. information from far more than 400,000 MIs, 2 million hospital admissions, and 600,000 CV deaths, London-based mostly researchers turned up conflicting and hard-to-interpret findings regarding the effects of air pollution on cardiovascular well being. Remarkably, the researchers did not discover a considerable association among brief-phrase exposure to air pollution and the chance for either MI or stroke. But they did flip up some important associations. Nitrogen dioxide was linked to hospital admissions for CV ailment, non-MI CV condition, arrhythmias, and heart failure. PM2.five — particulate matter with diameters smaller than 2·5 μm — was linked to deaths from arrhythmias, atrial fibrillation, and pulmonary embolism.

But though the review failed to elucidate the pathways by which air pollution might lead to cardiovascular occasions, the complicated final results might well reflect a broadly favorable trend in pollution reduction in the U.K. In an accompanying editorial, Anoop Shah and David Newby point out that air pollution in the research appeared to be really reasonable in contrast with “many of the megacities across the world,” which have PM2.5 levels 10-twenty occasions the median level measured in the U.K. in the recent examine.

The title of their editorial is, “Less Clarity as the Fog Starts to Lift.” They conclude: “Some have suggested that associations with adverse cardiovascular occasions persist even at reduced pollutant concentrations, but as air high quality continues to boost, the adverse affect on health will decline. The recent lack of steady associations with contemporary U.K. information could suggest that as the fog begins to clear, the adverse well being results of air pollution are commencing to have much less of an influence and are more tough to delineate.”

English: Air pollution

English: Air pollution (Photograph credit score: Wikipedia)

Cardiovascular Illness Declines in Wealthy Nations but Grows Elsewhere

A new Worldwide Cardiovascular Condition (CVD) Atlas portrays a divided globe the place wealthy countries are slowly freeing themselves from the yoke of CVD but in which numerous bad and middle-income countries are even now struggling.

Ischemic heart illness and stroke have been the two largest contributors to the global burden of disease in 2010, accounting for 5.2% and 4.one%, respectively, of all disability adjusted existence many years (DALYs). From 1990 to 2010 the global age-standardized mortality charges of heart illness and stroke decreased, but the absolute quantity of deaths increased from 5,211,790 to 7,029,270 deaths for heart illness and from 4,660,450 to five,874,180 deaths for stroke.

Diet program, large blood strain, and tobacco had been the three foremost chance elements throughout the world. Tobacco’s role was significantly more substantial in East Asia and Southeast Asia than in Australasia, Western Europe, and North America, in which efforts to curb smoking have been successful. Alcohol was the fifth most essential danger factor in Eastern Europe, but ranked no greater than 10th in other areas.  In East Asia air pollution was the fourth most essential risk factor. Higher entire body mass index was the third most essential threat issue in Australasia, North America, Europe, Central Asia, Latin American/Caribbean, North Africa, and the Middle East.

From 1990 to 2010 Norway, Ireland, the U.K., and Israel almost cut in half the crude DALY burden per a hundred,000 individuals.  “The reductions in CVD burden per capita in substantial earnings areas are extraordinary, and have occurred despite aging populations,” stated Andrew Moran, the first writer of a summary published in Worldwide Heart. “Other studies of CVD trends recommend that CVD reductions in the large revenue world are due to a mixture of reduced smoking, enhanced danger element management, and improved treatment options. Some adjustments in diet regime, life style, and broader social and economic forces could perform a position too, but are tougher to measure.”

By contrast, the nations of the former Soviet Union had huge increases of at least thirty% in their DALY burden.  Said Moran, “the big contributions of alcohol and tobacco factors to underlying social and economic forces at perform.”

Weight problems, bad diet regime, and substantial blood pressure have caused increases in the burden of CVD in North Africa and the Middle East. In Kuwait the incidence of CVD DALYs improved by 28%.

In the U.S., per capita DALYs decreased by 33% in between 1990 and 2010, but the general crude DALY charge of 4485.86 per 100,000 men and women left it in the middle of the pack of higher-cash flow nations. In 2010, Brunei had the lowest fee in this group — 2321.97  per a hundred,000 — whilst Greece had the highest price — 6455.03 per 100,000.

Moran stated that the only way to lower the higher burden of CVD in significantly of the globe “will be to lengthen the CVD manage successes of the high earnings planet to lower and middle revenue nations. In some instances this may imply adapting past effective applications in other circumstances locally tailored and modern approaches will be required.”

English: Mohawk Stop Sign

Novartis Trial Was Stopped Early Since Of A Substantial Drop In Cardiovascular Mortality

The biggest-ever trial in heart failure was stopped early due to the fact of a extremely statistically significant reduction in cardiovascular mortality, in accordance to 1 of the trial’s two principal investigators.

Earlier today I reported that the PARADIGM-HF trial testing LCZ696, a novel, first-in-class Angiotensin Receptor Neprilysin Inhibitor (ARNI), had been stopped early due to the fact the trial had demonstrated a considerable reduction in the combined major endpoint of cardiovascular death and heart failure hospitalization. This info was taken from a Novartis press release.

But it turns out that the press release wasn’t entirely accurate. For after, a business appears to have in fact downplayed a optimistic discovering in its trial. In accordance to Milton Packer, the trial’s co-Principal Investigator, the information is a lot more persuasive than may possibly be gathered from the press release. (I spoke with Packer at the American University  of Cardiology meeting in Washington, DC.)

English: Mohawk Stop Sign

English: Mohawk Stop Sign (Photo credit score: Wikipedia)

In general when a trial has a mixed endpoint– for PARADIGM-HF it was the mixture of cardiovascular death and heart failure hospitalization– the results are largely driven by the “softer” part of the endpoint (in this case, heart failure hospitalization and not the “harder” endpoint of cardiovascular death.) This usually prospects to criticism when a trial has been technically superior in minimizing a combined endpoint but shows small or no effect on the harder, more crucial endpoint.

We will not know the full final results of PARADIGM-HF until finally they are presented at a medical meeting, maybe the European Society of Cardiology meeting in August in Barcelona. But in accordance to Packer, the trial will certainly show a huge and convincing reduction in the far more essential endpoint part, cardiovascular death.

Packer advised me that the stopping rule for the trial was “the most conservative stopping rule in any clinical trial I have ever been concerned with.” A lot more importantly, he stated, “the stopping rule was not on the primary endpoint, it was on cardiovascular death. It was a stopping rule that required a really high level of statistical significance for early termination.” And it was based mostly on this stopping rule that “the Data and Monitoring Board decided that stopping the trial was proper.”

Packer explained “the press release implies that the trial was stopped for the primary endpoint but that was not the situation, the trial was stopped for a persuasive impact on cardiovascular mortality alone, and my enthusiasm was based mostly on that very persuasive impact.”

Packer also advised me that the trial had been powered to detect a variation in cardiovascular mortality, so the finding may possibly not be quite so sudden. This also explains the trial’s huge dimension.

Glucose Measurements Do not Increase Cardiovascular Danger Assessment

Though blood glucose and glycated hemoglobin (HbA1c) perform a central function in diabetes, the worth of these measurements to assess cardiovascular threat has been unclear. Now, in a paper published in JAMA, members of the Emerging Danger Elements Collaboration analyze data from nearly 300,000 individuals with no acknowledged diabetes or cardiovascular condition who were enrolled in 73 prospective research.

The authors identified that incorporating glycemia measures to standard cardiovascular threat evaluation presented little additional prognostic info. More, including info about blood glucose did not outcome in a substantial improvement in the classification of individuals used to help make a decision about preventive remedy.

1 relatively surprising locating was that 4 diverse measures of glycemia independently resulted in a  J-shaped curve of cardiovascular chance — even though reduce glycemia amounts were usually connected with lower ranges of danger, at the excessive lowest degree there was a rebound in risk. This finding “should encourage further scientific studies to check regardless of whether quite low glycemia ranges are markers of ill overall health,” compose the authors.

Yet another nonintuitive discovering was that HbA1c measures were “at least equal” to fasting, random, and postload plasma glucose levels in assessing risk. “This obtaining challenges recommendations that postload glucose ranges predict CVD incidence much more strongly than do other glycemia measures,” they say.

The authors conclude: “Contrary to suggestions in some guidelines, the current examination of individual-participant data in practically 300,000 people with out recognized diabetes and CVD at baseline indicates that measurement of HbA1c is not associated with clinically meaningful improvement in evaluation of CVD threat.”

6 out of ten die from cancer or cardiovascular condition, says ABS

Dementia and Alzheimer’s illness are taking an increasing toll on Australians, according to the most recent Bureau of Statistics trigger-of-death figures.

But poor habits are probably the most significant killer, with shut to 6 out of ten deaths in Australia triggered by cancers and cardiovascular illness. They have related danger factors, mentioned the Heart Foundation’s Dr Rob Grenfell, who called for a co-ordinated approach to smoking, bad nutrition, weight problems and bodily inactivity. This kind of an approach would conserve lives, he explained following the release of the figures on Tuesday.

General, 147,098 men and women died in Australia in 2012, 166 far more than in 2011.

Heart ailment remains the top killer, with 20,046 victims, even though this has fallen steadily since 2003.

Death by suicide reached a 10-yr peak of two,535 and remains the foremost result in of death for individuals aged 15 to 44. It was the 14th most typical cause of death total.

“These are quite troubling numbers,” explained Lifeline CEO, Jane Hayden.

Overall, people are as probably to die of circulatory system diseases as they are of ailments associated to tumours, such as cancer.

“The proportion of deaths due to circulatory ailments has been reducing, whilst the deaths from cancer have remained relatively stable,” explained Cancer Council Australia CEO, Professor Ian Olver.

“This partly displays the greater success in treating circulatory ailments compared with some varieties of cancer.”

Grenfell stated it truly is excellent information that far more individuals with heart ailment are surviving, but this means far more are living with heart injury and disability.

Dementia and Alzheimer’s disease are the third major triggers of death, accounting for 10,369 or 7% of all deaths in 2012. This is up from 4,275 deaths in 2003 and 7,318 in 2007. Ninety-5 per cent of these occurred in people aged 75 or over.

A lot more folks are creating dementia due to the fact men and women are residing to an older age, stated Dr Chris Hatherly, national investigation manager at Alzheimer’s Australia.

“It’s a terminal situation, so we assume the quantity of deaths to increase.”

Another aspect in the statistics was a lot more correct recording of dementia as a cause of death, he explained.

For females, dementia and Alzheimer’s ailment have overtaken cerebrovascular conditions such as stroke as the 2nd major lead to of death. Breast cancer stays the sixth most frequent killer.

For guys, lung cancer stays the 2nd leading lead to of death and dementia and Alzheimer’s condition are the fifth major leads to, replacing prostate cancer, which is now sixth.

The figures show the death price for Indigenous Australians is double that of non-Indigenous Australians. The leading result in of death for Aboriginal and Torres Strait Islander men and women was heart disease, followed by diabetes.