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Archive for the ‘cardiology -Preventive’ Category

Aspirin for primary prevention of CVD is an ongoing controversy for more than 2 decades. Please note, the controversy is not in the competence of Aspirin to prevent cardiovascular  event, but in the potential risk of GI bleed and whether that risk is worth taking. Secondary prevention has no such issues as the benefits easily outweigh the potential bleeding risk .

Male vs female

There is a “gender” and “age” difference  in the ability of Aspirin to prevent vascular events.Aspirin primarily prevents MI in men(>45)  and stroke in women(>55)  (Funny it may look,  that’s what data says!)

Age

Hence, the target age group  for aspirin is between 45/55  to 80 years. (Up to 45 and beyond 80 it has no role .Beyond 80 ,  risk of hemorrhagic stroke is significant )

Diabetic vs non diabetic

Many believe  all diabetics should straightway  get Aspirin as it was considered  CAD equivalent.Its not acceptable to all. . American diabetic association  has risk stratified DM and advice Aspirin only in high / Intermediate risk.Look for Key word ie “Net benefit (Ref 2)

Why so much confusion  ?  and What can be  the conclusion ?

The confusion is because each scientific body like AHA, ESC, ACCP, ADA ,USPSTF have  their own inference and the presence of too many risk assessment tools adds further dizziness .(SCORE /FRAMINGHAM, etc). It tempts me to say ignore all these and use  cortical sense !

Fortunately ,we do have some clarity as there is a common theme in all these advisories .Aspirin is indeed a wonder drug and able to block the platelets to prevent acute thrombus formation in the critical circulations.(FDA doesn’t seem to agree with this , How can a cheap generic do that job so effectively  ? Let the Bayer fight ! ) 

It seems reasonable to conclude

All men and women  between 45/55  to 80 years should get Aspirin (81mg /day or 325mg alternate days ) if there is at least one or two CVD risk factors provided there is no major bleeding risk .

Ongoing  studies on primary prevention with Aspirin 

ASCEND: A Study of Cardiovascular Events in Diabetes; or with diabetes taking a statin 

ENVIS-ion (Aspirin for the Prevention of Cognitive Decline in the Elderly )

ASPREE (Aspirin in Reducing Events in the Elderly) 

These  studies are  expected to  bring more data (and be ready for more confusion!)

Can we use Clopidogrel  for primary prevention if a person is intolerant to Aspirin ?

Logic may say yes.As of now it can not be advised for primary prevention.

Reference

1.A elegant advisory is hosted in Healthcare Research and Quality (AHRQ) website with supportive data from U.S. Preventive Services Task Force.

primary prevention of cad by aspirin

2.Pignone  M., Alberts  M.J., Colwell  J.A., et al; Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation. 2010;121:2694-2701

3.Sigrun Halvorsen,Felicita Andreotti,  Jurriën M., Aspirin Therapy in Primary Cardiovascular Disease PreventionA Position Paper of the European Society of Cardiology Working Group on Thrombosis  J Am Coll Cardiol. 2014;64(3):319-327.

 

2016 Update by USPSTF in Annals of Internal medicine has a Major revision.

It raises concern over bleeding risk, and ask for restricted use of Aspirin

within the age group of 50 -69 for both male and female.(Who are at risk of CAD)

Link to the Annals of Internal Medicine Article  Aspirin primary prevention 2016

 

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We all know to err is human , but most of us probably won’t agree medical mistakes , (bulk of which happen in the name of practicing state of the art of science ! ) could be the dominant theme in modern medical care !

BMJ exposes this  well known secret with the help of most authentic data from an apex scientific body CDC , Atlanta .

Reference

http://www.bmj.com/content/353/bmj.i2139#

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Coronary artery disease (CAD)  is man-kind’s  greatest threat in modern times.CAD ,diabetes ,Hypertension, obesity, mental illness  has become an epidemic  even among the young !

 

Lifestyle diseases cad risk smoking alcohol

There is a simple solution for  lifestyle diseases !

Just  . . .  Remove style from your life !

lifestyle diseases coroanry cardiology medical ethics inappropriate stents over treatment excess medical care , bio ethics,

Instead . . . try to live like these  Tibetian villagers

life purpose of living

Final message

One study which researched all lives who crossed 100 Years  concluded something like this !

“To live a longer and healthy life* ,Get up early  , have a purposeful daily chore that must include a physical component , work with conscience ,love every one sync with the nature and  lastly and most importantly remove style from your life !

Choose  your life . . . It is simply there in your hand for grabs !

Post-amble.

* Please note , Doctors  are never listed in the top with relevance to health of mankind  ! They simply cure some illness !

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I share my thoughts after going through this  85 page  land mark document !

acc aha 2013 guidelines cholesterol ncep

In whatever way I look at it  ,It  keeps  both physicians and their patient population guessing  in a  confused sate regarding their cholesterol levels  the treatment modalities !

It seems to revolve around a single point agenda,  how to fit a single drug called statin in the scheme of things !

What  if  ,  a new  drug comes and statin is  proved  not an angel  in our fight against the evil  of  atheroscerosis !

 

acc aha lipid guidelines atp 3 ncep  nhlbi dyslipidemia

Summary as  I interpreted

“All healthy and unhealthy human beings should ask only one  question

whether they can some how  benefit from taking statins  ? “

If your answer is yes ,  administer the statin  not in  low dose but in moderately high dose ! (It  appears  there is little role for low intensity statins )

There  is generally no  need to to monitor the lipid levels as long as patient is comfortable.

Disclaimer :  *Sorry , the Intention is not to  hurt the hard work of a elite panel who toiled for years to bring this much awaited guidelines on lipids and atherosclerosis! but to express my view , biased though !)

A mini research

To confirm my assumption I did a curious word search in this 85  page document .

For words statin , diet and exercise

  1. Statin appeared  814 times
  2. Diet appeared 8 times
  3. and exercise just once in the entire document !

statin search acc document statin acc aha 2013 guidelines statin acc aha 2013 guidelines 2

The importance of  diet and  body activity  which  are  the  primary   determinant of serum lipid levels is mentioned  in a cursory fashion in this  global guideline meant to control the total  cholesterol load  and atherosclerosis of our population .

Meanwhile . a drug which  acts in a  physiological  cell servicing  metabolic path way in a complex fashion  is glorified 814  times !Do  you still  think this post is is biased ?

 

 

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medical morality

Tree of life : When professional morality suffers a mortality . . . human health becomes a causality !

Greatest threat to the future of  human health is  . . .

  • Not from  exotic  infectious agents , bird flu  or  mosquito  fevers
  • Not from  epidemic of cardio vascular disease
  • Not from  thousands of  published  diseases in ICD code
  • Not from  aging population and failing  vital  organs
  • Not from  lack of availability of life saving  drugs and devices
  • Not from  lack of  hospital beds.
  • Not from  good sanitation
  • Not from  hunger and poverty
  • Not from  lack of para medical workers
  • Not from  lack of health awareness and education

But from  . . .

  • The way  health care is administered in this planet .
  • The way  noble professionals are created .
  • The way  trivial health  issues prevail over  major  health crises  that  wallop the health budgets.
  • The way by which  medical morality is systematically destroyed
  • The way   “concept of  health” is  sold  as a  buyable  commodity by insurance companies.
  • The way  medical journals churns out  junk articles in the name of research.
  • The way corporates indulge in  delirious pursuit  to  increase  bed occupancy rate of their  patient  ware houses (Also called Hospitals)
  • The  way greedy drug companies aim to increase the per capita drug consumption of  ill informed  homo-sapiens  by discovering  pseudo  drugs for pseudo  illness
  • The way   health insurance policies are misused
  • The way  rich spend billions for reconstructive  cosmetic  surgery while the poor die for want of basic medicines !

 

Link to a wonderful  article  on moral education for our kids in medical school !

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  • Diabetes , smoking , hypertension , dyslipidemia are the  leading cause of cardiac morbidity and  mortality .
  • Now air pollution the(  passive atmospheric smoking !) is threatening to be a major risk factor .
  • In fact , it has become the  official  cardiac risk factor nominated by WHO !
  • 40 %  of all deaths due to air pollution is due to cardiac events .
  • The surprise element is indoor air pollution is equally injurious .

WHO bulletin  in March 2014

air pollution and cardivascular health

The WHO assessment found the majority of air pollution deaths were linked with cardiovascular diseases.

For deaths related to outdoor pollution, it found:

  • 40% – heart disease
  • 40% – stroke
  • 11% – chronic obstructive pulmonary disease (COPD)
  • 6% – lung cancer
  • 3% – acute lower respiratory infections in children

For deaths related to Indoor pollution, it found:

  • 34% – stroke
  • 26% – heart disease

 

Related article from this site

A-new-coronary-risk-factor-community-smoking

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CokeMini_Happiness_03

  It costs just one Dollor !

Harvard school of Public health has  recently  published some  hard data about  the adverse effects of bad diet habits especially the impact of  soft drinks on long term cardio vascular health.

soft drinks and impact on healthAnother prestigious journal confirms it . . .

risk of soft drinks and coronary artery diseaseThe ultimate journal for the cardiologists Circulation reaffirms it .

soft drinks carbonated and coronary artery diseaseWe  have overwhelming evidence , prolonged use of soft drinks
increase CAD (Like tobacco ). Still , we haven’t added the customary caution on the bottles of these soft drinks ?

Why  ?

My guess would be, there are powerful forces in  modern society that would love to keep  the  threat of diseases high in the  human domain  so that all  stake holders  make a profit .

The poor , World health instigation(WHO)  and various public health forums  simply watch it .If they protest , they are at risk of sucked into the loop of deceit !

Failure to reverse public health hazards  may be a  lesser crime  in modern days  . . . But , here comes  a series of  advertisements in Indian media , that is a strong indicator that human  intellect and the sixth sense  is going nuts !

It suggests , Do you want  ever lasting happiness . . . Drink  it  . . . earnestly believe  in it  . . . and drink again  !

Coca-Cola-12

I was also told  a shocking fact that , The beverage war in India has  started and the soft drink giants have heavily Invested to take it into the rural markets .Their aim is to  provide  “health  for all Indians”  by 2020 !

Concluding question

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