In a paper, published in JAMA in 2010, the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet was examined. The amount of physical activity needed to prevent long-term weight gain is unclear. In 2008, federal guidelines recommended at least 150 minutes per week (7.5 metabolic equivalent [MET] hours per week) of …
Courage Under Fire – On the Management of Stable Coronary Disease
George A. Diamond, and Sanjay Kaul, J. Am. Coll. Cardiol. 2007;50;1604-1609 … While the actual numbers are open to debate, the simple fact is that many patients with stable angina (and an additional number of asymptomatic patients) are undergoing PCI without having received sufficient medical therapy.
Computed Tomography Coronary Angiography (CTCA) screening for Coronary Artery Disease
The major risk factors of inappropriate diet, physical inactivity, high cholestreol (> 250 mg%), high BMI (>26) and hypertension (>155 mmHg) and smoking, explain at least 75% of new cases of Coronary Artery Disease (CAD). In the absence of these risk factors, CAD is a rare cause of death. Two studies have addressed the issue of predicting the risk of …
The ABCS of Preventing Heart Attacks and Strokes
Each year, more than 2 million Americans have a heart attack or stroke, of whom more than 800,000 of them die; cardiovascular disease is the leading cause of death in the United States and the largest cause of lower life expectancy among blacks. Related medical costs and productivity losses approach $450 billion annually, and inflation-adjusted direct medical costs are projected …
Treatment of Chronic Kidney Disease (CKD) and multi-vessel CAD
CABG is associated with better survival than PCI with DES in patients with non Hemodialysis Dependent (HD) Chronic Kidney Disease (CKD) and multivessel CAD, but CABG patients have a greater short-term risk of needing permanent hemodialysis. A new study, published in the American Journal of Cardiology, compared the short- and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous …
Diastolic Dysfunction and Risk of Heart Failure
Left ventricular diastolic dysfunction is highly prevalent, tends to worsen over time, and is associated with advancing age. Worsening diastolic function can be detected even in apparently healthy persons, the conclusion by the authors of a recent article published in JAMA. Randomly selected participants 45 years or older (N = 2042) underwent clinical evaluation, medical record abstraction, and echocardiography (examination 1 [1997-2000]). Diastolic …
“Pump Head”
Decreased Oxygen blood levels in the brain during heart surgery correlates to increased risk of suffering from the mental impairment dubbed “pump head”.Heart surgery patients in whom a heart-lung machine was used often find their brain function slipping for months or years afterward. Studies have shown that 20-40% of patients set to undergo CABG surgery already had some degree of …
The MASS II Study
MASS II [i] is a small, single-center study designed to compare the long term effects of Medical Therapy (MT), Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG) among patients with stable angina, multivessel CAD and preserved ventricular function. Patients selected were appropriate candidates for all 3 therapies. In MASS II 611 patients were randomly assigned to CABG (n=203), …
PCI vs. CABG outcomes in Washinton State
In a large comparative study, interventions for CAD were compared. From 1999-2007 more than 150000 interventions were performed in Washington State. During that period, the volume of PCI procedures increased by 71%, while simultaneously, CABG diminished by almost 40%. In final analysis, PCI was almost five times more likely to happen than CABG. For patients undergoing CABG, the prevalence of, …
The Courage Trial – Optimal Medical Therapy with or without PCI for Stable Coronary Disease
Optimal Medical Therapy with or without PCI for Stable Coronary Disease, William E. Boden, M.D.,and others, NEJM april 12, 2007. This study was performed to evaluate and compare optimal medical therapy with percutaneous coronary intervention (PCI). In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI), combined with intensive pharmacologic therapy …