Today is World Diabetes Day

Health Care, Medicine 184 Comments
  • Renal hyperfiltration is associated with a greater risk of stroke, especially in patients with the metabolic syndrome or type 2 diabetes. In a single-center study, 22% of patients with either condition who also had renal hyperfiltration had a stroke, Harold Pretorius, MD, PhD, of the Cincinnati Cognitive Collaborative in Ohio, and colleagues reported at the World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease (WCIR). The study concluded that “If you divert blood flow away from the brain, adverse events like stroke are inevitable.
  • About 25% of healthy people who opted into a free screening at one hospital in Israel were found to have either dysglycemia or undiagnosed type 2 diabetes, Mona Boaz, PhD, of E. Wolfson Medical Center in Holon, and colleagues, reported at the World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease meeting. More than 20% of people screened had impaired glucose tolerance, and that another 4% had [type 2] diabetes but they didn’t know it.
  • In vitro and murine studies of the compound, XMetA, have shown that it selectively targets an allosteric insulin receptor — offering all the glucoregulatory benefits, but none of the mitogenic effects, according to Yehuda Handelsman, MD, president and organizer of the World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease.

CABG, PCI Guidelines stress collaboration

Health Care, Social Health Community 115 Comments
  • A multidisciplinary heart team — including an interventional cardiologist and a cardiac surgeon — should work together to develop a care plan for each patient with coronary artery disease, according to updated guidelines from the American College of Cardiology Foundation and the American Heart Association and published in the Dec. 6 issue of the Journal of the American College of Cardiology.
  • The team should review the patient’s medical condition and coronary anatomy and then determine whether percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG) were feasible and reasonable. After discussing options with the patient, a treatment strategy should be selected, according to the guidelines.
  • Support for this approach comes from reports that patients with complex coronary artery disease referred specifically for PCI or CABG in concurrent trial registries have lower mortality rates than those randomly assigned to PCI or CABG in controlled trials.
  • The team concept was included as a class I recommendation for patients with unprotected left main or complex CAD.
  • Another new recommendation in the guideline is the use of the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score when making treatment decisions for patients with multivessel disease. This system uses angiography results to estimate the extent and complexity of arterial disease and gives a more objective way to guide decision making.
  • The guidelines say that PCI is a reasonable alternative to CABG in stable patients with left main artery CAD, low risk of PCI complications, and a high risk for adverse surgical outcomes. They also confirm the superiority of CABG compared to both medical therapy and PCI in patients with three-vessel disease.
  • Specific to CABG, the experts also weighed in on the use of anti-platelet therapy both before and after the operation. The guidelines suggest aspirin should be given to CABG patients preoperatively. In those undergoing elective procedures, clopidogrel and ticagrelor should be stopped five days before elective surgery. In emergent situations, they should be discontinued for at least 24 hours if possible.
  • After the operation, aspirin should be started within the first six hours if not already begun before the procedure. Clopidogrel was termed a “reasonable alternative” in patients allergic to aspirin.
  • The PCI group also addressed anti-platelet therapy. The committee simplified the regimen for aspirin use, suggesting using 81 mg daily following PCI instead of higher maintenance doses. They also provided a class I recommendation for dosing ticagrelor for at least 12 months following insertion of both drug-eluting and bare metal stents.
    (Source MedPage Today)