Women more prone to heart diseases and associated mortality

Health Care, Heart Care Foundation of India, Medicine Comments Off

Apart from lifestyle changes, it is imperative to consult a specialist in case of any warning signs

New Delhi, 7 March 2019: The Heart Care Foundation of India (HCFI) wishes all its women readers a very happy International Women’s Day. On this day, there is a need to spread awareness on the fact that heart diseases are the number one killer in women. They are often diagnosed late in women and statistics indicate that heart diseases cause 1 in 3 deaths each year in this segment of the population.

Women over 20 years of age without an established heart disease should undergo periodic cardiovascular risk assessment every three to five years. This will help identify any underlying heart condition or risk factors to help take action on time. The choice of a specific risk model for heart disease risk assessment should be individualized based on patient-specific characteristics (age, gender, ethnicity).

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Heart disease is the leading cause of death in women. More women die of heart disease than all the seven cancers known to occur in women. Unfortunately, the level of awareness of heart disease is much lower compared to cancer. Hence, women are not diagnosed or treated as aggressively as men. Some heart disease risk factors are unique to women, including postmenopausal status, prior hysterectomy, oral contraceptive use and pregnancy and its complications. Warning signs of a heart attack in women differ from those in men. Although the most common symptom of heart attack is chest pain or discomfort, women are more likely to have pain in the jaw, neck or back (between the shoulder blades), unexplained weakness or fatigue or they may present with symptoms like shortness of breath, cough, dizziness or nausea. This often results in misdiagnosis and delay in treatment.”

Heart disease in women has a worse prognosis. Women tend to develop heart disease about a decade later in life than men, but their outcomes are often worse than in men.

Adding further, Dr Vanita Arora, Director and Head of Cardiac Electrophysiology Lab and Arrhythmia Services, Max Hospital, New Delhi, said, “Women do not consult a doctor when they have a heart problem. Tachycardia is not treated in women and usually passed off as anxiety. It is important to note that electrical disorders of the heart are highly common in women. They often experience an increase in heart rate called palpitation (a condition compared with the galloping of a horse). An increase in the heart rate of more than 130 or 140 is dangerous and requires immediate attention.”

Some tips from HCFI

For all Women

  • Moderate intensity physical activity for at least 30 minutes and for 60 to 90 minutes for weight management on most days of the week.
  • Avoidance and cessation of cigarette smoking and passive smoking
  • Keep waist circumference below 30 inches.
  • Take a heart-friendly diet. Include omega-3 fatty acids in diet.
  • Keep blood sugar, ‘bad’ LDL cholesterol and blood pressure (BP) under control.
  • In women older than 65 years of age, daily aspirin may be considered in consultation with the doctor.
  • Women who smoke should avoid oral contraceptive pills.
  • Treat underlying depression.

Women at high risk

  • Aspirin 75 to 150 mg, as prevention
  • Control of high blood pressure
  • No use of antioxidant vitamin supplement
  • No use of folic acid support
  • No Hormone Replacement Therapy
  • Lowering of LDL ‘bad’ cholesterol to less than 80

Maintaining oral hygiene is a must across all age groups

Health Care, Heart Care Foundation of India, Medicine Comments Off

Any warning signs such as bleeding are an indication to consult a specialist immediately

New Delhi, 8 March 2019: Older adults with poor cognitive function are found to have impaired oral health and higher risk of tooth loss later, says a study. According to the study, there was a clear association between cognitive function and tooth loss when cognitive function score was categorized into quintiles. The study, published in the Community Dentistry & Oral Epidemiology, showed people in the lowest quintile reflecting poorer cognitive function had 39% higher odds of tooth loss than those in the highest quintile.

The burden of dental diseases in the elderly is increasing around the world. The need of the hour is to understand and address the oral health needs of geriatric population and integrate them with overall health aspects. Various studies have demonstrated that a significant number of dental professionals differ in the treatment of geriatric patients, for a variety of reasons such as lack of complete knowledge about gerontology, including interaction of drugs.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Oral hygiene is extremely essential. Dental health is often ignored by many people. Stress can have lasting effects on the teeth as on the overall system. Under stress, many people pick up the habit of smoking and consuming alcohol, which can have serious implications on dental health at a later stage. Periodontitis is a serious condition and if not managed on time can be detrimental to dental health. One should not ignore warning signs and visit a dentist as soon as possible. A dull tooth ache, which does not subside, bleeding gums, and sensitivity to certain eatables are signs that should not be ignored.”

There are more than 700 different species of bacteria colonized in a healthy mouth, most of which are completely harmless and live in harmony with their host. However, in the absence of sufficient oral hygiene and tooth cleaning, bacterial deposits build up next to the gums, forming a plaque, and the conditions become suitable for more dangerous bacteria to flourish.

Adding further, Dr Aggarwal, who is also Group Editor-in-Chief of IJCP, said, “What many people are unaware of is that dental hygiene is also imperative for heart health. Poor oral health and tooth loss is associated with modest increases in future heart blockages and paralysis.”

Some tips from HCFI

  • Brush your teeth twice daily. Brushing helps in preventing the build-up of plaque and bacteria which can cause tooth decay and periodontal diseases.
  • Floss every day as flossing helps clean the crevices where the brush can’t reach.
  • Eat a healthy diet. Avoid sugary and starchy foods as sugar in such foods reacts with the bacteria in saliva to form an acid that erodes the tooth enamel leading to tooth decay.
  • The tongue too harbors bacteria. Therefore, it is a good idea to invest in a tongue scraper and clean it each time you brush your teeth.
  • Consult a dentist if your gums are inflamed or if they bleed. Do not ignore any pain in the teeth and/or gums.
  • Get your teeth checked every six months. Dental cleaning and check-up twice a year is imperative.

Totally indigenous biodegradable cardiac stent: Evidence shows biodegradable-Ppolymer DES no better than regular DES

Health Care Comments Off

Meril Life Sciences has asked for an exemption for its first locally made biodegradable cardiac scaffold, a naturally dissolving stent that clears blockages in arteries.

The National Pharmaceutical Pricing Authority (NPPA) in a meeting on 21 February has referred the matter to an overarching expert committee headed by the director-general of Indian Council of Medical Research to see if the product has any therapeutic advantage to merit a price exemption.

The exemption, if granted, will be valid for five years.

Meril Life is trying to seek an exemption under para 32 of the Drug Price Control Orders (DPCO).

“32. Non–application of the provisions of this order in certain cases: The provisions of this order shall not apply to, -

a manufacturer producing a new drug patented under the Indian Patent Act, 1970 (39 of 1970) (product patent) and not produced elsewhere, if developed through indigenous Research and Development, for a period of five years from the date of commencement of its commercial production in the country.
a manufacturer producing a new drug in the country by a new process developed through indigenous Research and Development and patented under the Indian Patent Act, 1970 (39 of 1970) (process patent) for a period of five years from the date of the commencement of its commercial production in the country.
iii. a manufacturer producing a new drug involving a new delivery system developed through indigenous Research and Development for a period of five years from the date of its market approval in India:

Provided that the provision of this paragraph shall apply only when a document showing approval of such new drugs from Drugs Controller General (India) is produced before the Government.

Explanation: Notwithstanding anything contained in this Order, for the purpose of this paragraph “new drug” shall have the same meaning as is assigned to under rule 122E of the Drugs and Cosmetics Rules, 1945;

Clearly, they are using the 32.1 clause for the exemption which says, “the price cap won’t apply if a new drug developed through a unique and indigenous process is patented under the Indian Patents Act and is not produced elsewhere”.

An earlier multi-disciplinary committee of experts met on February 7 and found that the product is eligible for exemption. The pricing regulator referred the applications to the Standing National Committee on Medicines.

Evidence shows that polymer stents are not better than the regular drug-eluting stents (DES).

The polymeric everolimus-eluting BVS (Absorb) was non inferior to the cobalt-chromium everolimus-eluting stent (Xience) for target lesion failure in the Absorb IV trial.

In the recently reported BIO-RESORT trial, further follow-up of patients who got the “Orsiro and Synergy biodegradable polymer-coated drug-eluting stents” continued to show no benefit over a traditional durable DES, according to the BIO-RESORT trialists. At 3 years, when the Orsiro should have completely lost its biodegradable coating, target vessel failure (combined cardiac death, target vessel-related MI, and clinically-driven target vessel revascularization) reached 10.0%, 8.8%, and 8.5% of those randomized to the Resolute Integrity, Synergy and Orsiro stents, respectively, with no significant differences between groups in this primary endpoint or its components.

If this stent is approved and introduced in the market, it should only be used with the informed consent of the patient.

An unnamed source said, “International data has shown that polymer stents are not better than the regular DES. The cost of the polymeric stent is exorbitant. We too had invested a large amount of money to develop a polymeric stent, but aborted the plan after information that this technology has been withdrawn from the international market. This is an innovation that does not bring any added benefit to the patient.”

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA