Dr K K Aggarwal

AHA/ACS update

1. Women were nine times more likely (4.6 times) to develop takotsubo cardiomyopathy or “broken heart syndrome,” than men, and older women more likely than younger [Dr Abhishek Deshmukh, at the University of Arkansas in Little Rock].
   1. Cholesterol checks should be part of periodic well-child visits for all children, according to new guidelines from the American Academy of Pediatrics. Screening cholesterol at least once between the ages of 9 and 11 and again at 17 to 21 was recommended in the comprehensive guide that addresses all the major cardiovascular risk factors.
   2. Optimal treatment with potent statin drugs significantly regresses coronary plaque as evidenced by intravascular ultrasound procedures. Stephen Nicholls, MBBS, PhD, medical director of intravascular ultrasound at the Cleveland Clinic, reported that in patients treated with high-dose (40 mg) rosuvastatin plaque burden decreased 1.22% (P<0.001) from baseline.
   3. Women who regularly drink sugary beverages may be increasing their cardiovascular risk. A longitudinal study showed that those who reported drinking at least two sugar-sweetened beverages every day were more likely to gain weight, increase waist size, and develop impaired glucose tolerance [Christina Shay, PhD, of the University of Oklahoma in Oklahoma City].
   4. Vitamin D deficiency may have damaging vascular effects in children with a high cardiovascular risk. Children and teens with serum 25-hydroxyvitamin D3 level less than 20 ng/mL had a significant reduction in carotid artery distensibility [Dr Getha Raghuveer, of Children's Mercy Hospitals and Clinics in Kansas City, Mo].
   5. Tripling the standard dose of clopidogrel was able to overcome genetic resistance to the drug. With a maintenance dose of 225 mg daily, patients who had one copy of an allele that confers resistance to clopidogrel were able to achieve levels of platelet reactivity similar to those of patients who responded to the standard 75-mg dose, according to Jessica Mega, MD, of Brigham and Women’s Hospital in Boston. Patients who had two copies of the loss-of-function allele, however, continued to have a poor response to clopidogrel, even at a dose of 300 mg daily.
   6. Short-term elective angioplasty and stenting appears similarly safe at experienced centers whether they have onsite cardiac surgery backup or not [Dr Thomas Aversano, of Johns Hopkins School of Medicine in Baltimore]
   7. Intra coronary glycoprotein IIb/IIIa inhibitor abciximab directly into the heart during percutaneous coronary intervention doesn’t boost the agent’s benefits. [Dr  Holger Thiele, of the University of Leipzig Heart Center in Leipzig, Germany].
   8. Drug-eluting balloons can be used in place of stenting in patients at high risk of bleeding. They are particularly useful for patients on warfarin.

10.  Infective endocarditis outcomes are better when patients head straight to surgery rather than waiting to see if antibiotics will resolve the infection. [Dr Duk-Hyun Kang, of Asan Medical Center in Seoul, South Korea]

In US only 25% hypertensive patients gets treatment

If this is the situation in the US, what will the figure be in a country like India? Following are the US statistics.

• According to Agency for Healthcare Research and Quality (AHRQ) more than 5.5 crore adults over the age of 18 were treated for hypertension in 2008 in USA.
• According to the American Heart Association (AHA), more than 7.6 crore adults have been diagnosed with high blood pressure, which is the most common cardiovascular disease, the leading cause of stroke and kidney failure, and a major cause of heart attack. This means about 2 crore people who have been diagnosed with hypertension are not being treated for it.
• As per CDC’s National Health and Nutrition Examination Survey, more than half of 7.6 crore people diagnosed with high blood pressure did not have controlled disease. Most high blood pressure feels fine and think treatment is unnecessary. Symptoms develop only when the organ damage occur.
• Over 60% of those over 65 were treated for hypertension in 2008.
• Only 33% of those in the 45 to 64 age group were treated for hypertension.
• Just 5% of adults younger than 45 were treated for hypertension in 2008.
• Slightly more women received treatment than men, but the cost of treatment did not differ between the genders.