What is the purpose of getting a coronary artery calcium score? The amount of calcium in the coronary arteries has been associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). Although obtaining a coronary artery calcium score can be quite helpful in certain individuals when making decisions about starting or escalating lipid-lowering therapy, the presence of […]
What is included in a baseline cardiac exam, and when should I have one? I am healthy and in my 30s, but my father had a heart attack in his late 40s and my grandfather in his early 50s. Cardiac examination involves a total body assessment with emphasis on the heart, lungs, extremities and blood […]
I had a heart attack and have been on statins. My doctor says my LDL cholesterol is not low enough. What should it be? What other treatment options exist? Since individuals with atherosclerotic cardiovascular disease (ASCVD), particularly those with a previous heart attack, are at high risk for a recurrent event, LDL treatment goals are […]
I am 60 and do not have heart disease. Will taking aspirin help prevent a heart attack? Few would argue against aspirin use to prevent a recurrent event (secondary prevention) in someone with known cardiovascular disease. However, aspirin for primary prevention of a first heart attack, stroke or death remains controversial. After a study showed […]
I take medications for blood pressure control. My friend read that it is best to take them at bedtime. Is this true? If so, why? Adequate control of high blood pressure (BP) is important to protect against heart attack and stroke. Many BP meds are long-acting for ease of use and once-daily dosing, which is […]
I recently had valve surgery, and my doctor recommended cardiac rehab. Isn’t that just for people who had a heart attack or bypass surgery? In addition to coronary artery disease and diagnoses such as heart attack, angina, bypass surgery and angioplasty or stenting, other indications for cardiac rehab (CR) include heart valve repair or replacement, […]
Why is it important to get a flu shot if you have heart disease? When is it too late to get it?Flu season can begin as early as October and extend as late as May, but typically peaks from December to February. Antibodies to the flu peak four to six weeks after getting vaccinated and then slowly decline for six months. The Centers for Disease Control & Prevention recommends that everyone over 6 months of age without a specific reason not to get vaccinated, such as a history of allergic reactions to the shot, get vaccinated by the end of October. However, getting vaccinated any time before January can still be beneficial.
The duration of DAPT depends on the reason for stenting (stable heart disease versus acute heart attack), the type of stent used and the patient's clotting and bleeding risks. Because the clotting risk is high after a recent heart attack, in your case there is strong data to support DAPT for at least one year. One recent clinical trial demonstrated a lower late clotting risk but more bleeding events with 30 versus 12 months of DAPT. This suggests patients with high clotting risk but low bleeding risk may benefit from taking DAPT longer.
Heart failure (HF) can be caused by a heart attack or similar event that impairs the heart's pumping function and reduces the amount of blood ejected with each beat (heart failure with reduced ejection fraction, or HFrEF). There is also a second form called heart failure with preserved ejection fraction (HFpEF). These patients typically suffer from heart failure symptoms, but their ejection fraction is normal. Morbidity and mortality are similar in both forms.
Such a group was studied in REDUCE-IT. This trial involved 8,179 patients with CVD or diabetes plus other risk factors and LDL levels of 40-100 mg/dL on statin therapy. Over five years, 4 grams a day of the fish oil icosapent ethyl reduced both first and subsequent heart attacks and strokes as well as CVD deaths by 25%. Although icosapent ethyl is a TG-lowering agent, the results appeared to be independent of patients' baseline TG levels. This suggests some benefit was due to independent actions, such as potent plaque-stabilizing properties. This fish oil product is currently FDA-approved only for treating TG levels above 500 mg/dL.
Between a Rock and a Hard PlaceSymptoms caused by very high and very low blood sugar levels can be frightening, and even dangerous. The extent and severity of symptoms interfere with quality of life. Many patients are unable to hold a job, or even make advance plans with confidence. Personal relationships can suffer. Some patients end up in the emergency department multiple times aweek.
Although the effects of ASA are not fully understood, they may be a possible risk factor for an unexplained ("cryptogenic") stroke, since the occurrence is higher in patients undergoing echo in this setting. In these cases, the ASA is usually large and/or hyper mobile and is associated with a large amount of blood being shunted between the atria due to a PFO or septal defect. Identifying these abnormalities in a stroke patient does not necessarily prove a causal relationship, since other stroke causes may be present.