Early Discontinuation of Aspirin After Stenting May Be Okay Following angioplasty and stenting, patients take aspirin plus clopidogrel (Plavix¨), ticagrelor (Brilinta¨) or prasugrel (Effient¨) for up to 12 months to prevent a blood clot from forming inside the stent. This regimen, known as dual antiplatelet therapy (DAPT), can cause unwanted internal bleeding. A study reported […]
SGLT2 inhibitors go above and beyond lowering blood sugar to prevent heart failure-related deaths and hospitalizations. By Holly Strawbridge Patients with diabetes have numerous options for drugs to lower their blood sugar (glucose) levels. But a newer class of diabetes medications known as sodium glucose cotransporter 2 (SGLT2) inhibitors has benefits that far surpass those […]
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, […]
If you are a regular reader of Cleveland Clinic Heart Advisor, you know the major modifiable risk factors for heart attack and stroke are diabetes, high blood pressure (hypertension), high cholesterol, obesity, physical inactivity and smoking.
Amainstay of treatment for men who undergo surgery or radiation therapy for prostate cancer is medication to suppress the male hormones that feed the cancer cells. The treatment, known as androgen-deprivation therapy (ADT), plays a vital role in helping the vast majority of patients achieve remission or cure. But the tradeoff is a sharply increased risk of heart disease.
Eggs yolks may be cholesterol bombs, but egg whites are packed with healthy protein. "Egg whites are one of the best protein sources we have. I tell patients to hard boil a dozen eggs, shell them, throw away the yolks and add the whites to oatmeal, salads and soups. The protein prevents them from getting hungry a couple hours after eating, and I've never seen anyone gain weight from eating too many egg whites," says Dr. Hazen.
"There's no reason why a heart patient without contradictions to strength training shouldn't do both," says Erik Van Iterson, PhD, Director of Cardiac Rehabilitation at Cleveland Clinic. "Strength training improves musculoskeletal health, which helps slow the loss of bone and muscle associated with aging. Aerobic exercise strengthens the lungs, heart and body-wide circulation. You will benefit from a global approach to cardiovascular health and fitness by doing both."
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.
PCSK9 inhibitors are so powerful that 10% of participants achieved LDL levels less than 20 mg/dL; 31% saw their LDL levels drop to 20 to 50 mg/dL. No safety concerns were seen in patients with these low LDL levels, and the rate of side effects was the same in the treatment and placebo groups. As expected, the number of cardiovascular events dropped as LDL levelsplummeted.
On a more hopeful note, there was some evidence that omega-3 long-chain polyunsaturated fatty acids (LC-PUFA) were associated with lower risk of heart attack and CAD, and that folic acid may help protect against stroke. However, the primary study on folate that reached this conclusion was conducted in China, where foods are not routinely fortified with folate like they are in the United States.
Low-dose dietary supplements of omega-3 fatty acids have little effect on lowering cardiovascular risk (see article on page 6). However, high doses of omega-3, either eicosapentaenoic acid (EPA) alone or EPA plus docosahexaenoic acid (DHA), can significantly lower cardiovascular risk in patients with high triglyceride levels. The U.S. Food & Drug Administration (FDA) has approved several products-Lovaza, Omtryg, Vascepa and Epanova-that are now available by prescription. Results of the REDUCE-IT trial, presented at the American Heart Association (AHA) 2018 Scientific Sessions, showed that in patients with elevated triglyceride levels and cardiovascular disease or diabetes plus one additional risk factor, 4 grams per day of purified EPA reduced the risk of a major cardiovascular event by 25%. In a science advisory issued Aug. 19 online in Circulation, the AHA summarized the findings of 17 clinical trials in which high-dose EPA or EPA plus DHA reduced triglyceride levels by 30 to 36%. The AHA concluded they are a safe and effective option for reducing triglycerides whether used alone or in combination with other lipid-lowering drugs.
Nevertheless, it may take several hours to determine whether a heart attack has occurred and what kind of treatment is needed. When someone is unsure what their symptoms mean, the thought of spending several hours in the emergency department may deter them from seeking care. Dr. Campbell emphasizes that it's wiser to err on the safe side.