Millions of people have no problems with the generic drugs they take. But a growing number of disturbing patient experiences and drug recalls have made it clear that some generics are not being manufactured according to the high standards set by the U.S. Food & Drug Administration (FDA).
In 1984, the U.S. enacted a law that allows generic companies to win FDA approval with limited tests proving their drugs are bioequivalent to the brand-name drug and perform similarly. It may not have exactly the same chemical composition, but it must act the same way in the body and produce the same results. It also must be made in the same format: pill, capsule or liquid. This is why, in theory, generics are considered equivalent to their brand-name counterparts.
Blood pressure (BP) is measured when the heart is contracting (systolic BP, the first number) and when the heart is resting (diastolic BP, the second number). Ever since the Framingham Heart Study identified that high systolic BP was a stronger predictor of cardiovascular outcomes than high diastolic BP, physicians have focused on lowering high systolic pressures. After the definition of hypertension was lowered from 140/90 millimeters of mercury (mmHg) to 130/80 mmHg in 2017-a controversial move-guidelines continued to emphasize treating the higher number. But a study involving more than 1.3 million outpatients published in the New England Journal of Medicine on July 18, 2019, may change this practice. In this study, researchers showed that having either high systolic or high diastolic high BP, or both, increased the risk of heart attack and stroke. Additionally, the negative influence of blood pressure on cardiovascular outcomes was seen at 130/80 mmHg, validating the lower threshold for hypertension.
But when blood pressure regularly spikes higher than normal, it's a sign that something is not right. Doctors call the condition labile hypertension, and it merits investigation.
The good news is that diabetes is not inevitable. The Diabetes Prevention Program (DPP) found that making lifestyle changes can prevent or delay the onset of type 2 diabetes. People who lost 7% to 10% of their body weight and exercised a minimum of 150 minutes per week decreased their risk of developing diabetes by 58% to 90%.
"It is important for anyone who receives this warning to go immediately to the emergency room for treatment to prevent a stroke from occurring," says M. Shazam Hussain, MD, Director of Cleveland Clinic's Cerebrovascular Center."The highest risk for stroke is within two days after the TIA, so no one should wait to get checked."
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.
"You need adrenaline to run away from a bear, but your adrenaline level has to come down after the bear is gone," Dr. Taylor explains. "If you block adrenalin completely, the bear will catch you, so we block some of the adrenaline slowly and gradually. This allows you to react to the bear, while giving your heart time to get better and stronger between bear attacks. The next time we increase the dose, the heart tolerates it better."
In their place, Zumpano recommends adopting a Mediterranean-style diet. This diet eliminates or minimizes red meat in favor of fish and skinless poultry. Three-fourths of your plate should be filled with vegetables, whole grains or legumes. Olive oil replaces butter and other oils, and fruit and nuts are used for snacks.
When this type of heart attack, (an ST-elevation myocardial infarction, or STEMI) occurs in the left anterior descending (LAD) artery, it's called a "widow maker," because it is often fatal. SuperSaturated Oxygen Therapy was designed to increase the amount of oxygen in the blood serving the heart muscle affected by the heart attack (infarct)to help prevent the tissue from dying. The more muscle that is saved, the greater the likelihood the patient will survive.
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.
"Using this formula, we would tell a 45-year-old patient with a score of 55 that his stress testing performance is more consistent with that of someone 10 years older, and that he is not likely to live as long as his 45-year-old peers," cardiologist Serge Harb, MD, explains. "It makes it easy for patients to understand their risk. We hope it will encourage them to exercise more."