Posts

One in 3 stent implants in India is possibly unnecessary

/0 Comments/in /by

Several senior cardiologists in India have raised concern over rise in the cases of unnecessary implant of stents in India. They say if an audit of stent implant cases was done, over a third of the elective procedures could turn out to be needless.

A few years ago in the US, which has better monitoring and oversight of medical procedures than India, studies had found that only half the non-emergency cardiac stenting procedures were appropriate. Several cardiologists and hospitals were forced to cough up millions of dollars in penalties for unnecessary stenting. Stent companies too paid heavy penalties to settle charges of giving kickbacks to doctors.

There is no regulation of hospitals in India, especially in the private sector where a majority of urban Indians seek healthcare. “At least 25-30% of the stenting done in this country is inappropriate. There are cases of stents being used in absolutely normal patients. External audit of every cath lab and all cardiac procedures is urgently needed. Every state government ought to have doctors with calibre and integrity comprising an audit committee. And doctors caught doing inappropriate stenting ought to be jailed for fraud to set an example,” said Dr T S Kler, head of the department of cardiology in Fortis Escorts Heart Institute.

In 2007 a study in the US that tracked patients over five years showed that in people with stable coronary artery disease, stents were no better than drug therapy. Until this finding, doctors had claimed that stenting in such cases showed excellent results.

In India, there are hospitals that boast of conducting up to 25,000 angioplasties a year and several cardiologists are too close to stent makers and suppliers for comfort. In the absence of any monitoring or oversight, patients in India have no protection from unnecessary use of stent.

“I agree that a significant percentage of angioplasties are inappropriate. I think the Cardiology Society of India should bring out guidelines and create a mechanism to audit themselves rather than giving a chance for an external body to be created. Such an audit is needed as society has lost trust in doctors because of such inappropriate use,” says Dr Devi Shetty, chairman of Narayana Health.

In 2009, an expert panel of cardiologists in the US published criteria for appropriate use of stents. A study preceding the publication looked at 2.7 million stenting procedures in 766 hospitals. It showed that inappropriate stenting in non-acute cases, fell from 25% in 2009 to 13% by 2014. Equally significantly, the total number of stenting in non-acute cases fell by about a third. As a result, the total number of cases of inappropriate stenting fell from 21,000 to just 8,000.

While there is broad consensus among cardiologists that stents can save the life of a patient with symptoms of heart attack, the decision to use stents on an elective basis is far more complicated. With the National Pharmaceutical Pricing Authority revealing that hospitals make the highest profit on stents, it seems obvious why hospitals are not pushing for audits to curb inappropriate use.

Source: http://timesofindia.indiatimes.com/india/one-in-3-stent-implants-in-india-is-possibly-unnecessary/articleshow/57071863.cms

Image source: https://www.drbillsukala.com.au/exercise/exercise-after-angioplasty-stent/

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Coming Soon: Pill To Ward Off Diabetes & Heart Disease

/0 Comments/in /by

If what some scientists are saying is true, preventing both heart disease and diabetes could be as simple as popping a single pill.
Soon, preventing both heart disease and diabetes could be as simple as popping a single pill, if predictions by a team of scientists prove true.

A large analysis of genetic data found that both the conditions, which are the leading causes of death and illness across the world, are linked by the same genes. The team led by researchers in the Perelman School of Medicine at the University of Pennsylvania first looked into what causes Type 2 diabetes (T2D) and then clarified how T2D and coronary heart disease (CHD) are linked.

Examining genome sequence information for more than 250,000 people, the researchers first uncovered 16 new diabetes genetic risk factors and one new CHD genetic risk factor; hence providing novel insights about the mechanisms of the two diseases.

They then showed that most of the sites on the genome known to be associated with higher diabetes risk are also associated with higher CHD risk. For eight of these sites, the researchers were able to identify a specific gene variant that influences risk for both diseases. The shared genetic risk factors affect biological pathways including immunity, cell proliferation, and heart development.

The findings add to the basic scientific understanding of both these major diseases and point to potential targets for future drugs. “Identifying these gene variants linked to both type 2 diabetes and CHD risk in principle opens up opportunities to lower the risk of both outcomes with a single drug,” said co-senior author Danish Saleheen. “From a drug development perspective, it would make sense to focus on those pathways that are most strongly linked to both diseases,” Saleheen said.

The researchers found evidence that, on the whole, the genetic link between the diseases appears to work in one direction, so that risk genes for type 2 diabetes are much more likely to be associated with higher CHD risk than the other way around. Additionally, there could be some pathways where pharmacological lowering of one disease increases the risk of the other.

The scientists also found that diabetes-linked gene variants tend to differ in their apparent effects on CHD risk, depending on their mechanisms. Variants that increase the chance of obesity or high blood pressure, for example, appear to boost CHD risk more strongly than variants that alter insulin or glucose levels.
The dual-effect risk loci also include the region covering the gene FABP4, which is already being investigated for its potential as a diabetes and heart-disease drug target. In mouse studies, inhibition of this gene’s protein has been shown to have anti-atherosclerotic, i.e., helps fight thickening and hardening with fat on the inside of arteries and anti-diabetic effects.

Saleheen, co-senior author Benjamin F. Voight and their colleagues now plan further investigations of the dual-risk genes uncovered in the study. The researchers also hope to learn more about the biology of the newly discovered dual-risk genes by studying people who have mutations in those genes, Saleheen said. The study is published in Nature Genetics.


Source: http://www.hindustantimes.com/health/miracle-cure-pill-to-ward-off-diabetes-heart-disease-could-soon-be-reality/story-jt5M8MrJWIQLhwhmQ27pNO.html

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Senior citizens, beware: High thyroid hormone levels can increase risk of heart disease

/0 Comments/in /by
A caucasian senior woman in a doctors office. She has white hair and is wearing a blue top. She is sitting in the examination room with an asian nurse holding a clipboard. She is holding a hand to her chest and looking uncomfortable. She is experiencing chest pains. The nurse is touching the patients shoulder to comfort her.

Older adults with higher levels of a thyroid hormone may be at an increased risk of artery disease and consequent death, according to new research. Free thyroxine (known as FT4) is a hormone produced by the thyroid gland that helps control the rate at which the body uses energy. Previous research linked the hormone to risk of irregular heartbeats.

The findings showed that elderly with high levels of FT4 hormone may be at twice the risk of having high levels of coronary artery calcification scores, which may be an indicator of atherosclerosis — the process of progressive thickening and hardening of the walls of arteries from fat deposits on their inner lining.

“We expected that thyroid function would influence the risk of developing atherosclerosis by affecting cardiovascular risk factors such as blood pressure. However, our results remained very similar after accounting for several cardiovascular risk factors,” said lead author Arjola Bano, from Erasmus University in the Netherlands. “This suggests that mechanisms other than traditional cardiovascular risk factors may play a role,” Bano added.
Further, increasing FT4 levels were associated with 87% greater risk of suffering an atherosclerosis-related cardiovascular event as well as double the risk of atherosclerosis-related cardiovascular death. “Our findings suggest that thyroid hormone FT4 measurement can help identify individuals at increased risk of atherosclerosis,” Bano said.

For the study, detailed in the journal Circulation Research, the team analysed data from 9,420 participants with an average age of 65. They looked at data on two types of hormones: thyroid-stimulating hormone and free thyroxine (known as FT4) and their link to atherosclerosis and death due to coronary heart disease, cerebrovascular disease or other artery-related illness.

Source: http://www.hindustantimes.com/health/senior-citizens-beware-high-thyroid-hormone-levels-can-increase-risk-of-heart-disease/story-MHyAosp0Z8nMAZncBfvgMJ.html

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

EECP Therapy – A new, cheaper, non-invasive treatment for heart disease

/0 Comments/in /by

EECP- Enhanced External Counter Pulsation is gaining prominence as far treating a heart disease is concerned. It is in fact a non-invasive surgical method employed to un-block the clogged arteries and blood vessels that carry blood to the human heart. Leggings are placed within your legs which are fitted with pneumatic cuffs. Whenever the heart beat has completed a contraction the same is detected on the EECP machine and the capillaries expand and give a better passage to pump blood into the heart.

The non-surgical method is definitely cheaper when compared to a bypass surgery. The total cost of EECP is 95,000 almost one-fourth of what it costs you to do a bypass surgery. Bypass surgery is done wherein artificial stents are introduced to expand the passage of blood carrying vessels to the heart muscle. This corrects blocked arteries. But there is a significant amount of risk involved while performing the operation. The chances of survival quotient of the patient involved, gets challenged apart from being very costly.

EECP heart treatment in a nutshell

What does EECP actually do?

The patient has leggings attached in between his/her legs and these are fitted with cuffs. The cuffs inflates with every contraction and sequentially contracts with every expansion felt by the heartbeat. The opposite swings between the cuff movement and heart muscles facilitates as a form of exercise which is experienced by the body. This is the reason why symptomatic reactions of chest pain or fatigue as experienced by patients even after a bypass surgery is nullified in this method of treatment.

The treatment takes an hour each for 35 sittings. Patients are able to experience very good results with the non-invasive mode of treatment. In Bangalore itself, there are four centers for EECP wherein you can avail the treatment. Medanta in Gurgaon, Frontier Lifeline Hospital (Dr KM Cherian Heart Foundation) in Chennai, BM Birla Heart Research Centre in Kolkata and Asian Heart Institute & Research Centre in Mumbai are some of the other units offering EECP at the national level.

Few take-aways from the session and pointers to maintain a healthy and a young heart

You ladies go for a facial session at the beauty parlor to get a glowing and a youthful skin, isn’t it? What do you really do about maintaining a healthy heart? Just think about it.

Drink plenty of water to keep the body well hydrated. A well hydrated body promotes better blood circulation and the enhanced blood circulation adds to the wellness of the heart muscles as well.
Do an hour of yoga or deep breathing exercises. Practicing meditation or deep breathing gives you a relaxing effect. Most importantly it keeps the blood pressure down which is needed for the healthy functioning of the heart.
Eat a lot of fruits and vegetables especially to reduce cholesterol and to supply the body with needed nutrients and vitamins for optimal functioning of the body.
Go for nature treks once in 6 months. A visit to a hill station or so. The relaxing effect soothes the stressed muscles of the heart.
Last but definitely not the least laugh out loud. Bring out the hilarious side of you. Laughter relates to a joyful mood. When you smile 16 muscles contract while you frown the number is 52. Hence smile or laugh a lot to have a healthy heart.

Source: http://eecpindia.co.in/eecp-heart-treatment-non-invasive-methods-of-treating-heart-disease/

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Children who eat at restaurants have extra body fat, risk of heart disease: Study

/0 Comments/in /by

Children who eat restaurant carry-out, or “takeaway,” meals once a week or more tend to have extra body fat and long-term risk factors for heart disease, suggests a UK study.

In the study of 9- and 10-year-olds, the kids who ate carry-out most often also consumed more calories but fewer vitamins and minerals compared with kids who rarely or never ate carry-out food, the authors report in Archives of Disease in Childhood.

“Frequent consumption of takeaway foods could potentially be increasing children’s risk of future coronary heart disease and type 2 diabetes by increasing their LDL cholesterol and body fat,” lead author Angela Donin told Reuters Health in an email.

“Takeaway outlets are increasing, as is consumption with more than half of teenagers reporting eating takeaways at least twice a week,” said Donin, a researcher at St. George’s, University of London.

In adults, regular consumption of carry-out meals is associated with higher risk of obesity, coronary heart disease, and type 2 diabetes, but little is known about the effects it may be having on children’s health, Donin said.

“We, therefore, wanted to see how much takeaway food children were eating and if there were any effects on their health.”

The researchers analyzed data from the Child Heart and Health Study in England, which looked at potential risk factors for heart disease and diabetes in pre-teens. Participants included about 2,000 kids aged 9 and 10 years at 85 primary schools in three cities: London, Birmingham, and Leicester.

The children answered questions about their usual diets, including how often they ate carry-out meals purchased from restaurants. Foods purchased at convenience stores or grocery stores were not included in the category. Photos of common foods were provided to help the kids recall and estimate portion sizes.

About one-quarter of the children said they never or rarely ate carry-out meals and nearly half said they ate carry-out less than once per week. Just over one quarter said they ate these kinds of meals at least once per week.

Boys were more frequent consumers of carry-out meals than girls, as were children from less affluent backgrounds.

The study team used the kids’ dietary responses to calculate calorie counts and nutrient intake. Among regular consumers of carry-out meals, the foods eaten were higher-calorie and higher-fat, while protein and starch intake was lower and intake of vitamin C, iron, calcium and folate was also lower compared with kids who didn’t eat these types of meals.

Researchers also measured the children’s height, weight, waist circumference, skinfold thickness and body-fat composition. In addition, they measured blood pressure and took blood samples for cholesterol levels.

There were no differences in blood pressure or how well the kids’ bodies used insulin based on who regularly ate carry-out meals. But skinfold thickness, body fat composition and blood fats like LDL (bad) cholesterol all tended to be higher in regular consumers of carry-out meals.

“Children who ate more takeaway meals had higher total and LDL cholesterol (both important risk factors for coronary heart disease) and body fat.,” Donin said.

“Most people who order takeout usually purchase fast food, which is high in sodium, fat, and calories,” noted Sandra Arevalo, who wasn’t involved in the study.

”Fast-food also has low nutritional value, which means it is low in vitamins, minerals, fiber and sometimes protein,” said Arevalo, a registered dietician who directs Nutrition Services and Community Outreach at Community Pediatrics, a program of Montefiore and The Children’s Health Fund, in New York. “If you eat these meals over a long period of time you can start seeing the health consequences associated with it.”

Arevalo recommends parents who need to bring home a meal, call the restaurant ahead of time to order salads, vegetables, brown rice, grilled meats and to provide a healthier meal for their children.

“The price might be a deterrent but you can cut portions in half and get two meals out of one large one,” she said by email. Another idea is to learn to prepare quick and healthy meals.

“For example, hummus, carrots, and crackers make a great lunch, as well as a tuna or turkey sandwich with lettuce and tomatoes. Eggs are an excellent source of protein, you can scramble an egg with spinach, onions, and tomatoes and have it with a toast,” she said.

Source: http://zeenews.india.com/health/children-who-eat-at-restaurants-have-extra-body-fat-risk-of-heart-disease-study-2071366

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Flavonoid-rich diet protects against cancer, heart disease: Study

/0 Comments/in /by

Washington D.C: Consuming flavonoid-rich items such as apples and tea protects against cancer and heart disease, particularly for smokers and heavy drinkers, suggests a recent research.

Researchers from Edith Cowan Universit’s School of Medical and Health Sciences analysed data from the Danish Diet, Cancer and Health cohort that assessed the diets of 53,048 Danes over 23 years.

According to the study published in the journal — Nature Communications — researchers found that people, who habitually consumed moderate to high amounts of foods rich in flavonoids, compounds found in plant-based foods and drinks, were less likely to die from cancer or heart disease.

Lead researcher Dr Nicola Bondonno said while the study found a lower risk of death in those who ate flavonoid-rich foods, the protective effect appeared to be strongest for those at high risk of chronic diseases due to cigarette smoking and those who drank more than two standard alcoholic drinks a day.

“These findings are important as they highlight the potential to prevent cancer and heart disease by encouraging the consumption of flavonoid-rich foods, particularly in people at high risk of these chronic diseases. But it’s also important to note that flavonoid consumption does not counteract all of the increased risks of death caused by smoking and high alcohol consumption. By far the best thing to do for your health is to quit smoking and cut down on alcohol,” she said.

“We know these kinds of lifestyle changes can be very challenging. So encouraging flavonoid consumption might be a novel way to alleviate the increased risk, while also encouraging people to quit smoking and reduce their alcohol intake,” she added.

It is important to consume a variety of different flavonoid compounds found in different plant-based food and drink. This is easily achievable through the diet: one cup of tea, one apple, one orange, 100g of blueberries, and 100g of broccoli would provide a wide range of flavonoid compounds and over 500mg of total flavonoids.

Dr Bondonno said while the research had established an association between flavonoid consumption and lower risk of death, the exact nature of the protective effect was unclear but likely to be multifaceted.

“Alcohol consumption and smoking both increase inflammation and damage blood vessels, which can increase the risk of a range of diseases. Flavonoids have been shown to be anti-inflammatory and improve blood vessel function, which may explain why they are associated with a lower risk of death from heart disease and cancer,” she said.

Dr Bondonno said the next step for the research was to look more closely at which types of heart disease cancers were most protected by flavonoids.

source: https://health.economictimes.indiatimes.com/news/diagnostics/flavonoid-rich-diet-protects-against-cancer-heart-disease-study/70694650

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Heart Disease – A Silent Killer

/0 Comments/in /by

Coronary Artery Disease (CAD), which claims the lives of both men & women, is a disease in which cholesterol deposits on the inner wall of heart blood vessels. These blood vessels carry oxygen to heart. When plaque builds up, the oxygen does notreach heart in adequate amount resulting in chest pain & heart attack. CAD can also cause heart failure, arrhythmia (electrical abnormality) and sudden death (SCD).

Women tend to have CAD 10 years later than men but it remains as number 1 killer in women, next only to malignancy. Women are more prone to small disease where in tiny vessels of the heart are diseased or damaged without major cholesterol deposits.

It is thought that fall in oestrogen levels during menopause along with conventional risk factors like hypertension, diabetes, hiugh cholesterol and strong family history of heart disease cause microvascular disease in women.

Ways To Healthy Heart

– Follow a healthy lifestyle

– Exercise regularly and include 30 minutes of walk for atleast 5 days a week

– Maintain a healthy weight: Height in cms minus 100 will give a person’s ideal weight

– Quit smoking and cut down on alcohol consumption

– Go for regular health checkup after 30 years of age

Dr. Rajeshwari Nayak

Senior Consultant,

Interventional Cardiology,

Chennai

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

A ‘Cure for Heart Disease’? A Single Shot Succeeds in Monkeys!!

/0 Comments/in /by

What if a single injection could lower blood levels of cholesterol and triglycerides — for a lifetime?

In the first gene-editing experiment of its kind, scientists have disabled two genes in monkeys that raise the risk for heart disease. Humans carry the genes as well, and the experiment has raised hopes that a leading killer may one day be tamed.

“This could be the cure for heart disease,” said Dr. Michael Davidson, director of the Lipid Clinic at the University of Chicago Pritzker School of Medicine, who was not involved in the research.

But it will be years before human trials can begin, and gene-editing technology so far has a mixed tracked record. It is much too early to know whether the strategy will be safe and effective in humans; even the monkeys must be monitored for side effects or other treatment failures for some time to come.

The results were presented on Saturday at the annual meeting of the International Society for Stem Cell Research, this year held virtually with about 3,700 attendees around the world. The scientists are writing up their findings, which have not yet been peer-reviewed or published.

The researchers set out to block two genes: PCSK9, which helps regulate levels of LDL cholesterol; and ANGPTL3, part of the system regulating triglyceride, a type of blood fat. Both genes are active in the liver, which is where cholesterol and triglycerides are produced. People who inherit mutations that destroyed the genes’ function do not get heart disease.

People with increased blood levels of triglycerides and LDL cholesterol have dramatically greater risks of heart disease, heart attacks and strokes, the leading causes of death in most of the developed world. Drug companies already have developed and are marketing two so-called PCSK9 inhibitors that markedly lower LDL cholesterol, but they are expensive and must be injected every few weeks.

Researchers at Verve Therapeutics, led by Dr. Sekar Kathiresan, the chief executive, decided to edit the genes instead. The medicine they developed consists of two pieces of RNA — a gene editor and a tiny guide that directs the editor to a single sequence of 23 letters of human DNA among the genome’s 32.5 billion letters.

The RNA is shrouded in tiny lipid spheres to protect the medicine from being instantly degraded in the blood. The lipid spheres travel directly to the liver where they are ingested by liver cells. The contents of the spheres are released, and once the editor lands on its target, it changes a single letter of the sequence to another — like a pencil erasing one letter and writing in another.

Not only did the system work in 13 monkeys, the researchers reported, but it appeared that every liver cell was edited. After gene editing, the monkeys’ LDL levels dropped by 59 percent within two weeks. The ANGPTL3 gene editing led to a 64 percent decline in triglyceride levels.

One danger of gene editing is the process may result in modification of DNA that scientists are not expecting. “You will never be able to have no off-target effects,” warned Dr. Deepak Srivastava, president of the Gladstone Institutes in San Francisco.

In treating a condition as common as heart disease, he added, even an uncommon side effect can mean many patients are affected. So far, however, the researchers say that they have not seen any inadvertent editing of other genes.

Another question is how long the effect on cholesterol and triglyceride levels will last, Dr. Davidson said. “We hope it will be one-and-done, but we have to validate that with clinical trials,” he said.

Jennifer Doudna, a biochemist of the University of California, Berkeley, and a discoverer of Crispr, the revolutionary gene editing system, said: “In principle, Verve’s approach could be better because it’s a one-time treatment.”

But it is much too soon to say if it will be safe and long-lasting, she added.

If the strategy does work in humans, its greatest impact may be in poorer countries that cannot afford expensive injections for people at high risk of heart disease, said Dr. Daniel Rader, chairman of the department of genetics at the University of Pennsylvania and a member of Verve’s scientific advisory board.

Dr. Kathiresan, of Verve, noted that half of all first heart attacks end in sudden death, making it imperative to protect those at high risk.

Dr. Kathiresan began the research at the Massachusetts General Hospital and the Broad Institute, where he and his colleagues found a collection of genes that increase risk of heart attack at a relatively young age, as well as eight genes that, when mutated, decrease risk.

Those protective genes, he reasoned, could be targets for gene editing if there were a way to alter them in people. Gene editing is only now succeeding, and so far its successes have been in rare diseases.

Other investigators and companies have tried editing genes in mice to prevent heart disease, with some success, but primates are a much more difficult challenge.

Dr. Kathiresan said that to his knowledge, his study is the first to use the pencil-and-eraser type gene editing in primates for a very common disease. Verve licensed the technology, called base editing, from Beam Therapeutics.

If all goes well, Dr. Kathiresan hopes in a few years to begin treating people who have had heart attacks and still have perilously high cholesterol. For them, the risk of another heart attack is so high that the possible benefit may far outweigh the risks of the treatment.

Heart disease generally occurs only after decades of high cholesterol levels, Dr. Davidson noted. By age 50, people most likely to have a heart attack already have a significant accumulation of plaque in their arteries.

But if the PCSK9 gene could be knocked out in 20-year-olds, he said, “there would be no heart disease in their future.”

Source: https://www.nytimes.com/2020/06/27/health/heart-disease-gene-editing.html

iMedWorks Ask Platform Links below:

1.  Get a Medical Second Opinion
2.  Search doctors and Request Appointment