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CARDIO NOTES
Cardio Notes are brief, to-the-point articles on controversial and novel issues in cardiology today, and that incorporate views from world leading experts. These articles can be accessed by clicking on the relevant links or using the category search form.
Expert opinion at your fingertips
Post-coronary heart disease diagnosis of depression strong predictor of death
2017-08-15 by Sian Claire Owen
Depression is a known risk factor for heart disease. However, researchers have uncovered a direct link between depression diagnosis and mortality in patients with coronary artery disease (CAD). [1] In a study published in the European …
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The rise of ‘statin denialism’ – is this a real risk?
2017-07-30 by Sian Claire Owen
The rise of ‘statin deniers’ – an online movement denouncing the use of statins to reduce cholesterol – is causing havoc in patients at risk of developing CVD, according to leading cardiologist Steve Nissen, Cleveland …
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Gender-specific dosage should be included on labels to prevent adverse effects
2017-07-26 by Sian Claire Owen
Sex-specific doses of cardiovascular drugs are needed to reduce adverse events in women, according to a position paper published earlier this year in the European Heart Journal. [1] In this paper, the authors state that: “Women …
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Wake up and smell the coffee: Can coffee prevent death and heart disease?
2017-07-12 by Sian Claire Owen
Two major studies recently published in the Annals of Internal Medicine have highlighted the possible health benefits of drinking two or three cups of coffee every day. Results of these observational studies, conducted in the …
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Can a vaccine lower cholesterol and prevent heart attacks?
2017-07-09 by Sian Claire Owen
A study published in the European Heart Journal recently hit the headlines, saying that a ‘cholesterol-lowering vaccine’ can be used to reduce the risk of heart attacks. [1] The study was carried out in mice bred …
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Twisted carrots and dynamite beets: Indulgent descriptions lead to higher vegetable consumption
2017-07-02 by Sian Claire Owen
A recent study published in JAMA Internal Medicine [1] suggests that the language used to describe vegetable dishes can influence people’s food choices and result in higher vegetable consumption. Current wisdom dictates that promoting healthy benefits …
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E-health and virtual clinics: The future of heart failure management programmes?
2017-06-25 by Dr Rachel Bastiaenen
Heart failure management programmes with dedicated multidisciplinary clinics have been shown to improve outcomes for heart failure patients. However, increasing prevalence of disease combined with an aging population may make it difficult for heart failure …
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The parallel tales of microvascular angina and heart failure with HFpEF
2017-06-18 by Dr Rachel Bastiaenen
Heart failure with preserved ejection fraction (HFpEF) is characterised by symptoms and/or signs of heart failure, normal or mildly reduced left ventricular ejection fraction (LVEF), elevated natriuretic peptides and relevant structural heart disease (left ventricular …
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Renin angiotensin system inhibitors: to use or not to use?
2017-06-11 by Dr Rachel Bastiaenen
Renin angiotensin system inhibitors in patients with stable coronary artery disease and preserved left ventricular function: to use or not to use? Guidelines advise use of renin angiotensin system inhibitors (RASi) in all patients with stable ischaemic …
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The impact of childhood obesity can last well into adulthood
2017-06-07 by Sian Claire Owen
Childhood obesity is on the rise. According to the Obesity Health Alliance – a coalition of over 40 organisations aiming to tackle obesity – almost one in five children are overweight or obese by the …
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Link between alcohol consumption and CVD is nuanced and complex
2017-06-01 by Sian Claire Owen
The relationship between alcohol consumption and cardiovascular disease is complex and not fully understood. Risks associated with heavy drinking are well established, however there is conflicting evidence that shows benefits of drinking small amounts on …
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The role of DOACs in pulmonary arterial hypertension
2017-05-25 by Dr Christopher Orton, Prof Brendan Madden
Pulmonary arterial hypertension (PAH) is a pathophysiological disorder defined as an increase in mean pulmonary artery pressure ≥25mmHg, a raised pulmonary vascular resistance ≥3 Wood units and a precapillary wedge pressure ≤15mmHg, as assessed by …
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Recent discovery heralds new pathway for hypertension treatment
2017-05-15 by Sian Claire Owen
The role nitric oxide (NO) plays in vasodilation is well established. However, much of the information to date has focused on the interaction of NO in the endothelial cells and vascular smooth muscle cells. A …
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Should all patients with myocarditis have an endomyocardial biopsy?
2017-05-08 by Dr Rachel Bastiaenen, Prof Brendan Madden
Myocarditis describes myocardial inflammation. The most common cause is viral infection (active infection or post-infective inflammation). Other causes include autoimmune disease, drugs and toxins. Endomyocardial biopsy (EMBx) is the gold standard diagnostic investigation. EMBx specimens …
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NSAIDs carry an increased risk of cardiac arrest
2017-05-01 by Sian Claire Owen
Non-steroidal inflammatory drugs (NSAIDs) are amongst the most commonly used medications in the world. In 2010, over 29.6 million adults in the US used NSAIDS on a regular basis, [1] with over-the-counter painkillers such as …
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Cardiovascular disease and air pollution: A deadly link
2017-04-25 by Sian Claire Owen
Air pollution is deadly; this is common knowledge. In the UK, around 40,000 people die every year because of air pollution, with eight out of 10 deaths caused by heart attack or stroke. And recent …
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Firefighting and cardiovascular disease: The ‘unseen’ risks
2017-04-24 by Sian Claire Owen
Firefighters risk their lives to keep us safe, but recent research confirms that some of the risks they face – the risk of heart attacks - are less obvious than others. A recent study published in …
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Is MRI safe for patients with non-MRI-conditional pacemakers and ICDs?
2017-03-27 by Dr Rachel Bastiaenen, Dr Manav Sohal
Modern pacemakers and implantable cardioverter-defibrillators (ICDs) have been designed to reduce the potential risks associated with magnetic resonance imaging (MRI). These devices are labelled MRI-conditional by the Food and Drug Administration (FDA) centre for Devices and …
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Hypertrophic cardiomyopathy
2017-03-20 by Dr Rachel Bastiaenen, Dr Maria Teresa Tome Esteban
Late gadolinium enhancement in hypertrophic cardiomyopathy: When should we use it in risk stratification of our patients? Hypertrophic cardiomyopathy (HCM) is associated with complications including heart failure and sudden cardiac death (SCD). The implantable cardioverter defibrillator (ICD) …
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Addressing the availability gap of quality generic cardiology drugs in developing countries
2017-03-16 by Sian Claire Owen
In September 2016, the World Health Organisation (WHO) launched the ‘Global Hearts’ initiative in order to tackle the global threat of cardiovascular disease, especially in developing countries. This is no mean feat. According to the …
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e-Cigarettes and cardiovascular disease: Are they as dangerous as the real thing?
2017-02-27 by Sian Claire Owen
The relationship between smoking and heart disease is well documented, but there is a growing body of evidence suggesting that e-Cigarettes – formerly hailed as an effective and harmless tool in smoking cessation – also …
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TAVI vs SAVR in severe aortic stenosis
2017-02-20 by Dr Rachel Bastiaenen, Prof Stephen J.D. Brecker
Transcatheter aortic valve implantation (TAVI) vs surgical aortic valve replacement (SAVR) in severe aortic stenosis The randomized PARTNER trial demonstrated similar long-term clinical outcomes in high risk patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) …
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How Social Media is bringing the cardiology community together
2017-01-23 by Sian Claire Owen
Social media is emerging as an exciting and promising set of tools that can help bridge the gaps in communication between patients and healthcare professionals. It facilitates peer-to-peer discussion between practitioners, enables dissemination of online educational …
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Cardio-protective effects of spermidine: A new elixir of life?
2017-01-16 by Sian Claire Owen
Polyamines are currently being heralded as the new anti-aging wonder compounds. Found typically in the Mediterranean Diet, this group of naturally-occurring chemicals are associated with anti-aging and anti-inflammatory properties. [1] And one polyamine in particular …
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Physician Burnout: Preventing a dangerous downward spiral
2017-01-09 by Sian Claire Owen
Physician Burnout has long been discussed in the medical literature and more recently in the mainstream media. Today it is well recognised as a condition that is not only detrimental for the physicians but also …
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Recurrent or persistent angina after coronary artery revascularisation and stent implantation
2017-01-02 by Prof Juan Carlos Kaski
Think coronary artery spasm! A relatively large proportion of patients -20% to 50% in different series- continue to experience angina after coronary revascularisation with percutaneous coronary intervention (PCI) and stent implantation. It is often suggested that …
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Coronary Artery Spasm as a Cause of Acute Myocardial Infarction – Diagnostic Pathways and Prognosis
2016-12-19 by Prof Juan Carlos Kaski
Coronary artery spasm has been shown to be one of the mechanisms responsible for myocardial infarction with non-obstructive coronary artery disease (MINOCA).  Despite this having been demonstrated convincingly several decades ago many physicians still question …
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Virtual reality and 3D printing in Cardiology: Science fiction becomes reality
2016-12-12 by Sian Claire Owen
Virtual reality (VR) and 3D printing are gradually entering the mainstream consciousness. People no longer associate these new technologies with Star Trek episodes, and it is a matter of time before we will take them …
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Targeting Lp(a) to reduce cardiovascular disease and calcific aortic valve stenosis
2016-12-05 by Prof Juan Carlos Kaski
Elevated concentrations of lipoprotein(a) (Lp[a]) –a modified LDL particle comprising LDL and apolipoproteine(a) have been associated with the development of atherosclerosis, cardiovascular disease and an increased prevalence of calcific aortic stenosis. (1-3)  Raised concentrations of …
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The not-so-hidden dangers of added sugar and cardiovascular disease
2016-11-28 by Sian Claire Owen
Sugar is a key ingredient for most processed foods and sweetened beverages, as an ingredient it adds flavor and can withstand the demands of industrial food preparation – and most of all, it is low …
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Hypertension treatment – Lower not always better!
2016-11-21 by Prof Juan Carlos Kaski, Dr Massimo Piccinini, Prof Thomas Kahan
A recent publication in The Lancet by Vidal-Petiot et al (1) reported that a reduction of blood pressure (BP) to levels in the region of 120–139 mm Hg systolic or a 70–79 mm Hg diastolic …
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NHS doctors showing clear signs of stress: a signal that cannot be ignored for much longer
2016-11-14 by Prof Juan Carlos Kaski
A recent article in the BMA News magazine (1) –signed by Keith Cooper- focuses on a major issue affecting the medical profession, which in the words of the GMC and the author of the BMA …
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The role of the gut microbiota in the treatment and prevention of cardio-metabolic diseases
2016-11-07 by Prof Juan Carlos Kaski, Dr Michael Mendall
Research in recent years has shown that intestinal microbial organisms, collectively named ‘microbiota’, take part in the metabolism of their host. (1) Moreover, it has become apparent that the microbiota may play an important role in …
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Happy Heart Syndrome
2016-10-25 by Prof Juan Carlos Kaski
HAPPY HEART SYNDROME - A VARIANT OF TAKOTSUBO SYNDROME Takotsubo syndrome (TTS), described initially by Sato et al in 1990 (1) has captured the attention of practicing physicians and researchers alike. TTS is characteristically associated with physical …
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Sleep disorders and cardiovascular health
2016-10-24 by Sian Claire Owen
Sleep is important for our general health and wellbeing. According to data from the National Sleep Foundation, published in Sleep Health, the optimal amount of sleep needed to function properly is seven to nine hours …
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Saturated fat and heart disease: Challenges to the status quo
2016-10-17 by Sian Claire Owen
What is the optimal diet for a healthy heart? Cardiovascular disease (CVD) is the leading cause of death globally. Every year, 17.3 million people will die from CVD, and in the UK alone over a quarter …
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Female-specific risk variables for CVD risk prediction
2016-10-03 by Prof Angela Maas
Sex-specific factors related to hormonal and reproductive status are known to relate to CVD risk. When considering all age-groups together, reproductive and pregnancy related disorders do not seem to be relevant in 10 years risk …
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‘Metabolically healthy obesity’ may not be a benign condition
2016-09-26 by Sian Claire Owen
Can you really be "Fit and Fat"? Can some obese individuals be considered ‘metabolically healthy’? This is a question that has been hotly debated over the past few years, and thanks to new research may be …
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Anticoagulation in Atrial Fibrillation patients prone to fall - What to do?
2016-09-26 by Prof Juan Carlos Kaski
In subjects with atrial fibrillation (AF) who are at an increased risk of falling, anticoagulation is often regarded as problematic and not infrequently avoided, in many cases, despite a clear indication for its use. Recommendations …
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Cardio-Oncology-Vascular disease resulting from radiotherapy for management of neck and head cancer
2016-09-19 by Prof Juan Carlos Kaski
The field of cardio-oncology continues to expand rapidly. A recent manuscript by Shah et al (1) assessed the effects of radiation therapy (RT) on the carotid arteries of individuals receiving RT for treatment of head …
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Statins: Friend or Foe?
2016-09-12 by Prof Juan Carlos Kaski
Statins have been shown to lower LDL-cholesterol, as result of which they reduce cardiovascular risk when used for primary prevention and improve clinical outcomes in patients with cardiovascular disease (secondary prevention). (1) It has been …
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Screening and patient awareness in familial hypercholesterolemia: Challenges for clinical practitioners
2016-09-09 by Prof Juan Carlos Kaski
Advances in the management of familial hypercholesterolemia Role of screening and patient awareness Yet another challenge facing clinical practitioners Familial hypercholesterolemia (FH) is a common genetic condition that results in high cholesterol levels and is associated with an …
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Non- Pharmacological management of refractory Angina
2016-08-22 by Prof Juan Carlos Kaski, Dr Mike Fisher
Spinal Cord Stimulation: Indicated or not indicated? Interest in the management of refractory angina has increased recently as a result of an ever growing prevalence of the condition due to several causes, and the availability of …
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Plasma ceramides for risk stratification of patients with CAD
2016-08-15 by Prof Juan Carlos Kaski, Prof Reijo Laaksonen, Dr Daniel Fernández-Bergés
Yet another "promising" marker or the real thing? The search for suitable markers of risk of cardiovascular (CV) events that can be useful in the individual patient, as opposed to large populations, continues in different centres …
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Dual Anti-Platelet therapy after angioplasty
2016-08-08 by Prof Abhiram Prasad, Prof Albert Ferro, Dr Kerry Layne
Continuation beyond 12 months - Effects on in-stent thrombosis Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is usually administered for 6-12 months after percutaneous coronary intervention (PCI) and stent placement to prevent stent …
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Sedentary lifestyles carry risk of mortality: How can we get moving?
2016-08-02 by Prof Juan Carlos Kaski
How to increase physical activity to mitigate the increased mortality risk associated with sedentary behaviour at home and at work - A major challenge confronting individuals and institutions. It is known that sedentary behaviour, extremely common …
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Do statins reduce cardiovascular risk in subjects with heterozygous familial hypercholesterolaemia?
2016-08-01 by Prof Juan Carlos Kaski
Familial hypercholesterolemia (FH), characterized by markedly increased low-density lipoprotein (LDL) cholesterol concentrations, is a hereditary disorder of LDL-cholesterol metabolism. The condition is common as it affects 1 in 250 persons (1–3). The risk of developing …
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Refractory Angina Pectoris: how important an issue?
2016-07-25 by Prof Juan Carlos Kaski, Dr Ranil de Silva, Christine Wright RN
Refractory angina pectoris, defined as “severe stable angina due to coronary artery disease resistant to conventional pharmacological therapy (beta-blockers, calcium antagonists and nitrates) and/or revascularisation procedures such as coronary artery bypass grafting (CABG) or percutaneous …
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End of the road for the hypothesis that shorter telomeres cause early atherosclerosis?
2016-07-18 by Prof Juan Carlos Kaski, Prof Jorge D. Erusalimsky
A study by Samani et al. (1) over 15 years ago triggered interest in the hypothesis that reduced telomere length predisposed to early cardiovascular disease. Interestingly, a recent meta-analysis by D’Mello et al confirmed Samani’s …
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The ‘Popeye’ strategy? Combating “hedonic hunger” to reduce the obesity epidemics
2016-07-18 by Prof Juan Carlos Kaski
The prevalence of obesity has risen dramatically to the point that a worldwide obesity epidemics is underway, which may increase the risk of cardiovascular disease and cancer.  “Hedonic hunger” is a term used to describe …
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UK Science at risk after Brexit
2016-06-30 by Prof Juan Carlos Kaski
Will British science suffer as a result of Brexit? The ‘leave’ vote in the UK referendum last week has shocked over half of Britain, and indeed the whole of the European Union (EU).  The result has …
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Ranolazine for management of microvascular angina
2016-06-27 by Prof Juan Carlos Kaski, Prof Filippo Crea, Prof Gaetano Lanza
Myocardial ischaemia in patients without obstructive coronary artery disease (NOCAD) is often caused by coronary microvascular dysfunction (CMD). Treatment of these patients is not straightforward and new therapies are needed to improve symptoms and signs …
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“Physician Burnout” – A New Epidemic?
2016-06-20 by Prof Juan Carlos Kaski, Dr Kavita Prasad, Dr Pedro Monteiro
A talk by Dr P Monteiro at the recent International Workshop on Management of Cardiovascular Disease in 2016, organised by the Cardiovascular and Cell Sciences Research Institute, St George’s University of London, highlighted the importance …
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Chronic Heart Failure – The Management of Comorbidities: atrial fibrillation
2016-06-13 by Prof Dennis V. Cokkinos, Prof George A. Dan, Dr Xavier Garcia-Moll
Heart failure (HF) and atrial fibrillation (AF) have emerged as two new cardiovascular epidemics1. They share predisposing risk factors such as hypertension, diabetes mellitus, ischemic heart disease, and valve heart disease and are also linked …
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Physical activity in the prevention of coronary heart disease
2016-06-05 by Prof Juan Carlos Kaski, Prof Francesco Pelliccia
Are we physicians neglecting an effective and inexpensive tool? A recent article by Varghese et al in Heart (1) has highlighted the importance of regular physical activity for primary and secondary ischaemic heart disease prevention. The …
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PPIs associated with endothelial senescence & adverse cardiovascular events
2016-06-05 by Prof Juan Carlos Kaski, Prof Jorge D. Erusalimsky
Proton pump inhibitors (PPIs) are widely used for the management of gastroesophageal reflux and in many countries these agents are sold over-the-counter leading in many instances to a misuse of PPIs. Recent studies have raised …
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Empagliflozin improves cardiovascular outcome: the road ahead
2016-05-30 by Prof Juan Carlos Kaski, Prof Nikolaus Marx
A recent paper by Zinman et al (1) reporting that the glucose-lowering agent empagliflozin reduced the relative risk for cardiovascular and all-cause mortality in patients with type 2 diabetes, has attracted the attention of physicians …
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Improved cardiovascular outcomes with empagliflozin treatment
2016-05-23 by Prof Juan Carlos Kaski
Results of the EMPA-REG OUTCOME trial (1) have captured the attention of endocrinologists and cardiovascular physicians worldwide. The reason for this is that the use of empagliflozin, the sodium glucose cotransporter 2 (SGLT2) inhibitor investigated …
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Patent foramen ovale: the current state of play
2016-05-16 by Dr Anna Marciniak
Dr Anna Marciniak, Dr Brian Clapp. Patent foramen ovale (PFO) is a common finding, occurring in up to 25% of population.1 An association between PFO and stroke has consistently been seen in up to 50% …
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Heart Failure - The management of Comorbidities: Is there a role for Statin therapy?
2016-05-09 by Prof Francesco Pelliccia, Dr Alberto Lorenzatti
Whether statin treatment is useful in HF continues to be debated. Several systematic reviews and meta-analyses have been conducted to assess whether statin therapy reduces major adverse events in HF. While some studies seem to …
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PPIs use linked to increased risk of dementia
2016-05-03 by Dr Britta Haenisch, Prof Peter Garrard
Proton pump inhibitors (PPIs) are widely used worldwide for the treatment of gastroesophageal reflux and the prevention of gastric irritation, ulceration and haemorrhage associated with gastrointestinal diseases or the administration of pharmacological agents that have …
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ARNI vs ACE inhibitors in heart failure
2016-04-25 by Prof Giuseppe Rosano, Prof Antoni Bayes-Genis, Prof John GF Cleland
Angiotensin-converting-enzyme inhibitors (ACE-I) have been the cornerstone of treatment for heart failure with reduced ejection fraction (HFREF) for nearly a quarter of a century and the heart failure treatment algorithm has remained essentially unchanged for …
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Heart Failure - The Management of Comorbidities: Diabetes
2016-04-25 by Dr Angeles Alonso-Garcia, Prof Keld Kjeldsen, Prof Mark Kearney, Dr Thomas Andersen Schmidt
Patients with type 2 diabetes mellitus (T2MD) are at a high risk of developing heart failure (HF). The frequent coexistence of diabetes and other risk factors for ischaemic heart disease and HF such as hypertension …
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Non-obstructive CAD: a woman’s problem?
2016-04-18 by Prof Eva Prescott, Dr Renate Schnabel, Prof Juan Carlos Kaski
Recognition of ischaemic heart disease (IHD) is frequently delayed in women. In part this relates to differences in the underlying pathophysiology. Whereas symptoms in men are commonly due to flow-limiting atherosclerotic coronary artery disease (CAD), …
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Treatment of hypertension – how low should you go?
2016-04-11 by Dr Massimo Piccinini
Treatment of hypertension reduces cardiovascular risk but the most appropriate targets for systolic blood pressure (SBP) control remain unclear. The current guidelines in Europe recommend treating to a target of 150/90mmHg in patients who are …
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Heart Failure - The management of Comorbidities: Iron Deficiency and Sleep Breathing Disorders
2016-04-11 by Prof Francesco Pelliccia, Prof Sang Hong Baek, Dr Jose Luis Lambert Rodriguez
RECENT ADVANCES IN THE TREATMENT OF CHRONIC HEART FAILURE Chronic heart failure (HF), the leading diagnosis at hospital discharge for elderly patients in Europe and the USA, carries a high mortality risk. Before the 1990’s HF …
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Perioperative beta-blockade in non-cardiac surgery: Harmful or helpful?
2016-04-04 by Dr Hector Bueno
Pre-operative beta-blockade is a widely accepted practice in patients having cardiac surgery, but in non-cardiac surgery use of perioperative beta-blockers is controversial. This is particularly true for patients at low risk of myocardial ischaemic events …
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Advances in the treatment of chronic heart failure: the use of Nesiritide
2016-04-04 by Dr Xavier Garcia-Moll, Dr Robin Ray
Heart failure (HF) is a major public health problem with increasing incidence1,2. Current goals of treatment include symptom relief, reducing hospital admission, and prolonging life. Pharmacological agents, devices, heart transplantation and lifestyle changes are currently …
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Should proton pump inhibitors be avoided in patients with an increased risk for cardiovascular events? 
2016-03-28 by Prof Juan Carlos Kaski, Dr Antonio Sacchetta
The debate continues as to the potential for proton pump inhibitor (PPI) drugs to impair cardiovascular outcomes. While some studies have suggested that PPI agents can harm patients with coronary artery disease (CAD) [1-4], particularly …
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Atrial fibrillation linked to higher risk of adverse events in women than in men
2016-03-28 by Prof Juan Carlos Kaski, Dr C. Noel Bairey Merz, Prof Karin Schenck-Gustafsson
Adding to the current debate as to whether -like other cardiovascular risk factors- atrial fibrillation (AF) is associated with a larger risk of adverse cardiovascular events in women than in men, a recently published meta-analysis …
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Chocolate consumption lowers CV risk
2016-03-23 by Prof Juan Carlos Kaski, Prof Juan Tamargo, Prof Gillian W. Cockerill
Evidence from several trials in recent years suggests that chocolate and cocoa flavanols may have a beneficial effect on endothelial function, blood pressure, insulin resistance and dyslipidaemia. Even harder endpoints such as incidence of stroke …
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Digoxin in atrial fibrillation and heart failure – useful, useless or dangerous?
2016-03-21 by Dr Felipe Martinez, Dr Hector O. Ventura, Prof George A. Dan
Digoxin has been widely used in the rate control of atrial fibrillation (AF) and as a positive inotrope in heart failure, but it is hampered by drug interactions and a relatively narrow therapeutic window. Over …
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Triple-rule out CT angiography for the evaluation of acute chest pain: should we be offering this test in our emergency departments?
2016-03-21 by Dr Alastair J Moss, Prof David E Newby
Chest pain is the most common presenting complaint in the emergency department for adult males. Triple-rule-out computed tomographic (TRO CT) angiography has been proposed as a cost-effective technique to evaluate the coronary arteries, aorta, pulmonary …
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Does aspirin prevent both cardiovascular events and cancer?
2016-03-14 by Dr S. Rao Kondapally Seshasai
Whilst the benefit of aspirin for cardiovascular disease (CVD) risk reduction remains well-established in people who have experienced a prior vascular event1, the benefit seems more modest in those who have not yet experienced a …
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Clinical ECG practice should not be confused with theory of electrocardiography
2016-03-07 by Dr Derek J. Rowlands, Dr Marcelo V. Elizari
The ongoing debate about whether the Tpeak-Tend interval of the standard ECG is a valid marker of transmural dispersion of ventricular repolarisation (DVR) recalls a similar debate about the so-called “QT dispersion” and its relation …
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Bio-resorbable scaffold drug eluting systems: are they here to stay?
2016-03-07 by Prof Juan Carlos Kaski, Prof Alberto R Galassi
The concept of a coronary-artery stent that could “fade away” after achieving its “mission” is extremely attractive, particularly in view of the longer term complications associated with intracoronary stents, including in-stent restenosis and endothelial dysfunction …
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Manual thrombus aspiration in STEMI patients leads to no benefit
2016-02-29 by Prof Juan Carlos Kaski, Dr Pablo Avanzas
Treatment of patients with STEMI aims predominantly at promptly restoring normal coronary blood flow using percutaneous coronary intervention (PCI). In many patients, however, microvascular obstruction (MVO) may develop despite successful epicardial coronary artery revascularisation. Data …
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Can pre-hospital point of care troponin testing help to ease workflow pressures in our emergency departments?
2016-02-22 by Dr David Gaze, Dr Marco Tubaro
Chest pain is a common presenting complaint in the emergency department (ED) and investigation of acute cardiovascular disease is a major resource intensive public health challenge. The current standard of care involves troponin testing to …
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Antibiotic prophylaxis for the prevention of infective endocarditis: should we or shouldn’t we?
2016-02-22 by Dr Rajan Sharma
The principle of antibiotic prophylaxis for infective endocarditis (IE) was developed from observational studies and animal models and aimed at preventing the attachment of bacteria onto the endocardium after transient bacteraemia following invasive procedures. Historically …
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Benzodiazepine use and risk of Alzheimer’s disease: case-control study
2016-02-15 by Prof Juan Carlos Kaski, Prof Peter Garrard
Abstract  Sophie Billioti de Gage, PhD student1, Yola Moride, professor23, Thierry Ducruet, researcher2, Tobias Kurth, director of research45, Hélène Verdoux, professor16, Marie Tournier, associate professor16, Antoine Pariente, associate professor1, Bernard Bégaud, professor1 Objectives To investigate the relation between the risk of Alzheimer’s disease and …
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More attention needed for the uterus in Cardiology
2016-01-27 by Prof Angela Maas
Within the ongoing war for the leading positions of novel oral anticoagulants (NOAC’s) in Cardiology there is a striking silence on the potential risk for uterine bleeding in premenopausal women and safety data are lacking. …
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Early Repolarisation and the Risk of Malignant Ventricular Arrhythmias
2016-01-11 by Prof Juan Carlos Kaski, Dr Velislav N. Batchvarov
Several recently published studies provided additional evidence of the link between the presence of early repolarisation (ER) especially in the inferior and lateral leads and increased risk of major arrhythmic events in ischaemic heart disease …
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Do SPRINT results require hypertension guideline changing?
2016-01-04 by Prof Juan Carlos Kaski, Dr Terek F Antonios
Debate has been going on for quite some time now as to what are the most appropriate targets for systolic blood pressure to reduce cardiovascular events among people with increased cardiovascular risk. To try and …
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Novel treatment strategies for hypercholesterolaemia: can your patients benefit from PCSK9 inhibitors?
2015-12-29 by Dr Antonio J. Vallejo-Vaz, Dr Alberto Lorenzatti, Prof Stephen Nicholls
Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors are monoclonal antibodies which lower LDL cholesterol by increasing availability of LDL receptors in the liver thus increasing LDL clearance from the bloodstream. The US Food and …
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Do beta blockers increase cardiovascular risk in patients with stable angina pectoris?
2015-12-14 by Prof Juan Carlos Kaski, Dr Antonio J. Vallejo-Vaz
The general assumption that β-blocker treatment may be beneficial in patients with cardiac atherothrombotic disease (ATD) has been challenged by recent reports in stable angina patients. Given the clinical implications of recent studies and the …
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Takotsubo cardiomyopathy: benign condition or malignant acute heart failure syndrome?
2015-12-03 by Prof Francesco Pelliccia, Prof Juan Carlos Kaski
Takotsubo or ‘stress’ cardiomyopathy, first described in 1990, is characterised by transient left ventricular dysfunction. The term Takotsubo, from the Japanese word for lobster pot, describes ballooning of the left ventricular apex seen on cardiac …
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Transfemoral vs Transradial approach for PCI - The DRAGON STUDY
2015-10-27 by Prof Juan Carlos Kaski, Dr Pitt Lim
The DRAGON trial (1) recently presented at the recent TCT meeting in San Francisco, which included more than 1700 consecutive patients from 29 centers in China, showed that subjects who were randomized to the transradial …
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Macrolide antibiotic use: cardiotoxicity issues
2015-10-16 by Prof Juan Carlos Kaski, Prof Juan Tamargo
A nationwide based study in Denmark assessed the risk of cardiac death associated with the use of clarithromycin and roxithromycin. Participants included Danish adults, 40-74 years of age, who received seven day treatment courses with …
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New pharmacological compound shown to reduce mortality in heart failure patients approved by FDA
2015-10-16 by Prof Giuseppe Rosano
A drug developed by Novartis for management of patients with heart failure - Entresto (sacubitril/valsartan) - also termed LCZ696, was approved for clinical use by the FDA. LCZ696 was assessed in the PARADIGM-HF trial (1), where …
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ARBs, ACEIs and direct renin inhibitors not to be used in combination
2015-10-16 by Prof Giuseppe Rosano
The European Medicines Agency (EMA) has recommended that angiotensin-receptor blockers (ARBs), ACE inhibitors, and direct renin inhibitors should not routinely be combined. EMA also recommended that particularly in patients with diabetic nephropathy ARBs and ACE …
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ACUITY trial: what's been discovered?
2015-09-16 by Prof Juan Carlos Kaski, Dr Pitt Lim
The large-scale Acute Catheterization and Early Intervention Triage Strategy (ACUITY) trial showed that in patients with diabetes, acute coronary syndrome (ACS) and multivessel coronary artery disease, Percutaneous Coronary Revascularization (PCI) versus coronary artery bypass grafting …
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Culprit lesion only or multivessel percutaneous coronary intervention in patients with ST-elevation myocardial infarction?
2015-09-02 by Prof Charles Knight, Prof Abhiram Prasad
In acute ST-elevation myocardial infarction (STEMI), coronary reperfusion with percutaneous coronary intervention (PCI) to treat the culprit lesion responsible for infarction improves clinical outcomes in nearly all patients. Complete revascularization and treatment of non-infarct vessels …
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Sudden unexpected death in epilepsy (SUDEP): What is the cause?
2015-09-02 by Dr Aidan Neligan, Dr Hannah Cock, Dr Elijah R Behr
Epilepsy patients have a 24-fold increased risk of sudden death compared to the general population, with sudden unexpected death in epilepsy (SUDEP) representing one of the commonest causes of death in these patients. Although no …
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Long QT syndrome and epilepsy
2015-09-02 by Dr Aidan Neligan, Dr Elijah R Behr
It has been proposed that pathogenic hyperexcitability may underlie both epilepsy and inherited cardiac arrhythmias, such as long QT syndrome (LQTS) or Bruguda’s Syndrome. LQTS is a genetic condition characterized by prolongation of the QT …
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QT prolongation associated with the use of anti-epileptic drugs (AEDs)
2015-09-02 by Dr Hannah Cock
Epilepsy, a disorder of the brain characterized by an enduring predisposition to seizures, affects approximately 1 in 105 people in the UK. The aim of treatment is to control seizures and maintain or restore quality …
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Poorer clinical outcome in seizure-related “takotsubo syndrome”.
2015-09-02 by Prof Juan Carlos Kaski, Dr Hannah Cock
Takotsubo stress cardiomyopathy (TS) is characterized by a clinical presentation compatible with acute myocardial infarction despite angiographically unobstructed coronary arteries, associated with left ventricular wall motion abnormalities typically showing apical akinesis and basal hyperkinesis that …
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Distinguishing between epileptic seizures and cardiac syncope
2015-09-02 by Dr Hannah Cock, Dr Velislav N. Batchvarov
Distinguishing between epileptic seizures and cardiac syncope in patients with recurrent, unexplained, episodic loss of consciousness can be difficult. Historical studies have estimated that between 20-30% of patients thought to have epileptic seizures have been …
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Dual antiplatelet therapy: A two-edged sword?
2015-08-14 by Prof Albert Ferro
The use of antiplatelet therapy in cardiovascular prophylaxis has always been a two-edged sword: on the one hand it inhibits arterial thrombosis and on the other promotes bleeding – a classic pharmacological lesson in benefit …
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Prediction of Alzheimer's Disease in clinical practice?
2015-07-20 by Dr Peter Garrard
Alzheimer's Disease (AD) is a common form of dementia that may acquire epidemic proportions as the world population continues to grow progressively older.  AD progressively disrupts memory and other cognitive abilities, and in its advanced …
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Guidelines (ESC & NICE) for the pharmacological management of angina pectoris - What's new?
2015-06-26 by Dr Chris Arden, Prof Juan Carlos Kaski
Treatment aims and current recommendations. The pharmacological management of patients with stable angina represents a major clinical and health-economic challenge for both clinicians and healthcare providers. The pharmacological management of stable angina patients aims mainly …
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Pharmacological treatment of stable angina - Conventional and novel anti-anginal agents
2015-06-26 by Prof Juan Carlos Kaski, Prof John Camm
Stable angina (symptoms stable for > 3 months) is caused by myocardial ischaemia, which, in turn, usually results from obstructive coronary artery disease (CAD) that limits the ability of the coronary circulation to increase coronary …
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Ranexa - Mode of action, dosing and side effects
2015-06-26 by Dr Rajan Sharma, Dr Ravi Patel
ISCHAEMIA AND INCREASED LEFT VENTRICULAR WALL TENSION. An increase in intracellular sodium (Na) is an early event during myocardial ischemia1. Increased Na concentration in the myocardium leads to calcium (Ca++) overload as a result of decreased …
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Ranolazine: indications, adverse reactions and contraindications
2015-06-26 by Dr Rajan Sharma, Dr Chris Arden
Ranolazine is generally very well tolerated but as a relatively new member of the anti-anginal armamentarium physicians have questions regarding its indications, contraindications and patient selection for the effective use of this agent in “real …
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Use of ranolazine in chronic stable angina patients and patients with type 2 diabetes mellitus - Summary of CARISA, MARISA & TERISA trials
2015-06-26 by Dr Ravi Patel, Prof Juan Carlos Kaski
Ranolazine is a novel antianginal drug with a mechanism of action that differs from that of conventional antianginal agents. Ranolazine is a selective inhibitor of the late sodium current in the myocardium and as such …
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Concomitant use of ranolazine and conventional anti-anginal agents
2015-06-26 by Prof Juan Carlos Kaski, Dr Chris Arden
Many patients with stable angina require treatment with more than one anti-anginal drug, particularly those who are very symptomatic and cannot –for different reasons- undergo myocardial revascularization. Reasons why the treating physician decides to prescribe …
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Cilostazol in coronary artery spasm
2014-10-27 by Prof Juan Carlos Kaski
In a recent double blind, placebo controlled trial (STELLA study), Shin et al (1) assessed the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase-3, for the treatment of vasospastic angina pectoris. Cilostazol is …
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Diclofenac and cardiovascular risk – An underestimated problem?
2014-04-10 by Prof Dimitrios N. Tziakas
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used of current medications usually bought over the counter. Taken singly or in combination with other classes of drug, they relieve symptoms across multiple clinical indications, …
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The Plato Trial – The controversy continues
2014-04-10 by Prof Albert Ferro
Ticagrelor (a member of the cyclopentyltriazolopyrimidines) is an anti-platelet agent that binds reversibly rather than irreversibly with the P2Y12 platelet receptor and has a more rapid onset of action than clopidogrel. The efficacy and safety …
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Management of Dyslipidemia in Post-Myocardial Infarction and Interventional Cardiology
2014-04-08 by Prof Juan Carlos Kaski
Over 150 Italian cardiologists visited the Cardiovascular and Cell Sciences Research Institute at St George’s, University of London - a centre of excellence in cardiovascular research. The Italian cardiologists attended a two day meeting organised …
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Clopidogrel with aspirin better than aspirin alone in patients who develop an acute minor stroke or transient ischemic attacks?
2014-02-21 by Prof Carlo Patrono
Stroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Dual antiplatelet therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone. …
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Testosterone treatment increases risk of death, infarction and stroke or does it?
2014-02-21 by Prof Giuseppe Rosano
The recent study from Vigen R et al. aimed at assessing the association between testosterone therapy and all-cause mortality, myocardial infarction, or stroke among 8709 male patients who underwent coronary angiography between 2005 and 2011 …
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Percutaneous coronary intervention or medical treatment for stable angina?
2014-02-09 by Dr Pablo Avanzas
A recent meta-analysis published in JAMA by Stergiopoulos et al. compared the effects of PCI and medical treatment (MT) combined, with MT alone in patients with stable coronary artery disease (CAD) and objectively documented myocardial …
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Coronary artery spasm – Dangerous or not dangerous?
2014-02-09 by Prof Filippo Crea, Prof John Beltrame
The incidence of coronary artery spasm in patients presenting with chest pain remains uncertain, with estimates varying according to the population studied. However, experts agree that the condition is widely under-recognised as a cause of …
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Angiotensin-converting enzyme inhibitors reduce mortality in hypertensive patients
2012-07-06 by Prof Juan Tamargo
A meta-analysis of randomised clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients has shown that these drugs reduce mortality in hypertension. Renin-angiotensin-aldosterone system (RAAS) inhibitors are well established in the reduction in cardiovascular morbidity, but …
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Dual blockage of the RAS caused increased adverse events in hypertensive patients
2012-07-06 by Prof Juan Tamargo
Recent research suggests that dual blockade of the Renin-angiotensin system (RAS) results in increased adverse events in hypertensive patients. A meta-analysis of randomized controlled trials published between 1990 and 2011 compared dual RAS blockade with a single …
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Thiazide diuretics increase risk of CV events in lean and overweight individuals but not in obese patients
2012-07-06 by Prof Juan Tamargo
People with normal body-mass index (BMI) tend to have unexpectedly higher cardiovascular event rates than overweight or obese patients. To understand this paradoxical finding Dr Michael Weber from SUNY Downstate Medical Centre, New York, USA, performed a prespecified …
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Azitrhomycin can increase the risk of cardiovascular death
2012-07-06 by Prof Juan Tamargo
Dr Wayne A. Ray from the Department of Preventative Medicine, Vanderbilt University School of Medicine, Nashville, US, examined data from patients enrolled in the Tennessee Medicaid program between 1992 and 2006. The study cohort included patients …
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How can the global cardiology community cope with the increase in CVD?
2012-07-05
During the European Society of Cardiology 2011 in Paris, France, Professor Salim Yusuf from McMaster University, Hamilton, Ontario, Canada presented results from the Prospective Urban Rural Epidemiological (PURE) trial, and the results made for very …
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