Important 2019 take home heart messages

Important 2019 take home heart messages

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

•             Icosapent ethyl.  a prescription omega-3 fatty acid, reduced the risk for cardiovascular events by 25% in people with elevated triglyceride levels who were taking statins (REDUCE-IT led the US FDA to approve icosapent ethyl for CV risk reduction in December.

•             COMPLETE trial: STEMI heart attack with multivessel disease benefit from complete revascularization of any other angiographically significant lesions, rather than a strategy of intervention only in the culprit lesion.

•             DAPA-HF trial showed that the glucose-lowering drug dapagliflozin is beneficial in patients with heart failure, both with and without type 2 diabetes.

•             In a large-scale study of over 419,000 Apple Watch users, the device accurately detected atrial fibrillation in more than one third of the participants who received notifications of an irregular pulse.

•             EXTEND trial: it's possible to extend the window for thrombolysis out to 9 hours after ischemic stroke onset in some patients.

•             PARTNER 3 trial: patients with severe aortic stenosis at low surgical risk who had transcatheter aortic valve replacement using the SAPIEN 3 system (Edwards Lifesciences) had lower odds of stroke, rehospitalization, and death compared with those who had traditional surgery.

•             Five-year findings from the NOBLE trial demonstrate that percutaneous coronary intervention  is not as effective as coronary artery bypass grafting in reducing the risk of death, myocardial infarction, repeat revascularization, and stroke in patients with left main disease.

•             In children with familial hypercholesterolemia (FH) showed statin therapy beginning at a young age reduced incidence of CV events from 26% to 1% at age 39, and reduced death from CV causes from 7% to 1% at age 39.

•             In older women reducing sedentary time by just 1 hour each day equated to a 26% lower risk of heart disease and a 12% lower risk of CVD overall. The physical activity didn't have to happen all at once — it could be accumulated throughout the day.

•             Older women who engaged in light physical activity, such as gardening or walking, had a 42% lower risk of MI or coronary death than the least-active women.

•             Taking anti BP drug at bedtime led to a 45% reduction of CV events

•             SPRINT MIND study: intensive blood pressure lowering cuts the risk for mild cognitive impairment in adults aged 50 years and older.

•             Children exposed to second-hand smoke from their parents were at a higher risk for atrial fibrillation. For every pack per day increase in parental smoking, their children were 18% more likely to develop atrial fibrillation

 [Medscape]

18 Important Medical Research Outcomes of 2019

18 Important Medical Research Outcomes of 2019

Dr KK Aggarwal
President CMAAO< HCFI and Past national President iMA

1. New neurons proliferate in the hippocampus as we age, even into the ninth decade of life [Nature Medicine].

2. Novel protein-coding genes evolve on a de novo basis far more commonly than previously thought [Nature Ecology and Evolution].

3. Children's long bones grow with the help of a stem cell niche with a radical clonality switch that develops in the epiphyseal growth plate [Nature.]

4. 10,000 steps or less: Researchers who ran a study of nearly 17,000 women found the cutoff for mortality benefit was just 4400 [JAMA Internal Medicine.]

5. Comparing the DNA of primary colorectal cancer tumors and metastases in the liver or brain revealed that for 80% of the 21 patients in the study, metastases took root early [Nature Genetics].

6. Typhoid toxin may not be required for people infected with Salmonella Typhi to develop typhoid fever [Nature Medicine].

7. Assessing myocardial viability is not a helpful marker to predict the long-term outcome of coronary artery bypass grafting surgery [NEJM]

8. Rising BMI among people living in rural areas ― not cities ― is the main driver of the global obesity epidemic [Nature].

9. The brain microbiome: It might actually exist, and herpesvirus might play a role in Alzheimer disease, [Neuron in 2018]

10. Cardiac stem-cell therapy appears to work by stimulating the immunologic wound-healing process rather than generating new cells [Nature].

11. Even if patients with severe aortic stenosis have no symptoms, early surgery to replace the aortic valve lowers their risk for death [NEJM]

12. Could we inherit mitochondrial DNA from our fathers as well as our mothers? Yes [Proceedings of the National Academy of Sciences in December 2018]

13. Screen time: not so bad for kids' well-being after all? (Nature Human Behaviour)

14. The morning meal may not help people lose weight, according to a meta-analysis published in the BMJ.

15. Applying evolutionary game theory to cancer therapy, as researchers did in this paper in Nature Ecology and Evolution, challenges the traditional approach of blasting tumors with the maximum tolerable dose of chemotherapy.

16. type 2 diabetics and high Lp(a) levels was associated with a 3.5-fold higher risk for a cardiovascular event compared to having no diabetes or a low Lp(a) level (<24 nmol/L or approximately 10 mg/dL) (Jin JL et al. Diabetes Care . 2019;42:1312-1318)

17. In an observational registry study of Swedish outpatients with type 1 diabetes, those who had high plasma lipoprotein(a) [Lp (a)] levels — defined as >120 nmol/L or approximately 50 mg/dL — were more likely to have albuminuria, calcified aortic valve disease, or a composite measure of cardiovascular disease. And patients whose blood glucose level (A1C <6.9%) was well controlled had lower Lp(a) levels. [ December 18 in Diabetes Care].

18. Caloric restriction can reduce insulin resistance, weight, hepatic fat, and cardiovascular risk factors, regardless of carbohydrate content. To achieve caloric restriction one can go for fasting regimens as time-restricted eating (meals consumed within a limited number of hours), alternate-day fasting, and the 5:2 eating pattern (unrestricted eating for 5 days, followed by 2 days of restricted intake).
[source: Medsacpe]

Medical updates in 2019

Medical updates in 2019 

Dr KK Aggarwal

President CMAAO and HCFI

A WHO report has shown that the confirmed cases of measles have increased from 716 in 2018 to 2719 in the first 11 months of 2019 in Turkey. Out of the 2,719 confirmed cases some 1,800 were children under five years of age, with over 900 unvaccinated children.

There is growing tensions between two approaches in medical research: the effort of finding treatments that are consistently effective in large populations versus the notion of "precision medicine, which favours therapy that we closely tailor to an individual's very personal needs.

In March this year, experts affiliated with the European Resuscitation Council by analyzing the data of more than 60,000 people, saw that nifedipine, appeared to increase the risk of sudden cardiac arrest.

A study, appearing in JAMA Internal Medicine in June, found that anticholinergic drugs may increase a person's risk of developing dementia. The research from the University of Nottingham in the United Kingdom looked at the data of 58,769 people with and 225,574 people without dementia.

In August, the FDA issued a warning against an allegedly therapeutic product available online sold under the names Master Mineral Solution, Miracle Mineral Supplement, Chlorine Dioxide Protocol, or Water Purification Solution that contained no less than 28% sodium chlorite, an industrial bleach.

A study in the New England Journal of Medicine in July, which involved around 1.3 million people, suggested that, when it comes to predicting the state of a person's heart health, both blood pressure numbers are equally important. The study found that older individuals with lower systolic blood pressures actually faced a 40% higher risk of death than peers with elevated blood pressure values.

Research in the Journal of the American Heart Association in August showed that people who adhered to plant-based diets had a 32% lower risk of death (also 25% lower risk of all-cause mortality).

A study from April in the journal Nutrients warned that people who follow a ketogenic diet may experience blood vessel damage.

According to Google Trends, some of the top searches in the United States this year included intermittent fasting diets, the Noom diet, and the 1,200 calorie diet.

One intriguing study, in Nature Metabolism in May, pointed that muscle building protein shakes, contain mostly whey proteins, which have high levels of the essential amino acids leucine, valine, and isoleucine. In mice  a high intake of these amino acids led to overly low levels of serotonin in the brain.  It also led to obesity and a shorter life span.

A WHO study appearing in The Lancet in January took into account the findings of 185 observational studies and 58 clinical trials, covering almost 40 years, concluded that to lower their death risk, as well as the incidence of coronary heart disease, stroke, type 2 diabetes, and colon cancer, a person should ideally consume 25–29 grams of fiber per day.