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Dr K K Aggarwal

Kidney patients more at risk for future heart attacks

By Dr K K Aggarwal
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Chronic kidney disease patients with kidney function less than 60% are included in the list of criteria for defining people at highest risk for future heart attacks.

In a large cohort Canadian study published in The Lancet led by Dr Marcello Tonelli at University of Alberta, patients with only chronic kidney disease had a significantly higher rate of heart attacks than those who only had diabetes. Those who had already had a heart attack had the highest overall rate of heart attacks.

Chronic kidney disease should be regarded as a coronary heart disease risk equivalent, similar to diabetes, as patients with the condition have high rates of cardiovascular events, particularly when they also have proteinuria. When chronic kidney disease was defined more stringently with kidney function less than 45% and increased proteinuria, the rate of first heart attack was higher in those with both chronic kidney disease and diabetes than in those with either disorder alone.

Women should quit smoking to lower their risk of heart disease

By Dr K K Aggarwal
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Smoking is still the leading preventable cause of death. Not only does tobacco smoke cause lung cancer, it is also implicated in heart disease, other cancers and respiratory diseases. As per WHO, an estimated 3 million people in industrialized countries will have died as a result of tobacco use by 2030, and an additional 7 million people in developing countries face the same fate. Women who quit smoking have a 21 percent lower risk of dying from coronary heart disease within five years of quitting their last cigarette. The risks of dying from other conditions also decline after quitting, although the time frame varies depending on the disease. For chronic obstructive pulmonary disease, it may take up to 20 years. It’s never too early to stop, and it’s never too late to stop. Women who are current smokers have almost triple their risk of overall death compared with non smoker women. Current smokers also have a 63 percent increased risk for colon cancer compared with never-smokers, while former smokers have a 23 percent increased risk. There was no significant association between smoking and ovarian cancer. Women who started smoking earlier in life are at a higher risk for overall mortality, of dying from respiratory disease and from any smoking–related disease. However, a smoker’s overall risk of dying returns to the level of a never–smoker 20 years after quitting. The overall risk decline by 13 percent within the first five years of abstaining. Most of the excess risk of dying from coronary heart disease vanishes within five years of quitting. For chronic obstructive pulmonary disease, the return to normal takes 20 years, although there is an 18 percent reduction in the risk of death seen within five to 10 years after quitting. And the risk for lung cancer does not return to normal for 30 years after quitting, although there is a 21 percent reduction in risk within the first five years.

ABO Blood Type is a Risk Factor for Coronary Heart Disease

By Dr K K Aggarwal
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ABO Blood Type is a Risk Factor for Coronary Heart Disease

By Dr K K Aggarwal
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Two prospective cohort studies have identified ABO blood group as a risk factor for the development of heart disease. People with blood groups A, B, or AB were 5-23% more likely to develop coronary heart disease compared with those with O blood type. The study by Dr Meian He from Harvard School of Public Health, Boston, MA included 62 073 women from the Nurses’ Health Study (NHS) and 27 428 men from the Health Professionals Follow–up Study (HPFS) and is published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100 000 person–years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively. Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age–adjusted model.

In non-O individuals, plasma levels of factor VIII-von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type. Elevated levels of factor VIII–vWF have been previously identified as a risk factor for coronary heart disease. The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions.

ABO Blood Type Is A Risk Factor For Coronary Heart Disease

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on ABO Blood Type Is A Risk Factor For Coronary Heart Disease

Two prospective cohort studies have identified the ABO blood group as a risk factor for the development of heart disease. People with blood groups A, B, or AB were 5–23% more likely to develop coronary heart disease compared with those with O blood type. The study by Dr Meian He from Harvard School of Public Health, Boston, MA included 62 073 women from the Nurses’ Health Study (NHS) and 27 428 men from the Health Professionals Follow–up Study (HPFS) and is published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100 000 person–years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively. Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age–adjusted model.

In non–O individuals, plasma levels of factor VIII–von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type. Elevated levels of factor VIII–vWF have been previously identified as a risk factor for coronary heart disease. The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions

ABO Blood Type is a Risk Factor for Coronary Heart Disease

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on ABO Blood Type is a Risk Factor for Coronary Heart Disease

Two prospective cohort studies have identified the ABO blood group as a risk factor for the development of heart disease. People with blood groups A, B, or AB were 5–23% more likely to develop coronary heart disease compared with those with O blood type. The study by Dr Meian He from Harvard School of Public Health, Boston, MA included 62 073 women from the Nurses’ Health Study (NHS) and 27 428 men from the Health Professionals Follow–up Study (HPFS) and is published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100 000 person–years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively. Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age–adjusted model.

In non–O individuals, plasma levels of factor VIII–von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type. Elevated levels of factor VIII–vWF have been previously identified as a risk factor for coronary heart disease. The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions

Alcohol: Benefits Vs Risk

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There is consensus that non drinkers should not start and the ones who drink can continue provided they do so in moderation and in absence of contraindications. People tend to consume more alcohol in winter and near the New Year.

  • Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to them even if they would agree to drink is not justified.
  • The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic stroke, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a substantial mortality benefit relative to abstention or rare drinking.
  • For young to middle-aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer).
  • Women who drink alcohol should take supplemental folate to help decrease the risk of breast cancer.
  • · Men under the age of 45 may also experience more harm than benefit from alcohol consumption. In this age group, moderate alcohol use is unlikely to provide any mortality benefit, but consumption of less than one drink daily appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even this level of alcohol use is dangerous.
  • Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 grams per day. Medically safe limits are 10 grams in one hour, 20 grams in a day and 70 grams in a week. (50% for the women).

Alcohol: Benefits vs risk

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There is consensus that non drinkers should not start and the ones who drink can continue provided they do so in moderation and in the absence of contraindications.

Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to them even if they would agree to drink is not justified.

The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic stroke, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a substantial mortality benefit relative to abstention or rare drinking.

For young to middle-aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer).

Women who drink alcohol should take supplemental folate to help decrease the risk of breast cancer.

Men under the age of 45 may also experience more harm than benefit from alcohol consumption. In this age group, moderate alcohol use is unlikely to provide any mortality benefit, but consumption of less than one drink daily appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even this level of alcohol use is dangerous.

Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 gms per day. Medically safe limits are 10 gms in one hour, 20 gms in a day and 70 gms in a week (50% for the women).

Routine ECG Does Not Help

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In populations of older adults, prediction of coronary heart disease (CHD) events through traditional risk factors is less accurate than in middle-aged adults. It has been shown that electrocardiographic (ECG) abnormalities are common in older adults and might be of value for CHD prediction. However, performing routine ECG among asymptomatic adults is not supported by current evidence and is not recommended by the US Preventive Services Task Force and the American College of Cardiology Foundation/American Heart Association.

The aim of this study by Auer and colleagues was to determine whether baseline ECG abnormalities or development of new and persistent ECG abnormalities are associated with increased CHD events.

Stenting may not always be the answer to treating heart disease with stable.

A German study has shown that patients with stable coronary artery disease who were put on an exercise regimen had significantly higher rates of event-free survival than those who had undergone percutaneous coronary intervention (PCI). In the study, 70% of patients in the exercise program had event-free survival — no stroke, heart attack, or death — compared with 50% of stented patients after four years.

Exercise is an important part of any type of prevention, and it should be instituted for “anyone with stable coronary heart disease.”

The study on stenting versus exercise come was a continuation of a pilot study first reported in 2004 in the journal Circulation. That study of 101 male patients found that after one year, 88% of patients who exercised had event-free survival compared with 70% of stented patients.

The updated data reflect an additional 100 patients, who performed moderate intensity exercise for two weeks under hospital supervision, and then were given an exercise bike to continue their regimen at home.

Patients with stable angina exercised at 80% of their threshold, and that after four weeks of exercising, their angina threshold increased.

The clear message for patients is to get 30 to 60 minutes of moderate-intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.

ABO Blood Type Is A Risk Factor For Coronary Heart Disease

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Two prospective cohort studies have identified the ABO blood group as a risk factor for the development of heart disease. People with blood groups A, B, or AB were 5-23% more likely to develop coronary heart disease compared with those with O blood type. The study by Dr Meian He from Harvard School of Public Health, Boston, MA included 62 073 women from the Nurses’ Health Study (NHS) and 27 428 men from the Health Professionals Follow-up Study (HPFS) and is published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100 000 person-years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively. Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age-adjusted model.

In non-O individuals, plasma levels of factor VIII-von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type. Elevated levels of factor VIII-vWF have been previously identified as a risk factor for coronary heart disease. The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions

Physical Inactivity Causes To One In 10 Premature Deaths Worldwide

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Physical inactivity kills. It is causing about one in 10 premature deaths around the world annually as per a report in July 18 in The Lancet. The problem of inactivity is like a pandemic.

Globally physical inactivity is associated with 6% of the incidence of coronary heart disease (range 3.2% to 7.8%), 7% of type 2 diabetes incidence (range 3.9% to 9.6%), 10% of breast cancer incidence (range 5.6% to 14.1%) and 10% of colon cancer incidence (range 5.7% to 13.8%).

People in higher income countries are the least active with those in the UK among the worst as nearly two-thirds of adults are judged not to be doing enough.

Keep the kidney functions above 80 to avoid getting a heart attack.

Reduced kidney function is a predictor of a more severe initial presentation of coronary heart disease.

In a case-control study (ADVANCE- Atherosclerotic Disease, Vascular Function, and Genetic Epidemiology) by Dr Alan Go, of Kaiser Permanente of Northern California in Oakland published in Journal of the American College of Cardiology, a declining estimated glomerular filtration rate (eGFR) – a marker of kidney function, was associated with an increasing likelihood of presenting with an acute heart attack rather than stable exertion related heart pain or angina.

Patients who had an eGFR less than 45 mL/min/1.73 m2 were four times as likely to present with an acute MI compared with those with normal kidney function.

Patients with chronic kidney disease have a greater likelihood of more clinically unstable and severe heart blockages. Clinical efforts should be targeted to identify this high-risk population before they develop symptoms of atherosclerosis with an aim to shift the expression of coronary heart disease from acute heart attack to more stable presentations.

Remember most patients with chronic kidney disease do not die of kidney failure but heart attacks.