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Posts Tagged ‘Johns Hopkins Hospital’


Hypertriglyceridemia concurrent Hyperlipidemia: Vertical Density Gradient Ultracentrifugation a Better Test to Prevent Undertreatment of High-Risk Cardiac Patients

Curator: Aviva Lev-Ari, PhD, RN

Equation May Give Wrong LDL Status

By Todd Neale, Senior Staff Writer, MedPage Today

Published: March 28, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

  • The widely used Friedewald equation may be underestimating LDL cholesterol levels in many patients, a study found.
  • Note that 14.6% of the patients in the study were placed into different treatment groups by the Friedewald estimates and direct measurements, mainly due to classification in a lower LDL cholesterol treatment group by Friedewald compared with direct LDL cholesterol.

After excluding the patients who had a triglyceride level of 400 mg/dL or greater — in whom there are known limitations of the Friedewald equation — the researchers examined data from 1,310,440 adults (mean age 59) who underwent lipid screening; 14.6% had a Friedewald-estimated LDL cholesterol level of less than 70 mg/dL, the treatment target for high-risk patients.

“Nevertheless, non-HDL cholesterol and apolipoprotein B are alternative approaches, with potential advantages over any measure of LDL cholesterol, and these measures avoid confusion that arises in defining LDL cholesterol …,” they wrote. “Moreover, in clinical trial patients with LDL cholesterol levels in the high-risk range highlighted in our study, non-HDL cholesterol and apolipoprotein B were stronger markers of residual risk than Friedewald LDL cholesterol.”

Martin S, et al “Friedewald estimated versus directly measured low-density lipoprotein cholesterol and treatment implications” J Am Coll Cardiol 2013; DOI: 10.1016/j.jacc.2013.01.079.

VIEW VIDEOBiomarker Series: Lipoprotein A — WellnessFX

VIEW VIDEO BioMarker Series: Apolipoprotein B — WellnessFX

The widely used Friedewald equation may be underestimating LDL cholesterol levels in many patients, researchers found.

The discrepancy between LDL cholesterol values that were estimated by the Friedewald equation and those that were directly measured was greatest when LDL cholesterol levels were low and triglyceride levels were high, according to Seth Martin, MD, of Johns Hopkins Hospital, and colleagues.

Among patients with a Friedewald-estimated value of less than 70 mg/dL, for example, the directly measured level was a median of 9 mg/dL higher when triglycerides were 150 to 199 mg/dL and 18.4 mg/dL higher when triglycerides were 200 to 399 mg/dL, the researchers reported online in the Journal of the American College of Cardiology.

Overall, 14.6% of the patients included in the study were placed into different treatment groups by the Friedewald estimates and direct measurements. This discordance was mainly due to “classification in a lower LDL cholesterol treatment group by Friedewald compared with direct LDL cholesterol,” which occurred in 11.3% of patients, they noted.

The discordance was greatest “when accuracy is most crucial, in patients with LDL cholesterol levels in the high-risk treatment range and concurrent hypertriglyceridemia,” Martin and colleagues wrote, noting that because the Friedewald estimates were generally lower than the directly measured values, using the equation could result in undertreatment of high-risk patients.

“This phenomenon warrants consideration in contemporary patient care and clinical practice guidelines,” the authors wrote.

With the Friedewald equation, LDL cholesterol is estimated by subtracting the HDL cholesterol level and the triglyceride level (divided by 5) from the total cholesterol level. Using the equation avoids the extra time and expense needed to directly measure LDL with ultracentrifugation.

Since the equation was introduced in 1972, however, practice guidelines have introduced lower LDL cholesterol targets, and high triglyceride levels have become more common due to the increasing problems of obesity, insulin resistance, and diabetes.

To assess the accuracy of the equation in a contemporary setting, the researchers compared Friedewald estimates with direct measurements performed with vertical density gradientultracentrifugation by the Vertical Auto Profile (VAP) from 2009 to 2011.

After excluding the patients who had a triglyceride level of 400 mg/dL or greater — in whom there are known limitations of the Friedewald equation — the researchers examined data from 1,310,440 adults (mean age 59) who underwent lipid screening; 14.6% had a Friedewald-estimated LDL cholesterol level of less than 70 mg/dL, the treatment target for high-risk patients.

The median directly measured LDL cholesterol level was 109 mg/dL. Lipid distributions were similar to those seen in the National Health and Nutrition Examination Survey for 2007 to 2008, indicating that the study sample was nationally representative.

In general, the Friedewald estimates were lower than the direct measurements of LDL cholesterol, and the discordance was greatest among patients with low LDL cholesterol levels and high triglyceride levels.

Of the patients with a Friedewald estimate of less than 70 mg/dL, 23% had a direct measurement that was higher than that. That figure rose to 39% when triglycerides were 150 to 199 mg/dL and 59% when triglycerides were 200 to 399 mg/dL.

The findings could have implications for patient care, according to the researchers.

“While we are not suggesting the need for routine clinical measurement of LDL cholesterol by direct assays, it bears mentioning that multiple direct assays beyond the VAP test [used in this study] are available,” they wrote.

“Nevertheless, non-HDL cholesterol and apolipoprotein B are alternative approaches, with potential advantages over any measure of LDL cholesterol, and these measures avoid confusion that arises in defining LDL cholesterol …,” they wrote. “Moreover, in clinical trial patients with LDL cholesterol levels in the high-risk range highlighted in our study, non-HDL cholesterol and apolipoprotein B were stronger markers of residual risk than Friedewald LDL cholesterol.”

They acknowledged some limitations of the analysis, including the possibility that patients who undergo a VAP test may be a special population and the use of one-time LDL cholesterol measurements. In addition, the researchers did not have access to detailed clinical characteristics of the patients or clinical outcomes or information on statin use and fasting status before the lipid test.

http://www.medpagetoday.com/Cardiology/Dyslipidemia/38147?xid=NL_DHE_2013-03-29

REFERENCES

http://my.americanheart.org/professional/General/Secondary-Prevention-Risk-Reduction-for-Cardiac-and-Vascular-Disease_UCM_432926_Article.jsp

Related Statements and Guidelines

Late Breaking Clinical Trials

LBCT.01     Practice Implications for CAD and VTE     Sun., Nov. 4, 2012 / 3:30pm-5:20pm

Aspirin for The Prevention of Recurrent Venous Thromboembolism After a First Unprovoked Event: Results of the ASPIRE Randomized Controlled Trial
ASPIRE: This trial is investigating the efficacy of aspirin in preventing recurrent venous thromboembolism (VTE) in patients with first unprovoked VTE

A Randomized Trial of Bedside Platelet Function Monitoring to Adjust Antiplatelet Therapy Versus Standard of Care in Patients Undergoing Drug Eluting Stent Implantation: The ARCTIC Study
ARCTIC was designed to compare a strategy of monitoring platelet function at the bedside to adjust antiplatelet therapy to standard of care in patients having drug eluting stent implantation.

First Large-Scale Platelet Function Evaluation in an Acute Coronary Syndromes Trial – The TRILOGY ACS Platelet Function Sub-study
TRILOGY ACS is an international, phase 3, randomized trial comparing the platelet inhibitor prasugrel+aspirin with clopidogrel+aspirin in medically managed US/NSTEMI ACS patients.

Results of the Trial to Assess Chelation Therapy
The Trial to Assess Chelation Therapy (TACT) is an NIH-sponsored randomized, double blind clinical trial testing the benefits and risks of 40 infusions of a standard ethylene diamine tetra-acetic (EDTA)-chelation solution compared with placebo in patients with coronary artery disease.

Main Results of the Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease (FREEDOM) Trial
FREEDOM – This trial was designed to determine whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is the superior approach for revascularization of diabetic patients with multivessel coronary artery disease.

LBCT.02     Health Economics and Quality of Life in Contemporary Trials     Sun., Nov. 4, 2012 / 5:30pm-6:43pm

LBCT.03     Treatments for Prevention of Cardiovascular Events: A Population Perspective     Mon., Nov. 5, 2012 /  9:00am-10:28am

LBCT.04     Novel Treatments for Managing Lipid Disorders     Mon., Nov. 5, 2012 / 10:45am-11:55am

LBCT.05     Cell-Based Therapies for Myocardial Regeneration     Tues., Nov. 6, 2012 / 10:45am-12:00pm

LBCT.06     Management of LV Dysfunction: Devices and Drugs     Tues., Nov. 6, 2012 / 3:45pm-5:35pm

Clinical Science: Special Reports

CS.01     Prevention and Treatment of Ischemic Heart Disease: Novel Approaches     Mon., Nov. 5, 2012 / 7:30am-8:46am

Low Dose Colchicine for Secondary Prevention of Cardiovascular Disease [LoDoCo]: A Randomized Controlled Trial
The LoDoCo trial was designed to determine whether colchicine given in addition to standard medical therapy therapy is effective for the prevention of major cardiovascular endpoints in patients with  stable coronary artery disease.

Results of the Responses of Myocardial Ischemia to Escitalopram Treatment Trial
This trial examines the effects of escitalopram, a selective serotonin reuptake inhibitor (SSRI) , on mental stress-induced myocardial ischemia (MSIMI) in coronary heart disease patients.

Safety and Efficacy of Losmapimod in Non-ST-Segment Elevation Acute Myocardial Infarction: Results of the SOLSTICE Phase 2 Randomized Trial
SOLSTICE (Study Of LoSmapimod Treatment on Inflammation and InfarCt SizE) is a randomized, double-blind, placebo-controlled, parallel group, multicenter phase 2a study to evaluate safety and efficacy of 12-week treatment with 2 dose regimens of losmapimod (GW856553), a potent oral p38-MAPK inhibitor, versus placebo (randomized 3:3:2) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) expected to undergo an invasive strategy.

EnligHTN™ I, First-in-man Multi-center Study of a Novel Multi-electrode Renal Denervation Catheter in Patients with Drug-Resistant Hypertension
EnligHTN I: This study was designed to study the efficacy and safety of a new radio frequency ablation catheter in patients withdrug-resistant  resistant hypertension.

CS.02     New Insights into Management of Common Cardiovascular Disorders     Mon., Nov. 5, 2012 / 5:30pm-6:40pm

CS.03     Emerging Therapeutics for Diabetes and Dyslipidemia     Tues., Nov. 6, 2012 / 7:30am-8:25am

CS.04     Valvular Heart Disease, PAD, Atrial Fibrillation: International Perspectives     Wed., Nov. 7, 2012 / 10:45am – 12:15pm

Related articles on this Open Access Online Scientific Journal include the following:

High-Density Lipoprotein (HDL): An Independent Predictor of Endothelial Function & Atherosclerosis, A Modulator, An Agonist, A Biomarker for Cardiovascular Risk 

Aviva Lev-Ari, PhD, RN, 3/31/2013

Artherogenesis: Predictor of CVD – the Smaller and Denser LDL Particles

Aviva Lev-Ari, PhD, RN 11/15/2012

Special Considerations in Blood Lipoproteins, Viscosity, Assessment and Treatment

Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN, 11/28/2012

What is the role of plasma viscosity in hemostasis and vascular disease risk?

Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN, 11/28/2012

Aviva Lev-Ari, PhD, RN, 3/7/2013

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Reporter: Aviva Lev-Ari, PhD, RN

 

According to The 2012 Johns Hopkins Heart Attack Prevention White Paper by Heart Experts

Roger S. Blumenthal, M.D. 

Director, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease

Professor of Medicine, Johns Hopkins University School of Medicine

and

Simeon Margolis, M.D., Ph.D.

Professor of Medicine and Biological Chemistry

Johns Hopkins University School of Medicine

 

The death rate from heart attacks has been declining steadily for many years, in large part because people are receiving better medical care. Yet too many men and women are not taking the steps that could help protect them.

It’s easier than you think. But you’d be amazed how many people ignore the #1 tool for preventing a heart attack:

What really triggers a heart attack?

What you need to know sooner rather than later.

See who’s most likely to have a heart attack. You’ll learn the most common risk factors and how to minimize them. You’ll also learn the importance of primary prevention if you haven’t been diagnosed with coronary heart disease (CHD) or suffered a heart attack.

Discover the changes that take place in the coronary arteries leading up to a heart attack.

Learn what happens during a heart attack, and how the steps you take during the first hour can affect survival.

Find out why a yearly flu shot can protect your heart. You’ll learn about the importance of taming inflammation.

Learn what your waist measurement can reveal about the health of your heart.

But this is only the beginning. Learn about the standard screening tests, and the newer, potentially better alternatives being developed.

The heart-mind connection: How cognitive behavior therapy (CBT) may help ward off a heart attack

Evidence linking the flu vaccine to lower heart attack risk.

Angina: A critical warning of heart disease that should never be ignored.

Latest thinking on how ministrokes (TIAs) lead to heart attack.

Explore new technologies that are now available to assess the health of your coronary arteries. See how the tests are done and how they compare to traditional methods of predicting future heart attacks.

You will feel far better prepared to have an intelligent conversation with your doctor about the issues that concern you most.

How great is your risk?

A close look at the factors that set the stage for heart attack.

Simply, clearly and accurately, the specialists at Johns Hopkins explain the major risk factors that lead to heart attack.

You will take a close look at the different types of lipids. Understand cholesterol’s role in your body… the difference between “good” HDL and “bad” LDL cholesterol… why reducing cholesterol levels can help prevent coronary heart disease and heart attacks… how triglycerides differ from the other lipids.

You will see how inflammation and C-reactive protein are associated with risk of heart disease and heart attack. Examine the role of blood clots and coronary artery spasms in triggering heart attacks.

You will learn which risk factors (like age and family history) can’t be changed, although knowing about them can motivate you to take the preventive steps that can LOWER your risk of heart attack.

More important you will learn which risk factors are within your control. You’ll be able to set clear, practical goals for yourself with guidance from Johns Hopkins specialists. And you’ll discover what to do if you have risk factors like high blood pressure, abdominal obesity or metabolic syndrome working against you.

Learn the MOST IMPORTANT STEPS After a Heart Attack —

Steps That Could SAVE YOUR LIFE

A special feature in The 2012 Johns Hopkins Heart Attack Prevention White Paper details essential steps you should take if you experience the warning signs of a heart attack.

Let us assure you, there is no more powerful motivator to get your cholesterol, your blood pressure and your weight under control than the threat of undergoing a heart attack sometime in the future.

This is just one of many reasons to order your own copy of The 2012 Johns Hopkins Heart Attack Prevention White Paper and start putting it to good use right away.

Direct to you from Johns Hopkins Medicine

Since 1889, Johns Hopkins researchers have advanced the development of science and medicine, quickly transferring new knowledge from the research laboratory to the patient’s bedside. The School of Medicine is the largest recipient of biomedical research funds from the National Institutes of Health, and in 2003, Johns Hopkins University’s own Peter Agre, M.D., won the Nobel Prize in chemistry.

The White Papers give Johns Hopkins an effective, affordable way to extend new knowledge to the widest possible audience, benefiting countless men and women with serious medical concerns.

When it comes to the health of your heart, you should insist on knowing where your information comes from. Check the credentials of the experts who advise you before you decide whether they are worthy of your trust.

The 2012 Johns Hopkins Heart Attack Prevention White Paper draws on the vast resources and experience of The Johns Hopkins Hospital and the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. It gives Johns Hopkins specialists a forum to explore the combination of lifestyle adjustments and medical therapies that can slow the progression of heart disease and decrease your risk of heart attack or stroke.

Prepared by two of the most respected experts in the field

You can trust what you read in The 2012 Johns Hopkins Heart Attack Prevention White Paper. Coauthor Roger S. Blumenthal, M.D., is Professor of Medicine in the Division of Cardiology at The Johns Hopkins Hospital and the Director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. His interests include the development of new strategies to manage coronary heart disease risk factors and the noninvasive detection of coronary atherosclerosis.

Co-author Simeon Margolis, M.D., Ph.D., is Professor of Medicine and Biological Chemistry at the Johns Hopkins University School of Medicine and the medical editor of The Johns Hopkins newsletter, Health After 50.

Their impeccable credentials and reputations ensure that what you read is responsible, practical and useful in your quest for a healthier heart.

You can also be sure that it reflects the latest scientific research and clinical findings.

The expertise you need, in clear, plain English you can understand and use every day

The 2012 Johns Hopkins Heart Attack Prevention White Paper brings you the latest news you can use. It’s designed with YOU in mind, the busy person who has no time, money or energy to waste on old or inaccurate information, or heart attack “prevention strategies” that are really just myths or hype.

Drug-free steps to take RIGHT NOW to lower your risk of a heart attack

The right lifestyle changes can go a long way toward bringing down high blood pressure and cholesterol levels. These simple changes may be enough to let you avoid medication altogether. But if not, making a few well-chosen adjustments in your habits can boost the effectiveness of the medications you take, perhaps even reducing the dosage you require.

How to protect against heart attacks with fiber. Find out if you are getting the recommended daily amount.

What new research reveals about calcium supplements and your risk of coronary heart disease.

What about soy? Antioxidants? Limiting your sodium? Boosting your potassium intake? Learn effective ways to get your risk factors under control through the food choices you make every day.

 

What counts as “exercise?”

Do you have to break a sweat before it’s good for your heart?

You’ve heard it before: regular exercise can raise HDL cholesterol, control your weight, improve the work capacity of your heart, reduce your blood pressure and blood glucose and relieve stress.

So why is it so difficult to get up off the couch and get moving?

You’ll learn how often to exercise. Whether short bursts of activity can offer the same protection as longer exercise periods when it comes to reducing risk of coronary heart disease.

And you will read how to exercise safely — a must-see if you are concerned about having a heart attack or cardiac arrest during physical activity.

“Alcohol to protect my heart? I’ll drink to that!”

Should you? Will drinking alcoholic beverages really lower your risk of heart attack, as the headlines proclaim? The 2012 Johns Hopkins Heart Attack Prevention White Paper looks at how a small amount of alcohol can help raise “good” HDL cholesterol. Discover what the research says is “enough” alcohol to reduce your risk of heart attack, and what’s “too much.”

See your heart’s health in a whole new way

Because solid, authoritative medical research stands behind the recommendations of Johns Hopkins Medicine, each White Paper includes highlights of new studies that are relevant to you.

When you have The 2012 Johns Hopkins Heart Attack Prevention White Paper, you have the power to affect your health care as never before. Use what you learn to:

Recognize and respond to symptoms and significant changes in your heart health as they occur.

Make conscious, deliberate choices in what you eat and drink and do, based on what is known to lower the risk of cardiovascular disease.

Communicate effectively with your doctor. A helpful glossary takes the mystery out of “medical-speak.” Words like ischemia and ejection fraction will lose their power to intimidate or confuse you.

You will be better equipped to ask informed questions and to understand the answers.

Make the right decisions, based on a better understanding of the newest drugs, the latest surgical techniques and the most promising research.

Take control over your condition and act out of knowledge, rather than fear.

 

Who will benefit from this timely intelligence?

The fact that you are reading this suggests that you’re not willing to leave your fate in others’ hands. You want to know more. You need to know more. And you’re willing to seek out the best and most current information so you can raise important issues with your own doctors.

The 2012 Johns Hopkins Heart Attack Prevention White Paper will prove valuable to you if any of the following criteria describe your personal situation.

You are being treated for high cholesterol or high blood pressure or have other cardiovascular risk factors such as diabetes, smoking, obesity or a sedentary lifestyle.

You have a family history of heart disease and want to break the pattern.

You want to reduce the likelihood of needing bypass surgery or other invasive procedures.

You have already had a heart attack and want to avoid a second one.

You realize that first heart attacks often prove fatal to women because the early warning signs — which are different from men’s — may be misunderstood or ignored.

You live with or care for someone with cardiovascular risk factors and want to do everything possible to prevent a heart attack.

 

The specialists at Johns Hopkins created The 2012 Johns Hopkins Heart Attack Prevention White Paper to serve as your first line of defense against a heart attack. Special Bonus: Place your order today and we will include a free gift that could, literally, save your life.

 

The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease takes a comprehensive approach to the management of heart health. In the FREE Special Report that you can download when you pay now for The 2012 Johns Hopkins Heart Attack Prevention White Paper, the experts share practical, specific advice on how you can slow the progression of cardiovascular disease and decrease your future risk of heart attack, stroke, bypass surgery or angioplasty.

What you need to know is yours free in Tested, Proven Ways To Save Your Heart. It’s our gift to you, when you order and pay by credit card… yours to keep and use even if you decide to return The 2012 Johns Hopkins Heart Attack Prevention White Paper for any reason.

 

 

FREE Heart Attack Prevention Special Report: 

Tested, Proven Ways To Save Your Heart

Heart Attack Prevention Strategies

The #1 Way to Prevent a Heart Attack 

The importance of smoking cessation cannot be underestimated.

Walking Your Way to a Healthier Heart 

Johns Hopkins specialists outline the best ways for starting a walking program to maximize your heart health.

Action Plan When a Heart Attack Strikes 

The crucial symptoms to look out for (which can often be different in men and inAs you wi women) and what to do and NOT do if you or a loved one starts to show the telltale signs.

Cholesterol Busting Foods

The latest research on stanols, sterols, soy, fiber, and more.

A Drink a Day for Heart Health?

Moderate alcohol intake has been suggested as a way to ward off heart attack. This special report discusses the pros and cons.

 

You’ll get BOTH — The 2012 Johns Hopkins Heart Attack Prevention White Paper mailed to you and your free Special Report as an instant electronic download, all for only $19.95 plus shipping and handling.

YOUR FREE GIFT shows you how to walk your way to a healthier heart. Yes, you’ve heard it again and again: Walking is a good way to protect your heart. Everyone knows how to do it. It doesn’t cost anything, and you don’t need special equipment other than the right shoes.

Do you know what a group of men did to lower their risk of coronary heart disease by 18 percent? Tested, Proven Ways to Save Your Heart reveals their winning walking approach that yielded big benefits. You will also discover:

A safe way to get started, and what’s “enough” exercise to give you the heart protection you’re after.

Is faster better? How to set a healthy pace for maximum cardiovascular benefit, and warning signs that you’re pushing too hard.

How to determine your “target” heart rate zone so your walks give you significant cardiovascular benefits.

The walking style that boosts your calorie burning by up to 10 percent.

How to make your walking plan work with the weather and your lifestyle.

Cool-down stretches that keep you from feeling sore afterward.

 

And so much more!

But walking is just the beginning. Your free copy of Tested, Proven Ways To Save Your Heart gives you a truly effective way to conquer your heart’s worst enemy. Despite everything the public has been taught for the last 40 years about the dangers of tobacco, cigarette smoking is responsible for about 440,000 premature deaths each year in the United States.

Smoking, or living with a smoker, can undermine your best efforts to achieve a healthy heart. Only 5 to 10 percent of people successfully quit on their own, which is why the information in this free gift is so essential. Based on vast clinical experience and knowledge of the full range of medications and techniques to help you quit, Johns Hopkins doctors give you tools that raise your chances of quitting for good.

Learn the three things that, if used in combination, give you a far greater likelihood of kicking the habit.

The latest scientific thinking on nicotine replacement gum, skin patches, nasal sprays and inhalers.

Who’s a candidate for the medications that can help reduce cravings and withdrawal symptoms.

Tips for people who have tried (perhaps many times) before without lasting success.

Why avoiding alcohol can help you avoid cigarettes…

 

and so much more…

The sooner you take steps to reduce your heart attack risk, the better. Prevention remains your most powerful medicine. But knowing how to respond in an emergency-whether it involves you or someone you are with-can be crucial to survival.

When heart attack strikes…

be prepared with a fast and appropriate response.

As you will learn in your free copy of Tested, Proven Ways To Save Your Heart, what you do and what you don’t do during the first crucial minutes and hours following a heart attack can make all the difference in the outcome.

Did you know that a third of all people having a heart attack never experience any chest pain at all? Your Johns Hopkins-designed “Action Plan When a Heart Attack Strikes” alerts you to the range of warning signs, including the less common ones that are more likely to occur in women.

At what point should you call an ambulance? When are you better off driving the person to the hospital instead of waiting for the ambulance to arrive? What information must the emergency personnel have right away? How do you handle the person in denial, who insists, “You’re overreacting” or “There’s nothing wrong?”

I hope you never need to use this information at all. But you’ll be much better prepared to respond calmly and effectively when you have your free gift, Tested, Proven Ways To Save Your Heart, on hand.

SOURCE:

http://www.johnshopkinshealthalerts.com/contact_us/

 

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Atrial Fibrillation: The Latest Management Strategies

Reporter: Aviva Lev-Ari, PhD, RN

UPDATED on 8/5/2013

Ischemic strokes are the most common type of AFib-related stroke5 and can be extremely debilitating.6,7 It’s important to help your patients understand the risk of ischemic stroke and how you can help lower that risk.

Nearly 9 out of 10 AFib-related strokes are ischemic, and most are cardioembolic5,8,9

  • Cardioembolic strokes are most commonly caused by AFib9,10
  • Hemorrhagic strokes account for approximately 10% of AFib-related strokes5
  • AFib-related ischemic strokes are primarily caused by an embolus formed in the left atrial appendage of the heart11

Ischemic strokes can be devastating, often resulting in irreversible brain damage2

  • Debilitating effects of a stroke include paralysis, slurred speech, and memory loss12
    • Every second, ≈32,000 brain cells can die due to hypoxia from lack of blood flow4
    • In 1 minute, nearly 2 million brain cells can die—increasing the risk of disability or death2-4
  • Severely disabling stroke is frequently rated by patients as equivalent to or worse than death13

Strokes are a leading cause of disability in the US14

The good news is you can significantly reduce your AFib patients’ risk of ischemic stroke with anticoagulation therapy.11,15,16 By keeping them appropriately anticoagulated, you can help your patients avoid the devastation of ischemic stroke.11

AFib=atrial fibrillation.

References

  1. Types of stroke. Johns Hopkins Medicine Web site. http://www.hopkinsmedicine.org/healthlibrary/printv.aspx?d=85,P00813. Accessed August 9, 2012.
  2. Maas MB, Safdieh JE. Ischemic stroke: pathophysiology and principles of localization. Hospital Physician Neurology Board Review Manual. 2009;13:1-16.http://www.turner-white.com/pdf/brm_Neur_V13P1.pdf. Accessed February 1, 2013.
  3. Rosamond WD, Folsom AR, Chambless LE, et al. Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke. 1999;30:736-743.
  4. Saver JL. Time is brain—quantified. Stroke. 2006;37:263-266.
  5. Mercaldi CJ, Ciarametaro M, Hahn B, et al. Cost efficiency of anticoagulation with warfarin to prevent stroke in Medicare beneficiaries with nonvalvular atrial fibrillation. Stroke. 2011;42:112-118.
  6. Vemmos KN, Tsivgoulis G, Spengos K, et al. Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic stroke. Am J Geriatr Pharmacother. 2004;2:265-273.
  7. Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27:1760-1764.
  8. Grau AJ, Weimar C, Buggle F, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German Stroke Data Bank. Stroke. 2001;32:2559-2566.
  9. Bogousslavsky J, Van Melle G, Regli F, Kappenberger L. Pathogenesis of anterior circulation stroke in patients with nonvalvular atrial fibrillation: the Lausanne Stroke Registry. Neurology. 1990;40:1046-1050.
  10. Freeman WD, Aguilar MI. Prevention of cardioembolic stroke. Neurotherapeutics. 2011;8:488-502.
  11. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm SocietyCirculation. 2006;114:700-752.
  12. Effects of stroke. American Stroke Association Web site. http://www.strokeassociation.org/STROKEORG/AboutStroke/EffectsofStroke/Effects-of-Stroke_UCM_308534_SubHomePage.jsp. Accessed December 8, 2012.
  13. Gage BF, Cardinalli AB, Owens DK. The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life. Arch Intern Med. 1996;156:1829-1836.
  14. Centers for Disease Control and Prevention (CDC). Prevalence of Stroke—United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2012;61:379-382.
  15. Singer DE, Chang Y, Fang MC, et al. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Ann Intern Med. 2009;151:297-305.
  16. Lip GYH, Andreotti F, Fauchier L, et al. Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis. Europace. 2011;13:723-746.

SOURCE

http://www.medscape.com/infosite/afib/public/

Straightforward, informed answers to your most important questions about living

with atrial fibrillation – the most common sustained cardiac arrhythmia.

Written by

Hugh G. Calkins, M.D., Director of the Arrhythmia Service

and Electrophysiology Lab at The Johns Hopkins Hospital,

and Ronald Berger, M.D.,

If you’ve ever run up a flight of stairs, chased a tennis ball across the court, or reacted in fright at a scary movie, you know what a pounding heart feels like…

But for the 2.3 million Americans who suffer from atrial fibrillation (AF or AFib), a racing heart is a way of life. Simple tasks like getting out of bed in the morning or rising from a chair can cause dizziness, weakness, shortness of breath, or heart palpitations. For these people, AF severely impairs quality of life – and even when symptoms stemming from AF are mild, the disorder can seriously impact health, increasing the risk of stroke and heart failure.

AF can be a debilitating even deadly condition. Fortunately, it can be successfully managed – but there are various approaches for treating AF or preventing a recurrence. How do you and your doctor choose which approach is right for you?

If you or a loved one has AF, there are so many questions: Do I need an anticoagulant… should I be taking medication to control my heart rate… will my symptoms respond to cardioversion… if I need an antiarrhythmic drug to control AF episodes, which one should I take… when is an ablation procedure appropriate… and more.

It’s critically important to learn everything you can now — so you can partner with your doctor effectively, ask the right questions, and understand the answers.

To help you, we asked two eminent experts at Johns Hopkins to share their expertise and hands-on experience with arrhythmia patients in an important new report, Atrial Fibrillation: The Latest Management Strategies.

Dr. Hugh Calkins and Dr. Ronald Berger are ideally positioned to help you understand and manage your AF. Together with their colleagues at Johns Hopkins, they perform approximately 2,000 electrophysiology procedures and 200 pulmonary vein isolation procedures for atrial fibrillation each year.

Hugh Calkins, M.D. is the Nicholas J. Fortuin, M.D. Professor of Cardiology, Professor of Pediatrics, and Director of the Arrhythmia Service, the Electrophysiology Lab, and the Tilt Table Diagnostic Lab at The Johns Hopkins Hospital. He has clinical and research interests in the treatment of cardiac arrhythmias with catheter ablation, the role of device therapy for treating ventricular arrhythmias, the evaluation and management of syncope, and the study of arrhythmogenic right ventricular dysplasia.

Ronald Berger, M.D., Ph.D., a Professor of Medicine and Biomedical Engineering at Johns Hopkins, is Director of the Electrophysiology Fellowship Program at The Johns Hopkins Hospital. He serves on the editorial board for two major journals in the cardiovascular field and has written and coauthored more than 100 articles and book chapters.

Atrial Fibrillation: The Latest Management Strategies is now available to you in a digital PDF download and print version.

“I feel like my heart is going to jump out of my chest…” 

An arrhythmia is an abnormality in the timing or pattern of the heartbeat, causing the heart to beat too rapidly, too slowly, or irregularly. Sounds pretty straightforward, but there’s a lot we don’t know about why the heart rhythm goes awry… or the best way to treat it.

In Atrial Fibrillation: The Latest Management Strategies, we focus on what we DO know. In page after page of this comprehensive report, we address your most serious concerns about living with AF, such as:

  • I don’t have any symptoms. Is my problem definitely AF?
  • Can drinking alcohol trigger or worsen AF?
  • Is every person who has AF at risk for a stroke?
  • If my doctor suspects AF, will I have to wear an implantable or event monitor to be sure?
  • Why does AF often show up later in life?
  • What would you recommend to the older patient – 75 and older – who has AF but no bothersome symptoms?
  • What do you recommend for the person with longstanding persistent AF?
  • Is the AF experienced by an otherwise healthy person different from that of a person with underlying heart disease or other health issues?
  • What are the differences among: paroxysmal AF, persistent AF, and longstanding persistent AF?
  • What is the “pill-in-the-pocket” approach to AF?

Anticoagulation Therapy: What You Should Know

While AF is generally not life threatening, for some patients it can increase the likelihood of blood clots forming in the heart. And if a clot travels to the brain, a stroke will result. Anticoagulation therapy is used to prevent blood clot formation in people with AF…

  • Why is anticoagulation therapy with warfarin (Coumadin) needed for some people with AF?
  • How is the use of warfarin monitored?
  • How does a doctor determine if a patient with AF needs to take warfarin?
  • What’s the CHADS2 score and how is it used?
  • If a patient’s CHADS2 score is 1, how do you decide between aspirin and warfarin, or nothing at all?
  • Why is it so difficult to keep within therapeutic range with warfarin?
  • Can I test my INR (a test measuring how long it takes blood to clot) at home?
  • What happens if my INR is too high?
  • What options are available if a patient cannot take warfarin?
  • What are the benefits of dabigatran, a new blood-thinning alternative to warfarin therapy?

Symptom Control: The Art of Rate and Rhythm Control

For many patients and their doctors, it’s difficult to achieve and maintain heart rhythm. Two key management strategies are used: heart rate and heart rhythm control. In Atrial Fibrillation: The Latest Management Strategies, you’ll read an in-depth discussion of the benefits of rate versus rhythm control for AF:

  • What have we learned from the AFFIRM study, and how has this knowledge affected the management of AF?
  • What is catheter ablation of the AV (atrioventricular) node?
  • Why is cardioversion needed?
  • Are there different types of cardioversion?
  • What is chemical cardioversion? What is electrical cardioversion?
  • Can medication be used to convert the heart back to normal sinus rhythm?
  • Which antiarrhythimic drugs are used to treat AF?
  • How is catheter ablation for AF performed?
  • What is pulmonary vein antrum isolation (PVAI) and how is it performed?
  • Who are the best candidates for PVAI?

There’s more to Atrial Fibrillation: The Latest Management Strategies, much more.

We explain surgical ablation of AF, a procedure performed through small incisions in the chest wall… discuss when it’s appropriate to seek a second opinion… take a close look at strokes and explain the warning signs and differences among ischemic, thrombotic, embolic, and hemorrhagic strokes… and provide an arrhythmia glossary of key AF terms used by electrophysiologists and cardiologists.

Direct to You From Johns Hopkins

Atrial Fibrillation: The Latest Management Strategies is designed to give you unprecedented access to the expertise of the hospital ranked #1 of America’s Best Hospitals for 21 consecutive years 1991-2011 by U.S. News & World Report. You simply won’t find a more knowledgeable and trustworthy source of the medical information you require. A tradition of discovery and medical innovation is the hallmark of Johns Hopkins research. Since its founding in 1889, The Johns Hopkins Hospital has led the way transferring the discoveries made in the laboratory to the administration of effective patient care. No one institution has done more to earn the trust of the men and women diagnosed with AF and other cardiovascular conditions.

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Reporter: Aviva Lev-Ari, PhD, RN

Written by
Hugh G. Calkins, M.D., Director of the Arrhythmia Service
 and Electrophysiology Lab at The Johns Hopkins Hospital,
 and Ronald Berger, M.D.

  • Hugh Calkins, M.D. is the Nicholas J. Fortuin, M.D. Professor of Cardiology, Professor of Pediatrics, and Director of the Arrhythmia Service, the Electrophysiology Lab, and the Tilt Table Diagnostic Lab at The Johns Hopkins Hospital. He has clinical and research interests in the treatment of cardiac arrhythmias with catheter ablation, the role of device therapy for treating ventricular arrhythmias, the evaluation and management of syncope, and the study of arrhythmogenic right ventricular dysplasia.
  • Ronald Berger, M.D., Ph.D., a Professor of Medicine and Biomedical Engineering at Johns Hopkins, is Director of the Electrophysiology Fellowship Program at The Johns Hopkins Hospital. He serves on the editorial board for two major journals in the cardiovascular field and has written and coauthored more than 100 articles and book chapters. 

If you’ve ever run up a flight of stairs, chased a tennis ball across the court, or reacted in fright at a scary movie, you know what a pounding heart feels like… But for the 2.3 million Americans who suffer from atrial fibrillation (AF or AFib), a racing heart is a way of life. Simple tasks like getting out of bed in the morning or rising from a chair can cause dizziness, weakness, shortness of breath, or heart palpitations. For these people, AF severely impairs quality of life – and even when symptoms stemming from AF are mild, the disorder can seriously impact health, increasing the risk of stroke and heart failure. AF can be a debilitating even deadly condition. Fortunately, it can be successfully managed – but there are various approaches for treating AF or preventing a recurrence. How do you and your doctor choose which approach is right for you? If you or a loved one has AF, there are so many questions: Do I need an anticoagulant… should I be taking medication to control my heart rate… will my symptoms respond to cardioversion… if I need an antiarrhythmic drug to control AF episodes, which one should I take… when is an ablation procedure appropriate… and more. It’s critically important to learn everything you can now — so you can partner with your doctor effectively, ask the right questions, and understand the answers. To help you, we asked two eminent experts at Johns Hopkins to share their expertise and hands-on experience with arrhythmia patients in an important new report, Atrial Fibrillation: The Latest Management Strategies. Dr. Hugh Calkins and Dr. Ronald Berger are ideally positioned to help you understand and manage your AF. Together with their colleagues at Johns Hopkins, they perform approximately 2,000 electrophysiology procedures and 200 pulmonary vein isolation procedures for atrial fibrillation each year. 

Anticoagulation Therapy: What You Should Know

While AF is generally not life threatening, for some patients it can increase the likelihood of blood clots forming in the heart. And if a clot travels to the brain, a stroke will result. Anticoagulation therapy is used to prevent blood clot formation in people with AF…

  • Why is anticoagulation therapy with warfarin (Coumadin) needed for some people with AF?
  • How is the use of warfarin monitored?
  • How does a doctor determine if a patient with AF needs to take warfarin?
  • What’s the CHADS2 score and how is it used?
  • If a patient’s CHADS2 score is 1, how do you decide between aspirin and warfarin, or nothing at all?
  • Why is it so difficult to keep within therapeutic range with warfarin?
  • Can I test my INR (a test measuring how long it takes blood to clot) at home?
  • What happens if my INR is too high?
  • What options are available if a patient cannot take warfarin?
  • What are the benefits of dabigatran, a new blood-thinning alternative to warfarin therapy?
Symptom Control: The Art of Rate and Rhythm Control

For many patients and their doctors, it’s difficult to achieve and maintain heart rhythm. Two key management strategies are used: heart rate and heart rhythm control. In Atrial Fibrillation: The Latest Management Strategies, you’ll read an in-depth discussion of the benefits of rate versus rhythm control for AF:

  • What have we learned from the AFFIRM study, and how has this knowledge affected the management of AF?
  • What is catheter ablation of the AV (atrioventricular) node?
  • Why is cardioversion needed?
  • Are there different types of cardioversion?
  • What is chemical cardioversion? What is electrical cardioversion?
  • Can medication be used to convert the heart back to normal sinus rhythm?
  • Which antiarrhythimic drugs are used to treat AF?
  • How is catheter ablation for AF performed?
  • What is pulmonary vein antrum isolation (PVAI) and how is it performed?
  • Who are the best candidates for PVAI? 

http://www.johnshopkinshealthalerts.com/catalog/special_report/6044-1.html

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