Americans spend billions in dietary supplements every year but, in truth, this money is only wasted, according to evidence form a recent study published in Intern Med. Most of dietary interventions and nutritional supplements including multi-vitamins, selenium and antioxidants, do not reduce cardiovascular risk or mortality, according to this large analysis and systematic revision of…
Many Guidelines, Much Confusion. Blood Pressure Targets in the Elderly
Seeing as hypertension prevalence and incidence increases with age, treating elderly patients of paramount importance. The AHA/ACC guidelines have lowered cohort hypertension thresholds to >130/80 mmHg, whereas the European guidelines have kept the classic >140/90 mmHg, though recommending lower thresholds for most patients at the same time. Lower than 130/80 mmHg is recommended with the…
After Much Toing and Froing, Gastrointestinal Protection Is Back to the Forefront
Several clinical guidelines differ in their recommendation regarding the prescription of proton pump inhibitors to patients being treated with dual antiplatelet therapy after infarction. In 2015, the European Society of Cardiology (ESC) recommended their use in patients with high bleeding risk; however, in the 2017 update that recommendation became general after the assumption that, for…
EuroPCR 2019 | Global Leaders: Ticagrelor Monotherapy at Long Term Could Have a Role in Complex PCI
This post hoc analysis of what had been a trial with negative outcomes should be considered only as a hypothesis generator. Patients receiving complex PCI treated with ticagrelor monotherapy after one-month dual antiaggregation therapy (DAPT) showed better results at 2 years when compared against patients receiving a conventional DAPT scheme. In the global analysis, this…
Bariatric Surgery Associated with a Lower Rate of Mortality Due to Infarction and Stroke
Prior bariatric surgery in a patient with morbid obesity is associated with a significant effect on survival after infarction or stroke. While these are observational data, the significant metabolic improvement experienced after the surgery can explain perfectly such findings. This large nationwide registry of bariatric surgery found a 40% decrease in the risk of death,…
Is Alcohol Good, Bad, or Neutral for Cardiovascular Health?
In the 2018 Guidelines on Hypertension, commandment no. 6 states that we should make lifestyle interventions such as sodium restriction, healthy eating, regular exercise, weight control, and smoking cessation, and also alcohol moderation. It is clear that heavy alcohol consumption induces hypertension and may probably be one of the main causes of secondary hypertension, but…
E-Cigarettes vs. Nicotine Therapy to Stop Smoking
E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy according to this randomized study recently published in the New England Journal of Medicine (NEJM). Both must be accompanied by medical and psychological support for optimal results. While e-cigarettes are commonly used as a smoking cessation strategy, evidence is limited regarding their effectiveness as compared…
ACC 2019 | AUGUSTUS: Apixaban Plus P2Y12 Inhibitor Is the Best Combination in Atrial Fibrillation and Angioplasty
Aspirin increases bleeding with no ischemic benefit, but a trend toward more stent thrombosis with placebo warrants further studies. Patients with atrial fibrillation who receive an anticoagulant agent and coronary angioplasty with a stent, and then continue with aspirin, experience an increased risk of bleeding without any ischemic benefit whatsoever. The use of a…
ACC 2019 | The New ACC/AHA Guidelines on Primary Prevention Focus on Life Style, Diet and Socioeconomic Factors.
These guidelines basically remind us that we should focus on life style changes to best prevent heart disease, heart failure and atrial fibrillation. These changes, of course, should be permanent. It is estimated that life style changes translate into 80% risk reduction of heart disease. These recommendations are based on 9 topics: risk estimation,…
ESC 2018 | CLARIFY: No Survival Benefit with Beta-Blockers Beyond 1 Year After Infarction
This is another study that concludes that beta-blockers have no impact on mortality at 1 year after infarction in stable patients and offer no survival benefit to patients with stable ischemic heart disease who have not experienced a myocardial infarction. This analysis represents 5 years of follow-up in a large, multinational registry and also shows a lack…
New European Hypertension Guidelines Contrast with American Recommendations
The European guidelines on hypertension have been updated and now feature differences compared with American guidelines regarding how to diagnose and treat patients with high blood pressure. The main difference particularly lies in how aggressive physicians should be in lowering blood pressure. These data are available from a preview of the document presented at the…