Cardiology

Danish researchers conducted a meta-analysis that looked at possible associations between coffee intake and obesity, metabolic syndrome, and type 2 diabetes. They reported finding only a low risk of these conditions in coffee drinkers, but no genetic variance to explain the relationships.

With the global boom in type 2 diabetes mellitus, many patients have greatest access to and are well-cared for by their primary care practitioners (PCPs). For those with basic, predictable, garden-variety diabetes, PCPs are perfectly capable of helping them. It's unclear when referral to a specialist for consultation or chronic management is most sensible.

The risk for blood clots may increase when taking newer oral contraceptives, according to findings published in BMJ.

Untreated strep infections can cause acute rheumatic fever and rheumatic heart disease in children. That complication has become rare in the continental US, but a new CDC report finds a resurgence in the American territory of Samoa and in people of Samoan descent living in the state of Hawaii.

Results from 2 trials presented at the recent Heart Rhythm Society meeting suggest that 2 alternative ablation technologies work about as well as those that are commonly used on patients with atrial fibrillation.

Researchers at ATS 2015 reported chronic obstructive pulmonary disease was a risk factor for cardiovascular disease, but was not independently linked to risk of stroke or systemic embolism.

Besides being the most common cause of chronic liver disease in industrialized nations, non-alcoholic fatty liver disease has serious hepatic consequences. It is expected to be the most frequent indication for liver transplantation by 2030.

A drug normally used to treat hypertension reduced the symptoms of multiple sclerosis in mice models of the disease.

Obesity rates have climbed nearly 50 percent since 1997, with as much as 30 percent of the population classified as obese. There is strong belief within the health care industry that obesity should be treated as a primary medical condition, with physicians playing a major role. Evidence suggests that patients are more likely to lose weight when they are advised by their primary care physicians to do so.

Analysis of data from a previous study indicates that opioid use may increase the risk of heart attack by triggering atrial fibrillation.

Research indicates that, despite the relative simplicity of dabigatran regimens, physicians and pharmacists must follow up with patients repeatedly to maximize the chances they'll adhere to prescriptions.

Angiotensin-converting enzyme (ACE) inhibitors are prescribed frequently and effectively for hypertension and heart failure, as well as to reduce urine protein excretion.1

Sitagliptin appears to have beneficial systemic and adipose anti-inflammatory effects in combination antiretroviral therapy-treated HIV-positive adults with impaired glucose tolerance. The drug may prevent cardiovascular problems by reducing inflammation linked to heart disease and stroke in this patient population.

The results of the largest study of its kind to date indicate that new antipsychotic medications-including quetiapine, olanzapine, and risperidone-do not appear to put women at additional risk of developing gestational diabetes, hypertensive disorders, or major blood clots that obstruct circulation, all conditions that often develop during pregnancy or with the use of older antipsychotic medications.

Changes in the way we think about sodium intake and cardiovascular risk, calcium supplementation, and other topics should remind us all of the advice we heard on the first day of medical school: 50% of what you learn here is wrong or going to disappear over your career; we just don't know which 50%.

Click here to review the Cardiology Review editorial advisory board.

UnitedHealth, the nation's largest health insurance company, recently announced a partnership with 3 telemedicine companies to cover video-based doctor visits in the same way it covers in-person visits.

More than 13,000 physicians and cardiovascular team members attended the ACC 2015 meeting in San Diego on March 14-16, 2015. In this issue of Cardiology Review, we focus on 6 important studies presented at ACC 2015: LEGACY, OSLER, PEGASUS, EMBRACE-STEMI, MATRIX, and CoreValve.

Mortality in patients with type 1 diabetes mellitus (T1DM) is higher than in the general population, and whether mortality improves or alters with glycemic control is unknown.

The recent FDA approvals of ivabradine and the WATCHMAN Left Atrial Appendage Closure Device, study results on EHRs and quality of medical care, and more are covered in this installment.

Hospitals have been paying Medicare penalties when patients are readmitted too soon after discharge. So far the focus has been on patients with heart failure and pneumonia but a study from NYU finds sepsis readmissions are also common.

A Chicago team surveyed medical residents and found harrowing tales of mishaps and near-misses due to botched handoffs when patients are stepped down from ICU care.

The presence of chronic kidney disease (CKD) in patients with atrial fibrillation increases the risk of stroke and thromboembolism (TE) as well as the risk of bleeding, thus complicating their treatment. In this context, it has been suggested that CKD should be included in the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes mellitus; previous Stroke, transient ischemic attack, or thromboembolism; Vascular disease; Age 65 to 74 years; Sex category) score.

After a brutal winter, particularly for those in the Midwest and on the East Coast, spring is finally in the air. I hope everyone had a nice spring break with their families and is eager to read some insightful material on cardiology.

The addition of a mitral valve repair to patients undergoing coronary artery bypass graft (CABG) surgery with moderate ischemic mitral regurgitation is still a source of controversy. Recent guidelines state that concomitant mitral valve repair at the time of CABG may be beneficial, but the evidence is inconclusive.

Refractory angina is a loosely defined term generally referring to the persistence of life-impacting angina despite maximal antianginal medications and, when possible, coronary revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]). Numerous novel pharmacotherapies and mechanical interventions have been proposed, and studies conducted, to treat patients with refractory angina.

Atrial fibrillation (AF) and heart failure (HF) often coexist. The use of beta-blockers in HF patients has a class 1A recommendation in both the European and American guidelines. In current guidelines for heart failure therapy, the recommendation for beta-blockers is not restricted to patients with sinus rhythm, and includes all HF patients.

In the era of progressive technology, the diagnostic modalities for stable coronary artery disease are various. The original cardiac stress test has been used in the past for many purposes, including diagnosis of obstructive coronary artery disease in a patient with chest pain as well as risk stratification for ischemia. More recently, coronary computed tomographic angiography (CCTA) has emerged as a great tool to diagnose anatomically obstructive coronary lesions. However, for the past few years, obtaining functional and physiologic data such as comparative fractional flow reserve (FFR) has become the gold standard for evidence of ischemia on CCTA similar to invasive angiography.

The primary objectives of treating acute ischemic stroke are to prevent death and limit functional disability. Similar to acute myocardial infarction (AMI), timely reperfusion using systemic thrombolysis has been shown to improve outcome of acute stroke, namely functional neurologic recovery, but not mortality. But unlike AMI, the role of intra-arterial or endovascular therapy in acute stroke has not been clearly established.