Shivalik Hospital Premises
Sector -69, Mohali
Helpline: +91-90413-86868, 0172-2216868, 2217878 (Ext. 219)
Appointments: +91-90413-87878, 0172-2216868, 2217878

Health Capsule

Nov. 22, 2017

  • In patients undergoing Coronary Angiography, neither IV Sodium Bicarbonate nor N-acetylcysteine(NAC) protect against adverse outcomes in patients at high risk for Renal complications. PRESERVE trial

Nov. 20, 2017

  • Dual Antithrombotic therapy with Dabigatran(Pradaxa) & P2Y12 inhibitor(Clopidogrel or Ticagrelor) is better than Triple therapy with Warfarin +P2Y12 inhibitor+ Aspirin and is associated with less bleeding risk in Atrial fibrillation patients undergoing PCI.

Nov. 15, 2017

  • Padding Coronary Artery Calcium(CAC) measurements to standard tools like the Framingham score improves the Risk assessment for Cardiovascular disease in patients with T2DM & Metabolic Syndrome. CAC score is independently associated with incident Coronary Heart Disease.
  • New ACC/AHA Hypertension guidelines released. SBP of 130-139 & DBP of 80-89 will be defined as Stage 1 Hypertension. Target for control changed from 140/90 to 130/80.
  • In Asian patients with CAD, high dose Statin therapy is superior and equally safe compared to Low dose Statin in reducing CV events. REAL-CAD trial comparing Pitavastatin 4 mg vs 1 mg in > 13000 patients of Japan.

Oct. 25, 2017

  • Post-Operative shivering may be significantly reduced by administration of IV Paracetamol during surgery. Post-Operative shivering is a frequent complication in patients recovering from general anaesthesia & can be harmful in patients with elevated CV risk.
  • Once a week injection of GLP1 analogue-Semaglutide is approved for use in Type 2 DM, albeit at increased risk of retinopathy

Oct. 16, 2017

  • Lower serum calcium levels even within normal range may increase the risk of sudden cardiac arrest (SCA). Persons with S.Calcium levels of <8.95mg/dl have more than double the risk of SCA than persons with Calcium levels > 9.55mg/dl

Oct. 14, 2017

  • Male vegetarians are at greater risk of Depression than their meat eating counterparts, Nutritional deficiencies (mainly Vitamin B12 or Iron) may be possible explanation.
  • Inhaled Corticosteroids (ICS) have a strong Dose-Response relationship with Non Tuberculous Mycobacterial Disease (NTM-PD) in older adults with COPD. Fluticasone, but not Budenoside is also associated with increased Pneumonia risk.

Oct. 13, 2017

  • Sitting Meditation practices like Samatha meditation, Vipasana meditation, Mindful meditation, Zen meditation, Raj yoga meditation can be included as an adjunct to standard guideline directed CV risk reduction strategies.
  • USFDA approves an implantable device to treat Central Sleep Apnea (CSA). The device- Remede System (Respicardia) is to be implanted in upper chest under the skin that sends signals to phrenic nerve through tiny wires thus stimulating diaphragmatic contraction.

July. 9, 2017

  • Intensive Statin therapy in Dyslipidemic patients with Diabetic Retinopathy without CAD with a goal to reduce LDL to < 70mg/dl does not reduce Cardiac events significantly but reduces risk of Cerebral events by almost 50%.

May. 17, 2017

  • Patients who discontinue long term low dose Aspirin therapy for reasons other than Surgery or Bleeding are at 37% increased risk of Cardiovascular events including MI,Stroke or CV death. One out of 74 patients who stop Aspirin have additional CV event in 1 year.

Mar. 4, 2017

  • Skipping Breakfast is linked to Increased Atherosclerosis. People who take no breakfast or low energy breakfast are at 50 to 75% increased risk of Subclinical Atherosclerosis as compared to people consuming high energy breakfast. (PESA study from Spain)

Jan. 4, 2017

  • Risk of CVD & Premature death much lower in patients achieving Systolic BP of 120-124 mmHg,much lower than current recommendations of 140mmHg
  • In patients presenting with ST Elevation MI(STEMI),Reloading of Clopidogrel- >=300mg as a loading dose to a person already taking Clopidogrel,is safe,does not increase risk of major bleeding & is associated with 20% reduction in hospital mortality
  • Even moderate drinking is associated with pathologic findings in Brain including hippocampal atrophy. Higher Alcohol intake predicts faster decline in cognitive measures of lexical fluency. No protective effect seen even with light intake
  • SGLT 2 inhibitor Canagliflozin reduces CV events by 14%, All cause & CV deaths by 13%, Heart failure by 33%, cuts Renal decline by 40% but doubles the risk of Lower limb amputations.

Nov. 5, 2016

  • Sitting down for long periods of time isn’t just bad for your metabolism, it can make you age quicker too. Sitting for 10 or more hours a day without regular exercise can make a person’s cells age prematurely. 40 minutes of moderate-to-vigorous exercise a day helps to prevent premature aging.

Sept. 19, 2016

  • Using Chlorthalidone to treat Hypertension not only reduces CV risk but also significantly reduces Hip & Pelvic fracture risk compared to Amlodipine & Lisinopril.

Aug. 11, 2016

  • Moderate tea drinking can help to slow progression of Coronary Artery Calcium & reduce risk of Cardiovascular events. Coffee intake has neutral effect. Regular tea consumption should be part of Heart Healthy diet.

July. 18, 2016

  • The first hour after a heart attack is crucial in which prompt medical treatment can save lives!
    But in India most patients reach hospital many hours later resulting in unexpected death. About 20% of patients die with one hour and one-third within 24 hours of onset of symptoms.
    The common symptoms of heart attack are: Pain in the centre or left side of chest radiating to left or both arms, the upper back, neck, lower jaw, or upper stomach. There may be accompanying Shortness of breath, cold sweats, nausea or light-headedness.
    If you experience any of these symptoms, please rush to the nearest hospital with a cath-lab where the affected artery of the heart can be opened up by performing a timely lifesaving Angioplasty.

June. 7, 2016

  • The Glycemic Index(GI) is an unreliable indicator of Blood Sugar response. GI of same food may vary by an average 20% within same individual and 25% in different individuals.

May. 24, 2016

  • Bariatric surgery of the Roux-en-Y variety (RYGB) yields much better and sustained weight loss as compared to other surgeries or no surgery over a period of 10 years.

April. 15, 2016

  • Cardiovascular Risk associated with Higher levels of Systolic BP & LDL Cholesterol is independent & cumulative.
    Combination of 18 mg/dL LDL lowering & 10 mmHg Systolic BP lowering is associated with almost 90% reduction in Major Vascular Events

Mar. 7, 2016

  • Low and Middle income countries have higher prevalence of Hypertension,Prevalence is gradually decreasing in High income countries while it is significantly increasing in Low/Middle income countries mainly due to Urbanization accompanied by unhealthy lifestyle factors.

Feb. 24, 2016

  • Higher levels of Omega 6 PUFA Linoleic acid stored in fat tissue is associated with a lower risk of death. This suggests a possible beneficial role of Omega 6 oils(Corn, Safflower, Sunflower & Canola oil) on mortality & Cardiovascular health.

 

Jan. 17, 2016

  • Pioglitazone significantly reduces the risk of developing Diabetes & risk of Recurrent Stroke & Heart attacks in people with Insulin resistance with recent history of stroke.
  • Diabetes is associated with significantly increased risk of premature death not only due to Cardiovascular causes but also due to Cancers, Kidney & Liver diseases.

 

Dec. 3, 2015

  • Elderly patients who are on ACE Inhibitor or ARB should not be given Cotrimoxazole as it increases risk of sudden death probably by increasing S. Potassium levels.
  • People with Non Obstructive CAD are also at significantly increased risk of Myocardial Infarction at 1 year as compared to people with normal angiography. All preventive measures ( Lifestyle, smoking cessation & Statin/Aspirin) may be needed for these people.
  • All COX 2 Inhibitors are harmful to patients at risk of CV events and stroke. Risk is higher with older COXibs.
  • Mega doses of Vitamin D 20000 IU per week given for long term are safe and helpful in reducing risk of fracture and falls in elderly people.

 

Nov. 19, 2015

  • Low dose Aspirin fail to show benefit in primary prevention of Cardiovascular events in high risk elderly patients with multiple risk factors like Diabetes, Hypertension & Dyslipidemia in Asians.
  • Patients with ST Elevation MI(STEMI) who are not Hypoxic, Oxygen Supplementation may actually be harmful as it increases Myocardial injury, Recurrent MI Rate, Infarct size & Risk of Cardiac Arrhythmia.
  • Implementing JNC 8 guidelines of 150/90 as cut off for hypertension management in elderly may put them at risk of developing CV event/ Stroke. ACC AHA still recommend lower goals.
  • Daily consumption of Pistachios (about 50 gms) improves metabolic profile in Prediabetics. Pistachios contain more Lutein, Beta Carotene and Alfa Tochoferol than other nuts.
  • Adding Ivabradine to standard therapy reduces heart rate by about 10/min but also has no beneficial effect on CV risk in patients with stable CAD without heart failure.

Oct. 5, 2015

  • Metformin is associated with reduced risk of Pancreatic Cancer in patients of T2DM. Several epidemiological studies have indicated reduction in overall cancer risk with Metformin.
  • Development of kidney stones is associated with increased risk of CAD & Stroke. The risk is greater in women. The association with DM, Obesity, HTN, Hyperuricemia, Hypercalciuria & Low Grade Inflammation caused by stones may explain the link.
  • Subclinical Hypothyroidism is linked to increased CV risk but treatment of Subclinical Hypothyroidism with Levothyroxine does not reduce death risk.
  • Intense glycemic control after an acute MI significantly prolongs survival in diabetic patients in long run. Long term follow up from DIGAMI 1.
  • Among patients with Type 2 diabetes, women are at 44% greater risk of Coronary Heart Disease as compared to men.
  • Use of Transradial Approach for PCI in Non STEMI patients is increasing globally but at a slower pace than expected from 2.2% in 2010 to 27% in 2013. Increase among STEMI patients is more gradual from 1% to 14% in same period.
  • Intensive BP lowering in Acute Intracerebral Hemorrhage patients is safe. It is associated with greater attenuation of Hematoma volume at 24 hrs and lower 3 month mortality & morbidity, metanalysis, neurology.
  • A combination of lifestyle factors modification (diet, physical activity, avoidance of smoking, reduction of adiposity) substantially reduces risk of stroke in women.

 

Sept. 25, 2015

  • South Asians are not only more likely to develop Diabetes, they also have faster trajectory of disease development and complications compared to whites.
  • A novel once weekly DPP 4 Inhibitor Omarigliptin is as effective as Sitagliptin in lowering HbA1c and has similar safety profile.
  • GLP-1 Analogue, Dulaglutide (Trulicity- Eli Lilly), is to be used once weekly for T2DM patients as Monotherapy and as combination therapy with Metformin, SU, TZDs &/or Prandial Insulin.
  • Severe Obstructive Sleep Apnea interferes with antihypertensive treatment and is responsible for Refractory Hypertension in patients with high CV risk.
  • Because of its effect on myocardial late sodium current (NaL), Ranolazine reduces frequency of angina and need for sublingual nitroglycerine in stable angina patients with T2DM having suboptimal glycemic control.
  • Severe Vitamin D deficiency is very common in critically ill patients. Supplementing high dose vitamin D (540000 units single dose orally or through RT) in such ICU patients significantly reduces overall mortality.

 

Sept. 12, 2015

  • In patients with heart failure & preserved EF, Spironolactone reduces risk of hospitalization for heart failure but fails to reduce risk of CV deaths & Cardiac Arrest.
  • Ivabradine is non-inferior to Atenolol in reducing heart rate and exercise capacity in chronic stable angina patients.
  • Night time BP preferably measured by ABPM is a stronger predictor of CV events & stroke as compared to clinic BP.
  • New data analysis from National Health & Nutrition Survey (NHANES 3) suggests that both fasting & non fasting LDL measurements have equal prognostic significance.
  • NAFLD more riskier in lean people (BMI<25) than in overweight people. Lean NAFLD people are at twice higher risk of death than obese NAFLD people.
  • The health risks associated with long term Hormone Replacement Therapy (HRT) outweigh the benefits. Risks include CAD & Ca Breast while the benefits include improvement of menopausal symptoms and general health.
  • Metformin and lifestyle intervention is significantly effective in reducing body weight & BMI in obese children. Higher the BMI or Insulin Resistance, more the effect.
  • Post partum weight gain (in 3-12 months after childbirth) is associated with adverse Cardiometabolic profile including increase in risk of DM, Hypertension, Dyslipidemia & Metabolic Syndrome.

 

Aug. 18, 2015

  • In patientswith Atrial Fibrilation, new anticoagulants (Dabigatran, Apixaban, Rivaroxaban) are better than Warfarin for preventing stroke and embolic events with increased risk of GI bleeding.
  • Habit of chewing betel quid (also known as paan or areca nut)is accociated with incrreased riskfor T2DM, CVD, Metabolic Syndrome, Obesity, HTN, Lipid Abnormalities & even CKD in addition to Oral/Esophagus cancer.
  • Pre Hypertension is also a risk factor for stroke. Compared with BP<120/80, individuals with a pre hypertensive reading of 120-139/80-89 mm Hg have 66% greater risk of stroke.
  • Patients with sleep apnea and resistant hypertension treated with CPAP for 12 weeks show significant improvement in 24 hours mean BP, nocturnal BP and diastolic BP as demonstrated by ABPM.
  • Depression joins the ranks of Obesity, Diabetes, Hypertension & Smoking as an official heart disease risk factor.
  • Iron supplementation for 12 months in patients with chronic heart failure & iron deficiency anaemia improves functional capacity, symptoms & quality of life.
  • In Type-2 DM patients taking Sulfonylurea, use of Ciprofloxacin, Clarithromycin, Levofloxacin, Metronidazole & Sulfa-Trimethoprim is associated with significant increase in risk of Hypoglycemia. Moxifloxacin not associated with this risk.

 

Aug. 7, 2015

  • Thiazides are as effective as other Antihypertensives in reducing CV events and more effective than Betablockers & ACEI in reducing stroke. Chlorthalidone is significantly more beneficial compared to HCTZ & is the only drug that increases life expectancy.
  • Obese patients with Obstructive Sleep Apnea (OSA) should be recommended to lose weight & use CPAP as initial therapy. Use Mandibular Advancement Devices if CPAP not tolerated.
  • USFDA approves Apixaban (Eliquis) for preventing DVT in adults who have undergone Total Hip/Knee replacement. The drug is already approved for prevention of stroke & embolism in pts with Non Valvular Atrial Fibrilation.
  • Supplementing moderate doses of Omega 3 fatty acids for 5 years fails to reduce incidence of CVD mortality, MI, Stroke, unstable Angina, CHF or Resuscitated Cardiac Arrest.
  • NAFLD more riskier in lean people (BMI<25) than in overweight people. Lean NAFLD people are at twice higher risk of death than obese NAFLD people.
  • Vegeterian diet probably due to its high potassium & low saturated fat content is associated with reduction of blood pressure by about 6/4 mmHg as compared to non vegeterian diet.

 

Jul. 23, 2014

  • Heart disease may be a leading cause of death, but that doesn’t mean you have to accept it as your fate. Although you lack the power to change some risk factors — such as family history, sex or age — there are some key heart disease prevention steps you can take.
  • You can avoid heart problems in the future by adopting a healthy lifestyle today. Here are six heart disease prevention tips to get you started.
  • Smoking or using tobacco of any kind is one of the most significant risk factors for developing heart disease. Chemicals in tobacco can damage your heart and blood vessels, leading to narrowing of the arteries (atherosclerosis). Atherosclerosis can ultimately lead to a heart attack.
  • Carbon monoxide in cigarette smoke replaces some of the oxygen in your blood. This increases your blood pressure and heart rate by forcing your heart to work harder to supply enough oxygen. Women who smoke and take birth control pills are at greater risk of having a heart attack or stroke than are those who don’t do either because both smoking and taking birth control pills increase the risk of blood clots.
  • When it comes to heart disease prevention, no amount of smoking is safe. But, the more you smoke, the greater your risk. Smokeless tobacco and low-tar and low-nicotine cigarettes also are risky, as is exposure to secondhand smoke. Even so-called “social smoking” — smoking only while at a bar or restaurant with friends — is dangerous and increases the risk of heart disease.
  • The good news, though, is that when you quit smoking, your risk of heart disease drops almost to that of a nonsmoker in about five years. And no matter how long or how much you smoked, you’ll start reaping rewards as soon as you quit.