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Tag Archives: cardiovascular disease

May 2020 Br J Cardiol 2020;27(2) doi:10.5837/bjc.2020.010

Cardiac complications in end-stage renal disease: a shared care challenge

Xenophon Kassianides, Adil Hazara, Sunil Bhandari

Abstract

End-stage renal disease (ESRD) represents a state of dysregulation of many processes including inflammation, endothelial dysfunction, vascular calcification, bone mineral metabolism, oxidative stress, autonomic balance, uraemia, volume control, coagulation, insulin resistance, and haematopoiesis. The process of haemodialysis, the most common form of renal replacement therapy, causes myocardial stunning, leading to strain and potential damage,2 and can create a pro-arrhythmic environment.3 The early dialysis period is indeed high risk, with more cardiovascular events reported within the first five months of dialysis.4 It is, therefore, not an

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April 2020

COVID-19 and cardiovascular disease

BJC Staff

Abstract

Leading experts treating COVID-19 patients now provide advice on managing cardiovascular disease during the pandemic. New European Society of Cardiology (ESC) guidance provides healthcare professionals with the best available knowledge, based on practical experience, on how to diagnose and manage cardiovascular conditions in COVID-19 patients, treat the coronavirus infection, and organise and prioritise care. It will be updated as more evidence is gathered. The authors stress that document is not a guideline but rather a guidance document. The recommendations are the result of observations and personal experience from health care providers at

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March 2020 Br J Cardiol 2020;27:31–3 doi:10.5837/bjc.2020.007

Primary prevention aspirin among the elderly: challenges in translating trial evidence to the clinic

J William McEvoy, Michael Keane, Justin Ng

Abstract

Introduction The ASPirin in Reducing Events in the Elderly trial (ASPREE), published in 2018, was a landmark randomised-controlled trial (RCT) that contributed important knowledge about primary cardiovascular disease (CVD) prevention among healthy older adults.1 ASPREE found that daily low-dose aspirin (LDA) does not statistically prevent disability or CVD among adults aged over 70 years when compared with placebo, but does significantly increase risk of haemorrhage; findings that immediately influenced clinical practice guidelines.2 When used as a case study of large RCTs, ASPREE provides further, more existential, lessons for both researche

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November 2019 Br J Cardiol 2019;26:141–4 doi:10.5837/bjc.2019.041

Lipid testing and treatment after acute myocardial infarction: no flags for the flagship

Louise Aubiniere-Robb, Jonathan E Dickerson, Adrian J B Brady

Abstract

Introduction Cholesterol is a key risk factor for atheroma and coronary heart disease. The evidence-base for high-intensity lipid-lowering therapy in secondary prevention of cardiovascular disease is unequivocal.1-4 Despite the introduction of novel drugs, including ezetimibe5,6 and monoclonal antibodies,7 statins remain first-line therapy.8,9 Statins decrease hepatic cholesterol synthesis by competitively inhibiting 5-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase receptors, as they have an affinity up to 10,000 times greater than the natural substrate.10 Through reducing intra-cellular cholesterol concentration, statins up-regulate

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Insights in patients with atrial fibrillation and co-existing cardiovascular disease

July 2019 Br J Cardiol 2019;26(suppl 2):S4–S9 doi:10.5837/bjc.2019.s08

Insights in patients with atrial fibrillation and co-existing cardiovascular disease

Khalid Khan, Honey Thomas

Abstract

Introduction Atrial fibrillation (AF) is encountered with increasing frequency in clinical practice,1 and is associated strongly with adverse clinical outcomes, including stroke, cardiovascular events and death.2,3 Concomitant atherosclerotic disease may increase the risk of adverse outcomes in people with AF. For example, peripheral arterial disease was present in 11% of a large cohort of European patients with AF, and increased the risk of all-cause and cardiovascular death, compared with patients with AF but no peripheral arterial disease.4 In addition, AF is associated with adverse outcomes in a range of other subgroups of patients, inclu

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Manage frailty effectively or manage decline – your choice and responsibility!

January 2019 Br J Cardiol 2019;26(1) doi:10.5837/bjc.2019.001 Online First

Manage frailty effectively or manage decline – your choice and responsibility!

Srikanth Bellary, Alan J Sinclair

Abstract

Frailty is strongly associated with cardiovascular disease (CVD) and, while the precise pathophysiological mechanisms linking frailty and CVD remain to be elucidated, it is likely that this association is bi-directional.4,6,7 Loss of muscle mass and function (sarcopaenia), insulin resistance and chronic low-level inflammation observed in the frailty state can predispose to CVD. On the other hand, the presence of CVD can lead to reduced activity, muscle loss and exhaustion, thus, predisposing to frailty. Large cross-sectional and longitudinal studies have shown that those with CVD were up to two to three times more likely to be frail than tho

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Prescribing for patients with type 2 diabetes and CV disease: should we be following the Scottish example?

December 2018 Br J Cardiol 2018;25:127–9 doi:10.5837/bjc.2018.030

Prescribing for patients with type 2 diabetes and CV disease: should we be following the Scottish example?

Sean L Zheng

Abstract

Dr Sean L Zheng CVOTs The key studies evaluated sodium-glucose co-transporter 2 (SGLT2) inhibitors – empagliflozin (EMPA-REG OUTCOME)4 and canagliflozin (CANVAS)5 – and glucagon-like peptide 1 (GLP-1) receptor agonists – liraglutide (LEADER)6 and semaglutide (SUSTAIN-6)7 – in patients with type 2 diabetes and cardiovascular disease or elevated cardiovascular risk (table 1). In the EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose) study, the use of empagliflozin resulted in 38% and 35% reductions in cardiovascular death and heart failure hospitalisation, r

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Introduction

September 2018 Br J Cardiol 2018;25(suppl 2):S3 doi:10.5837/bjc.2018.s06

Introduction

Naveed Sattar

Abstract

The risk of developing type 2 diabetes is amplified among the South Asian population in the UK, with estimates suggesting a two- to fourfold increase in risk. Why is this? Hanif and Susarala review putative reasons why South Asian people represent at least 15% of the population of people with diabetes in this country, and who also carry higher microvascular complication rates than their European counterparts. Although the reasons for excess coronary heart disease (CHD) mortality risk in South Asians are not entirely clear, studies have found higher levels of conventional risk factors present at a younger age, which may be an explanation for

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Drugs for diabetes: the cardiovascular evidence base

September 2018 Br J Cardiol 2018;25(suppl 2):S14–S18 doi:10.5837/bjc.2018.s09

Drugs for diabetes: the cardiovascular evidence base

Sam M Pearson, Ramzi A Ajjan

Abstract

Introduction Individuals with diabetes are at increased risk of vascular outcomes, and their prognosis following an event remains worse compared with those having normal glucose metabolism.1 The relationship between glycaemia and vascular disease is complex as it is affected by multiple glucose parameters, including chronic hyperglycaemia, hypoglycaemia and, potentially, glycaemic variability.2 To add to the complexity, the type of hypoglycaemic agent used may also alter predisposition to vascular events. Over a decade ago, one hypoglycaemic agent, rosiglitazone, was implicated in increasing the risk of vascular disease, which prompted the U

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October 2017

ESC 2017: PURE shows we should revisit dietary fat guidelines

BJC staff

Abstract

Results from the PURE (Prospective Urban-Rural Epidemiology) study, carried out on 135,000 individuals aged 35 to 70 years from 18 low, middle and high-income countries (North America, Europe, South America, the Middle East, South Asia, China, South East Asia and Africa) has contrasted with current dietary advice, by finding that high carbohydrate intake is linked to worse total mortality and non-cardiovascular mortality outcomes, while high fat intake is associated with lower risk. “Our findings do not support the current recommendation to limit total fat intake to less than 30% of energy and saturated fat intake to less than 10% of energ

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