Tag Archives: cardiovascular risk

Introduction Lipoprotein(a) (Lp[a]) is a LDL-like particle, with an apolipoprotein(a) (Apo[a]) moiety covalently bound to its apolipoprotein B (ApoB) component. The molecular mass of Apo(a) can vary between 275 and 800 kDa due to its genetic inheritance. Individuals producing the lower molecular mass Apo(a) have higher serum Lp(a) concentrations and vice versa.1 As an established causal risk factor for atherosclerotic cardiovascular disease (ASCVD), supported by mechanistic, epidemiologic and genetic evidence, Lp(a) is believed to contribute to ASCVD through the pro-atherogenic effects of the LDL-like structure, pro-inflammatory effects of th

Introduction It is time to adopt recent (and even some 20th century) evidence for obesity and weight management. Some aspects of current practice, both clinical and epidemiological, are still largely lodged in the mid-19th century. The body mass index (BMI) was first proposed in 1835 by Adolphe Quetelet, a Belgian mathematician, as a way to standardise body composition assessment for people of different heights. His work was published in the English language a few years later.1 At that time, few people, mostly affluent, had a BMI above 30 kg/m2, and far fewer had type 2 diabetes. The main public health concern was malnutrition, and BMI <18

Symptoms with which patients present vary widely, and include autonomic symptoms, such as sweating, shaking, palpitations, and hunger, or neuroglycopenic symptoms due to cerebral glucose deprivation, such as drowsiness, confusion, odd behaviour and speech disturbances. One of the most commonly used measures of the severity of hypoglycaemia, the Edinburgh Hypoglycaemia Scale, is shown in table 2. Sometimes, patients do not have the classical autonomic or neuroglycopenic symptoms related to hypoglycaemia. To a diabetologist, this hypoglycaemic unawareness is worrying. This is because, while the patient loses their warning symptoms, neurocogniti

Dr Gilbert Wagener (Transcrip Partners LLP) Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a new target for the treatment of hyperlipidaemia. PCSK9 is apparently complimentary to 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibition with statins.6,7 Most advanced in the development path are two monoclonal antibodies (mAbs) against PCSK9, alirocumab (SAR236533) and evolocumab (AMG145), both subcutaneous injectable drugs administered at bi-weekly or four-weekly intervals. Both compounds demonstrated solid reductions in LDL-C, however, dose selection for both focused on the most effective dose and did not consider titration ac

Introduction Daily low-dose aspirin (75–100 mg per day) substantially reduces the risk of subsequent vascular events, such as myocardial infarction and ischaemic stroke.1 Evidence from primary prevention trials has indicated a reduction in the risk of a first vascular event,2 but the benefit–risk balance for this is open to debate.3 The prevalence of aspirin taking by patients at increased vascular risk and by the general population is unknown in the UK. The following reports a survey to determine the taking of regular aspirin within a representative community sample of adult individuals in the south Wales county of Caerphilly. Methods T

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NHA joins with BHS The Nurses Hypertension Association (NHA) has become part of the British Hypertension Society (BHS) after the BHS decided to invite nurses working in the field of hypertension and cardiovascular disease to be full members of the society. “This acknowledges the shift of care towards specialist nurses, particularly in primary care,” said Naomi Stetson, former head of the NHA. “In the current economic climate, it also made good business sense to have one united organisation.” All members of the NHA are now full BHS members and so the NHA has disbanded. “There is a strong Nurses Working Party within the society, which

The guidance states: “Although the committee did not change their conclusion that dronedarone is not as effective as other anti-arrhythmic drugs in preventing the recurrence of AF, it accepted evidence that the drug did not lead to an increase in the risk of mortality, unlike the anti-arrhythmics with which it was compared. The Appraisal Committee also noted comments from patients and clinical experts received during consultation on the previous draft that all current anti-arrhythmic drugs, but particularly amiodarone, had side effects which had a significant impact on quality of life with long term use. Overall, the Committee concluded tha

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Atherosclerosis and inflammation It is not clearly understood why patients with rheumatoid arthritis should suffer accelerated atherosclerosis. Traditional modifiable risk factors alone are insufficient to explain the excess cardiovascular risk.3-5 Part of the answer is that rheumatoid arthritis causes chronic systemic inflammation, which may accelerate the atherosclerotic process. Atherosclerosis is essentially an inflammatory disease, with levels of different biomarkers of inflammation such as C-reactive protein (CRP), interleukin-6, and N-terminal prohormone B-type natriuretic peptide (NTproBNP) correlating closely with subsequent cardiac