Population: Elderly patients with normal LV function & did not undergo Aortic Valve Replacement
Poor survival with
Greater LV concentric remodeling
Lower stroke volume
Elevated LV filling pressures
Elevated PA pressure
6/19/2011
Echo Predicts Mortality in Aortic Stenosis
from AMERICAN SOCIETY OF ECHOCARDIOGRAPHY - 22ND ANNUAL SCIENTIFIC MEETING
5/02/2011
Gastric Bypass Does More Than Just Reduce Weight
April 29, 2011 (New York, NY) -- Gastric-bypass surgery may provide benefits to patients with type 2 diabetes beyond the benefits that can be directly attributed to weight loss, a new study finds [1].
According to Dr Blandine Laferrère (St Luke's Roosevelt Hospital, New York, NY) and colleagues, recent studies that show a strong correlation between the concentrations of plasma branched-chain amino acids (BCAAs) and related metabolites with insulin resistance and loss of insulin sensitivity raise the possibility that the rapid remission of diabetes seen in many diabetic patients after gastric-bypass surgery may be related to the pronounced changes in BCAAs or other metabolites and not the weight loss alone.
In a study published in the April 27, 2011 issue of Science Translational Medicine, Laferrère et al found the total amino acids and BCAAs decreased in the gastric bypass surgery group but not in a similar group of patients who lost the same amount of weight (10 kg) with diet alone. Also, the metabolites derived from BCAA oxidation decreased only in the surgery group. Levels of acylcarnitines and BCAAs and their metabolites were inversely correlated with proinsulin concentrations, C-peptide response to oral glucose, and the insulin-sensitivity index after weight loss, whereas the BCAAs and their metabolites were uniquely correlated with levels of insulin resistance.
4/13/2011
Now you see me, now you don't: The bioabsorbable stent in clinical practice
Washington, DC - Predicting the future is a fool's game, and predicting successful drug and device therapy in cardiovascular medicine is just as tricky.
 |
When bioabsorbable stents emerged on the radar of interventionalists this past decade, some dared to dream that they might one day have a stent that would do its job, then disappear, eliminating the long-term use of dual antiplatelet therapy, without a subsequent risk of stent thrombosis. In addition, bioabsorbable stents wouldn't interfere with diagnostic evaluations using noninvasive imaging, such as MRI and computed tomography (CT). Equally important, the technology offered the promise of doing away with vessels loaded up with multiple stents, the so-called full metal jacket, which has the potential to interfere with future coronary surgery.
After a number of years, one stent, a fully bioabsorbable everolimus-eluting stent (BVS, Abbott Vascular) shows promise and is furthest along in clinical development, but not everybody is sure of the role the vanishing scaffolds will play in everyday practice. Some experts see a more expansive role for the devices, even implanting the stents into vulnerable arteries that are not yet significantly closed, with the intention of making an unhealthy vessel healthy again. Others, however, see interventionalists implanting the stents only in a minority of patients.
New CT method gets calcium score and coronary anatomy in a single scan
Dr James Otton (St Vincent's Hospital, Sydney, Australia) and colleagues presented results from theirProspective Evaluation of an Algorithm for Coronary Calcium Estimation, a study of their algorithm for quantifying extraluminal coronary calcium in the major epicardial vessels from a contrast-enhanced CT scan.
Measuring calcium score from a single contrast CT has been tried before, but it has usually been impossible to accurately measure calcium across the whole range of Agatston scores, Otton told heartwire. "The key to [our] success was realizing, first, that it is not possible to adequately separate contrast from arterial-wall calcium using solely the traditional axial measurement approach, and second, that traditional calcium-score thresholds don't apply to high-resolution contrast-enhanced coronary CT."
Instead, Otton et al tested coaxial analysis—looking at the coronary artery in short axis—which allows for precise separation of the contrast-filled lumen and the vessel wall and can be mostly automated with standard software tools, he explained. The researchers also found that a lot of noncalcified material appears in the Hounsfield range of 130 to 200 Hounsfield units (HU) on high-resolution coronary CT scans, while the true calcium generally greatly exceeds 200 HU. This finding is supported by previous intravascular ultrasound (IVUS) studies.
11/22/2010
SIMPLE FACTS ABOUT SATURATED / UNSATURATED / TRANSFATTY ACIDS (TFA)
Simple facts about saturated / unsaturated / transfatty acids (TFA)
SATURATED FAT CAUSES ARTEROSCLEROSIS
SOURCES
| ANIMALS | PLANTS |
| Beef, Beef fat, veal, lamb, pork, lard, poultry fat, butter, cream, milk, cheeses and other dairy products made from whole and 2 percent milk | coconut, coconut oil, palm oil and palm kernel oil (often called tropical oils), and cocoa butter |
TRANS UNSATURATED FATTY ACIS (TFA) CAUSES ATHEROSCLEROSIS
SOURCES
| NATURAL | PROCESSED FOOD |
| beef, pork, lamb and the butterfat in butter and milk | making margarine, shortening, cooking oils cookies and white bread |
TFA IS MORE ATHEROGENIC THAN SATURATED FAT (CAUSES MORE DAMAGE)
UNSATURATED FAT DOES NOT CAUSE ATHEROSCLEROSIS
| SOURCES | salmon, trout, herring, avocados, olives, walnuts and liquid vegetable oils such as soybean, corn, safflower, canola, olive and sunflower |
Unsaturated fat = polyunsaturated fats + monounsaturated fats
Replacing saturated and TFA with unsaturated fat helps reduce blood cholesterol levels
American Heart Association recommends
Choose a diet rich in fruits, vegetables wholegrain, high fibre foods and fat free and low fat diary most often
Keep total fat intake between 25 to 35% of calories (mainly mono and poly unsaturated fats)
TFA less than 1% Calories
To reduce TFA in diet
Look for food labeled ZERO TFA
Use unhydrogenated vegetable oils (canola, sunflower or olive oil)
Soft margarine instead of harder stick forms and butter
Limit these
High TFA
French fries
Doughnuts
Cookies
Muffins
Pies
Cakes
Limit Saturated Fats = Limit TFA
Limit commercially fried foods – has large amount of Saturated Fats and TFA
10/31/2010
Barbershops a cut above for BP checks in African American men
HYPERTENSION
Barbershops a cut above for BP checks in African American men
OCTOBER 28, 2010 |Chicago, IL - In the Texas of 150 years ago, the town barber was probably also the guy who pulled an aching tooth. A cadre of barbers in today's Texas were true to their healthcare-provider heritage by participating in a hypertension-screening outreach experiment that helped many of their customers with hypertension to get their blood pressures under control.
In a unique randomized trial [1], African American men who were patrons of black-owned barbershops in Dallas County, where they had their BP regularly measured and were encouraged to contact a physician when it was elevated, showed a mean 7.8-mm-Hg drop in systolic pressure over 10 months.
That was only 2.5-mm-Hg more of a drop (p=0.08) than seen in a comparator group of men who had received standard educational pamphlets on high BP in African Americans, but no BP checks or other encouragement to assess blood pressure, at the barbershops.
"That doesn't sound like much of a blood-pressure fall for any one person, but at the population level it's a very large effect," lead author Dr Ronald G Victor (Cedars-Sinai Heart Institute, Los Angeles, CA) observed for heartwire.
10/25/2010
LIST OF MUSLIM FOOD OUTLET IN HONG KONG
ISLAMIC CENTRE CANTEEN
5th floor Masjid Ammar and Osman Ramju
Sadick Islamic Centre
40 Oi Kwan Road
Wan Chai Hong Kong
EBENEEZER'S KEBAB
Shop No G04
Wan Chai Central Building
89 Lockhart Road
Wan Chai Hong Kong
EBENEEZER'S KEBAB
Ground floor
52 Lockhart Road
Wan Chai Hong Kong
EBENEEZER'S KEBAB
Ground Floor
California Place
25 D'Aguilar Streeet
Lan Kwai Fong
Central Hong Kong
EBENEEZER'S KEBAB
G01C
Astoria Building
32 Ashley Road
Tsim Sha Tsui
Kowloon
EBENEEZER'S KEBAB
Shop No 2,3 & 5
Ground Floor
Multifield Plaza
5-7A Prat Avenue
Tsim Sha Tsui
Kowloon
EBENEEZER'S KEBAB
Shop 11 & 12
Ground Floor
Hong Kong Gold Coast
No 1 Castle Peak Road
Tuen Mun
New Terrritories
EBENEEZER'S KEBAB
Shop G03A
Discovery Bay Plaza
Discovery Bay
Lantau Island
ISTANBUL KEBAB
Shop F-1
Ground Floor
Rose Mansion
1 Hart Avenue
Tsim Sha Tsui
Kowloon
ISTANBUL KEBAB
Ground floor
34A Lock Road
Tsim Sha Tsui
Kowloon
MUGHAL CLUB
Room 211 2nd Floor
Hai Phong Mansion
53-55 Hai Phong Road
Tsim Sha Tsui
Kowloon
THE GREAT INDIAN KEBAB FACTORY
Shop 8
Level 2
Miramar Shopping Centre
132 Nathan Road
Tsim Sha Tsui
Kowloon
SPICE RESTAURANT
2nd Floor
Prosperous Centre
No 1 Knutsford Terrace
Tsim Sha Tsui
Kowloon
ZIAFAT RESTAURANT
6th Floor
Harilela Mansion
81 Nathan Road
Tsim Sha Tsui
Kowloon
THE NEW SANGEET INDIAN RESTAURANT
Shop UG06 - 08
Upper Ground Floor
Toyo Mall
Intercontinental Plaza
94 Granville Road
Tsim Sha Tsui
Kowloon
JOJO INDIAN CUISINE
2nd Floor
David House
37 - 39 Lockhart Road
Wan Chai Hong Kong
RANG MAHAL
Flat B 1st Floor
Percival House
83 Percival Street
Causeway Bay (near Times Square)
Hong Kong
JANSHAN CELEBRATING INDIAN CUISINE
1st floor
Amber Lodge
23 Hollywood Road
Central
Hong Kong
SHAFFI'S INDIAN RESTAURANT
Shop 7
Ground Floor
Fau Tsui Street
Yuen Long
New Territories
POPEYE'S CHICKENS AND BISCUITS
7T103 & 7E161
Level 7
Passenger Terminal 1
Hong Kong International Airport
Lantau Island
HABIBI RESTAURANT
1st Floor
Grand Progress Building
15 - 16 Lan Kwai Fong
Central
Hong Kong
HABIBI CAFE
112 - 114
Wellington Streeet
Central
Hong Kong
WARUNG MALANG
Flat B2
2nd Floor
Dragon Rise Building
9-11 Pennington Streeet
Causeway Bay
Hong Kong
BLITAR CAFE
201 Causeway Bay Centre
19 - 23 Sugar Street
Causeway Bay
Hong Kong
10/14/2010
NAIL IN COFFIN FOR TRANSMYOCARDIAL LASER SURGERY
I remember few months back there was a great "ho ha" about a certain tertiary teaching hospital buying "state of the art" transmyocardial laser surgery.
A lot of my patients were asking me whether he / she should be referred for it. Below is an article from medscape. It is really a nail in coffin for this therapy.. Furthermore, what a waste of public funding..
Lasers Vaporised from NICE Guideline Recommendations for Refractory Angina
Posted: 10/04/2010; Br J Cardiol. 2010;17(4):159-160
Introduction
As from May 2009 the National Institute for Health and Clinical Excellence (NICE) have removed transmyocardial laser revascularisation (TMLR) from the list of treatments for refractory angina.[1] From their analysis of efficacy they found no evidence of improved myocardial perfusion, ejection fraction or prognosis. There was also no evidence for improvement in exercise tolerance or Canadian Cardiovascular Society (CCS) class when compared with other treatments. Furthermore, looking at the data on safety, randomised controlled trials showed evidence of increased myocardial infarction in the TMLR-treated patient group, as well as evidence of left ventricular perforation.
There have been reservations regarding this technique for many years and it would seem to be a valid decision on behalf of the specialist advisers. It seems appropriate, therefore, to look at how to best treat this complex group of patients.8/28/2010
FROM HEARTWIRE : "MACSTATIN"
The "MacStatin": Fast food with some ketchup, salt, and a statin to go
AUGUST 13, 2010 |London, UK (updated) - Pushing the envelope of primary prevention to a point few doctors are likely to be comfortable with, a group of British cardiologists are proposing a rather radical strategy to neutralize the risk of cardiovascular disease caused by unhealthy eating habits.
They suggest that fast-food restaurants, such as McDonald's, offer customers a statin to go with their meal, one that could be found alongside the salt, sugar, ketchup, and mayonnaise. The statin, they say, could be sprinkled atop customers' Quarter Pounders, into their milkshakes, or onto their supersized French fries to offset the mounds of fat found in these unhealthy meals [1].
Consider the irony that you can have harmful condiments provided free of charge, in unlimited quantities, and yet people think this one simple, potentially protective additive would be crazy to add.The "mischievous" strategy, outlined in the August 15, 2010 issue of the American Journal of Cardiology, is not intended to encourage individuals to think they can eat unhealthily because the statin, which the authors dubbed the MacStatin—slogan: "I'm neutralizing it!"—is a panacea for all risks. Instead, they stress that medical direction should continue to place drug therapy behind lifestyle interventions, such as healthy eating, smoking cessation, and regular exercise.
"I am not crazy, and I do not tell my patients that they can eat unhealthily and get away with it," Dr Darrel Francis (Imperial College London, UK), senior author of the report, told heartwire. "We're simply providing a calculation for the medical community to think about the size of the effect of a statin tablet vs an unhealthy meal and to also consider the irony that you can have harmful condiments provided free of charge, in unlimited quantities, and yet people think this one simple, potentially protective additive would be crazy to add. And I don't know why they would think that."
FROM HEARTWIRE: Who's the boss? White House recommends physicians join hospitals, large groups
Who's the boss? White House recommends physicians join hospitals, large groups
AUGUST 27, 2010 || Adapted from Medscape Medical News—a professional news service of WebMD |
Washington, DC - The White House is advising physicians to accept a life in Big Medicine—as a hospital employee or member of a large group practice—in the wake of healthcare reform [1].
Some leaders of organized medicine, however, are objecting to the government message.
"We're not ready to write off the small practices," Dr J Fred Ralston, president of the American College of Physicians (ACP), said in an interview. "We think there needs to be more than one delivery model."
"America is not a one-size-fits-all country," added Dr M Todd Williamson (North Georgia Neurological Clinic, Lawrenceville), a spokesperson for the Coalition of State Medical and National Specialty Societies, which campaigned against the new healthcare-reform law, now called the Affordable Care Act.
America is not a one-size-fits-all country.Ralston and Williamson were responding to an article by two White House officials and one ex-official about the implications of healthcare reform for medicine that was published August 23, 2010 in the Annals of Internal Medicine. The authors are Nancy-Ann DeParle, director of the Office of Health Reform; Dr Ezekiel Emanuel, special advisor for health policy with the Office of Management and Budget; and Dr Robert Kocher, who stepped down in July from the National Economic Council.
The economic forces put in motion by the [Affordable Care Act] are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups," they write. Physicians who embrace the changes and opportunities created by the law "are likely to deliver the greatest benefits to their patients, the health system, and themselves" and "will be rewarded in the future payment system."
8/26/2010
it started with a dream..
MID RAMADHAN
WE HAVE PASSED THE HALF WAY MARK OF RAMADHAN. IT IS THE TIME TO INTENSIFY OUR PRAYERS. IT IS TME TO REFLECT ON OURSELVES.
MAY BE IS THE TIME TO COOL DOWN.. TO PONDER.. TO BE GRATEFUL..
INSYAALLAH
MAY THIS RAMADHAN BE FRUITFUL TO ALL OF US..
8/01/2010
Taking patients directly to existing PCI centers is more cost-effective than expanding PCI capacity
FROM HEARTWIRE..
ACUTE CORONARY SYNDROMES
Taking patients directly to existing PCI centers is more cost-effective than expanding PCI capacity
JULY 28, 2010 |Boston, MA - Improving the ability of emergency medical services (EMS) to move ST-segment-elevation-MI (STEMI) patients directly to existing PCI facilities is a more cost-effective regional strategy than building and staffing more PCI labs, a new computer simulation study shows [1].
In a study published online July 27, 2010 in Circulation: Cardiovascular Quality and Outcomes, Dr Thomas Concannon (Tufts University, Boston, MA) and colleagues estimated incremental treatment costs and quality-adjusted life expectancies of 2000 patients with STEMI who received PCI or fibrinolytic therapy in simulations of emergency care in a regional hospital system in Dallas County, TX.
PCI is generally more effective than fibrinolytic therapy for the treatment of STEMI, but most US hospitals are not equipped for PCI. Because the cost/benefit ratio of delaying any treatment in order to reach a PCI lab is different for each patient, depending on where they are and their specific condition, Concannon et al's model examined each case, Concannon told heartwire. "And in a county of pretty significant size, we were able to show that EMS detection and diversion would work better than hospital construction."
The researchers compared a base case strategy of no new construction or staffing with several different hospital-based strategies that entailed building new PCI laboratories or extending the hours of existing laboratories and then compared all of those strategies with a system in which EMS transported all STEMI patients to the existing PCI-capable hospitals.
7/30/2010
5 SIMPLE HEALTHY STEPS TO WEIGH REDUCTION
1. DO 10 000 STEPS PER DAY..
GET A PEDOMETER - any pharmacy
PARK YOUR CAR FURTHER THAN USUAL
DO NOT TAKE SHORT CUTS.. TAKE LONG CUT
PROPER SHOES OF COURSE..
10 000 IS ARBITRARY.. DO MORE IF YOU CAN
2. AVOID HUNGER
YOU WILL EAT MORE IF YOU ARE HUNGRY..
TAKE SMALL HEALTHY FREQUENT MEALS.. (2 HOURLY)
ALL KIND OF FOOD IS OK.. AS LONG AS THE PORTION IS CORRECT..
3. DRINK 3 BIG GLASS OF WATER AND EAT 3 GREEEN APPLES BEFORE ANY MEAL..
THEY FILL UP YOUR STOMACH.. MAKES YOU SATISFIED HENCE LESS OF YOUR USUAL DIET
4. SET SMALL REASONABLE TARGET
IDEAL WEIGHT REDUCTION SHOULD BE 0.5 TO 1KG PER WEEK..
IT WILL BE A SLOW PROCESS.. ITS WORTH IT
5. YOU MUST ENJOY DOING THIS..
IF THIS IS BORING.. YOU WILL QUIT..
USE YOUR IMAGINATION.. MAKE THE ABOVE 4 SOMETHING YOU LOOK FORWARD EVERY DAY..
MARTIN LUTHER KING.. YOU DONT HAVE TO SEE THE WHOLE STAIRS.. JUST TAKE THE FIRST STEP..
7/26/2010
FDA approves another triple-drug combination for resistant hypertension: Tribenzor
from heartwire
HYPERTENSION
FDA approves another triple-drug combination for resistant hypertension: Tribenzor
JULY 26, 2010 |Parsippany, NJ - The FDA has granted marketing approval to another three-drug combination for the treatment of hypertension in patients unable to get their blood pressure controlled with any two of the three classes of drugs that make up the combination [1]. The new product, Tribenzor (Daiichi Sankyo), combines the angiotensin-receptor blocker olmesartan (40 mg), the calcium-channel blocker amlodipine (10 mg), and the diuretic hydrochlorothiazide (HCTZ) (25 mg).
TO ALL SMOKERS...
to all smokers.. never mind if you want to keep smoking and kill yourself.. but just remember this.. almost all tobacco company is connected to zionist organization... every time you puff.. you are giving them a bullet to kill innocent palestinian children..
look carefully at their logos.. they all have illuminati symbols..
And Illuminati is strongly connected to zionist movement..
if you decide to kill yourself.. with cigarette.. remember palestine
Asian cigarettes too have illuminati symbols.. are they connected to zionist movement?
7/23/2010
HDL NOT SO IMPORTANT IF LDL IS VERY LOW..
from medscape
July 23, 2010 (Boston, Massachusetts) — A post hoc analysis of the JUPITER trial has shown that when patients have very low concentrations of LDL cholesterol attained through the use of potent statin therapy, "good" HDL cholesterol may no longer be predictive of cardiovascular risk [1].
This is the first time this has been observed in a primary-prevention population, although there are similar data from contemporary secondary-prevention statin trials, say Dr Paul MRidker (Brigham and Women's Hospital, Boston, MA) and colleagues in their paper published in the Lancet.
They emphasize, however, that HDL was predictive of cardiovascular risk in patients taking placebo in JUPITER, so "our data should not reduce enthusiasm for measurement of HDL-cholesterol concentration as part of an initial cardiovascular risk assessment."
Raising HDL cholesterol remains a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol.
In an accompanying comment [2], Drs Derek J Hausenloy (University College, London, UK), Lionel Opie (University of Cape Town, South Africa), and Derek Yellon (University College, London) say that it is "unclear" why HDL concentrations did not predict cardiovascular risk at very low concentrations of LDL cholesterol in those treated withrosuvastatin in JUPITER. But given that more potent drugs for raising HDL cholesterol are on the horizon, the issue will require more research and needs to be examined in large randomized trials, they say.
The findings from this study "should not detract from the fact that raising HDL cholesterol remains a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol; the problem, in most cases, is how to achieve this strategy," they stress
7/22/2010
IT IS SO EASY...
IT IS SO EASY TO EXERCISE. A LOT OF US GIVE SO MANY EXCUSES.. NO TIME.. TO HOT.. NO PROPER SHOES.. NO PROPER ATTIRE.. TOO BUSY WITH HOUSE CHORES..
I am actually a strong advocate of active lifestyle and always emphasize on exercise. I came across this website and it is very interesting one
Walking is actually the most natural way for us to exercise. Normal people walk about 3000 - 4000 steps per day. I just hooked myself to a pedometer and my normal walking per day was 6000 steps per day.
So if you have too many excuses to exercise, perhaps this might help.
Take the first step of your day to complete 10000 today... It is so easy to be active..
7/16/2010
7/15/2010
Atherosclerosis Prevention and Treatment in Children and Adolescents
This is an interesting article about how early atherosclerosis start and ways to approach it
http://www.medscape.com/viewarticle/722756
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