Sign up now to receive the
Boomer Health Report
absolutely free! |
 |
| Contributing Authors |
 |
|
Dr. Geoff Litner
has specialized in primary care and adult medicine for over 10 years. He has practiced in both academic and community settings and has been on active staff at Women's College Hospital and the Toronto Rehab Institute. He is also a Lecturer at the University of Toronto. Dr. Litner is the co-founder of MDDirect.
Dr. Lance Ceresne
specializes in primary care and adult medicine. Prior to co-founding MDDirect, Dr.Ceresne was the Director of the Family Medicine Residency Program at Sunnybrook Health Sciences Centre. Dr. Ceresne holds numerous teaching awards to his credit, awards earned during his tenure as Lecturer at the University of Toronto.
|
What level of blood pressure warrants a visit to the Emergency Room? |
| Click Here to Find Out | |
|
Welcome to the fifth edition of the "Boomer Health Report", Canada's first online health bulletin written by Canadian doctors for readers aged 45 and up.
We hope our Spring edition prepared you for the sun (even though we haven't seen much). In this Summer edition, we are pumping out the latest news in cardiovascular health.
Sincerely,
The Boomer Creative Team |
|
MDDirect: Your Partner in Personal Healthcare |
|
As a resident of Toronto, you know what it's like to wait for healthcare. You're familiar with overcrowded Emergency Departments, doctors' offices that won't return your phone calls, hospital staff that don't have time for you. You're tired of being treated as though your time wasn't important. Now, you have an alternative!
Introducing "Healthcare On Demand", a revolutionary new concept in personalized healthcare brought to you by MDDirect.
This one-of-a-kind program features 24/7 access to your doctor, house calls, telephone and email consultations, same day office visits, portable electronic health records, access to specialty and diagnostic care, nutrition, fitness, rehabilitation, and psychological support, and much more. Healthcare can be convenient, efficient, and hassle-free!
Our program is filling up quickly. Call us before September 15, 2009 to take advantage of our introductory pricing!
Call MDDirect at 416.922.2000 to find out how you can benefit from having a Personal Physician or navigate to www.md-direct.ca to learn more.
Please Note: The "Healthcare on Demand" Program includes OHIP and non-OHIP services. Payment options are available. Please contact us for further details. |
| Cholesterol: How Low Can You Go |
Numerous studies have shown that aggressively lowering patients' cholesterol levels can translate into as much as a 50% reduction in cardiovascular (CV) events and mortality. This is true even for patients who start out with normal cholesterol levels!
While "statin" medicines such as Lipitor and Crestor have the greatest amount of data to support their use, the latest evidence suggests that patients can achieve the same degree of benefit regardless of the specific medication used - as long as their cholesterol reaches target levels.
In 2006, the Canadian Cardiovascular Society established more ambitious cholesterol targets for high-risk patients - namely, an LDL (bad cholesterol) < 2.0 mmol/L and a Total Cholesterol/ HDL (good cholesterol) ratio < 4.0. However, it isn't enough to lower cholesterol below these thresholds. In order to achieve the desired reduction in CV events/mortality, LDL cholesterol also has to come down 50% from starting levels. For intermediate-risk patients, the targets are as follows: LDL < 3.5 mmol/L, Ratio < 5.0, and a 40% reduction of LDL from baseline.
Despite this information, it is estimated that only half of patients under treatment reach their targets. This is likely due to many factors including: lack of physician knowledge, physician tentativeness in prescribing medicines, medication side effects, and patients' reluctance to accept and comply with treatment.
Have you reached your targets? If not, speak with your doctor.
Two options that can lower your risk are to increase the dose of your current "statin" medication or to add a newer medication known as a Cholesterol Absorption Inhibitor (marketed in Canada under the trade name Ezetrol) which can be safely combined with your statin. Homer could definitely use one of these!
|
|
Calculating your Cardiac Risk: Life on Jupiter |
The decision to initiate pharmaceutical treatment for cholesterol is usually guided by an assessment of the patient's cardiac risk. As we saw from the previous section, therapeutic targets for cholesterol are also based on a patient's risk level, with higher-risk patients subject to more aggressive targets. There are a number of clinically validated tools that can assist clinicians in determining an individual's risk level. This process is known as "cardiac risk stratification".
In North America, the most commonly used tool for risk stratification is called the Framingham Risk Tool. It stratifies patients into low, intermediate or high risk levels based on various risk factors including: age, gender, systolic blood pressure, cholesterol levels (HDL and cholesterol ratio), and smoking status. "Low risk" corresponds to a 10-year risk of CV events of less than 10% (or less than 1% per year). "Intermediate risk" translates to a 10-year risk of 10-19%, while "High risk" denotes a 10-year risk of 20% or greater. Patients with Diabetes Mellitus are automatically stratified to the high-risk group.
Other risk factors such as early family history of heart disease have not been accounted for in these calculations. In addition, there are an abundance of cardiac risk markers that have not been included (homocysteine, Apolipoproteins A-1 and B-100, etc.) due to questionable benefit...until now!!!
High Sensitivity C-Reactive Protein (hs-CRP) is a non-specific inflammatory marker that has been shown to predict cardiovascular risk in a wide range of individuals. The Reynolds Risk Score is a more up-to-date and accurate cardiac risk assessment tool that incorporates information about hs-CRP and family history in addition to the traditional risk factors used in the Framingham Tool.
We're not sure about Mars, but there is life on Jupiter.
The recently published JUPITER study (Justification for the Use of Statins in Primary Prevention: an Interventional Trail Evaluating Rosuvastatin) was a landmark, multinational clinical trial of over 17,000 patients. Briefly, it demonstrated a significant lowering of CV risk and all-cause mortality by treating selected patients who have an elevated hs-CRP with the cholesterol drug rosuvastatin (Crestor).
Calculate your own Reynolds Risk Score by clicking the link below:
|
| Aspirin and Heart Disease: The Plot Thins |
Aspirin is helpful in preventing heart attacks, right? Everyone knows that!
Regular use of aspirin at a daily dose of 80-325 mg has been shown to reduce the risk of heart attacks in patients with established cardiovascular disease.
However, recent literature reviews have called into question the benefits of aspirin in patients without known heart disease - that is, patients who are taking the drug for primary prevention (including diabetic patients). Regular aspirin use is associated with some potentially very serious risks such as stomach ulcers and gastrointestinal bleeding. For the average patient, the benefits of aspirin outweigh the risks by only a very narrow margin.
Based on the analysis of current data, there is no evidence to recommend the use of aspirin for primary prevention of cardiovascular disease unless the patient has a significant risk of cardiac disease and no risk factors for bleeding.
Patients who are already taking daily aspirin for primary prevention of heart disease should discuss the relative risks and benefits with their doctor prior to stopping this medicine.
|
| New Pressures in Hypertension |
Hypertension is the most prevalent risk factor for cardiovascular disease. Each 20-point increase in systolic blood pressure above 120 mmHg is associated with about a 25% increase in CV events.
As such, physicians are now going to greater lengths to accurately measure BP control. Perhaps the most useful tool is the 24-hour Ambulatory BP Monitor. As the name suggests, this machine is worn continuously throughout a 24-hour period. BP measurements are taken automatically at 30-minute to 2-hour intervals, even while patients are sleeping! The data is then uploaded digitally and analyzed using computer software. By assessing the BP range, mean arterial pressures, and the pattern of BP throughout the day, physicians can gauge BP control more accurately.
Although more people are becoming aware of their blood pressure, targets for blood pressure lowering are often not met. For most patients, target BP is < 140/90. However, patients at highest risk of heart disease should aim for 130/80. It is important not to go too low as very low BP is also (ironically) associated with poor outcomes.
Unfortunately, a single blood pressure medicine is only capable of lowering BP by an average of 5-8 mmHg. As such, most patients require combination therapy to control their hypertension. Based on clinical trials, the most helpful regimens are an ACE (Angiotensin Converting Enzyme) Inhibitor or ARB (Angiotensin Receptor Blocker) in combination with a CCB (calcium channel blocker) and possibly the addition of a diuretic.
Whichever medicines you use, the most important goal is to reach the specified targets to reduce cardiovascular risk.
|
| Sneak Peek |
The Autumn 2009 issue of the Boomer Health Report will focus on the ongoing battle between humans and microbes at home and abroad, with special attention to swine flu.
Feel free to pass it along to your friends. It's sure to be contagious.
Stay Tuned...
| |
|
The contents of the Boomer Health Report are for information purposes only. The Boomer Health Report is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you have regarding a medical condition. Reliance on any information provided in the Boomer Health Report is solely at your own risk. | |
|
