Drugs for Angina or cardiac pain!

Angina pectoris, which is more commonly known as angina, is severe chest pain caused by a lack of blood (ischemia) in the heart muscle.

The commonest cause of angina is blocks in the coronary arteries which cause obstruction to the blood flow.

The common drugs which are used to treat angina are as follow:

1. Beta-Blockers: This is a class of drug which reduces the heart rate. Thereby, they reduce the oxygen requirement of the heart. This causes relief in angina. 

The drugs approved for this condition are Metoprolol,  Bisoprolol, Atenolol, Nebivolol and Carvedilol. These drugs are started in normal doses and then increased till the time patient is free of his symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate. 

If a patient is unable to tolerate the beta-blockers, the alternative group of drug which can be prescribed is called Calcium channel blockers. Some of the drugs used are Diltiazem and Verapamil. They can be used in patients with lung problems as they have no effects on lung function unlike beta-blockers.

2. Aspirin: the commonest drug prescribed to all cardiac patients. This is an anti-platelet drug and thus prevents clot formation in the arteries. It is given in a dose of 75-150 mg a day. It should be consumed after food to avoid gastric irritation.

3. Statins: These are drugs which reduce cholesterol and triglyceride levels. The prevent the formation of plaques or blocks in the coronary arteries. They also reduce the incidence of heart attacks in the patients. The common ones used are Atrovastatin, Rosuvastatin, Simvastatin etc. They are to be taken after dinner for maximum effect.

4. Nitrates: There are drugs which cause dilatation of the coronary arteries and are very helpful in relieving angina. They can be taken by keeping the tablet below the tongue (Tab Sorbitrate) or consumed with glass of water. They are also available as oral sprays or skin patches. They can cause headache or giddiness as their side-effect.

Most of the patients with angina can be easily controlled with drugs and can be symptom-free (pain free). The non-medical options are angioplasty or bypass surgery which can be reserved for patients with intractable symptoms.

D for Death-defying! Vitamin D!

A recent trial showed that low blood levels of  of Vitamin D levels were associated with an increased risk of subsequent mortality among African Americans and non-African Americans.

To date, there are no published data from controlled trials designed specifically to assess the effect of vitamin D supplementation on total mortality. Autier and Gandini conducted meta-analysis of 18 trials involving frail, elderly individuals of European descent taking ordinary doses of vitamin D supplements often with the addition of calcium  and they reported a significant 7% reduction in total mortality risk among vitamin D supplement users with a mean daily dose of 528 IU and a mean follow-up time of 5.7 years.

In this Trial, the Authors observed a significant trend  of increasing risk of all-cause mortality with decreasing levels of serum 25(OH)D (Vitamin D).

Those with the lowest levels of Vit D had an 80% increased mortality risk compared with those with the highest levels. The results were same even in patients with heart attacks, bypass surgery, diabetes and high blood pressure. It was found that normal Vitamin D levels in the blood reduced mortality in each of the groups. The trial advises individuals to maintain their Vit D levels in the normal range.

I would suggest to get a Vitamin D level done and see if its low. Vitamin D supplement can be then taken to increase these levels to normal range.

In the hospital where I work, 80% of the hospital employees were found to have low Vitamin D levels. The main reasons for this is inadequate exposure to sunlight and indoor working!

So it would be advisable to increase your exposure to the sun or take Vit D supplements if the are blood levels are low!

via Serum 25-Hydroxyvitamin D Levels and Mortality: Discussion.

Are Calcium supplements harmful?

Too much of a good thing may be just that: too much. That is the conclusion of yet another study, this time a prospective, longitudinal, population-based cohort of Swedish women, looking at calcium intake and cardiovascular mortality. Around 60000 women studied over 19 years.

In this study, high rates of calcium intake were associated with higher all-cause and cardiovascular death rates but not with deaths from stroke, reports an article published online February 13 in British Medical Journal.

Earlier this month, a National Institutes of Health–sponsored study suggested that a high intake of supplemental calcium increased the risk for cardiovascular disease (CVD) death in men, but not women.

The highest intakes of calcium (>1400 mg/day) were associated with higher all-cause risk for death  as compared with intakes of 600 to 1000 mg/day.

The association of calcium intake and all-cause and cardiovascular mortality “was especially strong if a high dietary intake of calcium was combined with calcium supplements.”

Women with the highest intake of calcium (>1400 mg/day) and who used supplement tablets had an all-cause risk for death 2.5 times higher than women who had similar total intakes but were not taking a supplement.

The authors suggested that one should not consume Calcium supplements if the food intake of calcium is good to make up for your daily requirement. The study results suggest that supplements, rather than the intake level, are the problem. So, it time to get rid of your supplements if your daily food intake of calcium is good!

via Mortality Doubles With High Calcium Intake Plus Supplements.

Vitamin C for Colds?

C for Common cold!

C for Vitamin C!

It is common practice by laymen and medical professionals to ingest and prescribe Vitamin C respectively to prevent and treat common cold, also called coryza in medical lingo. But does it really prevent or treat the irritating common cold?

A new meta-analysis of 72 trials examining the benefits of regular vitamin C supplementation concludes that although vitamin C may have a modest yet consistent effect on the duration of colds, it has no effect on the incidence of colds, except in people exposed to short periods of extreme physical stress.The review was published online January 31, 2013 in Cochrane Database of Systemic Reviews.


The number of people taking vitamin C supplements rose dramatically in the 1970s, after Nobel laureate Linus Pauling,  concluded that vitamin C could help prevent colds as well as reduce cold symptoms after onset.


In an effort to shed more light on that issue, these authors reviewed results from 72  trials carried out since 1966.

They concluded that in studies focusing on community populations, the benefits of taking Vit C were not significant. Regular intake of Vit C in communities did not prevent common cold!  

However, regular supplementation on people involved in extreme physical activities marathon runners, skiers, and soldiers on subarctic exercises would statistically reduce the risk of cold by 52%!

It is time to stop the regular supplements of Vit C! Try some natural lemon / sweet lime juice instead. Citrus fruits are rich sources of Vit C and and also act as appetizers before meals!

via Vitamin C for Colds Shows Limited Benefit: Meta-Analysis.

Drugs for the weak heart!

ImageWeak Heart is a condition caused by weakness of the heart muscle where in the heart is unable to pump blood to meet the daily requirement of the body.

This condition in medical terms is called Cardiomyopathy or Left ventricular (LV) dysfunction.

This condition causes breathless on exertion initially and then breathlessnes at rest in the late stages. One is unable to sleep supine at night due to the breathlessness. It may be associated with cough and swelling of the feet. This clinical condition is called Heart Failure.

The condition is diagnosed by carrying out an Ultrasound of the heart to know its pumping function. This test is also called 2D-Echocardiography.


There are some important medications which patients need to take:

1. Diuretics: These are drugs given either orally or intravenously. These act on the kidneys by flushing water and electrolytes from the body. By flushing out water from the body, these drugs reduce the congestion in the lungs and thereby reduce breathlessness. They also cause reduction in the swelling in the feet. This causes increase in the urine output. Thus, these drugs are advised to be taken in the mornings. 

The common ones used are Furosemide, Spironolactone, Amiloride, Triamterene etc.

These can cause electrolyte imbalance and dehydration and so the therapy need to be monitored.

These drugs are recommended to patients in heart failure who are breathless and develop swelling of the feet. They relieve patients of their symptoms but are not found to reduce the  long term mortality.


2. ACE Inhibitors. This is a class of drug which acts by blocking the conversion of angiotensin I to angiotensin II. They, therefore, lower arterial resistance and increase venous capacity; increase cardiac output. They reduce the cardiac mortality in the long run and are recommended in all patients with heart failure and LV dysfunction.

The common ones used are Enalapril, Captopril, Ramipril and Perindopril. These drugs can cause increased potassium levels in the blood and can cause dry cough in come patients. If a patient in unable to tolerate the drug due to dry cough, they can be substituted with ARBs. ARBs (angiotensin receptor blockers) are similar drugs but tend to be more expensive.

They are recommended for all patients with LV dysfunction and/or heart failure as they reduce long term mortality.


3. Beta-Blockers: This is a class of drug which reduces sympathetic over-activity. Thereby, they reduce the heart rate and blood pressure, thus giving the heart much needed rest to recover. 

The drugs approved for this condition are Metoprolol,  Bisoprolol and Carvedilol. These drugs need to be started in very small doses and then increased carefully as some of the patient may encounter worsening of their symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate.

They are recommended for all patients with LV dysfunction and/or heart failure as they reduce long term mortality.

Now you know what to take if someone suffers from LV dysfunction or heart failure. 

Take care!

Watching TV in your teens? It would make you fat in your 40s!


Television viewing habits and leisure-time physical activity at the age of 16 independently predicted the metabolic syndrome at age 43, according to the first study to examine this.


More TV, less exercise, doubled metabolic syndrome! This means that these teens have  higher risk of getting obese, having higher triglyceride (type of bad fat), increased blood pressure and increased sugar levels when they reach their 40s!


In this study, 888 individuals were studied. Those who reported “watching several [TV] shows a day” at 16 were twice as likely to have the metabolic syndrome at age 43 than those who said they watched “one show/week” or less!

Similarly, those who noted leisure-time physical activity “several times per month” were more likely to have metabolic syndrome later in life than those who reported “daily” leisure-time physical activity in their teens!


TV viewing and less physical activity at age 16 years was linked to central obesity, low HDL cholesterol, and hypertension at age 43 years!

So switch off the Idiot box and go walking with your family! 


via Metabolic syndrome in 40s linked to TV, exercise, at age 16 | theheart.org.

Beware! Analgesics can kill!

medicine       We never think  twice before popping in an analgesic pill for aches and pain. But now Beware!

There is increasing evidence to show that analgesics can increase cardiac mortality and cardiovascular event rates. A recent journal publication reports that Diclofenac was found to increase cardiac events by 38 to 67%. The increased risk with diclofenac was similar to the COX-2 inhibitor Rofecoxib (Vioxx, Merck), a drug withdrawn from worldwide markets because of cardiovascular toxicity. Diclofenac is the most widely prescribed analgesic in over 15 south asian countries.

In the meta-analysis, Rofecoxib, etoricoxib, and diclofenac were the three agents that were consistently associated with a significantly increased risk when compared with nonuse.  Rofecoxib increased the risk of serious cardiovascular events between 27% and 45%, and Etoricoxib increased the risk more than twofold compared with nonuse. In two observational studies, Diclofenac increased risk of acute heart attacks by approximately 38% and 39%, respectively.

In a paper published earlier in the premier journal Circulation, analgesic use in 43000 patients with heart attack was associated with a 59% increased risk of death after one year and a 63% increased risk of death after 5 years of use.

Currently, Naproxen, is one of the analgesic found to be safe and not increase cardiac event rates in the analysis.

Next time, think twice before you pop in that analgesic pill! More so, if you have suffered a heart attack before! Instead, try some local application like hot fomentation or balms to relieve the pain!

Obesity Facts from NEJM!

NEJM, the world’s premier medical journal has recently published  an article titled ‘Myths, Presumptions, and Facts about Obesity’ in their Feb 5, 2013 issue.


In this article they have busted some Myths and Presumptions about Obesity. Some of these are controversial and widely covered in the media.


But what was widely agreed upon were the 9 Facts they put forward, as there was considerable evidence to prove the same. These were ignored by the media!


Here are nine obesity Facts, highlighted in the NEJM, that should shape our response to obesity.

1. Genetic factors play a large role in obesity, but heritability is not destiny. Moderate environmental changes can promote as much weight loss as the most efficacious pharmaceutical agents available.

2. Diets very effectively reduce weight, but trying to go on a diet or recommending a diet generally does not work well in the long-term.

3. Regardless of body weight or weight loss, an increased level of exercise increases health.

4. Physical activity at a sufficient level helps with long-term weight maintenance.

5. Sticking with something that works for weight loss helps to maintain a lower weight.

6. For children with excess weight, programs that involve the parents and the home yield better weight outcomes.

7. Structured meal replacement programs and products yield more weight loss than less structured meals.

8. Obesity treatment drugs can help patients achieve and maintain meaningful weight loss for as long as they are used.

9. For people with severe obesity, bariatric surgery can be a life-changing and, in some cases, life-saving treatment.

via Beyond Myths: Obesity Facts from NEJM | ConscienHealthConscienHealth.

Treatment for Acute Stroke: Clot buster or Angioplasty?

There are 2 treatment options for patients suffering from acute stroke. One is a clot buster called t-PA which is given intravenously. The second is a procedure called Angioplasty wherein the blocked artery is opened mechanically by a clot aspirating device or giving the drug directly into the artery with the help of small tubes. In some cases, a stent (spring like device) is placed across the artery.

There has been a long standing debate to know which one is a superior treatment option. Physicians consider the Angioplasty option as superior as the doctor is directly opening the artery by a mechanical device. The drug option is considered inferior as the effect of the drug can be limited in some patients.

So for the first time, both these treatment options were compared directly with each other. They found that the Clot buster was more effective when compared to the angioplasty approach. The study got published in the NEJM, a premier medical journal in the Feb 6, 2013 issue.

362 patients with acute ischemic stroke underwent randomization (181 to endovascular treatment and 181 to drug-tPA). Primary outcome of death and disability was studied at the end of 90 days.

A total of 55 of the 181 patients (30.4%) in the endovascular-treatment group survived without disability as compared with 63 of the 181 patients (34.8%) in the intravenous t-PA, drug group (absolute difference, −4.4 percentage points).

At 90 days, 26 patients in the endovascular-treatment group (14.4%) and 18 in the intravenous t-PA group (9.9%) had died.

This trial failed to show that the Angioplasty approach was superior to the drug option: intravenous t-PA. It also challenged the Physicians common notion that Angioplasty is superior to the drug.

It is a victory of a Drug over a mechanical procedure called Angioplasty. Again, reminding us that with the advent of better drugs, equally good and sometimes more effective treatment can be delivered safely!

How not to get High blood pressure (Hypertension)!

Individuals detected to have mildly elevated blood pressure may be able to maintain normal blood pressure for the next 15 years without any medications!

That’s what the HARVEST trial says. The data was presented at the 2013 International Conference on Prehypertension and Cardiometabolic Syndrome.

Young adults (1012 in number with a mean age of 33 years) were diagnosed with mildly elevated blood pressure (grade 1 hypertension). They were followed up for the next 15 years.

It was observed that  in 198 patients, the blood pressure fell to within normal range within the first few months and they managed to remain normotensive (normal blood pressure) over next 15 years.

The patients whose blood pressure fell and remained normal had a  slightly lower body-mass index (BMI), lower coffee consumption, lower triglycerides, and higher physical-activity levels than the ones in whom the blood pressure remained higher!

Again a trial highlighting the importance of body weight and exercise to avoid diseases like diabetes and blood pressure.

Fifteen years later, hypertension free!

That’s great! Isn’t it? So start walking and eat healthy!

via Remaining normotensive: Insights from HARVEST | theheart.org.