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.

Fall in cardiac risk in diabetes with multiple risk-factor control

New study throws light on reducing Cardiovascular risk in patients with Diabetes!

It is a general feeling among diabetic patients and their physicians that controlling their sugar levels and their glycosylated hemoglobin (HbA1C) levels in the normal range would suffice to reduce the cardiovascular risk.

However, a recent study   including 26,636 diabetic patients with longitudinal blood pressure, LDL-cholesterol, and HbA1c measurements followed for a mean of 5.6 years proves that it would not suffice!

These patients were analysed and followed up over a period of 5.6 years and their first cardiovascular hospitalization rates were studied. The analysis got published online January 24, 2013 in the Journal of General Internal Medicine.

It was found that diabetic patients who kept their blood pressure, LDL cholesterol and glycosylated hemoglobin levels all under control showed a 2.5 fold drop in the risk of cardiovascular-disease hospitalization over 6 years, compared with those who controlled none of the 3 risk factors.

Most of the observed benefit came from control of blood pressure and LDL-cholesterol as per guidelines. 

Patients who had none of the three markers under control had the highest hospitalization rates of 18.2  per 1000 person-years. 

And, patients with all three parameters controlled had the lowest rates, at 6.1 per 1000 person-years.

So, Diabetics Beware! Pay equal attention to  your blood pressure and LDL-Cholesterol levels to reduce your cardiac risk!

Take care!

via Kaiser: Fall in CV risk in diabetes with multiple risk-factor control | theheart.org.