Cardiology

The Role of Beta-blockers: 2023 ESH Guidelines for Managing Arterial Hypertension

In June, the 2023 European Society of Hypertension (ESH) Hypertension guidelines were published. Overall, the new report closely resembles its predecessor published in 2018. The guidelines confirm the preferred use of renin–angiotensin system blockers, calcium channel blockers and Thiazide/Thiazide-like diuretics, and their various combinations, for blood pressure lowering treatment. Beta-blockers (BBs) are included among the major antihypertensive medications.

Modern Medicine – Issue 5 2023

Fluid Regulation is Vital in Hypertension Management

Fluid balance is inextricably linked with electrolyte balance, both in the intracellular (rich in K+ ions) and extracellular (rich in Na+ & Cl- ions) compartments, where trading of electrolytes is the core strategy of renal fluid regulation. Medicinal products that affect renal regulation of electrolyte excretion have a significant effect in terms of the quantity of fluid control and thus water homeostasis.

Modern Medicine – Issue 4 2023

Lipid Levels – Important Clues for Cardio and Pancreas Health

Hypertriglyceridemia (HTG), as an important component of atherogenic dyslipidaemia and a cardiovascular disease risk factor, should be carefully evaluated and managed via lifestyle modification and pharmacotherapy. Although statins form a basis of the contemporary lipid-modifying treatment, major trials support the findings that therapy with fibrates is most beneficial in patients with triglyceride levels above 204mg/dL and high-density lipoprotein cholesterol (HDL-C) below 34mg/dL.

Modern Medicine – Issue 4 2023

Add-on Fibrates’ Cardio Protection Still Evident Years On

The extended follow-up study (ACCORDION) of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, evaluated the ‘legacy effects’ of fibrate add-on therapy on mortality and major cardiovascular outcomes in patients with dyslipidaemia. Fibrate treatment during the initial trial period was associated with a legacy benefit of improved survival over a post-trial follow-up. This is a shortened version of the original article.

Modern Medicine – Issue 2 2023

Anticoagulation: Extended treatment for venous thromboembolism

Indefinite anticoagulation with direct oral anticoagulants (DOACs) is increasingly being recommended after symptomatic venous thromboembolism (VTE) in many clinical scenarios. This is because of the ease of use and lower bleeding risk of DOACs compared with warfarin and cumulative evidence of recurrence risk if anticoagulants are stopped, particularly after unprovoked VTE. The decision for extended use should be tailored to each patient, based on the risk of recurrence and bleeding, and patient preference.

Modern Medicine – Issue 2 2023

Heart Failure: A Growing Problem in Younger Patients

Heart failure (HF) is a major public health challenge, accounting for significant morbidity and premature mortality globally, including in sub-Saharan Africa (SSA). In contrast to Western countries, where HF is considered a disease of older persons, in SSA it affects younger individuals. Acute decompensated HF is the most common primary diagnosis for patients admitted to hospital with heart disease in SSA.

Modern Medicine – Issue 2 2023

Atrial Fibrillation: Management of older patients

GPs are central to the long-term primary care management of patients with atrial fibrillation (AF), noting that the target population of older people is both expanding and further rapidly ageing, rendering decision-making even more complex. A patient-centred treatment plan should focus on three key goals: detecting AF to enable early treatment initiation, managing the dysrhythmia to optimise cardiac function and prevent symptoms, and preventing thromboembolism to reduce stroke risk. An individualised, evidence-based approach to AF management requires comprehensive assessment of age-related factors to identify treatment goals, the riskbenefit profile of available treatments, and any medication management issues, with documentation of decision-making and regular reassessment to identify any changes. An integrated care approach can help GPs optimise AF management in older people, drawing on the collective expertise and support of the wider healthcare team, particularly as both risk assessments and treatment goals change with increasing age.

Modern Medicine – Issue 1 2023

Triglycerides – a Strong Predictor of CV Events

The increasing prevalence of obesity is directly associated with the increase in type 2 diabetes (T2D) and metabolic syndrome (MS), which, in turn, are associated with lipoprotein abnormalities described as atherogenic dyslipidaemia (AD). AD is causally linked to the development and progression of atherosclerotic CV disease (ASCVD).

Modern Medicine – Issue 6 2022

ADA Guidelines on Lipid Management in Those with Diabetes

Atherosclerotic cardiovascular disease (ASCVD)–defined as coronary heart disease (CHD), cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin – is the leading cause of morbidity and mortality for individuals with diabetes and results in an estimated $37.3 billion in cardiovascular-related spending per year associated with diabetes. Common conditions coexisting with type 2 diabetes (eg, hypertension and dyslipidaemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. This is a shortened version of the American Diabetes Association (ADA)’s article on cardiovascular risk management in Standards of Medical Care in Diabetes–2022

Modern Medicine – Issue 6 2022

Evaluating Basic Two-dimensional Echocardiography for Screening in Coronary Artery Disease

Background
Basic two-dimensional echocardiography (2D-echocardiography)screens for suspected coronary artery disease (CAD) by detecting impaired left ventricular function (LVF) which declines as atherosclerosis worsens.
Aim
To evaluate basic 2D-echocardiography for CAD screening.
Methods
CAD screening was performed with 2D-echocardiography. For global screening, left ventricular ejection fraction percentage (LVEF%) was determined and categorised into global systolic LVF. For regional screening, global average echocardiography score (GAES) was quantified, then categorised into functional impairment. After screening, high-risk patients
underwent diagnostic coronary angiography. Abnormal angiography had50% luminal stenosis. Angiography was also quantified with Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, then categorised. Statistical Package for Social Science 25.0 analysed data.
Results
There were 471 patients screened for CAD; 154/471 (33%) underwent angiography. For angiography selection amongst 471 screened patients, GAES was higher (p< 0.001) and positively correlated (Pearson’s coefficient 0.296); LVEF% was lower (p = 0.002) and negatively correlated (Pearson’s coefficient -0.187). Amongst 154 patients, SYNTAX score correlated negatively with LVEF% (Pearson’s coefficient -0.276) and positively with GAES (Pearson’s co-efficient 0.180). For categories, angiography had 66/154 (42.9%) normal and 88/154 (57.1%) abnormal results. SYNTAX score had 134/154 (87.0%) low-risk and 20/154 (13.0%) medium-high-risk categories. GAES correlated positively with angiogram results (Spearman’s coefficient 0.298) and SYNTAX categories (Spearman’s coefficient 0.110). LVEF% correlated negatively with angiogram results (Spearman’s coefficient -0.307) and SYNTAX categories (Spearman’s coefficient -0.254).

Conclusions

The distribution of underlying atherosclerotic vessels resulted in regional wall abnormalities being more significant than global function on 2D-echocardiography. We conclude that basic 2D-echocardiography remains useful in CAD screening.

Modern Medicine – Issue 6 2022