Fenofibrate and Cardiovascular Outcomes in Statin Users with Metabolic Syndrome
A propensity matched cohort study, by Kim et al. (2019), investigated fenofibrate as an add-on to statin treatment to reduce persistent cardiovascular risk in adults with metabolic syndrome in real-world settings. Results showed a significantly lower risk of major cardiovascular events compared with statin treatment alone.
Modern Medicine – Issue 4 2020
Atrial Fibrillation Management The central role of the GP
Opportunistic screening for atrial fibrillation (AF) is recommended for all patients aged over 65 years, and choosing between a rate and rhythm control strategy is important. Beta-blockers or nondihydropyridine calcium
channel antagonists are the first choice for rate control.
Flecainide is preferable for the pharmacologic rhythm control. The sexless CHA2DS2-VA assessment is recommended to assess stroke risk. Integrated care to support comprehensive treatment and address the specific needs of people with AF is required, and GPs are central to its effective delivery.
Modern Medicine – Issue 4 2020
Hypertension, Drugs and COVID-19 Risk
Arterial hypertension is the leading cause of death in the world and is frequently accompanied by other comorbidities such as diabetes, obesity, chronic kidney disease and established cardiovascular disease of different types. Patients suffering from infection by SARS-CoV-2 frequently present with arterial hypertension and these accompanying comorbidities. Concern has been expressed that medical therapy for cardiovascular disease might specifically contribute to the severity of illness in patients with COVID-19.
Modern Medicine – Issue 4 2020
Venous Thromboembolism Applying new guidelines in primary care
Venous thromboembolism (VTE) is a potentially life-threatening diagnosis commonly encountered in the primary care setting. Primary care doctors play an important role in timely diagnosis and evidence-based treatment decisions. The Thrombosis and Haemostasis Society of Australia and New Zealand guidelines on management of venous thromboembolism (VTE) provide succinct, evidence-based guidance on diagnosing and managing deep vein thrombosis and pulmonary embolism. The diagnosis of VTE rests on radiological findings. Duration of anticoagulation is determined by risk of progression and recurrence and must be weighed against bleeding risk.
Modern Medicine – Issue 2 2020
Hypertension in People with Diabetes Modern trends in management
The major cause of mortality in diabetes remains cardiovascular disease (CVD). Thus, any risk factors associated with CVD must be aggressively treated in patients with diabetes. Hypertension is one of these risk factors and should be appropriately managed in such individuals. The advent of new glucose lowering drugs such as sodium-glucose cotransporter
2 inhibitors may provide clinicians with additional opportunity to reduce BP.
Modern Medicine – Issue 6 2019
Hypertrophic Cardiomyopathy Keys to minimising morbidity and mortalitydiastolic
Hypertrophic cardiomyopathy can be an asymptomatic condition or can cause incapacitating symptoms. It is the most common cardiovascular genetic condition and genetic testing of affected individuals and their family members can help prevent the morbidity and mortality associated with hypertrophic cardiomyopathy. Treatment options include lifestyle modifications, medical therapies and interventions such as implantable cardioverter defibrillator therapy and surgical myectomy.
Modern Medicine – Issue 5 2019
How Should We Be Using Nonvitamin K Antagonist Oral Anticoagulants?
Atrial fibrillation is a common cardiac arrhythmia, and the most common cause of stroke in the elderly. Current US and European guidelines recommend the use of nonvitamin K antagonist oral anticoagulants (NOACs) over warfarin or aspirin for patients with nonvalvular atrial fibrillation (NVAF) who require anticoagulation for stroke prevention. The recommended parameters for prescribing represent a shift towards considering which patients with NVAF do not require anticoagulation, rather than focusing on those who do.
Modern Medicine – Issue 4 2019
The Cardio Protective Effect of Cannabinoids
Cannabis sativa/indica, better known as the illicit drug Marijuana, has been used for centuries for its psychoactive and medicinal properties. Recently it was found that delta-9- tetrahydrocannabinol (THC), the major active component of cannabis, also has various effects on non-neuronal tissues, including cardiac cells.The CB1 (neuronal) and CB2 (peripheral) G protein-coupled cannabinoid receptors are currently known to be activated by THC.
Modern Medicine – April/May 2019
Managing Patients after Implantation of a Cardiac Rhythm Management Device
Patients with cardiac rhythm management devices such as pacemakers and defibrillators are cared for jointly by GPs and cardiologists. GPs can manage issues such as wound care, bleeding and pain and provide guidance regarding work, travel and household appliance use. Early complications are best referred back to the interventional cardiologist; they include wound-related issues (active bleeding, infection, large haematoma), unusual postprocedural pain (pericardial or pleuritic pain) and noncardiac muscle twitching.
Modern Medicine – Dec/Jan 2019
Stroke Prevention Medical interventions for everyday practice
Paroxysmal or permanent atrial fibrillation associated with a CHA2DS2-VASc score of one or more for men, and two or more for women should prompt consideration of anticoagulation to reduce stroke risk. High-risk patients with atrial fibrillation remain significantly undertreated. Older patients, despite having a high risk of falls, are nevertheless likely to benefit from anticoagulation. Perioperative bridging anticoagulation for patients with atrial fibrillation is not routinely recommended. Direct oral anticoagulant drugs should be ceased 24 to 48 hours before procedures. Asymptomatic carotid atherosclerotic disease should be treated medically. Antiplatelet medication for secondary prevention has most benefit when given early after stroke or transient ischaemic attack.
Modern Medicine – Aug/Sept 2018
