Clopidogrel is an inactive prodrug that requires hepatic bioactivation via several cytochrome P450 enzymes, including CYP2C19. A number of different alleles of CYP2C19 have been identified; depending on the allele present the enzymatic activity of CYP2C19 can be normal, or reduced. […]
Category: General cardiology
7 ‘Heart Healthy’ Factors Reduce Risk of Death
In recent years an increasing emphasis has been placed on the need for improved primary prevention of cardiovascular disease. To this end, using evidence from clinical trials and epidemiological studies, the American Heart Association (AHA) has suggested seven ideal cardiovascular health behaviours (metrics), including: not smoking; being physically active; having normal blood pressure, blood glucose and […]
2-year PARTNER data published
While the last 5 years have seen an incredible expansion in the use of transcatheter aortic-vlave replacement (TAVR) for patients with severe aortic stenosis who are not considered suitable for surgery, long-term outcomes data remain scant. The randomised Placement of Aortic Transcatheter Valves (PARTNER) trial found that, as compared with standard therapy, TAVR reduced symptoms […]
Interleukin-6 and heart disease
Known vascular risk factors can explain only about half of all cardiovascular disease, leaving much to be discovered about other causes of stroke and heart attack. Persistent inflammation has been implicated in the pathogenesis of coronary heart disease, but causality has not been established for any specific inflammatory mediator. […]
Epinephrine Use and Cardiac Arrest Survival
Whist epinephrine (adrenaline) is commonly used during cardiopulmonary resuscitation (CPR), both in and out of hospital, its effectiveness is poorly established. Although some animal studies have suggested a short term benefit due to increased cerebral and coronary perfusion, an increase in myocardial oxygen consumption and ventricular arrhythmias has also been documented. The purpose of this […]
PFO and stroke – to close or not to close?
Approximately 40% of strokes are classified as cryptogenic or as having no identifiable cause. Some of these cryptogenic strokes may be due to an embolus from the venous circulation crossing into the systemic circulation through a patent foramen ovale (PFO). While PFOs are certainly common in the general population – with a prevalence of around […]
EuroSCORE updated
The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is one of the most widely used cardiac risk models for predicting mortality after cardiac surgery and forms the basis of many pre-operative discussions surrounding risk/benefit ratios and gaining informed consent for a procedure. First published in 1999 and derived from an international European database, the […]
Gender differences in myocardial infarction
In general, women present to hospital with symptoms and signs of coronary artery disease at a later age than males; furthermore, they often present with atypical symptoms. While a large amount of work has been directed towards examining sex differences in mortality, few studies have taken into account age difference when doing so. […]
No cardiac benefit of vitamin D in CKD
There is a renewed interest in the role of vitamin D in cardiovascular disease, largely due to observational studies suggesting a link between vitamin D deficiency and cardiovascular outcomes. Moreover, vitamin D receptors have been found on vascular smooth muscle, and endothelial cells. Given the vitamin D deficiency that commonly effects patients with chronic kidney […]
Statins inhibit thrombosis
Hypercholesterolemia is one of the primary risk factors for atherosclerotic coronary disease. Statins have revolutionised lipid management with their proven ability to reduce circulating cholesterol levels and have even demonstrated regression of coronary plaques. Interestingly, statins have also been shown to have anti-inflammatory and anti-thrombotic activities, with several studies having shown statin therapy to be […]