Commentary

Jun 3, 2016

Resistant hypertension (RH) is frequently encountered in primary care practice and often presents a significant clinical challenge because limited evidence-based guidance exists.1 RH is a major cause of cardiovascular disease and death, and has been associated with a 50% increased risk of myocardial infarction, stroke, congestive heart failure, and chronic kidney disease when compared to patients without RH.2,3   The American Heart Association defines RH as uncontrolled...

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May 20, 2016

Could a nutritional supplement be the “magic bullet” in heart failure therapy?  Coenzyme Q10 (CoQ10), or ubiquinone, is an electron carrier in mitochondria and plays a key role in ATP synthesis. It is also thought to have antioxidant effects and may stabilize LDL molecules. All of which would, theoretically, help the failing heart.1-3

 

Previous studies using CoQ10 in HF have suggested it may, indeed, have clinical benefits.4-6 Several meta-analyses have...

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May 6, 2016

“Slip! Slop! Slap! And Wrap!®”, the slogan created by the American Cancer Society is a catchphrase intended to attract the public’s attention, raise awareness of the dangers of ultraviolet (UV) radiation, and promote prevention against skin cancer.1 By slipping on a shirt, slopping on sunscreen, slapping on a hat, and wrapping on sunglasses, the organization reminds the public to take measures to protect themselves against all types of skin...

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Apr 22, 2016

After cardiovascular (CV) safety concerns emerged with rosiglitazone use, the Food and Drug Administration (FDA) now requires outcome studies to be performed for all new diabetes medications.1-3  Naturally, we’d prefer to use medications to treat diabetes that actually reduce CV risk – but, at a minimum, they shouldn’t be harmful.  The first CV safety study (ELIXA) for a drug in the glucagon-like peptide 1-receptor agonist (GLP-1 RA) class – lixisenatide - was recently...

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Apr 8, 2016

Managing behavioral health in persons with dementia is an enormous and growing problem. Today more than 5.3 million Americans are living with Alzheimer’s disease (AD) and that number is expected to increase by 30% by 2025.1 Most patients with AD have challenging neuropsychiatric symptoms such as agitation. These symptoms are distressing and often overwhelming for caregivers often resulting in institutionalization and increased healthcare utilization.1 Several...

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Mar 25, 2016

A 76 year-old male with a past medical history of hypertension, diabetes, and atrial fibrillation on warfarin management is undergoing elective surgery that requires warfarin to be held. The patient’s CHADS2 score is 3 with no history of stroke. Should this patient be bridged with low molecular weight heparin (LMWH)? For over two decades LMWHs have been routinely used to provide therapeutic coverage in patients who must temporarily stop warfarin.1 Current guidelines...

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Mar 11, 2016

Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25, 50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for patients with diabetes requiring insulin continues to expand. Current guidelines for glycemic management of patients with type 2 diabetes provide specific recommendations for the initiation of insulin therapy, but not insulin intensification. This is due to a lack of clinical trials comparing treatment strategies. Recent studies, however, provide a foundation for...

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Feb 28, 2016

With over 75% of people using mobile phones worldwide, text messaging might be a simple, cost-effective platform to encourage lifestyle changes.1  mHealth involves the use of mobile and wireless devices (e.g., wearable sensor technology) to provide health services and information.2,3  Such technologies have the potential to fundamentally change health practices.  Indeed, several healthcare-related applications and mobile phone text messaging systems have already been...

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Feb 10, 2016

The debate over the intensity of blood pressure (BP) lowering for patients with hypertension has been going on for decades.  Additional fuel to the fire was recently added with the early halt and publication of the Systolic Blood Pressure Intervention Trial (SPRINT).1  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood (JNC 7) published in 2003 recommended a goal BP of less than 140/90 mm Hg for most patients, with...

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Jan 26, 2016

It’s time to tell your patients that mom was right. You shouldn’t believe everything you see on television. Televised medical talk shows have become a daily viewing ritual for millions around the world. The Dr Oz Show is so popular that it earned him the title “America’s Doctor”, attracting massive numbers of followers as did the show The Doctors. It is no surprise that the public is drawn to the attention-grabbing headlines and sound bites used by the media to embellish...

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Jan 8, 2016

With increased emphasis on disease prevention, gestational diabetes (GDM) is worthy of more attention. The incidence of GDM is on the rise not only in the United States (U.S.) but worldwide.1,2 Complications of GDM such as preeclampsia, cesarean delivery, neonatal hypoglycemia, macrosomia, and birth trauma negatively impact maternal and fetal health.  And result in a heavy economic burden. An estimated $1.3 billion — that’s billion with a “b” — was spent on GDM-associated problems...

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Dec 31, 2015

Several studies have evaluated the correlation between low-dose aspirin and NSAID use and the development of colorectal cancer. In 2007, the U.S. Preventive Services Task Force (USPSTF) recommended against the use aspirin for the prevention of colorectal cancer in most adults.1 However, there is mounting evidence that daily, long-term aspirin use may prevent colorectal cancer in patients aged 50-69.2 Could something as simple as an aspirin a day prevent colon...

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Nov 19, 2015

When deciding which medications to use to treat a patient with type 2 diabetes, there are many options after initial treatment with metformin. The selection of a second-line agent is based on many factors including efficacy, cost, adverse effects, effect on weight, comorbidities, hypoglycemia risk, and patient preference.1  No clear consensus exists.  One characteristic that would truly help differentiate agents is their effect on cardiovascular events.

 

Many...

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Oct 30, 2015

After a patient has a transient ischemic attack (TIA) or minor stroke, the risk of having another is alarmingly high — 10% to 20% will have another stroke within 3 months and most events occur within 2 days.1-3  Both the American Heart Association (AHA) and American College of Chest Physicians (ACCP) guidelines recommend aspirin 160-325mg within the first 48 hours of symptom onset.4-5  The CHANCE (Clopidogrel in High risk patients with Acute Non-disabling...

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Oct 16, 2015

The recommended treatment duration for a first episode of unprovoked venous thromboembolism (VTE) is, at a minimum, 3 months with extended anticoagulation favored for those who are not at high risk for bleeding.  However, the optimal duration of anticoagulation therapy remains unknown.1  Earlier studies have shown that an extended course of oral anticoagulation (OAC) with warfarin reduced VTE recurrence but at the expense of increased bleeding.2,3  The Prolonged...

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Oct 3, 2015

Many clinicians are questioning the role pharmacists should play in anticoagulation therapy management as direct oral anticoagulants (DOACs) increasingly replace warfarin for a variety of indications. When we say “anticoagulation clinic” most of us envision a group of practitioners — often pharmacists — delivering coordinated care, providing ongoing patient education, and using laboratory data to make adjustments in warfarin doses. Unlike warfarin, DOACs do not require routine laboratory...

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Sep 20, 2015

To treat acute asthma exacerbations in children, how about a single dose of dexamethasone and your done!  Sounds simple, easy, and convenient.  But is it too good to be true?  Early administration of systemic corticosteroids is recommended in national guidelines to treat moderate to severe asthma exacerbations and mild asthma exacerbations that do not respond completely to short-acting β-agonists.1 The recommended treatment regimen consist of oral prednisone or prednisolone, taken...

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Sep 5, 2015

Monoclonal antibodies (mAb) are used to treat many disorders — from cancer to age related macular degeneration. These agents consistently come with a very high price tag often costing more than $200,000 per patient per year in the United States.1 Two new mAbs, alirocumab (Praluent®) and evolocumab (Repatha®), have been approved to treat elevated cholesterol when added to maximally tolerated statin therapy in patients with familial hypercholesterolemia or history of atherosclerotic...

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Jul 28, 2015

Clinical practitioners have used calculators such as the Framingham Risk Score to assess the probability that a patient will develop coronary heart disease (CHD) and to guide primary prevention therapy for decades.1  In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated risk calculator which has been widely criticized and may lead to over-prescribing of cholesterol-lowering agents (namely statins), aspirin, and...

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Jul 24, 2015

Stroke is responsible for 1 in 19 deaths in the United States each year and is the leading cause of long-term disability — arguable an outcome worse than death.1 More than 36 billion was spent on stroke treatment and rehabilitation in 2010.  Many strategies are used for the secondary prevention of stroke, but the real impact on health and healthcare cost can only be achieve by preventing the first stroke. Of the 795,000 people who have a stroke each year, more than 75% experience...

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Jul 18, 2015

Every health professional takes an oath to serve patients. To fulfill this covenant, patient trust must be earned. Without trust, patients are unlikely to share sensitive, personal information, hindering our ability to provide optimal care. Gaining trust is influenced by many factors. What influence does attire have on patients’ perceptions of their healthcare providers?

 

Several studies have examined the impact of attire on patient perceptions.  One study found that children...

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Jul 9, 2015

The role of continuous subcutaneous insulin infusion (CSII) in Type 2 Diabetes Mellitus (T2DM) is not clearly defined.1 In patients with type 1 diabetes mellitus, CSII improves glycemic variability, lowers the risk of hypoglycemia, reduces hemoglobin A1C (A1C), and increases treatment satisfaction as well as quality of life when compared with multiple daily injections (MDI).2,3 However, studies in patients with T2DM have produced conflicting findings.4,5,6,7...

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Jun 17, 2015

The results of the PEGASUS-TIMI 54 (Long-Term Use of Ticagrelor in patients with Prior Myocardial Infarction) trial were presented to a capacity audience at the opening session of the March 2015 American College of Cardiology meeting.  But after hearing the much anticipated results and reading the simultaneously published manuscript we’re left wondering if PEGASUS is a landmark clinical trial or simply a trial that validates what we have known for years.1

 

To...

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Jun 17, 2015

The appropriate duration of dual antiplatelet therapy (DAPT) for patients following placement of a drug-eluting stent (DES) remains controversial.1 Many clinicians have pushed for prolonged DAPT — beyond 12 months — on the assumption that extended therapy reduces recurrent cardiovascular (CV) events.  However, the benefits and harms of extended DAPT therapy are unclear and many health systems won’t authorize it.  Does the Dual Antiplatelet Therapy (DAPT) study provide sufficient...

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May 17, 2015

Could a commonly prescribed antibiotic, when combined with a renin-angiotensin system inhibitor, lead to sudden death?  Angiotensin converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), and spironolactone are frequently used in older adults for a variety of indications.  All can potentially cause hyperkalemia.1-2 Co-trimoxazole (trimethoprim-sulfamethoxazole) is commonly prescribed for a wide range of infections.  One study found that when co-trimoxazole is...

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