POPULARITY
10 episodes with secondary prevention
2 episodes with secondary prevention
3 episodes with secondary prevention
2 episodes with secondary prevention
2 episodes with secondary prevention
2 episodes with secondary prevention
2 episodes with secondary prevention
2 episodes with secondary prevention
2 episodes with secondary prevention
Chime In, Send Us a Text Message!Episode 81: Managing PFO after Stroke: A discussion on diagnosis, treatment options including the patient perspectives and quality of life decisions with David Thaler,MD of Tufts Medical Center.This conversation in collaboration with the SAYA Consortium explores the relationship between patent foramen ovale (PFO) and stroke, particularly in young adults. Our expert guest, Dr. David Thaler, a vascular neurologist with Tufts Medical Center, discusses the definition of PFO, its diagnosis, and its implications for stroke risk. The discussion highlights the importance of understanding cryptogenic strokes, which often have no identifiable cause, the PFO paradox and how a PFO is often discovered with cryptogenic strokes, the diagnostic tests and the management options available for patients with PFO. The conversation emphasizes the need for patient education and awareness regarding stroke risks and prevention strategies. In this conversation, Dr. Thaler discusses the implications of PFO closure in recurrent stroke prevention, medical management and the importance of patient choice and quality of life, plus the outcomes of the RESPECT Trial. Co-host David Dansereau shares his patient experience as a stroke survivor with PFO who elected for device closure. The dialogue highlights the evolving landscape of PFO research and the significance of understanding individual patient risks and lifestyle choices.More About Our Guest: David Thaler,MD-Tufts Medical CenterShow mentions: Lester Leung,MD, Katelyn Skeels, SAYA Consortium, RESPECT Trial , Co-Host David's Book ClosureThanks to: Rory Polera (guest on Ep.69), stroke survivor and interview outline reviewer with SAYA ConsortiumAdditional Education: Support Our Show! Thank you for helping us to continue to make great content. We appreciate your generosity! Support the showShow credits:Music intro credit to Jake Dansereau. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcast.Connect with Us and Share our Show on Social:Website | Linkedin | Twitter | YouTube | Facebook | SubstackKnow Stroke Podcast Disclaimer: Our podcast and media advertising services are for informational purposes only and do not constitute the practice of medical advice, diagnosis or treatment. Get Our Podcast News Updates on Substack
CME credits: 1.50 Valid until: 14-03-2026 Claim your CME credit at https://reachmd.com/programs/cme/factoring-solutions-to-the-management-of-stroke-care-in-the-settings-of-secondary-prevention-and-af/29099/ Despite significant efforts to prevent stroke in patients, there remains an unmet need among providers regarding the optimization and benefit-risk profile of anticoagulation therapies. Learn how these therapies may impact the prevention of ischemic stroke and secondary stroke in patients with atrial fibrillation. =
Section 1: Introduction (0:00 - 5:30) Dr. Valentin Fuster introduces a special issue on Prevention, covering societal and individual prevention aspects and key cardiovascular risk factors. He highlights issues like medication adherence, obesity, and the need for better education and healthcare systems. Section 2: Prevention in Society (5:30 - 35:30) Adherence to Medications The PURE trial shows low medication adherence (31% at follow-up) across 17 countries, despite technological advancements in diagnostics. Barriers include low health literacy and inadequate healthcare systems. Social Determinants of Health Social deprivation leads to worse cardiovascular outcomes, especially among sexual minorities in the U.S. The editorial calls for more equitable healthcare access and anti-stigma efforts. Environmental Factors: Aircraft Noise Higher aircraft noise exposure is linked to worse heart health, urging noise reduction policies for vulnerable populations. Section 3: Prevention in Individuals (35:30 - 55:30) Sedentary Behavior Even with exercise, high sedentary time (over 10.6 hours a day) increases cardiovascular risk. Reducing sedentary time can significantly lower heart disease risk. Intensive Lifestyle Interventions for Diabetes Weight loss and lifestyle changes improve cardiac biomarkers and reduce cardiovascular risk in type 2 diabetes patients. Section 4: Risk Factor Impacts (55:30 - 1:10:00) Hyperlipidemia & Obesity Hyperlipidemia and obesity management, including medications like semaglutide, play key roles in preventing cardiovascular disease. The 2024 ESC hypertension guidelines are also crucial in risk reduction.
In this episode, Dr. Paul Ridker explores the crucial role of inflammation and high-sensitivity CRP (hs-CRP) in cardiovascular health. He discusses the importance of measuring hsCRP and addresses common misconceptions about the variability of this biomarker. Tune in to gain a deeper understanding of how hsCRP can be a powerful tool in predicting and managing cardiovascular health.
The impact of omega-3 fatty acids on chronic disease risk has been a topic of considerable interest and research. The VITAL trial, which assessed the effects of vitamin D and omega-3 supplements on various health outcomes, including cardiovascular disease and cancer, provided insightful findings. Additionally, numerous other supplement trials have examined different dosages and formulations of omega-3s, yielding mixed results. Some trials have highlighted significant benefits, while others have shown minimal impact, leading to ongoing debates in the scientific community. Reconciling this evidence base requires a nuanced understanding of the study populations, dosages, and specific health outcomes investigated. The variability in results can often be attributed to differences in trial design, such as whether the focus was on primary or secondary prevention, the baseline dietary intake of participants, and the specific types of omega-3 supplements used. Understanding these nuances is crucial for making informed recommendations about omega-3 supplementation for chronic disease prevention. In this episode, Professor JoAnn Manson will delve into the complexities of omega-3 research, discussing the VITAL trial in detail, comparing it with other significant studies, and providing insights into how to interpret and reconcile the diverse findings in the context of chronic disease risk. Timestamps: 03:21 The VITAL Trial Explained 05:39 Biological Mechanisms and Observational Studies 07:25 Primary vs. Secondary Prevention 10:47 Key Findings from the VITAL Trial 13:39 Subgroup Analyses and Future Research 19:58 Dosage Considerations and Risks 23:47 Impact of Omega-3 on Chronic Diseases 32:18 Nuances in Omega-3 Research 44:27 Future Research Directions 48:54 Key Ideas Segment (Premium-only) Links: Subscribe to Premium Go to episode page Receive our free weekly email: the Sigma Synopsis Enroll in the next cohort of our Applied Nutrition Literacy course
Effective strategies for maximizing both inpatient and outpatient cardiac rehab are discussed by guest Jonathan David, MSN, RN, EBP-C, CCRP, NE-BC, AACC. Highlights include using a team-based approach, engaging patients in shared decision-making, providing a continuum of care that maximizes patient outcomes, and advocating for cardiovascular care.PCNA Patient Education tool: Leaving the Hospital After Your Heart Attack: https://pcna.net/clinical-resources/patient-handouts/acute-coronary-syndrome-tools-and-handouts/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Welcome to the fourth episode in our new CotECast series: “Ask the Expert“. This series we will be delving deeper into some of the hot topics in geriatrics and have started with a stroke mini-series! Dr Chris Taylor is back with Jonny and Emma to discuss both the complications that may develop in patients admitted with stroke and secondary prevention.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/how-do-we-effectively-integrate-the-latest-vte-treatment-and-secondary-prevention-guidelines-into-clinical-practice/24238/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/mrs-vt-elizabeth-a-case-study-on-the-secondary-prevention-of-vte/24237/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
Reading incidental CAC on chest CT scans, exercise benefits in women vs men, PCI with or without imaging, and trial non-reporting are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Incidental CAC on Chest CT Incidental CAC Tweet When Does a Calcium Score Equate to Secondary Prevention?: Insights From the Multinational CONFIRM Registry https://doi.org/10.1016/j.jcmg.2023.03.008 II. Exercise Health Gains of Exercise Greater in Women? https://www.medscape.com/viewarticle/health-gains-exercise-greater-women-2024a10003fv Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality III. PCI With or Without Imaging Intravascular Imaging in PCI: Time for a Guideline Update? https://www.medscape.com/viewarticle/995677 Meta-analysis paper Lancet https://doi.org/10.1016/S0140-6736(23)02454-6 Imaging uptake paper https://doi.org/10.1093/eurheartj/ehad430 IV. Trial Non-reporting The Ghost Research Haunting Nordic Medical Trials https://www.medscape.com/viewarticle/ghost-research-haunting-nordic-medical-trials-2024a10003gz Manuscript/preprint https://www.medrxiv.org/content/10.1101/2024.02.04.24301363v1#T10 Nissen (Rosiglitazone) https://www.nejm.org/doi/10.1056/NEJMoa072761 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net
In this episode, we discuss the importance of secondary prevention for people with a history of cardiovascular disease.
In Episode 12, Dr. William Cushman, co-investigator of the 2015 SPRINT (Systolic Blood Pressure Intervention) Trial, joins us for a discussion all about hypertension trials, their long history, and what's ahead for research in this space. Too young to remember SPRINT or looking for a "CliffsNotes" of HTN trials? This episode's for you!Here's a Renal Fellow Network post from 2017 with a link to a cheat sheet of hypertension clinical trial.Nephrons: Matthew Sparks, Samira FaroukGuests: William Cushman, Medical Director & Professor, Department of Preventive Medicine, University of TennesseeLinks from the Show:00:41: Systolic Blood Pressure Intervention Trial (2015)02:17: VA Cooperative Study (1967)05:13: ACCORD Study (2010)06:30: SPRINT MIND (2019)08:40: Framingham Heart Study (Started 1948)11:27: Attended vs. unattended blood pressure – learnings beyond SPRINT (2021)14:03: Systolic Hypertension in the Elderly Program Study (1989)14:05: Hypertension Detection & Follow Up Program (1979)15:32: JNC 8 Guidelines (2014)16:01 AHA/ACC Guidelines (2017)17:54: Syst-Eur (Treatment of HTN in Patients > 60 y, 1998)17:54: HYVET (Treatment of HTN in Patients > 80 y, 2008)18:01: Syst-China (2000)22:18: AAFP HTN Guidelines (2022)22:40: KDIGO HTN Guidelines (2021)25:37: ALLHAT Study (2002)32:22: Secondary Prevention of Small Subcortical Strokes Trial (SPS3, 2013)
Impact: New Evidence for Interpreting Calcium Score
Commentary by Dr. Valentin Fuster
Daily aspirin use could reduce cardiovascular deaths globally but compliance and inequity problems present.
Editor's Summary by Karen E. Lasser, MD, MPH, Senior Editor of JAMA, the Journal of the American Medical Association, for the August 22/29, 2023, issue. Related Content: Audio Highlights
Commentary by Dr. Valentin Fuster
Commentary by Dr. Valentin Fuster
On Episode 26 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the March 2023 issue of Stroke: “Tenecteplase Treatment and Thrombus Characteristics Associated With Early Reperfusion” and “Dual Antiplatelet Therapy With Cilostazol for Secondary Prevention in Lacunar Stroke.” She also interviews Dr. Mitchell Elkind about the life and the legacy of Dr. Ralph L. Sacco, Stroke's Editor-in-Chief, who died January 17, 2023. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20230308.776720
Welcome to MedEvidence podcast, where we explore evidence-based medicine and provide insights into the latest research findings. In this episode, Dr. Koren will discuss the use of aspirin for primary and secondary prevention and whether or not it is necessary to take it every day at age 70.Dr. Koren will address the question of whether or not individuals over the age of 70 should take aspirin every day, and what factors should be considered in making this decision. He will discuss the potential benefits and risks of daily aspirin therapy, and the importance of personalized decision-making based on an individual's overall health status and medical history.Thank you for joining us on MedEvidence podcast. We hope this episode has provided valuable insights into the use of aspirin for primary and secondary prevention and the considerations that should be made when making treatment decisions, especially at age 70. Remember to always consult with your healthcare provider before starting or stopping any medications.You will learn:
Doctors Sara and Lisa talk to Dr Aseem Mishra, Academic GP trainee involved in helping produce the Guidelines for the Greater Manchester Lipid Pathway. Greater Manchester has very high levels of Major Adverse Cardiovascular Events (MACEs). The guidelines for how to treat hyperlipidaemia and what we're aiming for have changed. Dr Mishra helps talk through these changes. Towards the end of the episode, we discuss injectable treatments for secondary prevention including Inclisiran. The resource links are extensive, we hope you find the discussion and the links as useful as we do. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources: NICE Clinical Knowledge Summaries for Lipid Modification Jan 2023 (links to both Primary and Secondary Prevention): https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/ Familial Hypercholesterolaemia Assessment Guidelines (links to Simon Broome and the Dutch Lipid Clinic Criteria): https://cks.nice.org.uk/topics/hypercholesterolaemia-familial/diagnosis/assessment-diagnosis/ Statins Prescribing Information, with risks of serious side effects and interactions: https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/prescribing-information/statins/#adverse-effects National Statin Intolerance Pathway: https://www.england.nhs.uk/aac/publication/statin-intolerance-pathway/ Manchester Secondary Prevention Lipid Pathway: https://gmmmg.nhs.uk/wp-content/uploads/2023/02/Lipid-Management-Pathway-for-Secondary-Prevention-of-Cardiovascular-Disease-CVD-21.12.22.pdf GMMMG Prescribing Information for Inclisiran: https://gmmmg.nhs.uk/wp-content/uploads/2022/11/Inclisiran-prescribers-information-leaflet-13.10.22-for-web.pdf SPIRIT Trial on Inclisiran: https://clinicaltrials.gov/ct2/show/NCT04807400 NHS Accelerated Access Collaborative: https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/commercial-partnerships/ Health Innovation Manchester Lipid Webinar and Links to Prescribers and Patient Information for Inclisiran: https://healthinnovationmanchester.com/cvdprevention-lipidpathway-resources/ HeartUK resource on Statins: https://www.heartuk.org.uk/getting-treatment/statins Reference for the discussion on Plaque Regression: Kalanuria A, Nyquist P and Ling G. (2012) The prevention and regression of atherosclerotic plaques: Emerging Treatments Vascular Health Risk Management: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459726/ Tool to Calculate Lifetime Cardiovascular Disease risk: https://u-prevent.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.
Trials on heart failure, hypertension and lipid-lowering drugs, and the evolution of antithrombin and antiplatelet therapy are discussed in part 2 of cardiologists Bob Harrington and Mike Gibson's annual review. This podcast is intended for healthcare professionals only. To read a transcript or to comment, visit https://www.medscape.com/author/bob-harrington Lipid Lowering Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure (STRONG-HF): A Multinational, Open-Label, Randomised, Trial https://doi.org/10.1016/S0140-6736(22)02076-1 Why Combination Lipid-Lowering Therapy Should Be Considered Early in the Treatment of Elevated LDL-C for CV Risk Reduction https://www.acc.org/latest-in-cardiology/articles/2022/06/01/12/11/why-combination-lipid-lowering-therapy-should-be-considered Incidental Coronary Artery Calcium: Opportunistic Screening of Prior Non-gated Chest CTs to Improve Statin Rates (NOTIFY-1 Project) https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062746 Equivalent Impact of Elevated Lipoprotein(a) and Familial Hypercholesterolemia in Patients With Atherosclerotic Cardiovascular Disease https://doi.org/10.1016/j.jacc.2022.09.021 Comparative Effects of Low-Dose Rosuvastatin, Placebo and Dietary Supplements on Lipids and Inflammatory Biomarkers https://doi.org/10.1016/j.jacc.2022.10.013 Antihypertensive Drugs No Survival Advantage for Either Torsemide or Furosemide in HF: TRANSFORM-HF https://www.medscape.com/viewarticle/983611 Chlorthalidone vs. Hydrochlorothiazide for Hypertension–Cardiovascular Events www.nejm.org/doi/full/10.1056/NEJMoa2212270 Antiplatelets Duration of Antiplatelet Therapy After Complex Percutaneous Coronary Intervention in Patients at High Bleeding Risk: A MASTER DAPT Trial Sub-analysis https://doi.org/10.1093/eurheartj/ehac284 PANTHER: Should Clopidogrel Become the 'New Aspirin' in CAD? https://www.medscape.com/viewarticle/980117 P2Y12 Inhibitor Versus Aspirin Monotherapy for Secondary Prevention of Cardiovascular Events: Meta-analysis of Randomized Trials https://doi.org/10.1093/ehjopen/oeac019 Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes https://doi.org/10.1056/nejmoa0904327 TCT-320 Pharmacokinetic and Pharmacodynamic Profile of PL-ASA, a Novel Phospholipid-Aspirin Complex Liquid Formulation, Compared to Enteric-Coated Aspirin at an 81-mg Dose – Results From a Prospective, Randomized, Crossover Study https://www.jacc.org/doi/10.1016/j.jacc.2021.09.1173 Pharmacokinetic and Pharmacodynamic Profile of a Novel Phospholipid Aspirin Formulation https://europepmc.org/article/pmc/pmc8773391 Antithrombins/Factor XI Rivaroxaban in Patients With a Recent Acute Coronary Syndrome https://www.nejm.org/doi/full/10.1056/nejmoa1112277 Genetically Determined FXI (Factor XI) Levels and Risk of Stroke https://doi.org/10.1161/strokeaha.118.022792 Factor XIa Inhibition With Asundexian After Acute Non-cardioembolic Ischaemic Stroke (PACIFIC-Stroke): an International, Randomised, Double-Blind, Placebo-Controlled, Phase 2b Trial https://doi.org/10.1016/s0140-6736(22)01588-4 Safety of the Oral Factor Xia Inhibitor Asundexian Compared With Apixaban in Patients With Atrial Fibrillation (PACIFIC-AF): a Multicentre, Randomised, Double-Blind, Double-Dummy, Dose-Finding Phase 2 Study https://doi.org/10.1016/S0140-6736(22)00456-1 A Multicenter, Phase 2, Randomized, Placebo-Controlled, Double-Blind, Parallel-Group, Dose-Finding Trial of the Oral Factor XIa Inhibitor Asundexian to Prevent Adverse Cardiovascular Outcomes After Acute Myocardial Infarction https://doi.org/10.1161/circulationaha.122.061612 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine Hear John Mandrola, MD's summary and perspective on the top cardiology news each week, on This Week in Cardiology https://www.medscape.com/twic Questions or feedback? Please contact news@medscape.net
ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research
In this interview, Martin Halle MD and Steven E. Nissen MD, MACC discuss a recent piece in JACC: Exercise for Primary and Secondary Prevention of Cardiovascular Disease. Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL
An interview with Dr. Surendra Shastri from the University of Texas MD Anderson Cancer Center in Houston, TX, and Dr. Jose Jeronimo from the National Cancer Institute in Bethesda, MD, co-chairs on "Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update." Dr. Shastri and Dr. Jeronimo review the updated recommendations in the guideline, covering screening, triage, management, follow-up, and considerations for special populations. Read the full guideline at www.asco.org/resource-stratified-guidelines. TRANSCRIPT Brittany Harvey: Hello, and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at: asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Surendra Shastri from the University of Texas MD Anderson Cancer Center in Houston, Texas, and Dr. José Jerónimo from the National Cancer Institute in Bethesda, Maryland; co-chairs on ‘Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update'. Thank you for being here, Dr. Shastri and Dr. Jerónimo. Dr. José Jerónimo: My pleasure. Dr. Surendra Shastri: Thank you very much. Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest policy is followed for each guideline. The full Conflict of Interest information for this guideline panel is available online with a publication of the guideline in the JCO Global Oncology. Dr. Shastri, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Surendra Shastri: No, I don't have any disclosures. Brittany Harvey: Thank you. And Dr. Jerónimo, do you have any relevant disclosures that are directly related to this guideline topic? Dr. José Jerónimo: No, I don't have any. Brittany Harvey: Thank you both. So, to start us off, Dr. Jerónimo, what prompted this update to ASCO's guideline on secondary prevention of cervical cancer, last published in 2016? And what is the scope of this guideline update? Dr. José Jerónimo: That's a great question. Yes, it's natural for people to start wondering why the guidelines change or are updated so frequently. And I think there are several factors. The main one is that science on cervical cancer and other diseases is evolving very rapidly; there are new publications, there are new technologies, there is new information about different aspects of cervical cancer prevention specifically. The updates of those technologies is so fast that we need to periodically update the guidelines to accommodate these new options. Now, I have to highlight that the ASCO guidelines in 2016 -- those guidelines were already very ahead of everyone else. What I mean is, in 2016, we were already recommending HPV testing for everyone all over the planet as a preferred option. It's something that other guidelines, other organizations were still wondering about, but we were really very upfront on that recommendation, considering that that's the best technology we have. I think the updates of the guidelines is important because we need to keep with science, and we need to keep the doctors using the guidelines also updated on what exactly is out there, and what options could be usable for the different settings. Brittany Harvey: Great, thank you for that background on the guideline update and for describing why the guideline needs to be updated over time. So then, Dr. Shastri, as this is a resource-stratified guideline, can you describe the four-tiered framework of the guideline? Specifically, what are the Basic, Limited, Enhanced and Maximal resource levels? Dr. Surendra Shastri: Saying one size doesn't fit all would be a cruel example in health situations where it's really unfortunate that there are large disparities across the world, between countries, within countries, and that's the reason why we need resource-stratified guidelines. We can't just sit in ivory towers and preach to people who don't have anything. So that's the reason why we have the resource-stratified guidelines, and we have followed the same resource structure that the Breast Health Global Initiative is following. So, we basically have four different resource levels. The most Basic one, or the core resources, is where you have just very basic public health services available. It's not services which are looking for outcomes and are just part of the social welfare that the country has to provide. Many times, those are also situations where the health priorities are very different. For example, health priorities for some countries might still be infectious diseases, as it was amply displayed in the current pandemic. So, considering those situations, the expenditure that the country does or expenditure a local governing body does on a particular disease could be very different. So, at Basic, just available screening services at the lowest level. Then you have the Limited; the Limited is slightly better than the Basics. They have maybe some of the newer technologies like Dr. Jerónimo just explained, not all of it. Some of those may not be able to provide in the same frequency or to everybody out there. But they are at this point of time looking at outcomes, looking at cost-effectiveness and those kinds of things. Step up a little bit, and you have Enhanced level. That's the third tier of the resource level that we are talking about. In the Enhanced level, we have much better services available, we have organized services available. And those services have probably a system of tracking and recording clients or people who undergo screening and early detection. And the final is the Maximal level. In the Maximal level, it is what we see across North America, or what we see in Europe, where you have the latest technologies, you have established systems, and you have systems to track and follow people. Again, I will caution here, even if I say North America or Europe, it's not across North America and across Europe. There are several places in North America, there are several places in Europe, which do not have the same resources. And that's why in this guideline, we're not talking about country guidelines, we're talking about resource-limited guidelines. Brittany Harvey: Understood. I appreciate that description of the stepwise approach and how it isn't necessarily applicable just to one country, but there are differences in resource levels across countries and within countries. So then, the guideline panel made recommendations across these four resource levels. Next, I'd like to review the key recommendations of this guideline update across those resource levels. So, Dr. Jerónimo, what are the recommended methods for cervical cancer screening? Dr. José Jerónimo: That's a challenging situation on what to use in the different settings. Dr. Shastri already described very clearly the different scenarios we are facing; places with extremely limited resources where basically you have only maybe an evaluation table there, and places in the other extreme with all the resources and all the technologies available. But even though we have very different areas with very different resources, the most recommended test for a screening for cervical cancer in all of them is HPV testing; the testing for the Human papillomavirus that is directly related to cervical cancer. The question could be, "Okay, why are you recommending that test for places where maybe now they are not going to be able to do it?" I think it's important to put that technology as a target, even though the sites are not prepared right now to do it, but they have to go towards that goal of implementing HPV testing. Meanwhile, the guidelines also highlight that there are other options that could be used in the meantime to do some screening, one is visual inspection with acetic acid that is being already implemented in many places. And the reason why we are recommending HPV testing even in those places with extremely limited resources is because there are some advantages. First, with HPV testing, it's very highly sensitive, extremely highly sensitive. That means that you have a sensitivity over 90% with good validated tests. Second, because it's highly sensitive, you have the option to have a smaller number of screenings in the lifetime. Instead of -- some people remember, some years ago, the screening for cervical cancer with Pap smear was done every year. But now we know that it's changing. With HPV testing, we are now recommending every five years or in these guidelines, depending on the resources, could be every 10 years, or could be once or two times in the lifetime of the woman. And with that, we are going to have a huge impact. The other great advantage of HPV testing is that it can be self-collected by women. That means that basically, a woman takes the small brush, goes to a private place and introduce that in their vagina and collect the sample herself, without the need of specula, without the need of trained personnel, without the need of having all the infrastructure that is required for a pelvic evaluation. And that's big because in that way, we can reach populations that are hard to reach. And also, we are dealing with some issues like cultural resistance to have a pelvic evaluation. I mean, that's the biggest advantage for HPV testing. And we have now examples showing that this is very well accepted in many, many studies around the world with different populations around the world showing that self-collection is very accepted. That means that the preferred test for cervical cancer prevention is HPV testing right now. There are options displayed in the guidelines for cities where it's not possible to do it now, but that's the role. Brittany Harvey: Understood. Thank you for explaining what testing is recommended; HPV testing, and then also the timing and collection strategies across settings. So, then following that, Dr. Shastri, what is recommended regarding triage for patients who have positive results or other abnormal results? Dr. Surendra Shastri: So, let me briefly explain what triage is; right up following the primary screening when the woman has a positive result, a second technique or technology is used to determine whether this person needs to be treated, or this person needs to be tracked and followed up in a particular way. So, our recommendations for triage in the updated guidelines is that for the Basic settings, just like Dr. Jerónimo mentioned, if we have used HPV screening in the basic settings; that's the molecular test, and if that is positive, then we use another strategy which is known as, visual assessment for treatment. And this strategy is used to determine whether a woman should be treated with thermal ablation, or with LEEP, or she just needs to be followed. Whereas all the other three settings, HPV genotyping along with cytology, or cytology alone should be used for triage. Brittany Harvey: Great. Thank you for explaining those triage recommendations. So then following triage, Dr. Jerónimo, what is recommended regarding management and follow-up strategies for patients with precursors of cervical cancer? Dr. José Jerónimo: I think treatment also has evolved significantly in the last 20 or more years. And specifically, in the last five years or 10 years, there are new options that are becoming more popular because there is more evidence supporting the effectiveness of this technology, and ablation of that tissue is really one of the best options in most of the places. I always try to compare the pre-cancer lesion like the paint on your wall, in your house. If one of the kids come with something and you start to scratch something in there, you don't need to turn the wall down in order to fix that problem. Basically, you just have to remove that area and put some new paint, and that's going to be corrected. In the same way, when you have a pre-cancer of the cervix, it's very, very superficial. It's not cancer, it's pre-cancer. You don't need to remove the whole cervix or the whole uterus to treat that. With ablation, basically what we are doing is destroying that tissue that is in the very surface, and new cells, healthy cells are going to come and are going to cover that area. That's the idea. The technologies that are more usable for areas with limited resources could be the thermal ablation or could be cryotherapy. The other advantage of those technologies is basically there is no major complication; no bleeding, no major problems. Of course, as Dr. Shastri explained, there are more resources in other places. In other places, you have more resources, you can do a LEEP; that is, basically using an electrical device, removing part of the cervix and sending that to the pathologist. That's also one option that is acceptable and recommended in the guidelines. I think the main idea is, we need to remove that area with disease, with pre-cancer. We can remove it using ablation; just destroying the cells, or we can remove it using some excisional procedure. That all depends on the resources you have. But how effective those technologies are, I could say there is very high cure rates using thermal ablation, for example, or LEEP. Very important to consider, doing the procedure, you can do it anywhere. Doing a LEEP, in theory, you can do it anywhere where you have electricity and you have the equipment. But remember, you have to be prepared not only for the treatment, you have to be prepared for the complication. If you have a LEEP, a very portable device and you have electricity, but if you are far from the next health facility, if you have a complication like you are bleeding in that setting, it's going to take hours, hours and hours just to evacuate that patient to the health facility. That's why you need to be very careful not only on the treatment, but also managing the complication. Brittany Harvey: Understood. I appreciate you reviewing those technologies. So then, following those notes that Dr. Jerónimo just made, Dr. Shastri, are there any changes to the recommendations for special populations or highlights that you'd like to note that are identified in the guideline? Dr. Surendra Shastri: This is a speciality of the ASCO guidelines really also to take a look and make recommendations for special populations. And by special populations here I mean the ones that we have looked at and recommended cervical cancer screening for are; women who are HIV positive or immunocompromised, immunosuppressed due to any other disease, or any other reasons, maybe because of medication, or cancer or other disease conditions which requires immunosuppressives. For such women, we would say you start screening for cervical cancer as soon as the first diagnosis; the diagnosis of the disease which is causing immunosuppression is done. That's the first time. And then, through their lifetime, you screen them twice as frequently as you would do for other women who do not have an immunocompromised situation. So, you do it more frequently. As far as the management post-screening with positive results is concerned, for women with HIV as with all immunosuppressed women, it is the same. The triage is the same and the management will be the same as for all other women. Then also pregnant women. For pregnant women, we recommend in the very Basic settings, pregnant women should be screened six weeks postpartum. And in all other settings, all other levels, we recommend that they should be screened six months postpartum. The very reason is, in many basic settings, you may not even get those women back for screening. That's the reason why we try to screen as early as possible. But on the safer side, the earliest possible is six weeks postpartum; that is, she is still probably following up for postpartum reasons of the pregnancy or immunization for the kid. That's the time we should go ahead and do it. And finally, women who have undergone a hysterectomy but still have an intact cervix, need to get screened in the same way as other women. However, they could stop screening over a period of time, if they have more than three negative results. A very interesting subject that we discussed in our committee, and we have put it up there as a statement to bring it up is that, we now come across several people who are transgender, who have an intact cervix. So, getting such people into screening, and screening them like all others, will be an important priority. We have put out a statement saying that, although we mentioned that this is for women, it is for all persons who have an intact cervix. So these screening guidelines apply to everyone. Brittany Harvey: Yes, it's important that all persons with a cervix get screened for cervical cancer as it is something that can affect anyone with a cervix. And those are important considerations for clinicians that you noted across several different populations. So then, in your view, Dr. Jerónimo, what is the importance of this guideline overall, and how does it impact clinicians? Dr. José Jerónimo: That's, I think the core of the guidelines is how this is going to affect the practice of clinicians. I think the main message here with the guidelines is: first, clearly acknowledging that the resources are different in different settings, and we need to accommodate to those settings to provide the best service. I think for clinicians, it is presenting options that could be suitable for their setting. As Dr. Shastri mentioned at the beginning, we are not talking specifically about countries. Because in one given country, you can have areas with Maximal resources, you can have areas with Limited resources, and you can have areas with Basic resources. If you try to apply that new, most modern, expensive technologies everywhere, you're going to be just doing the screening in very few places in the country because it's not possible. With the guidelines, we are giving the option saying, "Okay, if you don't have access to those technologies, you can get started using this. For example, visual inspection. If the technology becomes available, for example, HPV testing, you can start to use HPV testing, because that's the goal. That's what you really need to look for. If you don't have the resources or the conditions to do excision procedure like a LEEP, you can do ablation, and that's okay. And basically presenting, you have different options to accommodate to your place. But the most important part is, do it well. Do it well, reach as many women as possible with your screening, and treat as many positive women as possible." I think that's the best message here. And I think that's the way these guidelines are going to help and impact the world of clinicians. Brittany Harvey: Yeah, that's the core message of the resource-stratified guidelines; is using the resources you need to help and treat and screen the most people possible. So then finally, Dr. Shastri, how do these guideline recommendations affect patients? Dr. Surendra Shastri: I will just add one line to the response that Dr. Jerónimo just gave you. We already have an existing country guideline, these are meant to complement those guidelines, and meant for the policymakers in those countries to open their eyes and realize that there are people at different resource levels, who may or may not have an insurance program, who may or may not have a socialized system which provides the same level of health care for everyone. So, use what we recommend because that's the current evidence for use. Coming to how people are going to benefit, which was your question, these guidelines are going to make cervical cancer screening available and accessible to all women across the globe. We are talking about different options. We are not saying that, "if you don't have X, don't screen." We are saying, "if you don't have X, try Y. If you don't have Y, try Z." So, this opens up doors for all women across the globe to get screening. That is the ultimate goal, because if you want to reach the WHO goal of eradication of cervical cancer, then that's possible only through two means; one, is giving cervical cancer screening, preferably HPV, through whatever means or resources that the country has, and the vaccination, which is of course, being dealt by another committee over here. So of course, all women across the globe will get benefit of newer technologies, simpler, cost-effective technologies, technologies that don't require them to -- for example, a self-collection, the woman doesn't really have to go anywhere. She doesn't have to go and wait in a clinic for hours to get a screen. She doesn't have to make repeat visits to get a screen. She doesn't have to lose her wages. These are things which are real. She doesn't have to lose her wages for the day, she doesn't have to arrange for child support to look after her children just to go and get herself screened. Those are some of the social determinants of health, which prevent women from going and getting themselves screened. So, by a simple technique like self-collection, we removed that entirely. Going forward, we are going to see Artificial Intelligence, we are going to have deep machine learning, we are going to change the technology and the strategies, and we will come back with another update to this, maybe very soon, sooner than what we did this time. Brittany Harvey: Absolutely. Those are excellent points. And we'll look forward to future updates as technologies continue to advance. So, I want to thank you both so much for your work on updating these resource-stratified guidelines for the secondary prevention of cervical cancer. And thank you for your time today, Dr. Shastri and Dr. Jerónimo. Dr. José Jerónimo: My pleasure. Dr. Surendra Shastri: Thank you for inviting us. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO guidelines podcast series. To read the full guideline go to: www.asco.org/resource-stratified-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available on iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.
Delivery of ASCVD Secondary Prevention Strategies for Rural Communities Guest: Adelaide Arruda-Olson, M.D. Host: Stephen Kopecky, M.D. (@DrSteveKopecky) Dr. Steve Kopecky talks with Dr. Arruda-Olson on the Health of Rural Communities and how to improve our delivery of ASCVD preventive care to rural communities. They will define the rural communities and will talk about how to define secondary prevention. Discussion on why rural communities have more risk factors and how the barriers will be addressed in the Mayo Clinic Health Systems. Joining us today to discuss Delivery of ASCVD Secondary Prevention Strategies for Rural Communities is Adelaide Arruda-Olson, M.D., Associate Professor of Medicine, Department of Cardiovascular Medicine, Rochester, MN Specific topics discussed: What is secondary prevention? How do you define rural communities? Rural communities have an older population, lower income, hospitals are sparse, with less providers & services offered. How can we overcome these issues when trying to achieve secondary prevention? Why do rural communities have more diabetes, obesity, HTN, tobacco, inactivity, obesity among children, drug overdose death? Rural communities tend to be whiter than Urban communities but 54% of native Americans live in rural communities. Are there any special approaches you have for the native American group? Why do rural communities have worse health outcomes? What are the SOLUTIONS? It appears that it needs to be multifactorial-not only providers, pharmacist APCs, ENTs, but also payment structures for rural care, Telehealth, bricks and mortar for hospitals, and certainly more research ? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
Commentary by Dr. Valentin Fuster
Today we had Dr. Patricia Liu to talk about a new study from Journal of Hospital Medicine on the management of opioid use disorder in the hospital. And then we got a little carried away covering way too many articles! Inpatient Management of Opioid Use DisorderHepatitis C Care for People Who Inject DrugsFinal SOLIDARITY trial results for RemdesivirTAVI for Moderate Risk Severe Aortic StenosisMediterranean Diet vs Low Fat Diet for Secondary Prevention of CVDSteroids for IgA NephropathyGLP-1 Agonists and Gallbladder DiseasePig to Human Kidney XenotransplantationAspirin for Primary Prevention of CVDMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R
In this episode of Teach Me How To Vegan we welcome back Registered Dietitian Gabriel Gaarden to help us understand what Omega 3s are, whether or not we should be concerned about them, and how to be sure we are getting enough of them on a vegan diet. We also discuss pros and cons of supplements and what the research says about omega 3 supplementation. The contents of this podcast are not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Resources Mentioned: Omega 3 Fatty Acid Supplementation and Cardiovascular Disease Events (JAMA) https://jamanetwork.com/journals/jama/article-abstract/1555116 Efficacy of Omega 3 Fatty Acid Supplements and the Secondary Prevention of Cardiovascular Disease https://pubmed.ncbi.nlm.nih.gov/22493407/
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
PeerView Family Medicine & General Practice CME/CNE/CPE Video Podcast
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
PeerView Family Medicine & General Practice CME/CNE/CPE Audio Podcast
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
Go online to PeerView.com/TFY860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, two experts in the management of venous thromboembolism (VTE) discuss the importance of a timely diagnosis, appropriate treatment selection, and extended anticoagulation therapy for secondary prevention. Upon completion of this activity, participants should be better able to: Apply appropriate evidence-based clinical decision tools in an interprofessional manner to identify patients in primary care at risk for VTE, Compare the efficacy and safety profile and dosing regimens of available treatment options for VTE, Implement the most up-to-date evidence-based guidelines in the management of VTE to determine an individually appropriate treatment strategy for each patient, Explain the indications and rationale for standard vs extended treatment for the secondary prevention of VTE, Educate patients on the heightened risk of VTE recurrence, and the importance of treatment adherence.
Where are the biggest cardiovascular benefits for your patients with type 2 diabetes? Host Dr Silvio Inzucchi and cardiologist Dr Mikhail Kosiborod reveal winning strategies — for managing much more than just type 2 diabetes. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963270). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals. Resources New ACC Guidance on CVD Risk Reduction in Diabetes https://www.medscape.com/viewarticle/935218 Type 2 Diabetes in Adults: Management https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management Type 2 Diabetes and Causes of Sudden Cardiac Death: A Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525691/ Cardiometabolic Medicine – the US Perspective on a New Subspecialty https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410029/pdf/xce-9-070.pdf Antidiabetics, Glucagon-like Peptide-1 Agonists https://reference.medscape.com/drugs/antidiabetics-glucagon-like-peptide-1-agonists Antidiabetics, SGLT2 Inhibitors https://reference.medscape.com/drugs/antidiabetics-sglt2-inhibitors Dulaglutide and Cardiovascular Outcomes in Type 2 Diabetes (REWIND): A Double-Blind, Randomised Placebo-Controlled Trial https://pubmed.ncbi.nlm.nih.gov/31189511/ Mechanistic Insights Regarding the Role of SGLT2 Inhibitors and GLP1 Agonist Drugs on Cardiovascular Disease in Diabetes https://pubmed.ncbi.nlm.nih.gov/31381891/ SGLT2 Inhibitors for Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Systematic Review and Meta-analysis of Cardiovascular Outcome Trials https://pubmed.ncbi.nlm.nih.gov/30424892/ Empagliflozin in Patients With Heart Failure, Reduced Ejection Fraction, and Volume Overload: EMPEROR-Reduced Trial https://pubmed.ncbi.nlm.nih.gov/33736819/ Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/nejmoa1812389 CV Protection in the EMPA-REG OUTCOME Trial: A "Thrifty Substrate" Hypothesis https://diabetesjournals.org/care/article/39/7/1108/37341/CV-Protection-in-the-EMPA-REG-OUTCOME-Trial-A Worldwide Inertia to the Use of Cardiorenal Protective Glucose-Lowering Drugs (SGLT2i and GLP-1 RA) in High-Risk Patients with Type 2 Diabetes https://cardiab.biomedcentral.com/articles/10.1186/s12933-020-01154-w Albiglutide and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Cardiovascular Disease (Harmony Outcomes): A Double-Blind, Randomised Placebo-Controlled Trial https://pubmed.ncbi.nlm.nih.gov/30291013/ High-Sensitivity C-Reactive Protein https://emedicine.medscape.com/article/2094831-overview#:~:text=hs%2DCRP%20is%20an%20important,predicts%20mortality%20and%20cardiac%20complications. Optimal Use of SGLT2 Inhibitors and GLP-1 Agonists: 5 Things to Know https://www.medscape.com/viewarticle/960356 Cardiovascular and Renal Outcomes with Efpeglenatide in Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/34215025/ Coronary Artery Calcification on CT Scanning https://emedicine.medscape.com/article/352189-overview
Today we talk with Fernando Ortiz about the role of statins in secundary prevention of stroke. We have a great show today! And we wish Dr Ortiz the best for the Match.
Umbrella H&S: session 4, secondary prevention of stroke
The renal and cardiovascular protective effects of SGLT2 inhibitors
In our latest episode, Sam sits down with Dr. Sam Robinson, Founder & President of Canary Telehealth, and Carla Robinson, CEO of Canary Telehealth, to discuss the work they're doing in the diabetes space.
Welcome to the WellMedic podcast. In this podcast series. I will focus on going through several MRCGP AKT scenarios that will focus on the application of your knowledge. Each episode will cover a clinical topic taken from within the MRCPG curriculum guide. In this AKT podcast episode, we will cover acute coronary syndrome and the importance of knowing the secondary prevention medications. The key is to focus on the application of your knowledge, but also some of the finer details covered within the relevant guidelines. WellMedic.co.uk hosts this MRCGP AKT podcast. WellMedic is a platform that focuses on the wellbeing of doctors across the UK. As a founder of WellMedic, I have developed online courses to help GP trainees PASS the MRCGP AKT.
#ADAPTABLE trial was recently published in NEJM 2021 and it was also presented at ACC 2021 conference. It compared #HighDoseAspirin and #LowDoseAspirin in patients receiving it for secondary prevention. Follow Cardio-Ed for more such content. We discuss Recent advances, recent guidelines and recent articles in cardiology as well as core concepts in Cardiology. https://youtube.com/channel/UCVxInTblTpoy-THMuSxNyvw
Laurel Lake, PharmD (@laurel_pharmd) outlines the guideline recommendations for duration of antiplatelet therapy in acute coronary syndrome in patients using anticoagulation for atrial fibrillation, reviews recent literature examining antiplatelet therapy in patients with atrial fibrillation and stable coronary artery disease and discusses the balance of risks and benefits of antiplatelet and anticoagulant agents in these patients. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter! You can also connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
John Mandrola, MD, presents an ACC 2021 recap. https://www.medscape.com/twic ACC 2021 Reveiw I -- Left Atrial Appendage Closure LAAOS III: Surgical LAA Closure Cuts AF Stroke Risk by One Third https://www.medscape.com/viewarticle/951232 - Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke https://www.nejm.org/doi/full/10.1056/NEJMoa2101897 Watchman Registry: 1-Year Stroke Estimates Reassuringly Low https://www.medscape.com/viewarticle/951235 II - Angiotensin-Neprilysin Inhibition PARADISE-MI: Sacubitril/Valsartan Can't Beat Ramipril in Patients With Acute MI https://www.medscape.com/viewarticle/951236 Life Trial Rationale Paper: https://doi.org/10.1016/j.jchf.2020.05.005 III - Renal Denervation Ultrasound Renal Denervation Drops BP in Patients on Triple Therapy https://www.medscape.com/viewarticle/951248 IV -- Clopidogrel vs ASA post Stent HOST-EXAM: Clopidogrel Beats Aspirin as Monotherapy After Stenting https://www.medscape.com/viewarticle/951294 - Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial https://doi.org/10.1016/S0140-6736(21)01063-1 V -- AF Ablation in HF RAFT-AF, Despite Itself, Hints at Advantage for Ablation Rhythm Control in Heart Failure With AF. https://www.medscape.com/viewarticle/951326 VI -- Rivaroxaban in COVID-19 – ACTION Trial Therapeutic Rivaroxaban Dose: Risk Outweighs Benefit in Stable COVID https://www.medscape.com/viewarticle/951475 VII -- REHAB-HF Trial Novel Rehab Program Fights Frailty, Boosts Capacity in Advanced HF https://www.medscape.com/viewarticle/951244 - Physical Rehabilitation for Older Patients Hospitalized for Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2026141 VIII – ASA 81 vs 325 – ADAPTABLE Trial ADAPTABLE: Low-Dose Aspirin as Good as High-Dose in CHD? https://www.medscape.com/viewarticle/951230 - Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease https://www.nejm.org/doi/full/10.1056/NEJMoa2102137 Perspectives: Eight Things to Know About the Surgical Left Atrial Appendage Occlusion (LAAOS III) Trial https://www.medscape.com/viewarticle/951229 PARADISE-MI Makes Me Question the Benefits of Sacubitril/Valsartan https://www.medscape.com/viewarticle/951239 Sacubitril/Valsartan: Trending Toward PARADISE Post MI https://www.medscape.com/viewarticle/950300 Renal Denervation for Resistant Hypertension Is Not Back on Track https://www.medscape.com/viewarticle/951497 Acute Alcohol Consumption Raises Risk for Atrial Fibrillation https://www.medscape.com/viewarticle/950938 Does ADAPTABLE Inform Aspirin Dosing for Secondary Prevention? https://www.medscape.com/viewarticle/950969 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net
Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Lipid lowering is beneficial for secondary prevention but not primary prevention in patients 75 years and older '
To watch this episode, please visit Rachel’s YouTube channel. Listeners can find Dr. Stephen Hussey at his website https://www.resourceyourhealth.com/, on Instagram @ drstephenhussey, On Facebook @ Dr. Stephen Hussey DC, MS and Twitter @ Dr. Stephen Hussey Dr. Stephen Hussey MS, DC is a Chiropractor and Functional Medicine practitioner. He attained both his Doctorate of Chiropractic and Masters in Human Nutrition and Functional Medicine from the University of Western States in Portland, OR. He is a health coach, speaker, and the author of two books on health; The Health Evolution: Why Understanding Evolution is the Key to Vibrant Health and The Heart: Our Most Medically Misunderstood Organ. Dr. Hussey guides clients from around the world back to health by using the latest research and health attaining strategies. In his down time he likes to be outdoors, playing sports, reading, writing, and spending time with his wife and their pets. In this episode, we chat all about heart health, misconceptions surrounding heart attacks, how to realistically reduce toxins in your life, stress management, and more! "Ultimately, I think that health can be defined as the ability of your body to adapt to a new situation, and then return to homeostasis." Dr. Stephen Hussey Top Takeaways: Dr. Hussey’s explanation of metabolic heart attacks Heart attacks can be caused by these three imbalances in the body Benefits of cholesterol Three tips to reduce your risk of atherosclerosis Today’s Questions: What does a “heart healthy diet” actually consist of, in your opinion, versus what the government might be slapping on cereal boxes? I feel great eating tons of animal protein and low carb. But now my cholesterol is high. My doctor is worried. Should I worry? Should you worry about high LDL, if you have low triglycerides, and high HDL, and big fluffy particles? Is inflammation the primary cause of heart disease? And is all inflammation bad? What are the top three things that you would focus on besides diet? Is caffeine bad for your heart? For example, does the increase in heart rate harm the heart? My Apple Watch gives an HRV. But I don't know what a good number is? Why does it vary? Show Notes: [0:00] Welcome back to MetFlex and Chill! Rachel introduces guest Dr. Stephen Hussey @drstephenhussey [0:30] Rachel gives a brief summary of today’s episode surrounding the main topic- Heart Health! [1:30] Shout out to our sponsor NOW Foods for guest episodes for the month of October! [2:00] If you want to check out NOW Foods Click HERE! Use the code METFLEXLIFENOW10 for $10 off a $40 purchase [3:00] Rachel introduces guest Dr. Stephen Hussey @drstephenhussey to the listeners [3:30] Stephen gives a brief bio of his background and research primarily around heart health [6:30] Rachel and Dr. Hussey found a common ground-Metabolic Flexibility! [6:00] What is a Metabolic Heart Attack? And what causes it to happen? [15:30] Question: What does a “heart healthy diet” actually consist of, in your opinion, versus what the government might be slapping on cereal boxes? [22:30] Low Fat, Low Cholesterol Diet in Secondary Prevention of Coronary Heart Disease [25:00] Why striving to lower your cholesterol might not be the best choice in general [30:30] Prognostic value of cardiovascular disease status: the Leiden 85-plus study Lothian birth cohort studies [33:00] Question: I feel great eating tons of animal protein and low carb. But now my cholesterol is high. My doctor is worried. Should I worry? [39:30] Question: Should you worry about high LDL, if you have low triglycerides, and high HDL, and big fluffy particles? [40:00] Does LDL Particle Size Really Matter? [44:30] Question: Is inflammation the primary cause of heart disease? And is all inflammation bad? [49:30] What is endotoxemia? Misconceptions around what can cause atherosclerosis [51:00] Question: What are the top three things that you would focus on besides diet? [55:30] Question: Is caffeine bad for your heart? For example, does the increase in heart rate harm the heart? [59:00] Question: My Apple Watch gives an HRV. But I don't know what a good number is? Why does it vary? [1:02:30] Listeners can find Dr. Stephen Hussey at https://www.resourceyourhealth.com/ The Health Evolution [1:03:00] Instagram @drstephenhussey, Twitter @Dr. Stephen Hussey and Facebook @Dr. Stephen Hussey DC, MS [1:04:00] Thanks for listening to another MetFlex and Chill episode! The best way to grow the show if you’re enjoying it is to take a screenshot of the episode, share it on social media and tag me @rachelgregory.cns :) [1:04:30] If you have any questions please feel free to message me on instagram @rachelgregory.cns or email me rachel@metflexlife.com and If you want to check out NOW Foods Click HERE! Use the code METFLEXLIFENOW10 for $10 off a $40 purchase --- Join the FREE MetFLex Life Course: www.metflexandchill.com Rachel Gregory (@rachelgregory.cns) is a Board-Certified Nutrition Specialist, Strength and Conditioning Specialist, and Author of the best-selling book, 21-Day Ketogenic Diet Weight Loss Challenge. She received her Master’s Degree in Nutrition & Exercise Physiology from James Madison University and Bachelor’s Degree in Sports Medicine from the University of Miami. Rachel helps her clients transform their lives by starting with the physical (body), realizing the power of the mental (mindset), and ultimately gaining massive confidence that bleeds into every aspect of their lives (family, relationships, work, etc.).
Enduring CME will expire on 8/12/2022. The presentation is originating from Northeast Georgia Medical Center Gainesville. Objectives: Discuss clinical trials data and emerging evidence Review patient evaluation and workup Describe the current approved devices Review case examples Disclosures: - There is no commercial support for this activity - The speakers have disclosed that there are no relevant personal or financial relationships Accreditation and Designation: The Northeast Georgia Medical Center & Health System, Inc. is accredited by the Medical Association of Georgia to provide continuing medical education for physicians. The Northeast Georgia Medical Center & Health System, Inc. designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s) TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
What if the oil in your pantry was not only unhealthy but deadly? In today's podcast, Zane Griggs shares the effects of the different cooking oils on your body and will equip you with the knowledge you need to make the right choices for you and your family. LINKS: Leading Scientists Agree: Current Limits on Saturated Fats No Longer Justified Saturated Fats and Health: A Reassessment and Proposal for Food-based Recommendations: JACC State-of -the-Art Review Study in mice examines impact of reused cooking oil on breast cancer progression Study raises questions about dietary fats and heart disease guidance Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) Use of Dietary Linoleic Acid for Secondary Prevention of Coronary Heart Disease and Death: Evaluation of Recovered Data From the Sydney Diet Heart Study and Updated Meta-Analysis Omega-6 vegetable oils as a driver of coronary heart disease: the oxidized linoleic acid hypothesis Role of diets rich in omega-3 and omega-6 in the development of cancer Hunger Hunt Feast 30 Day Lifestyle Journal Quick Episode Summary: How oil affects diet Facts about olive oil The difference between saturated and unsaturated fat How oil damages The research behind oils What oils causes increasing heart risk What is being taught to doctors How saturated fat is healthy
Kira Furie earned her BS in Biological Sciences and her BA in Dance, graduating from UC Santa Barbara in 2018. She spent time dancing professionally in New York City and is currently working on a research project with an Addiction Medicine MD based in Los Angeles, California. Her interdisciplinary background, personal experience with injuries, yoga teaching, and research have given her a specific interest in Integrative Medicine, which she hopes to implement in her future medical practice. On this podcast, Megan Hall interviews Kira about the series of injuries that led to her interest in physical therapy and later to medicine. Influenced heavily by the prevalence of eating disorders and the Health at Every Size movement, Kira discusses her current plans to bring prevention and wellness aspects to medical practice, while promoting a body-positive environment. She also describes “thin privilege” - an aspect of the current medical system that many of us take for granted. Here’s the outline of this interview with Kira Furie: [00:01:23] Kira's background and interest in medicine. [00:05:27] An untreated hip injury leading to more problems. [00:10:40] Video: Brené Brown on Empathy. [00:11:10] Psychology and yoga. [00:12:39] The Minimalists Podcast. [00:13:47] Sports and Performance Psychologist Simon Marshall, PhD. [00:14:20] Prevention. [00:14:43] Jeffery N. Wilkins, MD, Addiction Medicine Specialist in LA. [00:15:17] Primary vs. Secondary Prevention. [00:17:34] Lack of connection as the greatest factor leading to addiction. [00:19:00] The importance of connection; Podcasts on social connection: Building Compassionate Communities to Improve Public Health, and Maintaining Social Connection in the Era of COVID-19, both with Julian Abel. [00:19:37] Health at Every Size (HAES). [00:19:51] Book: Intuitive Eating, 4th Edition: A Revolutionary Anti-Diet Approach, by Evelyn Tribole and Elyse Resch. [00:19:57] Book: Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand About Weight, by Linda Bacon, PhD. and Lucy Aphramor, PhD. Read the intro to the book. [00:21:11] Lindo Bacon (formerly Linda); Review: Bacon, Linda, and Lucy Aphramor. "Weight science: evaluating the evidence for a paradigm shift." Nutrition journal 10.1 (2011): 9. [00:23:22] Thin privilege. [00:25:19] Body Mass Index (BMI) as a health marker. [00:26:40] People in "overweight" category live longer; Study approved by CDC: Flegal, Katherine M., et al. "Excess deaths associated with underweight, overweight, and obesity." Jama 293.15 (2005): 1861-1867. [00:28:14] Looking ahead as a future physician. [00:32:41] Physicians for Ancestral Health.
Commentary by Dr. Valentin Fuster
Millions of Americans will have a myocardial infarction in their lifetime and 20% will have a recurrent fatal or non-fatal coronary heart disease event. Several modifiable risk factors, including elevated blood pressure, cholesterol, and glucose as well as tobacco use, can and should be addressed to reduce the risk of recurrent cardiovascular events. Systemic inflammation has also been associated with poor CV outcomes. Is systemic inflammation a modifiable CV risk factor? And if so, should an anti-inflammatory agent be added to the recommend post-MI drug cocktail to reduce the risk of morbidity and mortality? That's the question that the COLCOT Study attempted to answer. Guest Authors: Jessica Wearden, PharmD and Augustus (Rob) Hough, PharmD, BCPS, BCCP Music by Good Talk
In this podcast, Robert S. Rosenson, MD, from Mount Sinai Heart at the Icahn School of Medicine at Mount Sinai, discusses recent research about secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and the implications of the research for clinical practice. More at: www.consultant360.com/cardiology
With Bernard J. Gersh & Francisco Lopez-Jimenez, Mayo Clinic - USA Link to editorial Link to paper
Lipids Update! Get up close and personal with ASCVD prevention and lipid management guidelines, including changes in the 2018 update, with our discussion with Dr. Erin Michos @erinmichos, preventive cardiologist and associate professor of medicine at the Johns Hopkins University Hospital! We review the background on the ASCVD risk calculator, basics of primary and secondary prevention, statins benefits and misconceptions, appropriate follow up, cool things to look out for in the future, the deal with medications like aspirin and icosapent ethyl, among many other things! If that wasn’t enough, Dr. Michos also goes over great ways to counsel patients on healthy living and when that darn statin is giving you the “muscle aches”! ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Rate our infographics! Tell us what you think in this brief survey. Credits Producers: Christopher Chiu MD FACP FAAP; Jasneet Devgun DO; Justin Berk MD MPH MBA; Beth Garbitelli Writers: Jasneet Devgun DO; Justin Berk MD MPH MBA Infographic: Beth “Garbs” Garbitelli Cover Art: Kate Grant MBChB DipGUMed Hosts: Christopher Chiu MD FACP FAAP; Matthew Watto MD FACP; Paul Williams MD FACP Editors: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio) Guest: Erin Michos MD MHS Sponsor ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20 Time Stamps 00:00:00 Intro 00:01:52 Getting to know Dr. Erin Michos 00:O6:50 Picks of the Week*: Sparking Joy- concept for Marie Kondo (book and show), The Life-Changing Magic of Tidying Up by Marie Kondo; Shadowland, book by Peter Straub; The Crown, Netflix series; Catch and Kill, book by Ronan Farrow; Trick Mirror, essay collection by Jia Tolentino; Make it Stick, book by Brown, Roediger, and McDaniel 00:11:50 Digging into ASCVD Risk Calculator 00:16:12 Who should get 10 year ASCVD Risk assessment and what are the categories? 00:18:13 How Dr. Michos discusses healthy lifestyle and “Primordial Prevention” 00:19:42 What are “Risk Enhancing Factors”? 00:22:36 Who should get biomarker testing vs CAC scoring? 00:29:35 How Dr. Michos discusses statin therapy with her patients 00:32:18 How to address risks of side effects 00:37:57 Primary vs Secondary Prevention 00:39:40 “What should my cholesterol be?” 00:42:03 How often to follow-up labs? 00:46:00 Differences between stain intensity 00:47:57 How to manage side effects 00:52:05 PCSK9 inhibitor discussion 00:55:06 Aspirin, Fibrates and Icosapent Ethyl 01:02:13 High Risk vs Stable ASCVD 01:06:50 Take home points and the future 01:10:50 Outtro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will feel comfortable managing both primary and secondary prevention for ASCVD among different patient scenarios. Learning objectives After listening to this episode listeners will… Recognize the different risk levels and further ways to hone risk-stratification. Describe primary prevention management including how to discuss lifestyle changes, statins, and managing common statin-related complaints. Recognize the importance of lipid reduction for secondary prevention and different medications to achieve this. Disclosures Dr Erin Michos reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Michos E, Devgun J, Garbitelli B, Chiu C, Berk J, Williams PK, Watto MF. “#191 Lipids Update with Erin Michos MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. January 20, 2020.
In this interview, Dr. Priya Koilpillai and Dr. Sudhir Nishtala discuss the latest evidence, risks and benefits of low-dosage acetylsalicylic acid in primary and secondary prevention of cardiovascular disease. Dr. Koilpillai is a second year internal medicine resident at the University of Calgary who has a keen interest in medical education and women’s cardiovascular health. Dr. Nishtala is a former cardiac intensive care pharmacist and now is a cardiology fellow at the University of Calgary Libin Cardiovascular Institute. The Practice article they co-authored is titled “Five things to know about...the cardiovascular benefits of low-dosage acetylsalicylic acid.” The article is published in CMAJ: www.cmaj.ca/lookup/doi/10.1503/cmaj.191037 ----------------------------------- This podcast episode is brought to you by Dr. Bill. Dr. Bill is an easy-to-use mobile and web solution that truly simplifies the way you do medical billing. Join over 1500 physicians already using our billing software to save time, boost productivity and earn more. Visit www.dr-bill.ca for more information. ----------------------------------- Subscribe to CMAJ Podcasts on Apple Podcasts, iTunes, Google Play, Stitcher, Overcast, Instacast, or your favourite aggregator. You can also follow us directly on our SoundCloud page or you can visit www.cmaj.ca/page/multimedia/podcasts.
With Carl Chip Lavie, John Ochsner Heart and Vascular Institute in New Orleans, Louisiana - USA, & Sergey Kachur, University of Illinois at Chicago - USA. Link to paper Link to editorial
Commentary by Dr. Valentin Fuster
Steve and Nick are back wondering through the wilderness of science. This week were talking lightsabers, anti depressants and nonsense papers in ScienceVinyl Episode 5, Innervisions by Stevie Wonder! University Academics, Steve & Nick present Science Vinyl, using track listing of famous albums to focus sciencey discussion, hope you enjoy. If you like ScienceVinyl, Please share, RT, and subscribe. Show Notes. 1. Too High https://en.wikipedia.org/wiki/Armstrong_limit 2. Visions https://doi.org/10.1371/journal.pone.0084490 3. Living for the City https://www.ajpmonline.org/article/S0749-3797%2813%2900590-4/fulltext https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=9&ved=2ahUKEwimsOnLkKnfAhVS26QKHXq0DNUQFjAIegQICBAC&url=https%3A%2F%2Fwww.ons.gov.uk%2Fons%2Frel%2Fregional-trends%2Fregional-trends%2Fno--43--2011-edition%2Frural-and-urban-areas--comparing-lives-using-rural-urban-classifications.pdf&usg=AOvVaw3RHv9zvlyJ7cfPZlAkaQ9V 4. Golden Lady http://www.bbc.com/culture/story/20180716-goldfinger-and-the-myth-of-bond-girl-shirley-eaton-death https://www.youtube.com/watch?v=78tyO0QpGgY 5. Higher Ground https://physics.aps.org/synopsis-for/10.1103/PhysRevLett.111.080405 6. Jesus Children of America Stress Reduction in the Secondary Prevention of Cardiovascular Disease Randomized, Controlled Trial of Transcendental Meditation and Health Education in Blacks Robert H. Schneider , Clarence E. Grim , Maxwell V. Rainforth , Theodore Kotchen , Sanford I. Nidich , Carolyn Gaylord-King , John W. Salerno , Jane Morley Kotchen , and Charles N. Alexander. Originally published1 Nov 2012Circulation: Cardiovascular Quality and Outcomes. 2012;5:750–758 7. All In Love Is Fair https://www.youtube.com/watch?v=O7zewtuUM_0 8. Don't You Worry 'Bout a Thing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176700/ 9. He's Misstra Know-It-All https://www.newscientist.com/article/dn17288-crap-paper-accepted-by-journal/ https://powerm1985.files.wordpress.com/2012/11/access-points-3.pdf
Commentary by Dr. Valentin Fuster
In this episode of the Heart podcast, Digital Media Editor Dr. James Rudd is joined by Professor Ian Graham, from Trinity College Dublin. Professor Graham is a world authority in preventative cardiology. They discuss the differences in reaching secondary prevention targets amongst men and women in three different areas of the world. Link to published paper: http://heart.bmj.com/content/103/20/1587
Dr. Philip Castle, Professor in the Department of Epidemiology and Population Health at Albert Einstein College of Medicine, presents the ASCO Guideline on Secondary Prevention of Cervical Cancer, originally published in the Journal of Clinic Oncology in October 2016.
For the acute treatment of venous thromboembolism, the direct oral anticoagulants (DOACs) have increasingly replaced injectable anticoagulant therapy followed by warfarin. For patients with an unprovoked deep vein thrombosis or pulmonary embolism who may benefit from long-term extended prophylaxis for the secondary prevention of VTE, the choice is less clear. Should a DOAC be used? If so, which one and what's the best dose? What about low-dose aspirin? Is extended therapy needed at all? The EINSTEIN CHOICE study adds important new insights to the growing body of literature. Guest Author: Sarah Anderson, PharmD, BCPS Theme music by Good Talk
Commentary by Dr. Valentin Fuster
Interview with Marc Bonaca, MD, author of Antiplatelet Therapy for Long-term Secondary Prevention After Myocardial Infarction, and John Bittl, MD, author of Extended Dual Antiplatelet Therapy in Patients With Prior Myocardial Infarction
Editor's Audio Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the July 05, 2016 issue
Interview with Marc Bonaca, MD, MPH, author of Long-term Tolerability of Ticagrelor for the Secondary Prevention of Major Adverse Cardiovascular Events: A Secondary Analysis of the PEGASUS-TIMI 54 Trial, and Christopher Granger, MD, author of Understanding the Adverse Effects of Ticagrelor in Practice
Commentary by Dr. Valentin Fuster
Commentary by Dr. Valentin Fuster
Andrew Chan assesses new research about aspirin and cancer prevention.
A series of independent, unsupported programs developed by theheart.org featuring discussions with world renowned cardiologists on the importance of the latest clinical trial findings and cardiology news.
Background: This study aimed to inform the design of a pragmatic trial of stroke prevention in primary care by evaluating data recorded in electronic patient records (EPRs) as potential outcome measures. The study also evaluated achievement of recommended standards of care; variation between family practices; and changes in risk factor values from before to after stroke. Methods: Data from the UK General Practice Research Database (GPRD) were analysed for 22,730 participants with an index first stroke between 2003 and 2006 from 414 family practices. For each subject, the EPR was evaluated for the 12 months before and after stroke. Measures relevant to stroke secondary prevention were analysed including blood pressure (BP), cholesterol, smoking, alcohol use, body mass index (BMI), atrial fibrillation, utilisation of antihypertensive, antiplatelet and cholesterol lowering drugs. Intraclass correlation coefficients (ICC) were estimated by family practice. Random effects models were fitted to evaluate changes in risk factor values over time. Results: In the 12 months following stroke, BP was recorded for 90%, cholesterol for 70% and body mass index (BMI) for 47%. ICCs by family practice ranged from 0.02 for BP and BMI to 0.05 for LDL and HDL cholesterol. For subjects with records available both before and after stroke, the mean reductions from before to after stroke were: mean systolic BP, 6.02 mm Hg; diastolic BP, 2.78 mm Hg; total cholesterol, 0.60 mmol/l; BMI, 0.34 Kg/m(2). There was an absolute reduction in smokers of 5% and heavy drinkers of 4%. The proportion of stroke patients within the recommended guidelines varied from less than a third (29%) for systolic BP, just over half for BMI (54%), and over 90% (92%) on alcohol consumption. Conclusions: Electronic patient records have potential for evaluation of outcomes in pragmatic trials of stroke secondary prevention. Stroke prevention interventions in primary care remain suboptimal but important reductions in vascular risk factor values were observed following stroke. Better recording of lifestyle factors in the GPRD has the potential to expand the scope of the GPRD for health care research and practice.
Background: Colonoscopy in combination with endoscopic polypectomy has been shown to be an efficient measure for reducing colorectal cancer incidence. In Germany, a colorectal cancer screening program based on colonoscopy for individuals aged 55 and above was introduced in 2002. However, for largely unknown reasons, participation rates remain low. The purpose of this study was to identify factors influencing compliance with colorectal cancer screening. Methods: A structured survey of 239 individuals aged 55-79 years ;was performed. Statistical analysis included chi(2) test, t test, principal component analysis, and logistic regression. Results: 56% of previously screened, but only 26% of non-screened individuals had received a recommendation to undergo screening colonoscopy. 50% of the non-screened believed a screening colonoscopy should only be performed in case of complaints. Univariate analysis identified participation in any secondary prevention measures (p < 0.001), concerns about colonoscopy (p < 0.012), and knowledge about colorectal cancer (p < 0.001) as critical issues distinguishing between groups. Multivariate analysis revealed that secondary prevention (p < 0.001) and concerns about colonoscopy (p = 0.026) were independent predictors of compliance with screening recommendations. Conclusion: Our survey has identified critical factors deterring compliance with colorectal cancer screening recommendations. This will help to direct future campaigns in order to increase participation in colorectal cancer screening. Copyright (C) 2010 S. Karger AG, Basel
Fri, 1 Jan 2010 12:00:00 +0100 https://epub.ub.uni-muenchen.de/18000/1/oa_18000.pdf Gulliford, M. C.; Ashworth, M.; Rudd, A.; Wolfe, C. D.; Toschke, André Michael; Dregan, A.
There's yet more ammunition touting the health benefits of vitamin D, but if you think you're getting enough, you may want to think again. Most older women have their bone density checked, but does it make sense for a man to have the screening done? We'll discuss new information showing that heart attacks in diabetics are much more severe and this week's incredibly misleading headlines regarding vitamin supplementation and the impact on heart disease in women. Dr. Cooper answers listeners' calls. Program Reference Notes: "Low Vitamin D Levels Linked To Poor Physical Performance." Posted on www.medicalnewstoday.com, April 24, 2007 "Vitamin D and Insulin." http://wellnessblog.feelgreatcoaching.com/2007/08/01/vitamin-and-insulin.aspx "One dose of vitamin D boosts TB immunity." http://www.reuters.com/article/healthNews/idUSPAR27745920070802 "Common vitamins no help for women's hearts: study." http://www.reuters.com/article/healthNews/idUSN1336012020070814 "Japan study finds coffee may prevent colon cancer" http://www.reuters.com/article/topNews/idUST22187020070801 "Are antioxidants worthless against heart disease?" http://honestnutrition.blogspot.com/2007/08/are-antioxidants-worthless-against.html "A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women." http://archinte.ama-assn.org/cgi/content/abstract/167/15/1610?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=a+randomized+factorial+trail+of+vitamins&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT "Cost-effectiveness of Bone Densitometry Followed by Treatment of Osteoporosis in Older Men." http://jama.ama-assn.org/cgi/content/abstract/298/6/629?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=cost-effectiveness+of+bone+densitometry&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
There's yet more ammunition touting the health benefits of vitamin D, but if you think you're getting enough, you may want to think again. Most older women have their bone density checked, but does it make sense for a man to have the screening done? We'll discuss new information showing that heart attacks in diabetics are much more severe and this week's incredibly misleading headlines regarding vitamin supplementation and the impact on heart disease in women. Dr. Cooper answers listeners' calls. Program Reference Notes: Low Vitamin D Levels Linked To Poor Physical Performance Vitamin D and Insulin One dose of vitamin D boosts TB immunity Common vitamins no help for women's hearts: study Japan study finds coffee may prevent colon cancer Are antioxidants worthless against heart disease? A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women Cost-effectiveness of Bone Densitometry Followed by Treatment of Osteoporosis in Older Men
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