Smoking and Clopidogrel may not go together

Smoking and Clopidogrel may not go together New Delhi, July 15, 2016: "Clopidogrel is an important antiplatelet (anti-clotting) drug effective in preventing thrombotic (heart attack) events, especially for patients undergoing percutaneous coronary intervention (balloon angioplasty)," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. A study from the Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan, published in the Journal of Clinical Pharmacy and Therapeutics has concluded that smoking is a significant factor affecting the pharmacokinetics of clopidogrel, following administration of a single 75-mg dose in healthy young volunteers. The study supports smoking-cessation recommendations in all patients on clopidogrel. In the study, 76 healthy adult male volunteers were selected randomly. Each subject received a single 75-mg oral dose of clopidogrel after overnight fasting. Clopidogrel carboxylate plasma levels were measured. One-third of volunteers were smokers (n = 27). Smokers had lower area under the curve [AUC] (smokers: 6.24 ± 2.32 microg/h/mL vs. non-smokers: 8.93 ± 3.80 microg/h/mL, P < 0.001) and shorter half-life (smokers: 5.46 ± 2.99 vs. non-smokers: 8.43 ± 4.26, P = 0.001). Earlier studies have also shown that BP drugs are not effective in patients who continue to smoke. This study gives one more reason for smoker heart patients to quit.

Updated HIV guidelines integrate treatment and prevention

Updated HIV guidelines integrate treatment and prevention

Dr K K Aggarwal

The International Antiviral Society-USA panel on antiretroviral (ARV) drug therapy for HIV infection has released updated recommendations, which for the first time, have integrated treatment and prevention. The guidelines say that ARVs remain the cornerstone of HIV treatment and prevention and when used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. The guidelines “Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults2016 Recommendations of the International Antiviral Society–USA Panel” are published July 12, 2016 in JAMA. Some key recommendations are: • Antiretroviral therapy (ART) should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. • The recommended optimal initial regimens include an integrase strand transfer inhibitor (InSTI) + 2 nucleoside reverse transcriptase inhibitors (NRTIs). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. • ART should be started within the first 2 weeks after diagnosis for most acute opportunistic infections, with the possible exception of acute cryptococcal meningitis. • Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. • Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. If ART is being initiated on the first clinic visit, all laboratory specimens should be drawn prior to the first dose of ART; resistance testing results should be used to modify the regimen as necessary. Recommended pre-ART tests include CD4 cell count, plasma HIV-1 RNA, serologies for hepatitis A, B, and C, serum chemistries, estimated creatinine clearance rate, complete blood cell count, urine glucose and protein, sexually transmitted infection screening, and fasting lipid profile. Genotypic testing for reverse transcriptase and protease resistance mutations is also recommended pre-ART. • Systematic monitoring of time to care linkage following initial HIV diagnosis, retention in care, ART adherence, and rates of viral suppression is recommended in all care settings. • Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. Daily, rather than intermittent, tenofovir disoproxil fumarate/emtricitabine is the recommended PrEP regimen. Detailed sexual, substance use, and medical histories are important for deciding whether to provide PrEP. • The guidelines recommend vaccination against hepatitis A and hepatitis B for those who are not immune and human papillomavirus vaccination. • Postexposure prophylaxis is recommended as soon as possible after exposure without waiting for confirmation of HIV serostatus of the source patient or results of HIV RNA or resistance testing. Postexposure prophylaxis regimens should be continued for 28 days, and HIV serostatus should be reassessed at 4 to 6 weeks, 3 months, and 6 months after exposure.

Consume natural food and don’t just depend on supplements to prevent heart disease

Consume natural food and don’t just depend on supplements to prevent heart disease New Delhi, July 12, 2016: One should consume seasonal vegetables and locally grown natural food and vegetables or those grown in organic farms," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Eating less, a lighter dinner, and eating natural and in moderation are few of the mantras. Taking food supplements in excessive quantities can be harmful. According to the American Heart Association, supplementation with beta carotene and Vitamin E, either alone or in combination with each other or other antioxidant vitamins does not prevent heart disease. High-dose Vitamin E supplementation (400 IU/day) may be associated with an increase in all-cause mortality. Supplementation with vitamin C does not prevent second heart attack. Beta carotene supplementation may be dangerous and should be discouraged. Vitamin E supplementation may be of benefit for only secondary prevention of heart patients with chronic renal failure who are undergoing hemodialysis. The American Heart Association concluded that current data do not justify the use of antioxidant supplements for the prevention or treatment of cardiovascular disease risk. The above recommendations apply to supplementation only. Diets high in natural antioxidants are associated with lower cardiovascular mortality. Some tips • Have a mix of all seven colours & six tastes • Avoid refined carbs • Say no to trans fats • Reduce red meat

IMA Safe Sound Initiative: Safe Noise Points

IMA Safe Sound Initiative: Safe Noise Points • Noise has a lot of ill-effects on our health and it is the leading cause for permanent deafness. • Noise is a silent killer and affects all systems especially central nervous, cardiovascular, endocrine and immune systems. • Decibel (dB) is the unit of sound intensity. Zero dB is the minimum hearing capacity of a healthy person in a noise-free environment. Every 10 dB is 10 times more powerful. • Exposure to sounds above 80 dB for even shorter periods has serious effects on our health. • Traffic sounds are a major source of noise in Indian cities (90 to 120 dB). • Use of loudspeakers in public places after 10 pm and before 6 am is illegal. • DJs and cinemas have a noise level of 110 to 120 dB; limit your exposure to less than 2 hours in a week. Please note that even this duration is harmful to young children and pregnant ladies. • Staying away from very noisy situations, even for intervals of 5-10 minutes, reduces the ill-effects of noise to a great extent. • Use of ear plugs or muffler is highly recommended in very noisy situations. It will reduce sound exposure by 15 to 20 dB. • Participate actively in the IMA Safe Sound Initiative for a better, healthy in India. (Contributions from Dr John Panicker: Coordinator, IMA NISS)

Even cycling can cause erectile dysfunction

Even cycling can cause erectile dysfunction New Delhi, July 13, 2016: Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, and upright cycling for more than 3 hours a week can cause erectile dysfunction in men. "Those who cycle for more than 3 hours a week should do so in a reclining position and not upright position," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures. The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75% of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease. Eight of the twelve most common prescription medications list erectile dysfunction as a side effect. It is estimated that 25% of the cases of erectile dysfunction are due to drugs. Depression, stress, or the drugs used to treat depression can result in erectile dysfunction as well. Neurological causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, and dementia. In addition, pelvic trauma, prostate surgery or priapism may cause erectile dysfunction. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence. Cycling-induced impotence is primarily a problem of serious cyclists and is reported to occur in Norwegian men competing in a 540-km bicycle race. Penile numbness is attributed to the pressure on the perineal nerves whereas erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries. Recreational cyclists, those who cycle for less than three hours per week, and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

Traffic noise linked to increased risk of heart attack

Traffic noise linked to increased risk of heart attack Traffic noise has been known to trigger stress reactions. If you live near a highway, you are at a greater risk of heart attack. Results of a case–control study based on secondary data published 17th June, 2016 in the journal Deutsches Arzteblatt International show that the risk of heart attack increases with the amount of exposure to traffic noise. This increase in risk was found to be greatest with road and rail traffic noise and less with aircraft noise. The evaluation was performed on the basis of the continuous 24-hour noise level and the categorized noise level (in 5 decibel classes). The study compared data from 19,632 patients from the Rhine-Main region of Germany who were diagnosed with myocardial infarction in the years 2006–2010 with 834,734 controls. Their exposure to aircraft, road and rail traffic in 2005 was matched to their residences. Analysing data specifically for those who died of heart attack up to 2014-15, a statistically significant risk increase due to road noise (2.8% per 10 dB rise) and railroad noise (2.3% per 10 dB rise) was observed, but not airplane noise. The author suggest that this may be due to the fact that with aircraft noise, unlike road and rail traffic noise, a continuous noise level above 65 dB did not occur; hence, the low risk association with aircraft noise. This study is part of the Europe-wide NORAH (Noise-Related Annoyance, Cognition, and Health) study investigating the health consequences of traffic noise.

Frequent urination at night: look for snoring

Frequent urination at night: look for snoring New Delhi, July 14, 2016: "Frequent urination at night, a condition called nocturia, is common among snorers with obstructive sleep apnea (cessation of respiration during sleep)," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Nocturia is the need to void two or more times each night. In obstructive sleep apnea, soft tissues at the back of the throat temporarily collapse during sleep causing brief moments in which the patient stops breathing. The disorder can cause daytime sleepiness and can be effectively treated with a breathing device called CPAP that pushes air into the throat to prevent the tissues from collapsing. Quoting a Japanese study published in the journal Urology by Dr. Yoji Moriyama, Dr Aggarwal said that nocturia is present in 41% of patients with sleep apnea. The risk of nocturia is directly related to the severity of sleep apnea and the association is particularly strong in patients younger than 50 years of age. Snorers at risk of sudden death Interrupted nighttime breathing because of sleep apnea increases the risk of death. Sleep apnea is a common problem in which one has pauses in breathing or shallow breath during sleep. Studies have linked sleep apnea during snoring to increased risk of death. A study published in the edition of Sleep suggests that the risk is present among all people with obstructive sleep apnea. The study showed a sixfold increase which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who doesn't have sleep apnea. For the Busselton Health Study, the team collected data on 380 men and women, between 40 and 65 years of age. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow-up, about 33% of those with moderate-to-severe sleep apnea died, compared with 6.5% of those with mild sleep apnea and 7.7% of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly linked to the condition. People who have, or suspect that they have sleep apnea, should consult their physicians about diagnosis and treatment options