With your best care  at heart

King's Cardiology

Locations
Maroubra    806 Anzac Parade       02 9349 9000
Matraville  496 Bunnerong Road     02 9322 0000
Zetlands    2-4 Defries Ave        02 8076 7288
Redfern     147 Redfern Street     02 8313 2999
Sydney CBD  175 Liverpool Street   02 9283 1234


Thoughts, Trials and Data

ABOUT HYPERTENSION
- Drinks that may reduce hypertension include Hibis cus Tea , Beet juice, Pomegranate juice, Cranberry juice, 


 ABOUT CARDIAC AMYLOID
- 2018 ESC - Tafamidis treatment for patients with Transthyetin Amyloid Cardiomyopathy had significant benefit. ​
- Suspected Cardiac Amyloid investigation strategy to avoid biopsy - Serum light chains to rule out AL Amyloid then for Pyrophosphate nuclear medicine scan



ON INVESTIGATING CARDIAC SYMPTOMS
- Scot-Heart 2018 (CTCA plus functional testing vs functional testing alone) - CTCA plus standard of care was linked to less death an heart attacks in stable IHD. 4000 patients randomized to CTCA or standard therapy. 41% relative risk reduction in rates of death and non fatal AMI at 5 years.


ON ASPIRIN FOR PRIMARY PREVENTION
- Arrive Trial (2018)- Primary prevention with Aspirin 100mg in high risk non diabetic patients did not significantly reduce cardio or cerebrovascular events in 12000 patients. It did increase the risk of bleeding. 

- ASCEND (2018) - Aspirin 100mg daily in high risk diabetic patients. Mild decrease in cardiac events offset by increased bleeding risk. 


ON ATRIAL FIBRILLATION
- APPLE HEART STUDY - 2019 - Apple watch is able to detect some Atrial fibrillation. 
- Evidence has shown that in overweight individuals with atrial fibrillation, a 10% weight loss can have significant benifits in reducing paroxysmal atrial fibrillation.

- Andexanet Alfa (reversal agent) for Apixaban or Rivaroxaban




ABOUT OTHER MATTERS
Compass trial  - Rivaroxiban and its benefits in arterosclerosis

Endoscopic vs open vein-graft harvesting in CABG
November 2018 -REGROUP trial  (1150patients) - No difference in major events. Trend towards higher wound complications in the open technique

ABOUT HEART FAILURE
- TRED-HF trial 2019 - Risk of relapse in patient with prior dilated cardiomyopathy if they stopped medications was over 40%
- Pioneer HF Dec 2018 - Sacubitril -Valsartan started for heart failure in -hospital was safe and decreased re-hospitalisation rate

ABOUT HIGH TRIGLYCERIDES AND FISH OIL
- REDUCE IT trial Nov 2018 - Supplimentation with 4g/day of icosapent ethyl  reduced a composite of major cardiovascular outcomes. 

On Cryptogenic stroke  2019
- RE-SPECT ESUS trial - Pradaxa vs aspirin in cryptogenic stroke did not show an improvement in stroke but did have an increased bleeding risk. 


LAACS 2017  - Does doing a left atrial appendage closure during elective cardiac surgery decrease future stroke?

CONFIRM registry (5 year follow up results)- Non obstructive plaque on CTCA contributes to major adverse cardiac events. 

CANTOS 2017 - Canakinumab reducing inflammation thereby reducing further cardiac events in a post infarct population

PREDIMED Trial (Nejm 2013) - Mediterranean diet supplimented with extra virgin olive oil and nuts reduced major cardiovascular events ( http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801 )

Exercise - Doing physical activity in natural or "green" environments may have more benifit than in Urban settings. Benifits may include improved mental wellbeing, lower diastolic blood pressure and reducing inflammation.


Prescription exercise BMJ Aug 2016 - A meta analysis of 174 trials, suggests that the more physical exercise reduces risk of breast cancer, colon cancer, Ischaemic heart disease and ischaemic stroke. The amount of exercise equates to approximately 150mins a week of brisk walking or 75mins a week of running. Based on this, we recommend at least 10 mins a day of high intensity exercise like running or 20 mins a day of brisk walking


JAMA 2016 - Wearable technology does not improve weight loss.


JAMA internal medicine 2017 - Thiazide - like dieuretics have associated decreased risk of hip fractures compared to ACEi, ARBs and Ca channel blockers.  


CTCA strategy associated with fewer heart attacks vs functional stress testing (Meta-analysis) - JAMA Intern Med 2017


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Thoughts on Weight loss (Long term lifestyle changes)


Have a strong focus on re-assessing weights and having weight loss goals is vital. If you weight is not changing, trying something different is vital. 
Weighing in with your GP once a month may be helpful to keep you on track and accountable for your weight loss. 


Things to TRY for weight loss
1) Stop all carbonated drinks (Including sparkling water)
2) Cut out all products with refined sugars
3) Try doubling your vegetable intake and halving your carbohydrate portion and if there is no weight loss after a month, further halving your carb portion and doubling your vegetable portion again. 
4) Have healthy snacks readily available
5) Try to cut out or significantly cut back on unhealthy snacks
6) Generally less processed foods are better. More wholegrains and whole foods are better than refined foods. Foods you can buy from the butcher or grocers are better than foods that come from a can.
7) Regular exercise for at least 20 mins a day of brisk walking or jogging
8) If you are unable to spend 20mins a day, start small (eg 5 mins a day so you have no excuses and try to do more each day)
9) If you already eat very healthily and are unable to lose the weight, try cutting back on portion size. It may be worthwhile trying things like weight watchers / youfoodz
10) Having a good intake of fish and healthy oils (Extra virgin Olive oil and fish oil)   
11) It is generally easier to not purchase an item as opposed to purchasing it and trying not to eat it at home (eg snacks and ice cream)
12) Try going to bed earlier as staying up stimulates hormones and makes you more likely to snack



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