65M with Type 2 diabetes on oral hypoglycaemics but no proven coronary artery disease, BP 150/95mmHg despite 3 months of intensive lifestyle modifications, not currently on anti-hypertensives. Would you?
- Introduce low dose ACE inhibitors, with gradual up-titration
- Introduce combination ACE inhibitor / thiazide, with up-titration later on Read More
In primary prevention, CT calcium scoring has been suggested to help decision making surrounding statin use.
Some of the underlying concepts are somewhat complex, but the screening paradigm remains that of matching the intensity of preventive efforts with the individual’s absolute risk.
The appropriateness of CT calcium scoring in an individual patient therefore depends
patient’s pretest probability of atherosclerotic cardiovascular risk
potential benefits of preventive therapies
negative aspects and risks of preventive therapies
Nonsteroidal anti-inflammatory drugs (NSAIDs) use is associated with a significantly increased risk for myocardial infarction (MI). This includes naproxen, considered by some as one of the safest drugs in this class. This is according to a new patient level meta-analysis from the University of Montreal, studying celecopxib, diclofenac, ibuoprofen, naproxen and rofecoxib. Read More
The Mayo clinic has recently published an electronic tool called “Statin Choice Decision Aid”, which is immensely valuable in helping patients visualize cardiovascular risk, and the benefit of statin medications as applied to them. Read More
Sam is a 60-year-old male heart attack survivor who had an unremarkable recovery after the successful coronary artery stenting in the middle of the night of his presentation. Now it is 3 months and Sam feels absolutely grand. At follow-up, his cardiologist insists that he should continue all the prescribed medications. He read on the internet some bad press about statin medications and thought, “surely, nothing will happen if I stop taking statins?!” Read More
55M IHD with prior stents; prior myalgia with Simvastatin and Atorvastatin; but yet still more myalgia with Pravastatin. The treating physician decided to check his vitamin D level and his coenzyme Q10 level.
Which one, vitamin D level or coenzyme Q10 level, is relevant in statin myalgia? Read More