After Cardiac Surgery, How Does Nutrition Fit in With Risk Factors?

Kones, Richard

doi:10.1177/0148607109343111

Cited by 5 publications

(5 citation statements)

References 63 publications

(54 reference statements)

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“…CCBs may also suppress lower esophageal sphincter contraction and worsen symptoms of gastroesophageal reflux disease. CCBs inhibit the CYPA4 enzyme in the liver and, therefore, may raise levels of statins and many other drugs, which may be overlooked 39. Cimetidine and grapefruit juice may raise the effective level of CCBs.…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

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Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

Kones¹

2010

VHRM

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The objectives in treating angina are relief of pain and prevention of disease progression through risk reduction. Mechanisms, indications, clinical forms, doses, and side effects of the traditional antianginal agents – nitrates, β-blockers, and calcium channel blockers – are reviewed. A number of patients have contraindications or remain unrelieved from anginal discomfort with these drugs. Among newer alternatives, ranolazine, recently approved in the United States, indirectly prevents the intracellular calcium overload involved in cardiac ischemia and is a welcome addition to available treatments. None, however, are disease-modifying agents. Two options for refractory angina, enhanced external counterpulsation and spinal cord stimulation (SCS), are presented in detail. They are both well-studied and are effective means of treating at least some patients with this perplexing form of angina. Traditional modifiable risk factors for coronary artery disease (CAD) – smoking, hypertension, dyslipidemia, diabetes, and obesity – account for most of the population-attributable risk. Individual therapy of high-risk patients differs from population-wide efforts to prevent risk factors from appearing or reducing their severity, in order to lower the national burden of disease. Current American College of Cardiology/American Heart Association guidelines to lower risk in patients with chronic angina are reviewed. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial showed that in patients with stable angina, optimal medical therapy alone and percutaneous coronary intervention (PCI) with medical therapy were equal in preventing myocardial infarction and death. The integration of COURAGE results into current practice is discussed. For patients who are unstable, with very high risk, with left main coronary artery lesions, in whom medical therapy fails, and in those with acute coronary syndromes, PCI is indicated. Asymptomatic patients with CAD and those with stable angina may defer intervention without additional risk to see if they will improve on optimum medical therapy. For many patients, coronary artery bypass surgery offers the best opportunity for relieving angina, reducing the need for additional revascularization procedures and improving survival. Optimal medical therapy, percutaneous coronary intervention, and surgery are not competing therapies, but are complementary and form a continuum, each filling an important evidence-based need in modern comprehensive management.

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Section: Calcium Channel Blockersmentioning

confidence: 99%

“…Simultaneous administration of CYP3A4 inhibitors together with some statins remains a clinical concern 39,90…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

Kones¹

2010

VHRM

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“…CCBs may also suppress lower esophageal sphincter contraction and worsen symptoms of gastroesophageal reflux disease. CEBs inhibit the CYPA4 enzyme in the liver and, therefore, may raise levels of statins and many other drugs, which may be overlooked (Kones, 2010). Cimetidine and grapefruit juice may raise the effective level of CEBs.…”

Section: Calcium Entry Blockers (Cebs)mentioning

confidence: 99%

Coronary Artery Diseases

Dymarkowski

Bogaert

2011

Clinical Cardiac MRI

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he was working as lead researcher in hightech companies SQUID AG and MagScan GmbX (Germany). Currently, he is senior staff scientist in the field of medical cybernetics at International Research and Training Center for ITandS of NAS of Ukraine. He combines clinical work with research, focusing on advanced methods for analysis (including pattern recognition) of electrocardiogram , magnetocardiogram , heart rate variability and implementation of such approaches in clinical routine. His research in these areas has been presented at international congresses (ESC, AHA, ACC and many others) and has appeared in academic journals such as PACE, Clinical Cardiology, Annals of Noninvasive Electrocardiology, European Heart Journal, Biophysics etc. He is the author of the book (together with L. Fainzilberg) , devoted to analysis of ECG in phase space. Dr Nataliia Sydorova was born in Kiev, Ukraine, in 1975. She got University Degree in General Medicine (1999) and earned her PhD in Cardiology (2003) at the Bogomolets National Medical University. She has been working as a cardiologist at Cardiological Clinic of Main Military Clinical Hospital of Ministry of Defence of Ukraine (Kiev) till 2001, and then -at Department of Military Common Practice and Family Medicine of the Ukrainian Military Medical Academy (Kiev). Her current position at this department is Associated Professor. In addition Dr. Sydorova was a Deputy Editor of the 'Journal of the American College of Cardiology. Ukrainian edition' from 2008 till 2010. At the present time she is a Deputy Editor of the 'Therapia. Ukrainian Medical Bulletin' journal (from 2010). She has got 12 patents for an invention and ca. 130 scientific publications.

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“…The recent approval for use of rosuvastatin in middle-aged patients with no clinical CAD, but with elevated CRP levels and one other risk factor, adds to the clinician’s armamentarium for primary prevention [Kones, 2009], but does not solve the fundamental cause. The enormity of the issue suggests, however, more is needed sooner, but, most assuredly, in addition to the proven traditional approach of treating high-risk individuals aggressively [Kones, 2010c, 2009].…”

Section: Limitations Of Intervention In High-risk Patientsmentioning

confidence: 99%

Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention

Kones

2010

Therapeutic Advances in Cardiovascular Disease

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Americans are under assault by a fierce epidemic of obesity, diabetes, and cardiovascular disease, of their own doing. Lowered death rates from heart disease and reduced rates of smoking are seriously threatened by the inexorable rise in overweight and obesity. Latest data indicate that 32% of children are overweight or obese, and fewer than 17% exercise sufficiently. Over 68% of adults are overweight, 35% are obese, nearly 40% fulfill criteria for the metabolic syndrome, 8-13% have diabetes, 34% have hypertension, 36% have prehypertension, 29% have prediabetes, 15% of the population with either diabetes, hypertension, or dyslipidemia are undiagnosed, 59% engage in no vigorous activity, and fewer than 5% of the US population qualifies for the American Heart Association (AHA) definition of ideal cardiovascular health. Health, nutrition, and exercise illiteracy is prevalent, while misinformation and unrealistic expectations are the norm. Half of American adults have at least one cardiovascular risk factor. Up to 65% do not have their conventional risk biomarkers under control. Of those patients with multiple risk factors, fewer than 10% have all of them adequately controlled. Even when patients are treated according to evidence-based protocols, about 70% of cardiac events remain unaddressed. Undertreatment is also common. Poor patient adherence, probably well below 50%, adds further difficulty in reducing cardiovascular risk. Available data indicate that only a modest fraction of the total cardiovascular risk burden in the population is actually now being eliminated. A fresh view of these issues, a change in current philosophy, leading to new and different, multimechanistic methods of prevention may be needed. Adherence to published guidelines will improve substantially outcomes in both primary and secondary prevention. Primordial prevention, which does not allow risk values to appear in a population, affords more complete protection than subsequent partial reversal of elevated risk factors or biomarkers. Current evidence supports recent calls for massive educational programs supporting primordial prevention, individual responsibility and pride in achieving population-wide ideal cardiovascular health through lifestyle modification. Environmental and social changes will be necessary, along with major supportive adjustments in the food industry and the assistance of the media. Cooperation is critical to the success of such an initiative.

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After Cardiac Surgery, How Does Nutrition Fit in With Risk Factors?

Cited by 5 publications

References 63 publications

Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

Coronary Artery Diseases

Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention

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