Statin Therapy Reduces Future Risk of Lower-Limb Amputation in Patients With Diabetes and Peripheral Artery Disease

Lowering cholesterol has been important for a while now. It not just prevents heart disease, it can also lower your stroke risk.

There are those that use supplements as a way to lower cholesterol, but statins remain the gold standard in management.

Preamble: Although there is evidence to support the beneficial effects of statins on major cardiovascular events, few studies address the protective effect of statins on limb outcome.

Hsu CY et al. aimed to investigate whether the use of statin is associated with a risk reduction in lower extremity amputation in type 2 diabetes mellitus (DM) patients with peripheral arterial

disease (PAD).

Design: Observational cohort study.

Setting: A nationwide DM database in Taiwan from 2000 to 2011.

Patients: A total of 69,332 patients aged ≥ 20 years with DM and PAD were identified.

Intervention: Patients were divided into three groups: 11,409 patients were statin users, 4430 patients used non-statin lipid-lowering agents, and 53,493 patients were nonusers.

Main Outcome Measures: The primary outcome was lower-extremity amputation. Secondary outcomes were in-hospital cardiovascular death and all-cause mortality.

Results:

·    Compared with nonusers, statin users were associated with lower risks of lower-extremity amputation [adjusted hazard ration (aHR), 0.75; 95% confidence interval (CI), 0.62 to 0.90], in hospital cardiovascular death(aHR, 0.78; 95% CI, 0.69 to 0.87), and all-cause mortality (aHR, 0.73; 95% CI, 0.69 to 0.77).

·    In the propensity score matching analysis, the effect of statin on the risk of lower-extremity amputation was consistent. Only statin users were associated with the risk reduction of lower-extremities amputation (HR, 0.77; 95% CI, 0.61 to 0.97) and cardiovascular death (HR, 0.78; 95% CI, 0.68 to 0.89) when taking competing risk of death into consideration.

The authors concluded that compared with statin nonusers who were never treated with lipid-lowering drugs, statin users had a lower risk of lower-extremity amputation and cardiovascular death in patients with DM and PAD.

What Is Your Heart Disease Risk? Heart Doctor Vivek Baliga Discusses..

Heart disease affects millions of people across the globe. These days, one of the most common reasons why young people visit doctors is not just for the common cold or flu, but also to find out what their chances of developing heart disease are.

Years ago, a group of researchers started looking into whether an individual’s risk of developing heart disease could be estimated. 

Looking at normal parameters such as high blood pressure, diabetes, heart disease in the family and a history of high cholesterol and smoking were all well and good, but there was no way to know what exactly a person’s risk was in years to come.

In 1946, scientists embarked on the Framingham Heart Study. 

This remains, to date, one of the largest heart studies performed all over the world. This study was so robust and remarkable, that to this day we use data published from this to determine an individual’s heart disease risk. 

Not only that, the study also provided valuable insights into how various risk factors affect the heart and how one can make changes to reduce their risk.

The risk scoring system takes into account various parameters including age and gender, and churns out a 10 year risk score. 

This risk score determines what a person’s chances are of having a heart attack in 10 years time. 

Those who have a low risk score have a 10% chance of heart disease in 10 years, those with an intermediate risk score have a 10 – 20 % risk while those with a high risk score have a >20% risk.

Since the Framingham risk score emerged, a number of different scoring systems are being used not only to predict chances of developing heart disease, but also outcomes of patients following a heart attack. 

The Q-risk score is being used more widely these days. Similarly, the GRACE score and CHADS2VASc scoring systems are also used for patients with heart disease.

It must be remembered that these scoring systems are arbitrary. They apply to majority of individuals but not to all. Ask your doctor about what your heart disease risk is today.

How Is Your Cognitive Reserve? Dr Vivek Baliga Writes...

Okay, so this topic may be a little complicated for you, but let me try and explain. Have you heard of cognitive reserve?

In the 1980’s, scientists and researchers were baffled to find that post mortem specimens of the human brain had changes suggestive of Alzheimer’s disease in subjects who had led completely normal lives and had not had any memory problems when alive. 

This is when the phenomenon of cognitive reserve emerged.

Cognitive reserve is a phenomenon where the brain fights the development of the any damage. It is the resistance against damage. 

Imagine you are driving a car. An ambulance starts to siren behind you, and you must move your car. You change gears and speed up to move to a location where the ambulance has sufficient room to pass through.

Similarly, at times of need, the brain has the ability to ‘change gears’ to function at a higher capacity. This can occur despite there being brain damage or age-related change. 

This capability is cognitive reserve.

Medically, it is the ‘hypothesized capacity of mature adult brain to sustain the effects of disease or injury without manifesting clinically'. 

'It accounts for individual differences in the cognitive processes and neural networks which allow one to cope better than others with the brain damage'.

Those with a better reserve tend to avoid developing problems such as Alzheimer’s, Parkinson’s disease and similar problems. They can manage unexpected life events such as financial stress, loss of a loved one and similar scenarios in a better manner. 

These circumstances require your brain to function differently, and this depends on how good your cognitive reserve is.

So how can you build your cognitive reserve? Well, there are many ways to improve your memory.

Learning a new skill, reading, continuing your work for as long as possible, exercising your body and your mind and eating a healthy diet are all linked to your brain’s reserve function. 

Enjoy your hobbies. They will keep your mind active and sharp for years to come!!

A FOURIER Analysis for Evaluation of Evolocumab for Reducing Cardiovascular Events in Diabetic Patient - Dr Vivek Baliga

Hospitalization for Heart Failure and Death in patient with/without prior CVD in New Users of SGLT-2 inhibitors: a CVD-REAL Study

T2DM patients with CVD on sodium glucose co-transporter 2 inhibitor (SGLT-2i) have shown reduction in cardiovascular death and hospitalization for heart failure (HHF).

This study used clinical practice data from 2012-2016 and compared HHF and death in patient with/without prior CVD or heart failure in new users of SGLT-2i vs other glucose lowering drugs (oGLD).

HHF and deaths were collected via medical records, medical claims, electronic health and death records, and national register; Hazard ratio (HR) for HHF, death and the composite endpoint (HHF or death) was calculated as average.

Overall, 306,156 patients with >150,000 person year(PY) 100,947 PY for SGLT-2i; 89,208 PY for oGLD) and 950 new HHF events were analyzed.

SGLT-2i was associated with significant lower rates of HHF with/without prior CVD (HR 0.69;95% CI 0.59-0.80) compared with oGLD (HR 0.55, 95% CI 0.34-0.88).

Similarly, death and composite endpoint was significantly lower for SGLT-2i when compared to oGLD, irrespective of heart failure or CVD.

SGLT-2i was associated with significant reduction in HHF and death vs oGLD in both with/without prior CVD or heart failure patients, which shows the beneficial effect of SGLT-2i over broad range of patient population with T2DM.

Checking Your Blood Pressure The Right Way - Dr Vivek Baliga Advice

Many of you reading this blog have high blood pressure. If you don’t, then you are in that small category of people in India that do not suffer from the problem. 

Aptly called the ‘silent killer’, high blood pressure affects many individuals across India and carries a great deal of mortality and morbidity. If you have been diagnosed with high blood pressure, your doctor will prescribe for you certain medications that will not only help control the BP but will also reduce your chances of developing complications in the future. 

High blood pressure is associated with heart disease, stroke, kidney disease and eye disease in addition to a number of other medical problems. Making sure that you follow the right lifestyle changes such as salt reduction and regular exercise are paramount to achieving adequate control.

An important aspect of management of BP is monitoring it at home. Numerous BP measuring devices are now available on the market and are quite accurate when compared to what your doctor measures in their clinic. It is therefore advisable to own one of these machines at home if you have high blood pressure as they can be invaluable in times of need especially if you are calling the doctor for advice. 

However, there are certain aspects of checking the BP at home that you need to be aware of so that the reading you obtain is as accurate as possible. Here are some simple steps that can guide you on how to check your blood pressure correctly.

1. Don't drink a caffeinated beverage or smoke for at least 30 minutes before the test. Doing so can affect the BP recordings.

2. Sit quietly for five minutes before the test begins. If possible, do not talk to anyone and just close your eyes and concentrate on your breathing.

3. During the measurement, sit in a comfortable chair with your feet on the floor and your arm supported so your elbow is at about the level of your heart.

4. The inflatable part of the cuff should cover at least 80% of your upper arm, and the cuff should be placed directly on the skin, not over any clothing. Make sure that the tubing that accompanies the cuff is placed over the inner aspect of the forearm so that it falls upon the brachial artery. The BP that is recorded is that of the brachial artery.

5. Don't talk during the measurement. When the machine is inflating the cuff, do not look at the readings as this can sometimes cause a slight amount of stress. This can falsely increase the BP which could get you even more stressed!

6. Have your blood pressure measured twice, with a brief break in between. It is recommended that you wait around 10 minutes before the next reading. If the readings are different by 5 points or more, have it done a third time. If you wish to, you may take an average of the three readings.

When recording the BP at home, it is important to bear in mind that there will be a slight difference between the machine readings and one which your doctor gets in the clinic. 

Currently, this is a well-known fact by the medical authorities and it is often assumed that a small difference between the manual readings and the machine readings is acceptable. 

In fact, a difference of about 10 mmHg either way would be regarded as acceptable. If you find that multiple readings that have been taken over a space of time are always elevated, it is advisable to contact your doctor to get further advice.

It is not uncommon for BP recordings to fluctuate throughout the day. BP readings may be high prior to taking medicines and may settle after taking medicines. 

There is no clear guideline as to when to check the BP but we often tell our patients to check it at least two hours after they have taken their medicines. 

This way, we can assess whether the medicines that have been prescribed are working effectively or not. If the BP readings at home taken at the suggested times match the BP readings that are obtained in the clinic, then it is safe to assume that the medicines are working effectively and that no further adjustments are required or necessary.

Try and maintain a diary of your BP either on your phone or in a scribble pad. Use this diary to also record your day-to-day activities and dietary patterns. 

Show this to your doctor every time you visit them. It will help guide them on further management. Use an approved device that has a good reputation and review online. 

Dr. Vivek Baliga, Baliga Diagnostics, Bangalore

An accomplished medical professional, Vivek Baliga began his education at Sri Aurobindo Memorial School, located in Bangalore, India. Excelling in and out of the classroom, Dr. Baliga participated in the school's organized basketball team. Following grade school, he matriculated at Bangalore's National College Jayanagar.

Concentrating on pre-university science courses, Dr. Baliga continued playing sports and earned recognition as a badminton champion for his college in 1994.

After two years, Vivek Baliga successfully completed his studies and enrolled in Manipal Academy of Higher Education in 1995. Anticipating a career in medicine, Dr. Baliga pursued his Bachelor of Medicine, Bachelor of Surgery (MBBS) degree and graduated in 2000. 

During his time at the academy, he played on the basketball team, which clinched championships in 1999 and 2000. Today, he continues to play from time to time as a hobby. Loves the 3 points still!!!

Dr. Baliga continued to expand his education by working toward a doctorate with a focus on cardiovascular research. He is currently a member of the Royal College of Physicians and of the Indian Academy of Echocardiography, of which he is the secretary of the Karnataka Chapter.

 Since beginning his career, Vivek Baliga has published several articles in various medical journals. In 2009, he co-authored an article for Prescriber, a periodical devoted to prescribing and medicine management. His article concerned advice for managing acute coronary syndrome. 

His article on Diabetes and heart failure was the most downloaded article on Sage publications two years in a row.

Dr. Baliga also co-penned a piece for the American Heart Association regarding the effect of insulin receptor levels and other factors contributing to insulin sensitivity on the endothelial cells, a thin layer of cells found on the interior of certain vessels.

 Vivek Baliga also contributes to the medical community as a philanthropist. In 2011, he took part in the 10-kilometer Bupa Great Manchester Run, accepting donations for the Desk & Chair Foundation. He was also part of a team of doctors in Mangalore which provided education to teachers and children about malaria prevention.

Dr Vivek Baliga is  the author of a number of different articles across different medical specialties. He is an expert author on ezine articles, has published numerous article for his newsletter Sowkhya Magazine and has published articles in peer reviewed journals as well.

In addition to authoring number of articles online, Dr Vivek is also an expert author on Medlife.com. His articles are published on their blog and also in their patient magazine. You can also finding him tweeting health tips here.