Patients with sepsis are at increased risk of stroke or myocardial infarction (heart attack) in the first 4 weeks after hospital discharge, according to a large Taiwanese study published in CMAJ (Canadian Medical Association Journal).
Sepsis accounts for an estimated 8 million deaths worldwide, and in Canada causes more than half of all deaths from infectious diseases.
Researchers looked at data on more than 1 million people in Taiwan, of whom 42 316 patients had sepsis, matched with control patients in the hospital and the general population. All sepsis patients had at least one organ dysfunction, 35% were in the intensive care unit and 22% died within 30 days of admission. In the total group of patients with sepsis, 1012 had a cardiovascular event, 831 had a stroke and 184 had a myocardial infarction within 180 days of discharge from hospital. Risk was highest in the first 7 days after discharge, with more than one-quarter (26%) of myocardial infarction or stroke occurring in the immediate period and 51% occurring within 35 days.
The commonly used painkiller diclofenac is associated with an increased risk of major cardiovascular events, such as heart attack and stroke, compared with no use, paracetamol use, and use of other traditional painkillers, finds a study published by The BMJ this week.
The findings prompt the researchers to say that diclofenac should not be available over the counter, and when prescribed, should be accompanied by an appropriate front package warning about its potential risks.
Diclofenac is a traditional non-steroidal anti-inflammatory drug (NSAID) for treating pain and inflammation and is widely used across the world.
But its cardiovascular risks compared with those of other traditional NSAIDs have never been examined in large randomised controlled trials, and current concerns about these risks make such trials unethical to conduct.
A new guideline for managing disorders of consciousness (people in a minimally conscious state) has been published in the journals Neurology(PDF) and Archives of Physical Medicine and Rehabilitation(PDF). The development of the new guideline was partially funded by ACL’s National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), and two of its co-authors are grantees in NIDILRR’s TBI Model Systems program.
The guideline provides recommendations to improve diagnosis, health outcomes, and care of people with these disorders. About four in 10 people who are thought to be unconscious are actually aware.
Consciousness is a state of being awake and aware of one’s self and surroundings. A person with a disorder of consciousness has trouble being awake, or being aware or both. People in minimally conscious state have behaviors that show they are conscious, such as tracking people with their eyes or following an instruction to open their mouths, but the behaviors are often subtle and inconsistent. A disorder of consciousness can be caused by a severe brain injury resulting from trauma, such as a fall, a car accident or sports injury. It can also be caused by a disease or illness, such as stroke, heart attack or brain bleed.
Bilirubin, a yellow-orange pigment, is formed after the breakdown of red blood cells and is eliminated by the liver. It’s not only a sign of a bruise, it may provide cardiovascular benefits, according to a large-scale epidemiology study.
A recent analysis of health data from almost 100,000 veterans, both with and without HIV infection, found that within normal ranges, higher levels of bilirubin in the blood were associated with lower rates of heart failure, heart attack and stroke.
The results are published in the Journal of the American Heart Association.
Several studies have suggested that bilirubin may have beneficial effects, by acting as an antioxidant or interfering with atherosclerosis. The data from the veterans adds to this evidence, and specifically looks at people living with HIV and at an anti-HIV drug, atazanavir, known to elevate bilirubin. The researchers did not see an independent effect of atazanavir on cardiovascular risk.
The ripple effects of childhood abuse extend well beyond the immediate time surrounding the abuse and can continue to cause significant disruption throughout a person’s life, even if on the surface things seem calm.
Studies show that so-called adverse childhood experiences – stressful or traumatic events including physical, emotional or sexual abuse and physical or emotional neglect – can raise the risk of everything from substance abuse and mental health issues to sleep disruption, obesity, heart attack and diabetes and even shortened lifespan. Research has found childhood abuse is associated with depression not only in kids, adolescents and young adults, but in later life as well.
“Time just doesn’t magically heal,” says Adria Pearson-Mauro, an assistant professor of family medical and psychiatry at the University of Colorado School of Medicine, and a clinical psychologist at CU’s Helen and Arthur E. Johnson Depression Center in Aurora. She says these kinds of threats and the impact they can have on neurodevelopment of someone who is abused as a child physically or sexually always matter. “It doesn’t become less important with age,” Pearson-Mauro says.
A diet created by researchers at Rush University Medical Center may help substantially slow cognitive decline in stroke survivors, according to preliminary research presented on Jan. 25 at the American Stroke Association’s International Stroke Conference 2018 in Los Angeles. The findings are significant because stroke survivors are twice as likely to develop dementia compared to the general population.
The diet, known as the MIND diet, is short for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay. The diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Both have been found to reduce the risk of cardiovascular conditions such as hypertension, heart attack and stroke.
Patients with peripheral artery disease (PAD) are at high risk of heart attack, stroke and cardiovascular death. In addition, PAD patients can suffer major adverse limb events, such as acute limb ischemia — the equivalent of a heart attack in the leg — that can lead to limb loss. Managing PAD is challenging for patients and physicians alike — despite best available treatment including high-intensity statins, risk of cardiovascular and limb events remains high. With few clinical trials focused on patients with PAD, physicians must often extrapolate from studies in broader populations with atherosclerosis about the best treatment approach for these patients. Unfortunately, few of these studies have characterized limb risk and fewer have demonstrated benefits of preventive therapies in reducing this risk. A new sub-analysis of the FOURIER clinical trial, however, now offers information on the safety and effectiveness of giving the PCSK9 inhibitor evolocumab on top of statin therapy to this high-risk population. At the 2017 American Heart Association Scientific Sessions, Marc Bonaca, MD, MPH, investigator at the TIMI Study Group and director of the Aortic Disease Center at Brigham and Women’s Hospital, presented results from the sub-analysis, which are published simultaneously in Circulation.
“Whenever trials like FOURIER demonstrate benefit of a therapy in a broad population, we then want to understand the efficacy and safety in subpopulations to help clinicians understand which patients are going to derive the greatest absolute benefit. We’ve found that several sub-groups of patients respond well to evolocumab, but it’s especially encouraging to see these results for patients with PAD since this is a population at heightened cardiovascular risk and there are few therapies that modify limb risk,” said Bonaca. “We see that adding evolocumab can make a big difference for these patients.”
Patients with a prior history of heart attacks or stroke have better outcomes when cholesterol-lowering medications are used after they’re discharged from the hospital, according to a new study from the Intermountain Medical Center Heart Institute in Salt Lake City.
Prior surveys in hospitals found that statins, a common medication prescribed to lower cholesterol, aren’t being used as consistently in patients who’ve been admitted to the hospital following a heart attack or stroke. Researchers also found that when the medication is prescribed, dosing is likely not as high as it should be to provide optimal benefits.
Researchers from the Intermountain Medical Center Heart Institute examined more than 62,000 records of patients from the Intermountain Healthcare system between 1999 and 2013 who survived an initial atherosclerotic cardiovascular disease event , such as a heart attack or stroke. They were then followed for three years, or until death, to identify the effectiveness of statin use prescribed at the time of their discharge.
If you have a heart attack or stroke, it’s important to get your “bad” cholesterol measured by your doctor on a follow up visit. Researchers have found that one step is significantly associated with a reduced risk of suffering another serious cardiovascular episode.
The new research, conducted by researchers at the Intermountain Medical Center Heart Institute in Salt Lake City, found that patients who don’t follow up with their doctor by getting a low-density lipoprotein (LDL) cholesterol test following a heart attack or stroke are significantly more likely to have a reccurrence.
Researchers found a significant and clinically meaningful difference in major adverse outcomes — including death, a heart attack, a stroke, and a vascular bypass or an angioplasty — based on whether or not a patient has a follow-up measurement of their LDL cholesterol.