CT angiography of the chest is becoming an excellent alternative to coronary angiogram to diagnose heart disease.
TITLE
Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease: JACC State-of-the-Art Review.
JOURNAL
Journal of the American College of Cardiology
DOI
10.1016/j.jacc.2021.06.019
Author(s)
PW Serruys;H Hara;S Garg;H Kawashima;BL Nørgaard;MR Dweck;JJ Bax;J Knuuti;K Nieman;JA Leipsic;S Mushtaq;D Andreini;Y Onuma
Abstract
Coronary computed tomography angiography (CTA) has shown great technological improvements over the last 2 decades. High accuracy of CTA in detecting significant coronary stenosis has promoted CTA as a substitute for conventional invasive coronary angiography in patients with suspected coronary artery disease. In patients with coronary stenosis, CTA-derived physiological assessment is surrogate for intracoronary pressure and velocity wires, and renders possible decision-making about revascularization solely based on computed tomography. Computed tomography coronary anatomy with functionality assessment could potentially become a first line in diagnosis. Noninvasive imaging assessment of plaque burden and morphology is becoming a valuable substitute for intravascular imaging. Recently, wall shear stress and perivascular inflammation have been introduced. These assessments could support risk management for both primary and secondary cardiovascular prevention. Anatomy, functionality, and plaque composition by CTA tend to replace invasive assessment. Complete CTA assessment could provide a 1-stop-shop for diagnosis, risk management, and decision-making on treatment.
What are lignans? Compunds found in plants that have some similarity to estrogens. Foods that contain lignans include flax seeds, sesame seeds, whole grain cereals and vegetables. Of note is that they can significantly reduce the risk of heart disease. Eat your vegetables!
TITLE
Lignan Intake and Risk of Coronary Heart Disease.
JOURNAL
Journal of the American College of Cardiology
DOI
10.1016/j.jacc.2021.05.049
Author(s)
Y Hu;Y Li;L Sampson;M Wang;JE Manson;E Rimm;Q Sun
Abstract
BACKGROUND: Evidence regarding lignan consumption in relation to coronary heart disease (CHD) risk remains limited and mixed.
OBJECTIVES: The aim of this study was to prospectively examine associations between lignan intake and CHD risk in U.S. men and women.
CONCLUSIONS: Increased long-term intake of lignans was associated with a significantly lower risk of total CHD in both men and women. Possible synergistic effects may exist between lignan and fiber intake in relation to CHD risk reduction, possibly through enhancing the production of enterolignans.
https://faiz.focalize.md/lignan-intake-and-risk-of-coronary-heart-disease/
Many patients are prescribed both aspirin and plavix. The combination can increase risks of GI bleeding and, as this study shows, there is an increased risk of intracranial hemorrhage. In our patient population it may be prudent to discontinue either aspirin or plavix.
TITLE
Intracranial Hemorrhage During Dual Antiplatelet Therapy: JACC Review Topic of the Week.
JOURNAL
Journal of the American College of Cardiology
DOI
10.1016/j.jacc.2021.07.048
Author(s)
ACT Ha;DL Bhatt;JT Rutka;SC Johnston;CD Mazer;S Verma
Abstract
Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 inhibitor is an established therapy for a broad spectrum of patients with cardiovascular disease. The ischemic benefit of DAPT is partially offset by its increased bleeding risk, with intracranial hemorrhage (ICH) being the most serious complication. Although uncommon (0.2%-0.3% annually), its cumulative burden can be substantial given the number of patients afflicted by cardiovascular disease worldwide. Patients with a history of stroke or transient ischemic attack harbor a particularly high risk for ICH when treated with DAPT. Prediction rules may assist clinicians when weighing the risk/benefit ratio of prescribing DAPT for patients with stroke/transient ischemic attack in the nonacute, ambulatory setting. Currently, there are no reversal agents that can rapidly and effectively reverse the effect of P2Y12 inhibitors in routine practice, although a reversal agent for ticagrelor is under clinical investigation.
