Hair Loss is usually treatable and self-limited. Careful diagnosis of the type of hair loss will aid in selecting effective treatment. Reassurance is an important component of any treatment regimen.
As age is an independent risk factor for AF, the global burden of this condition is expected to increase with the aging population. The management and treatment of this common arrhythmia in older people has proven to be a dilemma for many, as they are a heterogeneous group of individuals complicated by the presence of functional, and social factors that contribute to their vulnerability, in addition to multimorbidity and polypharmacy; all of which need to be taken into account. It is also partially attributable to the lack of guidelines specific to this patient population.
There are conflicting data regarding whether statins predominantly
metabolized by CYP3A4 reduce the metabolism of clopidogrel to its active
metabolite and diminish its clinical efficacy. Despite theoretic concerns and ex vivo testing suggesting a potential
negative interaction with concomitant clopidogrel and CYP3A4-MET statin
administration, there was no evidence of an interaction clinically in a
large placebo-controlled trial with long-term follow-up.
Our current treatment of hypertension is based on a sound understanding of pathophysiology and pharmacology and the data on which we base our current recommendations are solidly grounded in information from clinical trials. We clearly should be doing a better job, considering all of the safe and effective medications and lifestyle modifications available. Perhaps the increased use of fixed-dose combination therapy may make it easier for our patients to remember to take their pills and get them to the goal quicker and with less trouble. This should improve the rates of blood pressure control and ultimately accelerate the reduction in cardiovascular disease events attributable to hypertension.
The renin-angiotensin-aldosterone system (RAAS), when overexpressed, has
long been recognized as a significant contributor to CVD through
increases in blood volume and arterial pressure, fibrosis, a
prothrombotic state, and progression of vascular lesions. Angiotensin
receptor blockers (ARBs), which came into clinical use in the 1990s, are
important therapeutic agents for the treatment of CVD. The importance
of the pharmacological vascular changes brought about by various ARBs may be an important consideration in the choice of an agent, because
although controversial, their effect in BP lowering may be equivalent
across the drug class.
Recent clinical trials of glucagon-like peptide 1 receptor agonists
(GLP-1 RAs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors showed encouraging CV outcomes in T2DM patients, which are attributed to the diverse extra-pancreatic effects of these medications. This CME will discuss the CV benefits of the newer incretin-based
therapies and SGLT-2 inhibitors as observed in their CV safety trials.
Overweight and obesity are the most common medical problems seen in primary care practice.Obesity is a risk factor for several of the leading causes of preventable death, including cardiovascular disease, diabetes mellitus,
and many types of cancer. Thus, successful treatment and control of obesity should be major imperatives.
Gliptins have been of interest in the elderly population because they do
not cause postprandial hypoglycemia, attributed to hyposecretion of
GLP-1. Gliptins have a promising role in the control of T2DM, decreasing A1C
without hypoglycemia or weight gain, and with no obvious adverse effect
on cardiovascular outcomes. They appear to be safe in the T2DM elderly
Gliptins represent a novel class of agents that improve beta-cell health and suppress glucagon, resulting in improved post-prandial and fasting hyperglycemia. They function by augmenting the incretin system (GLP-1
and GIP) preventing their metabolism by dipeptidyl peptidase-4 (DPP-4).
Not only are they efficacious but also safe (weight neutral) and do not
cause significant hypoglycemia, making it a unique class of drugs.
The syndrome is the consequence of disruption of a vulnerable coronary
artery plaque, complicated by intraluminal thrombosis, embolization, and
varying degrees of obstruction to perfusion.
The severity of coronary arterial obstruction and the volume of
affected myocardium determine the characteristics of clinical
presentation. Patients with complete occlusion may manifest ST segment
elevation infarction if the lesion occludes an artery supplying a
a substantial volume of the myocardium, but the same occlusion in the presence
of extensive collateralization may manifest as infarction without ST
segment elevation (non-ST elevation ACS).