Eggs Galore.....

Limiting egg consumption has little effect on cholesterol levels, research has confirmed. A University of Surrey team said their work suggested most people could eat as many eggs as they wanted without damaging their health." The researchers said that previous warnings to limit egg consumption are "based on out-of-date evidence," and "eating saturated fats was far more likely to cause health problems." Researcher Professor Bruce Griffin said, "The ingrained misconception linking egg consumption to high blood cholesterol and heart disease must be corrected.

What Now for Vytorin? In? or Out?

Not too long ago Vytorin which is a combination of simvastatin and ezitimibe was lambasted after a negative study with the ENHANCE trial showing no proof of plaque regression despite a significant reduction in LDLc. It may have been a faulty study for which I think the study investigator maybe pushing this drug too much that their baseline thickness of the carotid intima maybe considered normal to start with......how can you expect further improvement when your baseline is already almost normal? It would have been better if they looked at a longer term trial comparing reduction of LDLc with inhibition of plaque progression rather than regression. I have always deep inside me believe that this was a flawed trial right from the beginning and I have continued to use the drug most importantly to my severely hyperlipidemic patients waiting for more proofs.

In medicine, our dictum is to do no harm. We have not seen harm done on patients with vytorin...that one study showed us that it " may " not be doing what it is supposed to do. We also need to mention that Simvastatin which is the statin component of vytorin has tons of proofs for the benefit our patients get from the drug hence, it just does not make sense why additional reduction of LDLc could hurt our patients?

Recently, the SANDS trial ( Stop Atherosclerosis in Native Diabetes Study) published in the Journal of the American College of Cardiology December 2008, a 36-month study, looking at regression in carotid intima in the diabetics showed that aggressive LDL reduction with ezetimibe + a statin or statin alone noted in patients with Type 2 diabetes mellitus was associated with a similar regression in carotid intima thickness. This is surely a a positive news and a welcome respite for this drug and a good reassurance not only to the medical practitioners but patients alike who got confused with earlier study results.

State of the Art in Cebu!

Finally the wait is over, our patients can now avail of the state of the art technology right at the heart of Cebu City. As Director of the Cebu Doctors' University Hospital Cardiac Catheterization Laboratory, I am proud to introduce our new GE Innova 2100 Flat Panel cardiac catheterization machine. This state of the art laboratory being made available to patients in the Visayas and Mindanao.

Cebu Doctors' University Cardiovascular Center is considered to be the most active cardiovascular center in Cebu City. This new laboratory would embolden our patients to take the right choice for their cardiovascular needs because they know we don't take their health for granted investing in high end machine to provide accurate and reliable result. We do various procedure including left and right heart catheterization, pacemaker implantation, hemodynamic studies, coronary angiography as well as percutaneous coronary intervention including surgical coronary bypass procedures, valvular replacements and many more.....

For more information, comments, or inquiries, please email me at: EdgarTan62@yahoo.com.

PCI vs CABG: Is it really an option?

In the real world, coronary disease remains to be the most prevalent cause of cardiovascular mortality and morbidity. The treatment options have continued to evolve especially with the rapid advances in percutaneous intervention blurring the difference between which form of therapy is better for a particular patient. The evolution of drug-eluting stent blurs the once mighty benefit of surgical bypass to the issue of lower incidence of repeated intervention rather than the hard end points of myocardial infarction and death.

PCI saves lives in acute coronary syndrome, these are patients brought to the emergency room with acute chest pains due to ischemia.

PCI has never been shown by various studies to be superior to optimal medical therapy in preventing MI in the stable patient. PCI in the setting of stable patient is best reserved for those that remain symptomatic inspite of maximal medical therapy.

Diabetics are a special group of patients at risk for repeated intervention if percutatneous intervention is employed hence, diabetics as a rule are best served with coronary artery bypass surgery rather than PCI. There are always exeption to the rule hence, an office discussion with your physician maybe warranted in this regard.

I will be giving a talk on revascularization options for patients with coronary artery disease during the Philippine Heart Association Post Graduate course on February 8, 2008 at the Waterfront Hotel, Cebu City. Feel free to email me at EdgarTan62@yahoo.com for any quesitons.

Mitral Valve Prolapse: No longer indicated for Endocarditis Prophylaxis

A recent update from the Amecian Heart Association convention is the exclusion of MVP (Mitral Valve Prolapse) with or without Mitral Regurgitation as an indication for Subacute Bacterial Endocarditis prophylaxis. Preventing disease based on lifetime risk is no longer a justified mode of approach to these subset of patients. Prophylaxis in preventing valvular infection is reserved to the higher risk groups of patients e.g. prosthetic valves etc. etc.

Homocysteine and CAD: Are Folates Protective?

Homocysteine levels have been associated with coronary artery disease (CAD) however, after the Western Norway B-Vitamin Intervention Trial (WENBIT) failed to find protective effects of vitamin B supplementation especially with Folates and Vitamin B6, known to reduce homocysteine......the relationship remained just as it is "An Association", with no causal relationship between CAD and Homocysteine.

The Study included 3090 patients with established CAD randomized into vitamin B6 alone, Folic + Vitamin B12, Folic + Vit. B6 and B12 followed for 38months. Inspite of the lowering of folate by 28% in the folate group and unchanged in the non-folate group, there were no observed protective benefits in terms of reducing cardiac hard end points (MI, ACS and cardiac death)

This trial confirms the findings of similar trials in the past and may just be the last nail on the coffin regarding vitamin B supplementation as a secondary prevention for cardiac heart events.

It's SIESTA TIME!

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A recent study in Greece published in the Annals of Internal Medicine showed that siesta is good for the heart. They studied 23,681 apparently normal and healthy population and their behaviors regarding siesta time.

They were followed up for 6.3yrs and after controlling for cofounders, they found that those who regularly take a 30minute siesta at least 3x/week had a 37% lower mortality rate compared to those that did not. Those irregularly taking siesta defined as those taking less than 3x/week had a 12% risk reduction only. There is an inverse relationship between siesta time and major adverse cadiovascular effects. This maybe explained by the lowered sympathetic response during the rest period..

This data seems to suggest that lifestyle modification should not only include dietary modification, BP control, lipid control and regular exercise but also a regular dose of rest as well. Naps make us feel reenergized and obviously with this study there is more to it and that siesta is at least safe.