What’s new in vascular risk?

Highlight: EPCCS satellite symposium held at WONCA meeting in September 2008 in Istanbul

Session moderated by Dr Bjorn Gjelsvik (Sweden), Dr Carlos Brotons (Spain)
Speakers:
- What’s new in hypertension? Thierry Christians
- What’s new in stroke and AF? Richard Hobbs
- What’s new in hyperlipidemia? Richard Hobbs
- What’s new in CVD Prevention Guidelines? Edmond Walma

What is new in hypertension in 2007-2008?

Four important questions were answered regarding the use of drugs, home-monitoring and sodium intake.
First, paracetamol appears to cause secondary hypertension (HT) since people who use of paracetamol 6 to 7 days per week showed a relative risk for incident HT of 1.34 (95% CI 1.00-1.79; P=.01 for trend) compared with nonusers.
Second, the association of anti-HT drugs was discussed and incident diabetes appears to be lowest for ARB and ACE inhibitors, followed by CCB and placebo, beta-blockers and diuretics in rank order.
Third, home monitoring was found to be important as it mostly lower BP values and gives a better correlation with CV morbidity and mortality. This has implications for general practice.
Finally, long-term dietary sodium reduction decreased cardiovascular morbidity by 25%, with a non-significant lowering of total mortality.

Read more...

Highlight: EPCCS satellite symposium held at WONCA meeting in September 2008 in Istanbul

What's new in atrial fibrillation and stroke?
Atrial fibrillation (AF) is the most common cause of arrhythmia. The prevalence of AF is 1% in the general population and increases with age. For example, at the age of 65 over 5% of the population has AF and this percentage increases to 10% at the age of 75 years.
Depending on the duration of the fibrillation, three types are distinguished. Persistent forms last over seven days, permanent ones over a year and paroxysmal forms stop within 48 hours without treatment but may come back.
Symptoms include palpitations, lack of energy, dizziness, chest discomfort and shortness of breath. Sometimes the disorder is asymptomatic.
An irregular pulse can be detected in AF. Diagnosis is best made by an (holter) ECG. Treatment consists of rhythm control (drugs, ablation or cardioversion), rate control (pacemakers and drug) and thromboprophylaxis.

Atrial fibrillation is a risk factor for the development of stroke as it increases the risk of stroke 5-fold. The annual risk of stroke is 5%. Fibrillation causes relative stasis of blood in the heart, which in turn may result in clot formation. If this clot embolises, this could result in a stroke. Of all patients with a stroke, 15% have fibrillation. After an initial stroke, the risk for recurrence is 12% per year and the annual risk of death is 5%. Factors that increase the risk for stroke in AF are congestive heart failure within 100 days, hypertension, age over 75 years, diabetes mellitus and a prior stroke or TIA. AF also has a secondary impact on stroke. It increases the mortality of stroke by 70%. In addition, it increases the duration of hospital stay, decreases the chance of returning home by 40%, increases residual disability and silent cerebral infarctions. Treatments available to reduce stroke are oral anticoagulants such as warfarin, which reduces the blood clot size, and aspirin, which makes the platelets less sticky. The number needed to treat in primary prevention is 32 and in secondary prevention it is 12 for oral anticoagulants.

Direct comparison of oral anti-coagulants vs. aspirin in 7 trials with more than 4000 patients with AF yielded that the first medication is superior. In the group of patients on warfarin there were significantly less cases of stroke and other cardiovascular events. The rate of (vascular) death was similar in both groups. In the oral anticoagulant group there were significantly more bleedings. To overcome this problem, tight regulation of the INT between 2 and 3 is needed.