: Peripheral arterial disease (PAD), being a manifestation of systemic atherosclerosis, carries a high risk of adverse cardiovascular events. Secondary medical prevention therapies of same magnitude as that for coronary artery disease (CAD) are recommended for PAD patients also. Available evidence indicates that this condition commonly remains underdiagnosed and undertreated. There is lack of any report about management of these patients in India. Objective: To characterize the atherosclerotic risk factor profile and pattern of drug prescription for patients of PAD at a tertiary care teaching hospital and to compare this management with standard guidelines. Material and methods: Data were collected from prescriptions of patients attending CTVS OPD with diagnosis of atherosclerotic PAD from July 2012 to Jun 2013. Results: One hundred twenty prescriptions were analysed. The mean age (± SD) of patients was 53 ± 7.18 years and 23.3% were females. History of smoking, either past or present, was present in 91.6% patients. History of ischemic heart disease was present in 25% while 26.7% patients were diabetic. Mean number of cardiovascular risk factors was 2.6. The percentage of eligible patients who were receiving a particular drug was 100 % for aspirin and statins, 48.3% for ACE inhibitors, 46.7% for beta blockers and 66.7% for cilostazol. Conclusion: The vascular surgeons of this centre are using antiplatelet agents and statins adequately for PAD. The prescription of ACE inhibitors, beta blockers and cilostazol is low. Exercise therapy and smoking cessation need more attention. Introduction Peripheral arterial disease (PAD) is a common disorder which affects large populations of adults worldwide. It most commonly... ... middle of paper ... ...entoxyphylline) was recorded. Prescription of drugs for other purposes (e.g. antacids, analgesics or antipyretics, multivitamins) was not recorded. Assessment of eligibility for drugs: Each prescription was analysed for eligibility for drugs for modification of atherosclerotic risk factors (aspirin, ACE inhibitors, beta blockers and lipid lowering drugs) and for drugs for intermittent claudication (cilostazol and pentoxyphylline). Eligibility was decided based on ACC/AHA and TASC-II guidelines for management of patients of PAD.[11, 12] All patients were considered to be eligible for aspirin, ACE inhibitors, lipid lowering drugs and cilostazol. In addition, patients with history of ischemic heart disease (IHD) were considered as eligible for beta blockers. Patients were considered eligible for pentoxiphylline only if cilostazol was contraindicated / not tolerated.
A 46-year-old Hispanic man presented to the clinic for a routine physical and a review of his recent laboratory studies. His medical history was significant for high cholesterol. His daily medication regimen included a multivitamin, aspirin 81 mg, and simvastatin (Zocor) 40 mg for high cholesterol. His family history was remarkable for type 2 diabetes, hypertension, and hyperlipidemia in his mother, maternal grandmother, maternal aunt, and maternal uncle. Physical examination revealed a height of 69 inches, weight of 199 pounds, body mass index (BMI) of 29.4 kg/m2, waist circumference of 36 inches and blood pressure of 125/72 mm Hg. Initial laboratory results were: total cholesterol 195 mg/dL; triglycerides 136 mg/dL; low-density lipoprotein cholesterol (LDL), 124 mg/dL; high-density lipoprotein cholesterol (HDL), 44 mg/dL; and fasting plasma glucose (FPG), 119 mg/dL. Complete blood count, renal function and liver function tests were all normal. Additional studies included an oral glucose tolerance test (OGTT) of 157 mg/dL and hemoglobin A1c (HbA1c) of 5.9%. The patient’s physical exam was unremarkable with no abnormalities noted.
Ischemic Stroke is caused due to a blood clot in an area of the brain, leading to loss of neural function if last for more than 24 hours. In the United States, ischemic stroke affects 2.7% of men and 2.5% of women of age range 18 years and older. In addition, it has reported that annually about 610,000 and 185,000 of new strokes and recurrent strokes cases occur in US1. Moreover, it has reported that patients who have suffered from a stroke have more chances of recurrent stroke, Myocardial infarction, and death from vascular causes2. One of the risk factor of ischemic stroke is formation of plaque in the blood vessels causing blood clot3. Several randomized trials have also reported that antiplatelet medications are efficient in preventing recurrences of stroke in patients who had an incident of ischemic stroke. Antiplatelet medications for preventing recurrences of stroke are aspirin, combination of aspirin and extended-release dipyridamole, and clopidogrel alone4. It ha...
“Chronic diseases and illnesses are the leading causes of death and disability in the United States” (CDC.gov, 2014). These types of illnesses are the most common health problems that people in this country face today and they are also the most preventable (CDC.gov, 2014). Every year the cost to help care for and manage people with these types of illnesses increases and there is less being done about educating people about prevention. Venous Thromboembolism is one such chronic disease that is very deadly but also very preventable if the right precautions are taken. This paper will aim to educate about the disease, courses and costs of treatment, clinical microsystems that are involved and what barriers if any exist to achieving generative relationships among the various clinical microsystems involved.
National Institutes of Health, Heart, Lung and Blood Institute, What is Peripheral Arterial Disease? (2011). Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/pad/
Coronary artery disease (CAD) is the most common type of multifactorial chronic heart disease. It is a consequence of plaque buildup in coronary arteries. The arterial blood vessels, which begin out smooth and elastic become narrow and rigid, curtailing blood flow resulting in deprived of oxygen and nutrients to the heart [1].
“If you’re at high risk for ischemic stroke, your doctor may prescribe drugs that reduce clots by interfering with the aggregation (clumping together) of blood cells called platelets” (Prevention of a Stroke 4). Your doctor would prescribe a specific type of medication called antiplatelet drugs. Anticoagulants (blood thinners), like antiplatelets, interfere with the formation of blood clots, but they work at a different stage in the clotting process- preventing the formation of fibrin, a protein that plays a role in blood clotting. “Statin medications lower blood cholesterol levels by blocking the activity of an enzyme crucial for the production of cholesterol by the liver. These medications also help stabilize plaques- the fatty deposits in arteries that can rupture and trigger the formation of a blood clot that can lead to a stroke” (Prevention of a Stroke 18). Statins are used to lower blood cholesterol levels and reduce inflammation in the artery walls. The medications your physician prescribes will depend on how great your risk of a stroke is as well as your risk of side effects from these
Whether it is Lipitor being used to lower cholesterol or aspirin to lower blood pressure, until the present, cardiovascular and heart diseases have been tackled by a variety of medications that address its various risk factors. However, this strategy focuses on secondary and tertiary prevention instead of heart diseases’ underlying causes. Yes, diabetes mellitus and hypertension have a concrete proven link to heart disease, but addressing them with medication only masks them and does not address the root of the problem.
... J. (2009). Heart disease and stroke statistics--2010 updated: a report from the American Heart Association. Journal of the American Heart Association. doi:10.1161/CIRCULATIONAHA.109.192667
(Novo 2012) In 2005, it was found that CVDs are responsible for the deaths of more than 17 million people each year, almost a third of total mortality rates, reported by the World Health Organisation (1, 2). The majority of these deaths were strongly related to Coronary Artery Disease of approximately 7.6 million. However, in the latter 15 years mortality rates in relation to CVD’s have significantly reduced according to age in develo...
Today, cardiovascular disease is “the number one killer in the United States and the developed world” (Sapolsky, 2004, p. 41). Coronary heart disease (CHD) is the most common form of cardiovascular disease, and is responsible for claiming an unreasonable amount of lives every year. CHD can begin to accumulate in young adults, but is prominently found in both men and women in their later adult lives. As a result of CHD, men typically experience heart attacks, whereas women present with chest pains, known as angina (Matthews, 2005).
Mcmurray, J. "Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: Putting guidelines into practice." HUG - Service de pharmacologie et toxicologie cliniques - Genève. The European Journal of Heart Failure, 5 July 2005. Web. 20 Mar. 2014.
More research should be done on new oral anticoagulants with different study population and similar patients that are seen in everyday clinical practice as well as attempt to define the best pharmacodynamic monitoring tools. Research should be conducted to outline monitoring protocol including timing relative to dosing and frequency as well as therapeutic targets. Using these strategies, future trials could enhance further the efficacy and safety of these new agents and could extend their use to new indications.
The American Medical Women's Association. Guide to Cardiovascular Health, New York, NY: Dell Publishing, 2009.
WILLIAMS, P and POULTER NR et al (2004) Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society. British Hypertension Society, pp. 139-85
The arteries supply blood rich in oxygen to the body, the veins direct deoxygenated blood from the capillaries back to the heart. These roles make up the circulatory function. Blood flow through these blood vessels can be disrupted resulting in peripheral vascular diseases. These diseases occur as a result of narrowing or blocking of the blood vessels. The risk factors of peripheral vascular diseases include diabetes, smoking, high level of cholesterol, overweight, high blood pressure etc. these risk factors result to aneurysms, Raynaud’s diseases, Buerger’s disease, renal artery disease etc. With this diseases, the peripheral vascular system should be assessed to enable nurses and other health personnel make good