Cardiovascular
Diseases
ju-boo lim
The most common cardiovascular diseases
(CVDs) seen today include coronary artery disease (CAD), hypertension (high
blood pressure), heart failure, arrhythmias, and stroke. Managing these conditions
without drugs involves lifestyle modifications and preventive measures that can
significantly reduce the risk and progression of CVDs.
These include coronary artery disease
(CAD) caused by atherosclerosis (plaque buildup in arteries). Patients normally
complain of chest pain (angina), shortness of breath, heart attack
However, before they get to CAD, the
most common we see would-be hypertension (high blood pressure). Many people
think and blame hypertension caused by genetic factors, and they give excuses
that they cannot do anything about this. But I think hypertension is mainly
caused by unhealthy eating such as excessive salt intake, lack of exercise, and
obesity. Often hypertension is asymptomatic but can lead to complications like
stroke and heart attack. If we can eat healthily, we can override the
expression of genetics if we think that hypertension is carried down by our
parents and there is nothing, we can do about this? Is this really true?
Blame our lifestyle and eating habits first, not our parents who have
nothing to do with the ways we live our lives.
CVD may lead to heart failure caused by
CAD, hypertension, cardiomyopathy, heart valve disease. The symptoms presented
are shortness of breath, fatigue, swollen legs, rapid heartbeat.
Another CVS is arrhythmia caused by
CAD, heart failure, electrolyte imbalances and medications which I shall
discuss shortly.
In arrhythmia or irregular heartbeats,
patient would complain of palpitations, dizziness, fainting, shortness of
breath
One of the most common of CVD is
cerebrovascular accident (CVA), brain attack) or stroke. This is caused by
a blockage or rupture of blood vessels in the brain. In a stroke there is a
sudden weakness or numbness, confusion, trouble speaking, severe headache
What would be the best methods to
manage and prevent cardiovascular diseases without drugs
Let’s have a look together.
First, is to adopt a health-protective
diet such as a Mediterranean diet rich in fruits, vegetables, whole grains,
lean proteins, and healthy fats (e.g., olive oil, nuts). Nutrition in the
prevention of almost all diseases is exceedingly important not just for
cardiovascular diseases or metabolic and endocrine diseases like diabetes
mellitus. This diet is associated with lower risks of heart disease. More
important is to reduce sodium intake. Limiting salt helps manage blood
pressure.
Limit also the consumption of saturated
and trans fats such as animal fats and margarine. Reducing these fats lowers
cholesterol levels. White, refined sugar is very deadly, according to Professor
John Yudkin who was the Chair of Nutrition at the University of London.
Sugar (sucrose) is the primary cause of coronary heart disease, and I
strongly support this theory.
In order to prevent CAD, it is also
important to increase fibre intake by consuming whole grains, fruits, and
vegetables. Intake of these foods help maintain a healthy heart.
Regular physical activity such as
aerobic exercise like walking, moderate running, cycling, or swimming for at
least 150 minutes per week. Consider also strength training,
muscle-strengthening activities at least twice a week or flexibility and
balance exercises to include yoga or tai chi to improve overall physical
health.
But importantly is weight management to
prevent overweight and obesity. Maintaining a healthy weight reduces the strain
on the heart and lowers the risk of hypertension, CAD, and diabetes.
We need also to consider a balanced
caloric intake to ensure that calorie intake matches energy expenditure to
prevent weight gain.
One of the other causes of CAD is
smoking besides the risk of developing lung cancer. Avoid tobacco since smoking
is a major risk factor for CVD. Quitting smoking reduces the risk
significantly. By this, I mean also to avoid second hand smoke as exposure
to second-hand smoke in crowded places where people smoke. Exposure to second
hand smoke also increases the risk of heart disease.
If you drink, moderate drinking is
strongly advisable. Alcohol consumption should be in moderation (up to one
drink per day for women and up to two drinks per day for men.
Another factor to prevent CAD is stress
management. Practicing relaxation techniques such as meditation, deep breathing
exercises, and mindfulness can reduce stress. Regular exercise too helps manage
stress and improve mental health.
Ensuring you have adequate sleep (7-9
hours per night) is crucial for heart health.
Regular checks on blood pressure are
preventive. Regular monitoring to ensure blood pressure remains within a
healthy range. Regular testing for blood cholesterol may be useful to maintain
healthy cholesterol levels although there is a lot of disagreement if high
cholesterol levels is the cause of cardiovascular disease
Does Cholesterol Cause Heart Disease?
https://scientificlogic.blogspot.com/search?q=cholesterol+does+not+cause+heart+disease
But I think diabetes screening would be
more useful as early detection and management of diabetes reduce the risk of
CVD.
But what are the larger scale
prevention strategies? I believe in education. Educate and raise
awareness. By this I mean understanding the risk factors and symptoms of CVDs
can lead to early intervention and lifestyle changes.
We can also have Community Programs by
participating in community health programs that promote physical activity and
healthy eating. We can also have support networks by joining support groups for
smoking cessation, weight loss, or stress management can provide motivation and
resources.
We can have public policies. We can
advocate for policies that promote healthy environments, such as smoke-free
zones, availability of healthy food options, and safe spaces for physical
activities.
By adopting these lifestyle changes and
preventive measures, individuals can significantly reduce their risk of
developing cardiovascular diseases and manage existing conditions more
effectively without relying solely on medications. Prevention is always better
than cure.
But what if CVD has set in and
medication is needed.
Let us now look at the treatment aspect
using drugs and medication that I strongly would try to avoid. But let us say
drugs are now needed to manage cases of CVD. Let’s have a short discussion
about the use of various vascular drugs.
Treating cardiovascular diseases
involves a range of medications, each targeting different aspects of heart and
blood vessel function. The various kinds of drugs used, including their
dosages, advantages, disadvantages, and effectiveness.
There are antihypertensives drugs to
manage hypertension. Examples of these would include:
Angiotensin-Converting Enzyme (ACE)
Inhibitors such as Lisinopril, Enalapril, Ramipril. The dosage for Lisinopril
is 10-40 mg once daily, Enalapril is given at 5-40 mg once daily or divided
doses and Ramipril titrated at 2.5-20 mg once daily
The advantages is, it is effective in
lowering blood pressure, improving heart function, and reducing the risk of
stroke and heart attack. The disadvantages with these drugs are they can cause
cough, elevated blood potassium levels, low blood pressure, and kidney
dysfunction. However, their effectiveness is high, particularly in patients
with heart failure or diabetes.
Then there are Angiotensin II Receptor
Blockers (ARBs) such as the popular Losartan, Valsartan, or combined with a
diuretic such as hydrochlorothiazide as in Co-Diovan used to treat high blood
pressure. Another example of antihypertensive is Telmisartan The dosage for
Losartan is 50-100 mg once daily, Valsartan is 80-320 mg once daily and
Telmisartan (rarely used) is 20-80 mg once daily.
The advantage with this medication is,
they can lower blood pressure and risk of heart failure, with fewer side
effects than ACE inhibitors. The disadvantages are, they may cause dizziness,
elevated blood potassium, and kidney dysfunction. The effectiveness is similar
to ACE inhibitors, often used as an alternative.
We also have beta-blockers such as
Metoprolol, Atenolol, Carvedilol. The dosages normally prescribed are
Metoprolol at 50-200 mg once daily, Atenolol given at 25-100 mg once daily and
Carvedilol given at 12.5-50 mg twice daily
The advantages with these drugs are
they reduce heart rate, blood pressure, and risk of heart attacks; improve
survival in heart failure patients. The disadvantages are they can cause
fatigue, cold extremities, depression, and sexual dysfunction. Their effectiveness
is high, especially post-heart attack and in heart failure management.
Cholesterol-lowering drugs are the
statins groups. These include (examples) Atorvastatin, Simvastatin,
Rosuvastatin The dosage for Atorvastatin is 10-80 mg once daily, Simvastatin
given at 10-40 mg once daily and Rosuvastatin at 5-40 mg once daily. Lipitor is
another commonly used statin. The dosage for Lipitor is between 10 – 20 mg once
a day preferably at night when cholesterol is mostly synthesized by the liver.
These statins significantly lower LDL
cholesterol, reduce risk of heart attack and stroke.
The disadvantage with statins is, they
can cause muscle pain, liver enzyme elevation, and increased blood sugar
levels. Their clinical efficacies are very high in preventing cardiovascular
events.
Sometimes Ezetimibe is also being
prescribed elsewhere. The dosage is 10 mg once daily This drug also reduces LDL
cholesterol by inhibiting absorption in the intestines.
However its disadvantage is, it can
cause gastrointestinal issues and muscle pain. It is often used in combination
with statins for better effectiveness. I think most doctors would not bother to
monitor the liver enzyme levels when they prescribe all these statins because
these statins can damage the liver. I would strongly advise conducting liver
function tests when we use statins for at least the first few months, and
perhaps at 6 months intervals after that. We must not assume using all these
drugs are safe without monitoring. All drugs are chemicals and are poisons and
they can cause acute reactions or accumulative poisoning especially used for
chronic disorders over long term.
Next, we come to the antiplatelet
agents. The most common is aspirin given at 75-325 mg once daily. However,
there are 100 mg presentation tablets that can be used especially at night
after dinner.
Aspirin can reduce the risk of heart
attack and stroke by preventing blood clots. However, the disadvantage with
aspirin is, it can cause gastrointestinal bleeding and ulcers. Nevertheless,
aspirin effectiveness ranges from moderate to high, widely used for secondary
prevention.
Another antiplatelet agent is
Clopidogrel. This is prescribed for the prevention of blood clots, often used
in patients who can't take aspirin. Its disadvantages, like aspirin, the risk
of bleeding, gastrointestinal issues. Nevertheless, its effectiveness is high,
especially in combination with aspirin for certain conditions. The dosage for
Clopidogrel is 75 mg once daily. This can also be prescribed to prevent blood
clots, often used in patients who can't take aspirin. But there is also
the risk of bleeding and gastrointestinal issues.
Next, are the anticoagulants used for
CVD. An example is warfarin. The dosage is individualized based on INR
(International Normalized Ratio) monitoring, Warfarin advantages are effective
in preventing blood clots in conditions like atrial fibrillation and after
certain surgeries. But its disadvantages are, warfarin requires regular blood
monitoring, risk of bleeding, interactions with foods and other medications. In
short, warfarin effectiveness is high, but requires careful management.
Examples of other direct oral
anticoagulants (DOACs) are Apixaban, Rivaroxaban, and Dabigatran The dosages
for Apixaban is 2.5-5 mg twice daily, Rivaroxaban is 10-20 mg once daily and
for Dabigatran it is given at 150 mg twice daily. The advantage with these
three DOACs is, no regular blood monitoring is needed, fewer food and drug
interactions. But their disadvantages are, the risk of bleeding which is not
easily reversible in case of emergency. But its effectiveness is high, often
preferred over warfarin for ease of use.
But I think diuretics such as thiazide
diuretics should be considered as the first line of choice in the management of
CVD especially for hypertension.
Examples of water-throwing drugs are
hydrochlorothiazide and chlorthalidone
The dosages normally given for
hydrochlorothiazide is 12.5-50 mg once daily and for chlorthalidone is, 12.5-25
mg once daily
The advantages with diuretics are their
effectiveness in lowering blood pressure and reducing fluid retention. The
disadvantage with diuretics is, they can cause electrolyte imbalances,
dehydration, and increased blood sugar. Nevertheless, the effectiveness with
diuretics is high, and this should be first-line treatment for hypertension.
We can also consider using loop
diuretics Furosemide prescribed at 20 -80 mg once or twice a day, and
Bumetanide given at 0.5 – 2 mg once or twice a day are two examples with loop
diuretics.
These two are powerful diuretics,
effective in reducing oedema and fluid overload in heart failure. Like all
drugs there are disadvantages. With diuretics there is always the risk of
electrolyte imbalances, dehydration, kidney dysfunction. Despite that, its
clinical efficacy is very high in managing heart failure symptoms.
Next, we also have the calcium channel
blockers (CCB). Examples of CCB are Amlodipine, Diltiazem, Verapamil where
Amlodipine is prescribed at 5-10 mg once daily, Diltiazem given at 120-360 mg
once daily and Verapamil at 80-120 mg three times daily or extended-release
formulations
These agents lower blood pressure,
reduce chest pain (angina), and control heart rate.
But they can cause swelling,
constipation, dizziness, and heart rate irregularities.
Their clinical efficacy is quite high
for hypertension and angina, moderate for heart rate control.
There are also the nitrates such as
nitro-glycerine, and Isosorbide Mononitrate
Nitro-glycerine is normally given at
0.3-0.6 mg sublingually as needed for chest pain whereas Isosorbide Mononitrate
is prescribed at 20-60 mg once or twice daily
These nitrates relieve chest pain
(angina), improve blood flow to the heart. Unfortunately, they can cause
headaches, dizziness, low blood pressure, and tolerance with long-term use.
Efficacy for nitrates is high for angina relief, especially in acute settings.
I may say, the effectiveness of these
medications varies based on individual patient conditions and comorbidities. A
physician typically customizes the treatment plan to achieve the best outcomes,
balancing benefits and potential side effects. Regular monitoring and
follow-ups are crucial to ensure optimal effectiveness and safety of the
prescribed regimen. We normally consider benefit and risk ratios when we use
risky drugs.
But once again, I would strongly like
to emphasize on prevention rather than using all these drugs to solve a
problem. I don’t believe using drugs is the right way to acquire health.
All these drugs should be used last.
Prevention for most diseases,
especially for modern chronic lifestyle diseases also known as non-communicable
diseases (NCDs), are typically caused by a combination of genetic,
physiological, environmental, and behavioural factors that are best treated by
lifestyle changes. These diseases are long-lasting and often progress
slowly. The main chronic lifestyle diseases include:
Cardiovascular Diseases like coronary
artery disease, hypertension (high blood pressure), stroke, congestive heart
failure, diabetes mellitus. Type 2 diabetes and prediabetes, chronic
respiratory diseases such as chronic obstructive pulmonary disease (COPD) like
chronic bronchitis, emphysema, asthma should be treated by addressing their
root causes as first line management.
Not just CVD only but also cancers like
lung, breast, colorectal, prostate cancers, and even skin cancer (melanoma and
non-melanoma). Other lifestyle diseases are obesity, metabolic syndrome,
chronic kidney disease, liver diseases such as non-alcoholic fatty liver
disease (NAFLD), cirrhosis, arthritis like osteoporosis, osteoarthritis,
rheumatoid arthritis, mental health disorders such as depression, anxiety
disorders, not forgetting neurological disorders (examples are Alzheimer's
disease and Parkinson's disease), and gastrointestinal diseases (examples are,
irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), including
Crohn's disease and ulcerative colitis).
These diseases are often influenced by
lifestyle factors such as diet, physical activity, tobacco use, and alcohol
consumption. Prevention and management typically involve lifestyle changes,
such as adopting a healthy diet, regular physical activity, maintaining a
healthy weight, avoiding tobacco use, and limiting alcohol consumption.
Even if a patient is on medication for some form of cardiovascular disease,
that does not mean he cannot change his dietary lifestyles or engage in some
light physical activities, such as tai chi and qigong, indulges in stress management and mediation, perhaps
not strenuous exercise if he suffers from or has a history of coronary heart
disease where there may be a risk here:
https://scientificlogic.blogspot.com/2024/07/do-you-think-exercise-and-jogging-are.html
He may even
benefit from these activities even if he suffers from heart block.
Heart block does
not mean the coronary vessels of the heart are blocked by fatty plaque buildup.
That is arteriosclerosis, not heart block. Heart block, also known as
atrioventricular (AV) block, is a condition where the electrical signals that
control the heartbeat are partially or completely blocked as they travel from
the atria (upper chambers of the heart) to the ventricles (lower chambers).
This disruption can cause the heart to beat irregularly and more slowly than
normal. Heart block is classified into three main degrees based on the severity
of the block.
First-degree heart block is the mildest
form where electrical signals are slowed but still reach the ventricles. The
ECG characteristics show prolonged PR intervals (greater than 0.20 seconds)
without missed beats. Often asymptomatic; typically discovered incidentally
during an ECG.
In the second-degree heart block some
electrical signals from the atria fail to reach the ventricles. In the
second-degree heart block, there are two types. There is the Mobitz Type I
(Wenckebach) in which the ECG characteristics show progressive lengthening of
the PR interval until a beat is dropped. The patient is often asymptomatic but
may cause dizziness or palpitations. In the Mobitz Type II, the ECG shows
sudden dropped beats without a change in PR interval length. More likely to
cause symptoms such as dizziness, syncope (fainting), and can progress to
complete heart block.
Third-degree (complete) heart block
shows no electrical signals reach the ventricles from the atria. The atria and
ventricles beat independently of each other. The ECG shows no relationship
between P waves and QRS complexes; atrial rate is faster than the ventricular
rate. This can cause severe symptoms such as fatigue, dizziness, syncope, and
can be life-threatening.
Dietary changes, physical activity,
control of body weight, stress reduction themselves can bring about tremendous
changes for the better to his existing cardiovascular problems. It may not be
surprising that he may no longer need any more medication if he takes the
trouble to institute all these health promoting changes. Take heed, the body has
amazing ability to heal itself if not continuously injured by harmful living
and destructive exposures such as consumption of harmful foods, excessive eating,
contacts with chemicals, intake of unnecessary drugs and medication, exposure
to infective agents, radiation, free radicals, smoking, constant trauma and injuries
from external and internal stress, etc. Once these injurious agents are
removed, the body begins to repair itself from the damages especially if we can
stimulate, massage, needle, coax, nourish and rest it. By and by the body restore
itself, till finally we may no longer need any of those medication that do not cure
or heal anything
As a former senior medical researcher
and a clinician, I would place prevention of all these NCDs first rather than
trying to look for a “cure” using all these drugs that are actually chemicals
that the body tries to break down and throw away into the urine.
I am not very happy and comfortable
using all these chemicals under the hidden and glorified name called “medicine”
to “cure” most of our modern lifestyle diseases.
I hope my essays and efforts here and
elsewhere are useful and educational for everyone, including medical doctors
who are more interested in prescribing drugs and promoting all these chemical
pharmaceuticals the easy and short-cut way than addressing the root causes and
educating the patient.
References:
For further reading on medicines and
drugs here are a few:
1. The
Dilemma Between the Doctor, the Patient and the Drugs They Take
https://scientificlogic.blogspot.com/search?q=pharmacology
2. Ancient
Medicine and Modern Medicine: My Personal Experience
Scientific
Logic: Search results for history of medicine
3. Synthetic Drugs
vs Botanical and Herbal Medicines. Which is Better?
https://scientificlogic.blogspot.com/2024/05/my-brother-in-law-ong-geok-soo-senior.html
4. All
On Drugs. How Do They Work? Are They Safe?
https://scientificlogic.blogspot.com/search?q=emergency+drugs
Here are some other recent studies and
reviews on the clinical efficacy and dosage of various cardiovascular drugs:
1. Statins (Rosuvastatin vs.
Atorvastatin): The LODESTAR trial conducted in South Korea compared the
efficacy of rosuvastatin and atorvastatin in adults with coronary artery
disease. Participants were randomized to either a treat-to-target strategy with
titrated statin intensity to achieve LDL cholesterol levels of 1.3-1.8 mmol/L
or a high-intensity statin strategy irrespective of LDL levels. The trial
demonstrated that both statins effectively managed dyslipidemia, with
particular emphasis on adherence to the assigned statin type throughout the
follow-up period (BMJ).
2. Sacubitril/Valsartan
(Entresto): Sacubitril/valsartan has shown significant clinical benefits in
heart failure patients compared to valsartan alone. This combined therapy not
only improves heart failure symptoms but also reduces hospitalizations and
cardiovascular death. The shift from monotherapy to combination therapy has
marked an important advancement in cardiovascular pharmacotherapy (Frontiers)
3. Semaglutide
(Wegovy): The SELECT trial investigated the cardiovascular benefits of
semaglutide 2.4 mg in overweight or obese individuals without diabetes but with
established cardiovascular disease. The study found a 20% reduction in major adverse
cardiovascular events (MACE) compared to placebo. Semaglutide's safety profile
was consistent with previous trials, highlighting its potential to change
obesity treatment paradigms by reducing cardiovascular risks (Novo Nordisk).
These studies illustrate ongoing
efforts to optimize cardiovascular drug therapies, emphasizing tailored
treatment strategies to improve patient outcomes. For more detailed
information, you can access the full articles and reviews in the respective
medical journals and publications.
Take Care!
Jb
No comments:
Post a Comment