ABSTRACT
Pulmonary hypertension is a relatively common disorder that leads to right heart failure if untreated. Symptoms and signs of pulmonary hypertensionare often subtle and nonspecific. As a result a significant delay between the onset of symptoms and the diagnosis of pulmonary hypertension is common. Recently improved understanding of the pathophysiology of pulmonary hypertension leads to various treatment options that enable us to treat this disorder more efficiently.
ABSTRACT
Coronary artery disease (CAD) is one of the most important causes of morbidity and mortality worldwide despite considerable therapeutic advances that control the risk factors. Numerous clinical trials have shown an inverse association between high density lipoprotein cholesterol levels and the risk of coronary artery disease. So, high density lipoprotein has become a new therapeutic target after low density lipoprotein in the management of risk factors of coronary artery disease. In this review, we explore existing and future treatment strategies along with their benefits and failures which will guide our management strategy. HDL raising therapies showed very promising results in many clinical trials but larger clinical trials are ongoing.
ABSTRACT
Background : Postmenopausal women are at greater risk for coronary artery disease (CAD) than premenopausal women. This may be due to deprivation of estrogen, which acts directly and indirectly on the vasculature. In light of this finding the aim of the study was to find the relation of serum estrogen level with severity of atherosclerotic lesion and number of risk factors in CAD among postmenopausal women. Methods: One hundred postmenopausal women undergoing coronary angiography (CAG) were studied. Among them 50 patients with estrogen level <25 pg/ml constituted study Group I and another 50 postmenopausal women with >25 pg/ml constituted study Group II. Serum estrogen level was measured by radioimmunoassay. Other important risk factors like dyslipidaemia, diabetes mellitus, hypertension, family history of CAD, smoking and waist circumference were evaluated between the 2 groups of patients. CAG findings were analyzed by eye estimation and by Gensini score. Results: All the risk factors were significantly higher in Group I patients than that of Group II. Among the risk factors hypertension was most prevalent (64%) in Group I and dyslipidaemia (40%) in Group II. Multivariate regression analysis showed that serum estrogen was a strong and an independent predictor of CAD (p=0.001) when considered with other standard risk factors. Association between the angiographic severity of CAD and serum estrogen level were evaluated and negative correlation was observed, i.e. lower the serum estrogen level higher the vessel score. Conclusion: In postmenopausal women serum estrogen level is a strong & an independent predictor of CAD. It is also found that low estrogen group of postmenopausal women with CAD have more severe atherosclerotic lesions in comparison to the group with normal estrogen level.
ABSTRACT
Complementary and alternative medicine (CAM) refers to a broad set of health care practices that are not part of a country’s own tradition and are not integrated into the dominant health care system. Herbal remedies, dietary supplements, acupuncture, homeopathy, ayurveda, unani, traditional Chinese medicine, prayer, yoga and meditation are the common examples. CAM therapies often represent an enormous area of unregulated and widely practised therapeutics with an inadequate scientific literature. However, there is emerging evidence that some of the CAM therapies are effective in certain clinical conditions. Presently, throughout the world, there is rampant growth of CAM industries, and increasing number of reputed pharmaceutical companies are producing herbals and dietary supplements. Herbal products used for cardiovascular purposes include garlic, hawthorn, ginkgo, horse chestnut and arjun. These substances are often popularly believed to be ‘natural’, hence safe. But adverse reactions including deaths have been reported with some of the CAM products. There is also growing concern for significant drug interaction among commonly used herbals, dietary supplements and cardiovascular drugs. At present, CAM therapies may best be regarded as an adjunct to standard medical care. More scientific research and strict regulation by standard national and international authorities are needed to ensure their efficacy and safety in cardiovascular care.