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November 2010 Archives:
November 19, 2010 -- 8:50am EST The Gene of Damocles -- Assessing Heart
Disease Risk They then performed genetic tests on these patients' existing blood samples to find if any of 11 genetic variants were present. Called single-nucleotide polymorphisms (SNPs) these variants have been found to be potential risk factors for heart attack. As a result, about one-third of the patients wound up being reclassified to a higher or lower risk category. Genetic information was used to alter the standard FRS. There's been much ado about adding new types of risk factor information to the Framingham formula: the SHAPE guidelines, for one, claim that a Calcium score, derived from a non-contrast CT scan, should be incorporated. Of course, the point of determining patients' risk factors for heart disease is to help them modify the risk factors that are under their control -- like stopping smoking, exercising more, etc. and also possibly starting certain courses of medication, such as statins. But the Mayo study reminded me of the "Sword of Damocles" -- a story related by the ancient Roman Cicero about a courtier Damocles who was given great fortune by being allowed to trade places with his king, except that a sword was positioned over the throne he sat on, suspended by a single strand of hair. Damocles soon gave up his new-found fortune, one moral of the story being: "There can be nothing happy for the person over whom some fear always looms". Studies have shown that stress is certainly a factor in heart disease. So, if one discovers that his or her genes are putting them at higher risk for a heart attack, a situation that really can't be altered, won't the negative stress from that knowledge be a Damocles' Sword and multiply the genetic risk factor's effect? I mean, sure, it might be motivational to get one to stop smoking, eat better, exercise more. But shouldn't we all be doing that anyway? Just sayin'.... « permalink » « send comment » « back to top »
November 1, 2010 -- 5:30pm EDT Did I (Cough!) Say ACE Inhibitors? (Cough!
Cough!) It is a provocative article because of the word "deceptive" in the title: the word indicates that patients and physicians are not being adequately informed about the incidence of a side effect of ACE inhibitors: the cough. And is that ever the case! The PDR and FDA labeling of the ACE inhibitor enalapril states that coughing has been reported as a side effect approximately 1.3% of the time. So your chances of getting a cough due to this drug are slightly higher than 1 in 100. So would you believe it's more than ten times that: almost 12 in 100? That's what this study shows. By doing a meta-analysis of 125 studies of ACE inhibitors that constituted 198,130 patients, the authors discovered that:
What this means is that when patients find they have this problem (coughing) and they call their doctors, they're told it might be a side effect of the drug, but that it only happens in 1 out of 100 patients. In reality, this study is saying that it is 1 out of 10: that this side effect of coughing is vastly under-reported. Anecdotally, if you search Angioplasty.Org for "ACE inhibitors cough" (hint: select "find all words") you will see how many patients have posted to our Forum with coughs. By the way, our Patient Forums get almost 40,000 pages accesses a month.) I understand the patient perspective on this; a number of years ago I was prescribed an ACE inhibitor -- and I developed a terrible cough. I had no idea what was going on, until I researched this side effect on "the inter-webs". |
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study in the current issue of The American Journal of Medicine confirms
what we've been telling heart patients on