1. Update in Cardiology A Cardiologist’s Eye for the Primary Guy Abdul H Sankari Heartland Cardiovascular Center

2. CASCADE 15% OF SVG occludes within one year, and almost half is occluded within 10 years Intimal Hyperplasia is the foundation for graft disease Clopidogrel has been shown to inhibit Intimal Hyperplasia, and the subsequent platelet aggregation and activation cascade.

3. CASCADE There was an improvement in SVG patency at one year in the ASA+Clopidogrel group, although not statiscaly significant. Clopidogrel is recommended for the first 3-12 mo after CABG

4. Sleep and CV risk High correlation between bad sleep habits and CV risk factors (Higher cholesterol, higher BP, higher BMI, increased waist size) Adolescents with high consumption of fried food, soft drinks, sweets, caffeinated drinks, and exercised less had a higher sleep disturbances score. Parents should encourage healthy sleep habits (no Caffeinated beverages before sleep, limited media use before bed, strict bed time McCrindle B, et al; CMAJ, October 2012

5. Shift Work and CV Risk Shift workers who work outside of the regular daytime 9-5 hours have increased risk of MI (23%), ischemic Stroke (5%), and CV events (24%) Night shift workers have the steepest increase in the risk of Coronary Events (41%) Previous studies also noted increased incidence of Hyperlipidemia, Hypertension, and Diabetes in shift workers Vyas MV, Garg AX et al. BMJ 2012; DOI 10.1136/bmj

6. BB of No Use in Stable CAD The REACH registry found no advantage for BB in close to 45,000 pts without Heart Failure (31% with prior MI) on reducing cv death, stroke, and non-fatal MI In pts with CAD, without LV dysfunction, who can not tolerate beta blockers, it could be stopped after 1 year without significant effect on outcome. AHA guidelines puts BB in CAD as a class II-b recommendation Bangalore S, PHG S, et al; JAMA 2012; 308:1340-1349

7. ASA for Primary Prevention Meta Analysis revealed that the risk of bleeding outweighs the benefits of reducing incidence of Cancer and Cardiovascular events ASA reduced the risk of CV events by 10%, and increased the risk of non-trivial bleeding y 30% ASA is still recommended for pts with a CHD risk of more than 1% per year Kausik R, Archives of Internal Medicine, January 2012

8. Statins For Primary prevention ? JUPITER showed a 27% increase in incidence of DM PROVE – IT showed that high dose Atorvastatin worsened glycemic control FDA now had changed the PI of the statin drugs to include reversible cognitive For every 100 patients who take Statins for five years, CV event will be prevented in 1 pt, and DM will occur in one pt Consider use of CAC score to guide therapy JAMA, April 2012, 307:1489-1490