Farhan Aslam

Peripheral Arterial Disease: Current Perspectives and New Trends in Management

Peripheral arterial disease (PAD) is defined as an arterial brachial index (ABI) of ≤0.90 in the lower extremities and results from a narrowing of the arteries as a result of progressive atherosclerosis. PAD affects 12–20% of Americans aged 65 years or older; however, most are asymptomatic and many do not seek treatment. Improved awareness and education in both the general population and among health care providers about these modifiable risk factors has the potential to improve general health and decrease morbidity and mortality secondary to atherosclerotic vascular disease.

Hyperlipidemia in Older Adults

Older adults carry the highest risk for coronary artery disease and the highest burden of atherosclerosis. Although most clinical trials of cholesterol-lowering therapy have not specifically targeted older persons, growing evidence supports treatment of elevated low-density lipoprotein cholesterol levels in older patients, especially those at high risk for coronary events. The decision to treat a high or high-normal cholesterol level in an elderly individual must be individualized based on chronologic and physiologic age. This article summarizes current data on lipid-lowering therapy in older adults and the management of hyperlipidemia in elderly patients.

The Frequency and Functional Impact of Overlapping Hypertension on Hypertrophic Cardiomyopathy: A Single‐Center Experience

J Clin Hypertens (Greenwich)

Patent foramen ovale: assessment, clinical significance and therapeutic options.

Foramen ovale plays an important function in the fetus but is of no physiologic significance after birth and closes in most individuals. In about one fourth of the population, however, foramen ovale remains open for life and has been associated with cerebrovascular accidents, especially in younger patients, presumably through paradoxical embolism. Patent foramen ovale (PFO) has also been associated with hypoxia, migraine headaches and neurologic findings of decompression illness in scuba divers. Availability of transesophageal echocardiography and its frequent use in the management of patients with stroke has lead to frequent detection of PFO. In addition, the recent development of devices and techniques for percutaneous closure of PFO has resulted in widespread enthusiasm for such interventions, even when a clear etiologic role for PFO may not be established. In the United States, the Federal Drug Administration (FDA) has approved two such devices through compassionate investigational device exemption without adequate data from large randomized clinical studies. Other such devices are undergoing evaluation in clinical trials. Expert opinions have been helpful for clinical decision making in management of patients with PFO associated with stroke, hypoxia, decompression sickness and migraine headaches.

Hypertension Prevalence and Prescribing Trends in Older US Adults: 1999–2004

J Clin Hypertens (Greenwich). 2010;12:75–81. ©2009 Wiley Periodicals, Inc.

Geographic Variance of Cardiovascular Risk Factors Among Community Women: The National Sister to Sister Campaign

BACKGROUND There are substantial variations in cardiovascular disease (CVD) risk and outcomes among women. We sought to determine geographic variation in risk factor prevalence in a contemporary sample of U.S. women. METHODS Using 2008-2009 Sister to Sister (STS) free heart screening data from 17 U.S. cities, we compared rates of obesity (body mass index [BMI] ≥30 kg/m(2)), hypertension (HTN ≥140/90 mm Hg), low high-density lipoprotein cholesterol (HDL-C <40 mg/dL), and hyperglycemia (≥126 mg/dL) with national rates. RESULTS In 18,892 women (mean age 49.8 ± 14.3 years, 37% black, 32% white, 14% Hispanic), compared to overall STS rates, significantly higher rates were observed for obesity in Baltimore (42.4%), Atlanta (40.0%), Dallas (37.9%), and Jacksonville (36.0%); for HTN in Atlanta (43.9%), Baltimore (42.5%), and New York (39.1%); for hyperglycemia in Jacksonville (20.3%), Philadelphia (18.1%), and Tampa (17.8%); and for HDL-C <40 mg/dL in Phoenix (37.4%), Dallas (26.5%), and Jacksonville (18.1%). Compared to national American Heart Association (AHA) 2010 update rates, most STS cities had higher rates of hyperglycemia and low HDL-C. CONCLUSIONS In a large, community-based sample of women nationwide, this comprehensive analysis shows remarkable geographic variation in risk factors, which provides opportunities to improve and reduce a womans CVD risk. Further investigation is required to understand the reasons behind such variation, which will provide insight toward tailoring preventive interventions to narrow gaps in CVD risk reduction in women.

Heart failure in subjects with chronic kidney disease: Best management practices

Renal dysfunction is common in patients with heart failure (HF) and can complicate HF therapy. Treating patients with HF and kidney disease is difficult and requires careful assessment, monitoring and balancing of risk between potential benefits of treatment and adverse impact on renal function. In this review, we address the pathophysiological contexts and management options in this adversarial relation between the heart and the kidney, which exists in a substantial proportion of HF patients. Angiotensin converting enzyme inhibitors and β-blockers are associated with similar reductions in mortality in patients with and without renal insufficiency but usually are less often prescribed in patients with renal insufficiency. Careful monitoring of side effects and renal function should be done in all patients with renal insufficiency and prompt measures should be adopted to prevent further complications.