Olivier S. DescampsPublished in the journal : September 2018Category : GRAPA
The "sneaky" aspect of the risk associated with high blood cholesterol given its asymptomatic nature before complications arise makes hypolipidemic treatment often problematic for our patients. This is especially so because the side effects that can occur such as myalgia and the polemics diffused through the media by some critics cause worry and doubts in our patients. In this article, we will discuss three of the most frequently encountered problems and how to address them.
The news from the GRAPA provide a summary of the presentations made at the 9th GRAPA symposium, with a focus on treatment adherence in the prevention of cardiovascular diseases, mainly in the areas of lipidology, diabetology, and rhythmology. The presentations also addressed related topics, such as therapeutic inertia, therapeutic education, empowerment, and the impact of treatment-related adverse events and media controversies on the initiation and continuation of cardiovascular medications. Finally, arguments for the control of cardiovascular risk factors in the prevention of atrial fibrillation, based on recent medical literature, are also presented.
Christophe ScavéePublished in the journal : November 2016Category : GRAPA
Cardiovascular diseases remain the principal cause of natural death worldwide. Besides the standard risk factors, there is also stress, an undervalued source of cardiac events. Among the underlying causes of stress, there are natural disasters, as well as terrorism, with the latter having now reached Europe. A recent study revealed that, following the attacks at Charlie Hebdo in Paris, the number of both sudden deaths and hospitalizations for cardiovascular events abruptly rose. Similar statistics were observed in the US after the 2001 attacks in New-York, or in the aftermath of a major earthquake in Los Angeles. As a result, the harmful effects of stress must be better assessed in order to enable us to minimize its impact on the individuals’ health.
Véronique GoddingPublished in the journal : November 2016Category : GRAPA
Smoking cessation is the most efficient step for reducing cardiovascular risk in smokers. Stopping smoking is associated with a decreased risk of stroke and hypertension, in addition to improving patients' lipid and inflammatory profiles. It also lowers the risk of developing Type 2 diabetes, along with improved diabetes control and lowered risk of complications. Smoking cessation has been shown to improve physical fitness, in association with a more balanced diet. It is therefore crucial to pay attention to active and passive smoking in cardiovascular risk factor management by means of the 5A rule.
Véronique MaindiauxPublished in the journal : November 2016Category : GRAPA
LDL-cholesterol is the major therapeutic target in the management of cardiovascular risk factors. Several dietary interventions showed significant improvements whilst lowering blood LDL-C levels, such as replacing atherogenic fats by unsaturated fats, eating plant sterols from enriched foods, increasing soluble fiber consumption, consuming unsalted nuts, and, at times reducing dietary cholesterol. When considered separately, each result seems modest. If we however associate the proposed dietary interventions, the results are cumulative, resulting in a greater impact on LDL-C levels that decrease by 20 to 30%. This is relevant for primary prevention and for target groups at the highest cardiovascular risk, thereby increasing the nutritional quality of the diet.
Michel P. HermansPublished in the journal : November 2016Category : GRAPA
For any diabetes type, glucose control aims to prevent microvascular complications. The speed of the β-cells' functional decline will guide the progressive or rapid initiation of lifestyle changes, supplemented by oral monotherapy, combination therapy, triple therapy (oral or injectable), and eventually basal or basal-prandial insulin administration. All currently marketed therapeutic classes can be used either alone or in combination, preference being given to medications with weight neutrality, free of hypoglycemic episodes, without deleterious effects on β-cells, and possibly with additional macrovascular benefits.
Michel P. HermansPublished in the journal : November 2016Category : GRAPA
Regardless of the diabetes type, glucose control aims to prevent microvascular complications. Besides acute metabolic decompensation settings, appreciation of this control is mainly based on determining past and current HbA1c levels while documenting the occurrence of hypoglycemia episodes. Recently, the Social Security has made available to Type 1 diabetes patients the continuous measurement of interstitial glucose by means of subcutaneous sensors. On account of this therapeutic advance, we have now to consider new statistics and glycemic targets based on ambulatory glucose profiles generated in this way, including the concept of time spent within the target area.
Olivier S. DescampsPublished in the journal : November 2016Category : GRAPA
Familial hypercholesterolemia (FH) is one of the most common fatal genetic diseases, affecting over 25,000 Belgians. It is responsible for very high cholesterol levels (> 300mg/dL) from birth, along with an increased risk of early vascular, cardiac, and cerebral complications, such as myocardial infarction and stroke, from the age of 30 years onwards in men and 40 in women. Cardiovascular complications may, however, be prevented by means of early diagnosis and proper treatment, ideally started in childhood.
A recent broadcast of the ARTE channel titled "Cholestérol: le grand bluff" was questioning one of the most solid pillar of cardiovascular prevention: the role of cholesterol in cardiovascular disease and the usefulness of the drugs lowering cholesterol to prevent this disease. It raised many reactions amongst our patients creating doubt on the justification of their treatment for their high cholesterol. To face such "denial" attitude, the Belgian Association of Patients with Familial Hypercholesterolemia (www.belchol.be) and the Belgian Society of Atherosclerosis (Belgian Society of Atherosclerosis) responded by sending a letter to the President and the Director of Arte as well as the Manager of the show. Louvain Medical reproduced here this letter.
Olivier S. DescampsPublished in the journal : November 2016Category : GRAPA
In recent years, prescription of antilipemic drugs, particularly statins, has been marked by various controversies, calling into question the patients' beliefs as to the rationale, efficacy, and usefulness of these treatments. Doctors also face regular complaints from their patients, especially of the musculo-articular type, which the patients tend to assign too readily to their statin treatment. As a result, over the past years, there has been a growing number of patients who abandon their antilipemic treatment, at times without medical advice. The adverse reactions caused by the drugs, along with the implementation of such beliefs, are rather challenging to the doctor, and this to such an extent that some physicians feel that, nowadays, it takes courage to prescribe a statin therapy, while being confronted to this public counter belief. This article attempts to address these issues, while providing a reply to the most-commonly raised accusations.