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Selected Articles in Cardiology

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https://www.haaretz.co.il/news/health/new-research/.premium-1.4382244

A Doctor Recounts: Search the Web and Suffer a Heart

Attack

Many are influenced by unprofessional information that calls on people

to stop taking statins for reducing cholesterol, risking both disease and

death

09:15 August 24, 2017 Updated 09:16

Ran Kornowski

A., 58 years old, recently underwent an emergency heart catheterization

following a heart attack – in addition to the two catheterizations he had

already undergone. The coronary heart disease from which A. suffers erupted

13 years ago, at a relatively young age. At the time he smoked, was

overweight, and his blood cholesterol level was high. His family history was

also not encouraging: his father died of a heart attack at the age of 58.

Therefore, at some stage A. decided to stop smoking, to go on a diet (and

indeed – his weight loss was drastic), to engage in physical activity twice a

week and to take medications – among them cholesterol-reducing medication

from the statin family. These medications inhibit the activity of the enzyme

responsible for producing cholesterol in the liver.

Seven months before the heart attack A. encountered an article on the

internet about the “statin scam”. The article included an interview with

someone who is not a physician who supposedly claimed that statins have

side effects and do not contribute to the patients’ health. Without thinking

twice A. stopped taking the medication. The heart attack he suffered seven

months later was caused by a sclerotic layer that blocked the main coronary

artery (that supplies blood to the heart muscle). This layer was in effect an

excess accumulation of cholesterol on the arterial wall. Luckily A. did not

ignore the symptoms, came to hospital on time and underwent a life-saving

catheterization during which the artery was opened and a drug coated stent

(scaffold) was implanted. When admitted to the hospital A.s blood cholesterol

levels were very high. Several days after he was discharged from the hospital

he came to my clinic and asked if discontinuing the statin treatment had

caused the heart attack. I answered that most likely yes.

A. is one of the many cases I encounter recently. The deluge of

unprofessional information on the Internet has become a clear and immediate

danger. Current agreement in the medical community maintains that the

greater the reduction in the total blood cholesterol value, the greater the

reduced risk of developing a coronary event. Moreover, in contrast to the

contents flooding the internet, the values of the “good” cholesterol (HDL) and

the “bad” cholesterol (LDL) that require statin treatment are determined by the

leading cardiology associations in the world, among them the Israel Heart

Society. It is estimated that following the severe guidelines published by the

associations in recent years – that determine a more stringent threshold for

LDL values relative to the past, and accordingly for the patient’s profile –

about half the population of Israel above 50 years of age will need statin

treatment in the coming years in order to reduce cholesterol levels. This is the

case for primary and secondary prevention of cardiovascular diseases.

An extensive study, conducted with the participation of researchers from

Harvard Medical School and published last month in the Annals of Internal

Medicine, found differences in morbidity and mortality rates between patients

who had discontinued the use of statins because of their side effects and

those who nonetheless continued their use. The study analyzed the data of

patients treated with statins in a hospital in Boston in the years 2000 to 2011.

During this period more than 200 thousand adults were treated with these

drugs. Among them, 45 thousand reported side effects which they attributed

to the drug, mainly muscle pain and stomach aches. Of the 45 thousand, the

researchers focused on 28,266 patients; 19,989 of them continued to take

statins despite the side effects, while the others discontinued their use. About

four years after beginning to report side effects, 12.2% suffered a heart attack,

a stroke or passed away among those who continued to take statins. This in

contrast to 13.9% in the group of patients that completely discontinued their

use. This difference was found to be statistically significant. The researchers

note that the study has its limitations, among them inability to determine

whether the patients did indeed actually take the statins. Nonetheless, they

agree that the continued use of statins, despite the side effects, is related to a

lower frequency of cardiovascular diseases.

In summary, at-risk patients must make sure to take statins in order to

minimize the risk of morbidity and mortality.

Prof. Ran Kornowski is President of the Israel Heart Society, Director of

the Cardiology Department at the Rabin Medical Center and a full

professor in the Faculty of Medicine at Tel Aviv University.

 

Chief of Staff Medal of Courage

The dramatic decision of Gadi Eizenkot, the IDF Chief of Staff, to prohibit

the sale of cigarettes on IDF bases is expected to save the lives of

thousands of Israelis in the coming years. Now it is time to extend the

boundaries of the struggle against smoking and to apply the same

decision to high schools and academic institutions as well

By: Prof. Ran Kornowski

“For his decision, that has saved thousands of families in Israel, while acting

courageously and striving to save human life without unnecessary risk, we

recommend awarding a special medal of courage to Chief of Staff Gadi

Eizenkot”.

If a special public committee was convened to discuss the ramifications of the

Chief of Staff’s decision to prohibit the sale of cigarettes on IDF bases, it would

not be an exaggeration to say that this would be the statement it would issue.

As of July 2017, several days after the Chief of Staff’s decision, such a

statement has not been made, but this does not mean that it is not grounded in

reality. “The goal is an IDF clean of smoking” declared several days ago in the

Knesset, the Israeli parliament, Colonel Prof. Eilon Glazberg, Head of the IDF

Medical Services Department and IDF Deputy Chief Medical Officer. This is a

worthy and important goal.

To understand the dramatic significance of the decision we need to refer back

to the results of a comprehensive survey conducted several years ago which

revealed a 40% average increase in the number of smokers during army

service. This is an amazing finding which only serves to heighten the

importance of the Chief of Staff’s decision. In the U.S. by the way, smoking is

banned on most army bases, while in Israel, according to an internal IDF

survey, about 85% of the non-smokers are exposed to cigarette smoke during

their service.

It is important to understand: in addition to the severe medical risk that can

result, as noted, in death (smoking is responsible for the death of about

8,000 Israelis every year), smoking also inflicts huge economic damage of

hundreds of millions of New Israeli Shekels every year. After all, every patient

who needs medical treatment as a result of the health consequences of

smoking translates into enormous economic costs borne by hospitals and

health funds. Just imagine how many life-saving drugs that currently remain

outside the drug basket due to budget considerations could be included in the

basket if the number of smokers was cut by half.

If the Chief of Staff’s decision is indeed implemented, the significance is that

the exposure of thousands of soldiers to cigarette smoke will be cut drastically.

What’s more, and primarily, chances are high that many soldiers will stop

smoking and many others will not join those who do. Medically, this is in effect

the great blessing. Why? Because stopping to smoke under the age of 40

decreases the risk of death from a smoking-related disease by 90%. This is a

virtually unbelievable figure which points to the need to make a supreme effort

to bring young people to stop smoking.

Thus, after we praised and supported the Chief of Staff, I would like to call on

the Minister of Education, Mr. Naftali Bennett, to join the struggle against

smoking – that many times begins as early as the teen years. The fact that

there are “smoking corners” in many high schools in the State of Israel is a mark

of shame for the education system. Smoking should be nipped in the bud

already at an early age – since it is at these ages that the damaging habit

becomes a real addiction. Of course, as I see, the next step is a sweeping ban

on the sale of cigarettes on the premises of academic institutions as well.

Clearing the public space from smokers – even if we just make it harder for

them to obtain what they want – in effect means saving lives. As a cardiologist

I encounter innumerable cases daily which demonstrate the fact that smoking

increases the risk of heart attacks, cardiac arrest, stroke, peripheral vascular

diseases, etc. At the same time, in some cases stopping to smoke has rapid

effects (as in the case of coronary heart disease).

So whether or not a special committee is convened – IDF Chief of Staff Eizenkot

has already earned the medal of courage – mainly for having proven to all of

us that courage can be demonstrated not only on the battlefield.

The writer is the President of the Israel Heart Society and Director of the

Cardiology Department at the Rabin Medical Center - the Beilinson and Hasharon hospitals in Petah Tikva.

 

Chief of Staff Medal of Courage

The dramatic decision of Gadi Eizenkot, the IDF Chief of Staff, to prohibit

the sale of cigarettes on IDF bases is expected to save the lives of

thousands of Israelis in the coming years. Now it is time to extend the

boundaries of the struggle against smoking and to apply the same

decision to high schools and academic institutions as well

By: Prof. Ran Kornowski

“For his decision, that has saved thousands of families in Israel, while acting

courageously and striving to save human life without unnecessary risk, we

recommend awarding a special medal of courage to Chief of Staff Gadi

Eizenkot”.

If a special public committee was convened to discuss the ramifications of the

Chief of Staff’s decision to prohibit the sale of cigarettes on IDF bases, it would

not be an exaggeration to say that this would be the statement it would issue.

As of July 2017, several days after the Chief of Staff’s decision, such a

statement has not been made, but this does not mean that it is not grounded in

reality. “The goal is an IDF clean of smoking” declared several days ago in the

Knesset, the Israeli parliament, Colonel Prof. Eilon Glazberg, Head of the IDF

Medical Services Department and IDF Deputy Chief Medical Officer. This is a

worthy and important goal.

To understand the dramatic significance of the decision we need to refer back

to the results of a comprehensive survey conducted several years ago which

revealed a 40% average increase in the number of smokers during army

service. This is an amazing finding which only serves to heighten the

importance of the Chief of Staff’s decision. In the U.S. by the way, smoking is

banned on most army bases, while in Israel, according to an internal IDF

survey, about 85% of the non-smokers are exposed to cigarette smoke during

their service.

It is important to understand: in addition to the severe medical risk that can

result, as noted, in death (smoking is responsible for the death of about

8,000 Israelis every year), smoking also inflicts huge economic damage of

hundreds of millions of New Israeli Shekels every year. After all, every patient

who needs medical treatment as a result of the health consequences of

smoking translates into enormous economic costs borne by hospitals and

health funds. Just imagine how many life-saving drugs that currently remain

outside the drug basket due to budget considerations could be included in the

basket if the number of smokers was cut by half.

If the Chief of Staff’s decision is indeed implemented, the significance is that

the exposure of thousands of soldiers to cigarette smoke will be cut drastically.

What’s more, and primarily, chances are high that many soldiers will stop

smoking and many others will not join those who do. Medically, this is in effect

the great blessing. Why? Because stopping to smoke under the age of 40

decreases the risk of death from a smoking-related disease by 90%. This is a

virtually unbelievable figure which points to the need to make a supreme effort

to bring young people to stop smoking.

Thus, after we praised and supported the Chief of Staff, I would like to call on

the Minister of Education, Mr. Naftali Bennett, to join the struggle against

smoking – that many times begins as early as the teen years. The fact that

there are “smoking corners” in many high schools in the State of Israel is a mark

of shame for the education system. Smoking should be nipped in the bud

already at an early age – since it is at these ages that the damaging habit

becomes a real addiction. Of course, as I see, the next step is a sweeping ban

on the sale of cigarettes on the premises of academic institutions as well.

Clearing the public space from smokers – even if we just make it harder for

them to obtain what they want – in effect means saving lives. As a cardiologist

I encounter innumerable cases daily which demonstrate the fact that smoking

increases the risk of heart attacks, cardiac arrest, stroke, peripheral vascular

diseases, etc. At the same time, in some cases stopping to smoke has rapid

effects (as in the case of coronary heart disease).

So whether or not a special committee is convened – IDF Chief of Staff Eizenkot

has already earned the medal of courage – mainly for having proven to all of

us that courage can be demonstrated not only on the battlefield.

The writer is the President of the Israel Heart Society and Director of the

Cardiology Department at the Rabin Medical Center - the Beilinson and

Hasharon hospitals in Petah Tikva.

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