Which doctor to go to?
When it comes to the heart, treatment is divided among three specialities. To prevent the first heart attack in a person with risk factors such as smoking, overweight, raised cholesterol or family history of heart disease or, to prevent a second or subsequent heart attacks, a patient needs an Endocrinologist with interest in Lipid Management. During an acute heart attack, we need a Cardiologist for percutaneous coronary intervention.
Additionally, we need their regular review for maintenance of cardiac health. In triple vessel disease or left main stem disease, a patient needs a Cardiac surgeon for bypass surgery.
In simple terms, one has to go to Endocrinologist to mitigate the risk factors associated with Ischaemic heart disease.
Top three Preventable causes of Death:
Cardiovascular disease is one of the top three preventable causes of death, the others being road traffic accidents and cancer. Therefore, It is vital to identify and treat the risk factors
Cardiovascular risk score:
It is calculated by information such as Body Weight, Smoking status, High blood pressure, Cholesterol levels, Diabetes, inflammatory disorders and a family history of heart disease.
How to decrease the risk of Cardiovascular disease :
a) What is the latest management of Cholesterol?
Up until recent, cholesterol management was limited to statins and few other drugs. Statins can be intolerant in 9% of patients. This would result in sub-optimal management of cholesterol and an increased risk of heart attack. Now, we have many newer drugs for better management of LDL cholesterol, triglycerides and Lipoprotein(a), which are more efficacious and better tolerated. These drugs are available as oral and subcutaneous injections and giving better compliance. All in all, now we better understand and manage lipids and reach target levels.
b) New diet and drugs on horizon for better management of Obesity.
Management of weight is seeing a revolution in this decade. Drugs showing 7-24% weight loss have been approved by FDA.
Understanding of diet and quantification of carbohydrates has been a key area of success. In the past, several doctors and dieticians claimed to have the winning recipe for weight loss, such as the Atkin’s diet, keto diet, protein shakes, etc, but all showed to be nonsustainable over long term. Carbohydrate counting skills have improved and with the right quantity per meal we are able to achieve weight loss fairly quickly
c) Management of Diabetes:
With Continuous glucose monitoring devices, we have greater success in achieving normal blood sugar and target HbA1c in type1 and type 2 diabetes. Additionally, SGLT-2 inhibitor drugs have confirmed significant cardiovascular protection.
d) Smoking Cessation made easy.
Smoking cessation is another area where we have wide range of newer products. These have shown to be very efficacious.
Summary:
In summary, its all about minimising risk factors, so one can live longer with a healthy heart and vascular system.
Dr Oraizi Jafery
Consultant in Endocrine, Diabetes, Obesity,
Lipids and Internal Medicine
Bedfordshire, United Kingdom
