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Dr Sudhir Kumar MD DM Profile picture
@hyderabaddoctor
Mar 31, 2023 • 6 tweets • 2 min read • Read on X
Lowering triglyceride with medicines does not result in better clinical outcome

1. High serum triglyceride levels are associated with increased incidence of heart attack, stroke and death. In a recent research, the effect of pemafibrate (which lowers triglycerides) was tested.
2. 10,497 patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia (triglyceride level, 200 to 499 mg/dL), and high-density lipoprotein (HDL) cholesterol levels, 40 mg/dL or lower received pemafibrate (0.2-mg tablets twice daily) or matching placebo.
#MedTwitter
3. The median baseline fasting triglyceride level was 271 mg per deciliter, HDL cholesterol level 33 mg per deciliter, and LDL cholesterol level 78 mg per deciliter. All patents were on statins.
The median follow-up of patients was 3.4 years.
#CardioTwitter #stroke #HeartAttack
4. Pemafibrate significantly lowered triglyceride, VLDL cholesterol, remnant cholesterol, and apolipoprotein C-III levels, as compared to placebo.
5. The incidence of cardiovascular events-heart attack, stroke or death due to these diseases- was similar in patients who took pemafibrate or placebo.
Moreover, pemafibrate caused more renal adverse effects and venous thromboembolism.
Ref: nejm.org/doi/full/10.10…
6. Take home message
*Lowering triglyceride with medication (in people with normal LDL with or without statins) does not lead to any clinical benefits.
*Lifestyle modification (diet, exercise) and cessation of alcohol intake are better options for reducing triglycerides.

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More from @hyderabaddoctor

Dr Sudhir Kumar MD DM Profile picture
Jan 26
Why you should NOT reheat your tea and drink?
We all enjoy a hot cup of tea. Sometimes, if one is unable to have tea on time, and it gets cold, tea is often reheated and served. But this practice is unhealthy. Here are the 5 reasons:
1/n
1. Polyphenols and other bioactive compounds in tea can get damaged with repeated heating, thereby reducing their antioxidant properties.
2/n
2. If tea is left for more than 4 hours at room temperature, there is a risk of bacterial growth. Reheating is not enough to get rid of this bacteria, thereby increasing the risk of gastrointestinal infection.
3/n
Read 8 tweets
Dr Sudhir Kumar MD DM Profile picture
Jan 1
Short Story of a minor Struggle and Successfully overcoming it
May 2024
Flare up of ankylosing spondylitis (AS), caused pain in multiple joints, tendons and ligaments.
Sudden break on running after three and half years.
Even walking was difficult- every step was painful.
1/n
Waited for a day or two for pain to reduce/subside; as that was the norm earlier (during the past 34 years, after the most severe relapse in 1990, when I was hospitalized for more than three weeks at CMC Vellore).
Pain did not reduce, instead, it became more severe.
2/n
Consulted a rheumatologist and an orthopedic surgeon;
Investigations confirmed a relapse of AS (enthesopathy, tendinopathy, joint inflammation, etc)
Was suggested complete rest; pain-relief medications and specific medications (biologicals) for AS.
This appeared depressing..
3/n
Read 12 tweets
Dr Sudhir Kumar MD DM Profile picture
Jul 31, 2024
Running as a form of aerobic exercise increases longevity, but there are other factors to consider too.

The news of Jogi ji's passing away due to cardiac arrest during sleep is shocking. Our heartfelt condolences🙏

1. Joginder Chandna ji was extremely fit and had amazing statistics for a long-distance runner. His PB for 5k, 10k, HM and FM were 23 min, 46 min, 1:39 hours and 3:40 hours.Image
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2. He had an amazing control over heart rate while running long distances. His latest long run (23 Km) was on Sunday, 28th July (2 days before we lost him). An AHR of 127 bpm (and a max HR of 139 bpm) for a pace of 6:50 min/Km is amazing.Image
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3. His running mileage was not excessive. If we look at his last 12 months, his monthly running mileage ranged from 170-240 Km (which translates to 6-8 km per day, or 50-60 Km per week). This is within the safe zone as per research.Image
Read 7 tweets
Dr Sudhir Kumar MD DM Profile picture
Jan 30, 2024
By the time diabetes mellitus is diagnosed, it is already too late.

Take control when insulin resistance sets in. Or may be even before that.

Low carbohydrate diet and regular exercise are the keys to prevent insulin resistance, prediabetes and type 2 diabetes.

Ref: (1/n)doi.org/10.3390/antiox…Image
Lifestyle tips to manage insulin resistance

1. Lose excess weight (especially abdominal and visceral fat),
2. Engage in regular physical activity,
3. Sleep well,
4. Minimize stress,
5. Reduce carbohydrate intake,
6. Quit smoking.
(2/n)Image
Insulin resistance-related diseases in humans
(3/n)Image
Read 5 tweets
Dr Sudhir Kumar MD DM Profile picture
Jan 26, 2024
Running and heart diseases
Learning points from the past 30 years of published research

1. Runners have a lower risk of heart attack, as compared to people leading sedentary lifestyles,

2. Runners are 45% less likely to die from heart disease than non-runners,

3. The benefit starts with as little as 10 minutes of running per day, and increases with increasing running duration up to 60 minutes. There is no additional mortality benefit from running beyond 60 minutes per day (or beyond 7 hours per week),

4. In terms of distance, the benefit starts with 1 mile (1.6 km) of running and increases with greater running mileage. There is no established upper limit beyond which running is detrimental to heart health, however, benefits may plateau beyond 80 km of running per week,

5. Runners have a lower resting heart rate. Lower resting HR is associated with greater longevity,

6. Running has a favourable effect on risk factors for heart attack. Running is associated with higher HDL-cholesterol, lower LDL-cholesterol, lower triglyceride, lowering of BP, improved insulin sensitivity, lower HbA1C level and lower body mass index,

7. Sudden cardiac arrest during long distance running is rare. The incidence is 0.8 per 100,000. The fatality due to sudden cardiac arrest during running is 0.4 per 100,000,

8. Majority of cardiac arrests occur while a person is sleeping, sitting or standing; only a miniscule of them occur while a person is running or doing some form of exercise,
9. Sudden cardiac arrests that occur during marathons make it to the headlines, as they are dramatic, unexpected and those affected are younger and fitter,

10. Marathoners have a greater chance of surviving a cardiac arrest, as compared to non-runners,

11. Sudden cardiac arrest during running is more common among men as compared to women,

12. Sudden cardiac arrest during running is most often NOT caused by running. However, running may precipitate sudden cardiac arrest among people with pre-existing cardiac diseases,

13. The commonest cause of sudden cardiac arrest in people aged 35 or less is hypertrophic obstructive cardiomyopathy,

14. The commonest cause of sudden cardiac arrest among people above 35 is coronary artery disease (due to blockage of artery supplying blood to the heart muscles),

15. The ideal average heart rate while running is 180 minus age (ref: MAF method). This ensures better recovery between runs, reduces the risk of injuries, and allows adaptation of the heart for better pace during races,

16. A good night sleep (7-8 hours) before a long run is of paramount importance,

17. Periodic hydration/nutrition breaks during a long run is also important. Dehydration, exhaustion, fatigue, and heat stroke can lead to a runner collapsing during a marathon,

18. If the body gives signals, such as dizziness, breathing difficulty, chest pain, tightness in chest, severe fatigue, or light-headedness, during a run; withdraw from the run and seek immediate medical help,

19. Do not start a run with a pre-meditated pace or finishing time. Alter thepace (increase or decrease) based on the route, elevation, temperature, how you feel and other race-day factors,

20. Long distance running is not a competition to be ahead of others. It is a passion to be enjoyed and cherished. Enjoy the entire run and not just the chip time.

Dr Sudhir Kumar MD DM 26-01-2024Image
There are various causes for cardiac arrest among runners and they differ based on the runner's age. Survival depends on the underlying cause of cardiac arrest; prompt performance of CPR (by the bystander) and use of defibrillator (on site).

Image
Image
Image
Majority of cardiac arrests among marathon and half marathon runners occur during the last qartile of the run (after 26th mile in marathon, and after 10th mild in half marathon, until completion).Image
Read 6 tweets
Dr Sudhir Kumar MD DM Profile picture
Dec 17, 2023
Why are teenagers (adolescents) getting affected by heart attacks?

1. Heart attacks commonly affect older people. However, we have seen a recent increase in number of young people and even teenagers getting affected. What are the underlying reasons?Image
2. It is easy to put the entire blame on Covid 19 illness & covid vaccines, but that won't do proper justice (to our youth). There are several other possible reasons that have increased the risk of heart attacks in younger population, including adolescents. Let us look at them:
3. High prevalence of depression, anxiety & stress (DAS) among school-going children.
In a survey done among school going adolescents, the prevalence of depression, anxiety and stress was found to be 65%, 81% and 47%, respectively.
DAS increase the risk of heart attack. Image
Read 12 tweets

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