August 31, 2020

David C. Lew, MD, FACC. FSCAI | FHV Health

1.7 min read| Published On: August 31st, 2020| 0 Comments|

By Akers Editorial

David C. Lew, MD, FACC. FSCAI | FHV Health

1.7 min read| Published On: August 31st, 2020| 0 Comments|

Q. When do hypertension and/or diabetes become serious enough to involve the services of a cardiologist?

A. Management of essential hypertension and diabetes is usually within the purview of primary care physicians. So when is it appropriate for patients with these conditions to schedule an appointment with their cardiologist?

The first thing to realize is how interconnected the systems of the body are. One singular diagnosis that seems isolated can trigger a domino effect of symptoms, health concerns, diseases, and treatment options.

While hypertension and diabetes are most known as contributors to kidney disease, these two “silent killers” are also major risk factors for the development of a staggering number of cardiac and vascular diseases. Heart attack, stroke, renal vascular disease resulting in kidney failure, and PAD, which could lead to limb amputation, are only a few conditions that come to mind. And all of these conditions are set squarely within the purview of a cardiologist.

The statistics bear that out in stark relief. High blood pressure is seen in:

• 69% of people who have their first heart attack.

• 77% of people who have their first stroke.

• 74% of people who have congestive heart failure.

Hypertension is a major contributing factor to atherosclerosis. The hardened or blocked arteries that disease causes will almost certainly require the services of an interventional cardiologist. Angioplasties and stent placement are the treatment choice for a vast array of vascular diseases that affect the carotid, cardiac, and renal arteries. Although renal artery stenosis is not as common a cause of hypertension as compared to primary essential hypertension, it can lead to severe secondary hypertension easily treatable with angioplasty and stent placement. A successful intervention with either option may result in improved blood pressure control for approximately 25-50% of patients. 

In the case of diabetes, again, services of a cardiologist are usually not indicated. Though an interesting new study does reinforce how interconnected medical treatments can be. In the DAPA-Heart Failure Trial, 4,744 patients were treated with a diabetic medication Farxiga (dapaglifozin). The study investigators noted that the risk of worsening heart failure or cardiac-related death was significantly reduced when compared to placebo therapy. 

Finally, for patients with advanced kidney failure on hemodialysis, an interventional cardiologist can prove vital in providing procedures and services to maintain adequate function of the A/V fistulas or grafts (dialysis access). This gives patients renewed ability to continue with their life-saving dialysis therapy.  


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