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    Default Cardiology Heart Study

    Hi

    Interesting and informative read ,any thoughts and coments please .

    http://www.vetgo.com/cardio/concepts...?conceptkey=53
    Brian M

    Poppy the Tri, Daisy the Blen, Rosie the Ruby and Lily the B & T

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    I think it is fascinating. They provide their analyses and insights into the recent studies of medications and their rationales for their recommended therapies.
    Rod Russell

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    Hi Rod

    I knew you would so, when you have time to digest all or just the part that refers to our CKCS ,near the end ,any thoughts or conclusions pls .It seems to
    say the way to go once CHF is then to start with pimobenden which could give an extension of maybe two more years .
    Brian M

    Poppy the Tri, Daisy the Blen, Rosie the Ruby and Lily the B & T

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    Quote Originally Posted by Brian M View Post
    It seems to
    say the way to go once CHF is then to start with pimobenden which could give an extension of maybe two more years .
    I thought that too. I was looking for the use of this before CHF which Rod has a note of caution about but it looks like there is evidence of increasing life once they are in CHF.

    "

    • As of 2009, the evidence in support of the ability of pimobendan to increase survival and quality of life for patients with CHF due to:
      • DCM is overwhelmingly supportive. See the University of Guelph DCM trial results below.
      • Chronic mitral valve insufficiency is also strongly supportive. See the QUEST trial results below.
      • Studies investigating the use of pimobendan in asymptomatic (occult) CMVI or DCM are currently ongoing or being planned. Thus there is currently no data to support the use of pimobendan in occult (pre-CHF) CMVI or DCM."


    I also thought the SVEP Trial was interesting because it was CKCS and the large amount of cavaliers enrolled 229. I am sure this is old news but I thought the conclusions was interesting and how they said

    "This study is the most exhaustive cardiovascular clinical study conducted in veterinary medicine to date."
    Last edited by anniemac; 5th November 2012 at 10:15 PM.
    Anne Proud mother of Elton 5 and Angel Ella

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    Hi Annie

    And Daisy's cardio says Quotes

    "Sadly, despite several trials[SIZE=2](2 and 3)[/SIZE] there is no evidence that treatment with an angiotensin converting enzyme (ACE) inhibitor before the onset of heart failure delays the onset of heart failure. No trials have been performed using Pimobendan in this group of dogs and there is little theoretical basis for its use. Interestingly, asymptomatic dogs fed a “heart diet” had a reduction in heart size[SIZE=2](4)[/SIZE]. The “heart diet” included decrease sodium, increased levels of arginine, carnitine and taurine as well as supplementation with omega 3 fatty acids. Whether this translates into a delay before heart failure develops remains to be proven.

    Heart failure is characterised by breathing difficulties, poor appetite, weight loss, exercise intolerance and a cough usually at night. Once heart failure develops, diuretics such as frusemide are required to control the oedema in the lungs. The QUEST study confirmed that pimobendan prolongs survival significantly longer than an ACE inhibitor when combined with frusemide[SIZE=2](2)[/SIZE]. However, although there is no data concerning the combination with an ACE inhibitor, most cardiologists would add an ACE inhibitor to frusemide and pimobendan. A recent study indicated that the addition of a mild diuretic, spironolactone, improves quality of life and prolongs life(5). This drug counteracts the effects of a natural hormone, aldosterone, which is

    increased in heart failure and has harmful consequences.

    Unfortunately, the disease is progressive and many dogs progress to advanced heart failure. Other drugs may be indicated to:
    • Reduce systemic blood pressure and increase output
    • Control arrhythmias
    • Reduce pulmonary hypertension
    • Increased doses or frequency of diuretics"




    So Pimodeben before the onset of CHF there is no proof of benefit but after and when combined with other drugs it seems the one to go for.But am glad he pushes the "heart diet"

    Bri
    Brian M

    Poppy the Tri, Daisy the Blen, Rosie the Ruby and Lily the B & T

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    Quote Originally Posted by Brian M View Post

    ... But am glad he pushes the "heart diet"
    I think the "heart diet" is pretty much a joke. It was conducted mainly by a pet food manufacturer and consisted of dry food, kibble, also/known/as junk food. Heart supplements, like those listed here -- http://cavalierhealth.org/diets.htm#Cardiac_Supplements -- when added to a good canned meat and vegetable product (ideally, however, I prefer home-prepared meat and vegetables), is much preferrable to the kibble "heart diet" mentioned.

    You have to be very careful of so-called "prescription diets" marketed by such pet food companies as Hills and Waltham. They skimp at the dog's expense.
    Rod Russell

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    Quote Originally Posted by Brian M View Post
    Hi Rod

    It seems to say the way to go once CHF is then to start with pimobenden which could give an extension of maybe two more years .

    Limitations:

    This study did not address the important question of whether one should treat such patients with the combination of pimobendan and benazepril (or another ACE inhibitor) and diuretics as is the case in most practices.

    Our conclusions:

    This study provides the most compelling evidence that pimobendan has an important role in the management of CHF due to CMVI.
    This study does not answer the question of the benefit or lack of benefit of triple therapy (pimobendan, an ACE inhibitor, and furosemide) - our current practice in the management of these cases.


    Pat
    Pat B
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    I didn't think the argument on pimobendan and CHF was new though? Weren't those studies on waiting til onset of CHF done some time ago?

    Also think 2 years is probably a stretch -- the initial study in this area suggested maybe 9 months on average:

    http://www.medicalnewstoday.com/releases/60791.php

    It is interesting to read all the arguments on various approaches.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy Libby (foster) Mindy (foster)
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

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    Actually I read a pretty dismissive evaluation of Omega 3s from fish oils today -- quoted numerous studies which said that while there was a benefit in omega 3 and to eating oily fish several times a week to get omega 3s, that fish oil supplements had not been shown to have any clear benefit, especially as the benefit perceived could easily be due to other factors. Think this was in the Guardian -- will try and find it. They said that it seemed likely that the benefits of omega 3s came from a combination with other vitamins etc in the actual food source. It was certainly pretty persuasive -- not dissimilar I suppose to studies that show glucosamine seems to have very little benefit. But there is strong popular belief in both omega 3 supplements and glucosamine so would be very hard to convince people.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy Libby (foster) Mindy (foster)
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

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    Quote Originally Posted by Brian M View Post
    ....It seems to say the way to go once CHF is then to start with pimobenden which could give an extension of maybe two more years .
    According to cardiologist Mark Oyama in a recent talk to a group of GP vets, pimo and an ACE-inhibitor and a diruetic are being combined as soon as the MVD dog enters congestive heart failure.

    Using pimo at the start of CHF is relatively new, I think (at least, that is what Dr. Oyama said in his talk). In the past, the pimo was reserved for the last resort, to boost the heart when the ACE-inhibitor, diruetic, and whatever else lost their effectiveness.
    Rod Russell

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