The DASH Diet Benefits

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is a dietary pattern that is designed to help lower blood pressure and reduce the risk of heart disease. 

The DASH diet emphasizes the consumption of whole foods, such as fruits, vegetables, whole grains, lean proteins, and low-fat dairy products, while limiting the intake of processed and high-fat foods.

The DASH diet is high in fiber, potassium, magnesium, and calcium, all of which have been shown to have beneficial effects on blood pressure. It also emphasizes the reduction of sodium intake, which is an important factor in controlling blood pressure.

The DASH diet is a flexible and balanced eating plan that can be adapted to meet the needs and preferences of individuals. It has been recommended by many health organizations, including the American Heart Association, as a heart-healthy dietary pattern.

Sure! Here are some additional details about the DASH diet:

- The DASH diet was developed by the National Heart, Lung, and Blood Institute (NHLBI) in the United States as a way to help people lower their blood pressure without medication.

- The diet emphasizes the consumption of fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. It also includes nuts and seeds, and limits the consumption of red meat, sweets, and sugary beverages.

- The DASH diet is high in nutrients such as fiber, potassium, magnesium, and calcium, which have been shown to have beneficial effects on blood pressure.

- The diet also emphasizes the reduction of sodium intake, which is an important factor in controlling blood pressure. The NHLBI recommends limiting sodium intake to 2,300 milligrams per day, or 1,500 milligrams per day for those with high blood pressure.

- The DASH diet is a flexible eating plan that can be adapted to meet the needs and preferences of individuals. It can be tailored to various calorie levels, and can accommodate different cultural and dietary preferences.

- Studies have shown that the DASH diet can help lower blood pressure in people with hypertension, and can also reduce the risk of developing heart disease, stroke, and other chronic conditions.

- The DASH diet is often recommended as part of a comprehensive approach to managing hypertension and reducing the risk of heart disease, along with regular exercise, stress management, and other lifestyle modifications.

Overall, the DASH diet is a balanced and nutritious dietary pattern that emphasizes whole, nutrient-rich foods and can help improve cardiovascular health.

Novel oral anticoagulants(NOACs)

1-Other names:

Direct oral anticoagulant(DOACs), non vitamin K antagonist oral anticoagulant(NOACs)

2-Either Direct thrombin inhibitors (dabigatran), anti factorX (Rivaroxaban, apixaban, edoxaban)

Are Contraindicated as follow

3-Contraindicated in Pregnancy and lactation

4-Contraindicated in Mechanical prosthesis and Mitral stenosis (Mitral valve area 1.5 cm2 or less)

5-Contraindicated in the first three months after mitral valve repair or tricuspid valve repair

And contraindicated in the first 3 months after Implantation of mitral or tricuspid tissue valve

6-Contraindicated in liver cirrhosis, Child C

Main points to be considered:

7-The approved one in Chronic kidney disease or dialysis is Apixaban

8-Antidote for dabigatran is Idarucizumab, antidote for Anti Factor X (mainly Rivaroxaban) is andexanet alfa,

you can give 4 factors prothrombin complex concentrate for NOCAs related Bleeding

9-When you switch from Warfarin to NOACs, start NOACs when INR is 2. 5 or less

10-When switch from NOACs to warfarin, give both till INR reach 2 for two consecutive readings

11-As a general rule, NOACs are stopped 2 days before surgery (except for dabigatran in patients with CKD,

will need longer interval)

12-As a general rule, you can restore NOACs 3 days after surgery

13-As a general rule, the risk of GIT Bleeding with NOACs is more than Warfarin except Apixaban 5mg twice or

dabigatran 110 mg twice which have a comparable GIT Bleeding risk similar to Warfarin

14-PTT can be prolonged with dabigatran, and dabigatran is the only one that be be cleared with

dialysis in case of toxicity

15-As a general rule, NOACs are at least as effective as Warfarin and they are more safe as regard Bleeding risk

16-The risk of Hemorrhagic stroke or cerebral hemorrhage is low with all NOCAs when compared to Warfarin

17-The only 2 NOCAs that showed superiority over warfarin in stroke risk reduction are:

apixaban 5 mg twice and Dabigatran 150mg twice

Other NOACs have a comparable stroke risk reduction VS. Warfarin

18-Dabigatran is associated with reduction of vascular mortality, Apixaban is associated with

reduction of all cause mortality,

edoxaban is associated with reduction of Cardiovascular mortality

19-Rivaroxaban should be given with meal

20-Highest renal excretion with dabigatran, lowest renal excretion with apixaban

21-Trials of NOACs with P2 Y12 inhibitors

-Redual PCI(dabigatran)

-Pioneer AF(Rivaroxaban) 

-Augustus(apixaban)

-Entrust(Edoxaban) (ongoing)

Trials of NOACs in AFib

-Rely (dabigatran)

-Rocket(Rivaroxaban)

-Aristotle (Apixaban)

-Engage (Edoxaban)

Trials of NOACs in venous thromboembolism

-Recover(Dabigatran)

-Einstein(Rivaroxaban)

-Amplify(Apixaban)

22-No need for concomitant treatment with parenteral anticoagulant upon starting with apixaban or

Rivaroxaban in treatment of Venous thromboembolism

Instead, you can give apixaban 10mg twice for 1 week then 5 mg twice daily thereafter

And Rivaroxaban 15mg twice daily for 3 weeks then 20mg once daily thereafter