Tuesday, January 31, 2006

Danger: apple-shaped women

In a recent study, researchers propose that women who develop thick waists and high cholesterol at menopause may be at higher risk of heart disease because they also have more damage to their arteries.

After menopause many women undergo a shift in body fat so that there is more fat in the abdomen. This can cause the sympathetic nervous system, which controls blood vessel function, to become elevated and stiffen the arteries.

And because the women are no longer producing estrogen, a natural antioxidant, they begin to suffer from artery disease.

Are you an apple? Ladies, measure your waist circumference and your hip circumference, then calculate your waist to hip ratio. If you are .80 or above you are an apple. Below .80 you are a pear.

Marie Savard. M.D. explains how body shape can forecast health destiny and offers steps to take to decrease health risk. Also, view an interview with the author-internist. Just click "play" to see the video here.

Friday, National Wear Red Day, is fast approaching. Learn more about it.

Raised glucose and raised blood pressure - syngergistic effect

Arterial stiffness is an indicator of arterial damage and cardiovascular risk. A study was performed to see if elevated blood glucose and raised blood pressure, even at levels below what is defined as diabetes and hypertension, might work synergistically to increase arterial stiffness.

Raised blood pressure was defined as 130/85 or higher. Raised blood glucose was defined as 110mg/dL or higher. Results of the 3-year study on 2080 Japanese men, average age 42, indicated that the estimated annual rate of increase of arterial stiffness (pulse wave velocity) was higher in subjects with both the abnormalities than in those with either abnormality alone or neither of the 2 abnormalities.

Researchers concluded that blood pressure and fasting plasma glucose levels, even below those defining hypertension and diabetes, may synergistically lead to progression of arteriosclerotic arterial damage. This synergistic progression may contribute to the additive increases in the risk of cardiovascular events, at least in part.

What to learn from this? Physicians and patients should aggressively treat these two risk factors for cardiovascular disease even if they are not elevated enough for one to diagnose hypertension or heart disease. And, this is especially true for small elevations of both.

(Hypertension is "officially" defined as having a reading equal to or above 140 and/or 90.
Diabetes is "officially" defined as having a reading equal to or above a fasting level of 126 mg/dL.)

We now see that results lower than the official minimums, when combined, act to increase arterial stiffness and, perhaps, cardiovascular risk.

Monday, January 30, 2006

New research could help diagnose heart disease in women

A team at the St. Louis School of Medicine, has new data on the use of dobutamine stress echocardiography – a test that enables doctors to better predict future heart disease.

Researchers studied 421 women between the ages of 49 and 75, an age range historically mis- and under-diagnosed for heart disease.“Our research is extremely important to women in this age group." By detecting problems earlier, we can help prevent heart attack or death and extend these women’s lives.”

Dobutamine stress echocardiography tests are ultrasound heart scans in which patients are injected with a drug that makes the heart beat faster to determine if they have abnormalities of the heart wall. No exercise is involved. Traditional echocardiography tests are performed without the aid of drugs by having patients run on a treadmill to increase their heart rate.

Researchers followed the patients for two years and found that women who tested positive on the stress test were more likely to experience cardiac events, heart attacks, and even heart failure and death: 18% had had a heart attack, and 5% had died of one.

In a second study researchers studied 1,404 patients who underwent preoperative dobutamine stress echocardiography to determine if they had ischemia. “In the medical community, it is common to believe the heart rate must be at least 85 percent of the maximal heart rate,” Dolan says. “However, we found that a negative dobutamine stress test without abnormalities has a strong predictive value whether the heart rate is maximal or not.”

The implications for such results are that doctors ordering stress echocardiography can have more confidence in tests returning negative for ischemia than they had previously thought, effectively broadening the parameters normally used to rule out ischemia – meaning some patients will not have to undergo additional heart scans to rule out the condition before they undergo surgery. This is good news for individuals who cannot achieve a maximal heart rate on a treadmill stress test for reasons such as muscle discomfort, arthritis, shortness of breath from lung disease, etc.

Echocardiography combined with exercise stress testing is a well-tolerated and valuable procedure for noninvasive evaluation of coronary artery disease. The sensitivity and specificity is comparable to that of nuclear perfusion imaging (thallium stress testing.)

It's also good to see more cardiac research being performed on women. Friday, National Wear Red Day, is fast approaching. Learn more about it.

The overlapping stent choice

As mentioned in a recent post, the sirolimus-eluting CYPHER stent is the stent of choice in complex cases.

Now, the FDA has revised instructions for use of the CYPHER Sirolimus-eluting Coronary Stent. The labeling now reflects FDA's review of clinical trial data that suggests there is no increased risk of heart attack with the use of overlapping CYPHER Stents in comparison to bare metal stents. This labeling change is based on a retrospective analysis of several clinical studies of overlapping CYPHER Stents examining more than 900 patients. The CYPHER Stent is the only drug-eluting stent with this new label.

Overlapping stents are most often used in patients with complex coronary artery disease in which the blockage is too long for a single stent. Today, approximately 25 percent of stenting procedures involve the use of overlapping coronary stents.

The study data leading to the revised instructions.
The CYPHER site for more general information.
Surgical webcast of CYPHER stent implantation. (Click on View Archived Webcast on the right side of the page.) Highly recommended.

Sunday, January 29, 2006

Heart Attack Patients Do Best at Hospitals That Specialize

Patients are less likely to die during their hospital stay, and will receive faster treatment, if they have their emergency angioplasty at hospitals where it is the "default" treatment, used on the vast majority of heart attack patients, according to a study in the journal Circulation.

By contrast, the in-hospital death risk and risk of delayed treatment were both higher for angioplasty patients treated at hospitals where emergency angioplasty was used in a minority of heart-attack patients. On the whole, they were significantly more likely to die before leaving the hospital, and waited an average of 20 minutes longer for treatment, than those treated at hospitals where most heart attack patients received angioplasty.

Also, according to the study, it's not the number angioplasties that are performed each year that's most important, but "the overall commitment to doing emergency angioplasties, and the protocols and staffing that come out of that commitment."

"The bottom line for anyone having a heart attack," says lead author Brahmajee Nallamothu, MD, MPH, "is still to call 911 and let the emergency medical staff decide which hospital to choose.

You want the "door to balloon" time to be less than 90 minutes.

A study last year indicated that just under 50% of those whose heart attacks occurred during business hours were treated within the 90 minutes recommended by AHA. After hours, only 25% were treated that quickly. The "door to balloon" times for angioplasty patients rose from 95 minutes during business hours to 116 minutes after hours.

You may want to inquire as to whether the hospitals near your home and workplace perform emergency angioplasties within 90 minutes of arrival. Keep the list of those that do in your head. Then, perhaps, you can make suggestions to the emergency personnel as to which hospital to go to.

Contact your local hospitals.


I'm adding categories to the blog, which requires me to go to all previous posts and tag with appropriate topic names. The "Categories" function on the right side of this page is not fully functional, but will be soon.


Saturday, January 28, 2006

AHA updates BP guidelines - focus on diet, weight loss

The American Heart Association (AHA) updated its position statement on lifestyle modifications for the prevention and treatment of high blood pressure (BP). The modified guidelines are published in the February issue of Hypertension.

Because cardiovascular disease (CVD) risk increases progressively throughout the range of BP, beginning at 115/75 mm Hg, efforts to reduce BP in both nonhypertensive and hypertensive individuals are warranted. Dietary changes alone can lower BP and prevent hypertension in nonhypertensive individuals. In uncomplicated stage I hypertension, defined as systolic BP of 140 to 159 mm Hg or diastolic BP of 90 to 99 mm Hg, dietary changes are a useful first step before starting drug therapy.

For patients with hypertension who have already started drug therapy, reduced salt intake and other lifestyle modifications can further reduce BP. The guidelines emphasize increased intake of fruit and vegetables, and limiting alcohol intake to moderate levels for patients who drink alcohol.

  1. Maintain normal weight or lose weight if overweight
  2. Reduce salt intake to about 1.5 g/day
  3. Eat 8 to 10 servings of fruits and vegetables daily
  4. Moderate alcohol intake
  5. Follow the DASH diet

Dietary measures thought to have a limited or uncertain effect on BP include fish oil supplementation, other types of fat, fiber, calcium, magnesium, carbohydrates, and protein.

"The key message is simple: as a person ages, blood pressure rises," Dr. Appel says. "While an individual's BP may be normal now, 90% of Americans over 50 years of age have a lifetime risk of high BP. Americans should take action before being diagnosed with hypertension."

DASH diet details.

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Stents in small vessels - which to use?

The two most popular drug-eluting stents, one coated with the drug sirolimus (Cypher; Johnson & Johnson) and the other coated with the drug paclitaxel (Taxus; Boston Scientific) are amazing devices that have revolutionized the treatment of coronary artery disease.

Both, sirolimus- and paclitaxel-eluting stents effectively reduce restenosis in small coronary vessels. But, which one is more effective?

A new study indicates that the sirolimus-eluting stent performs better in small coronary vessels. Angiographic restenosis was found in 19.0% of the lesions in the paclitaxel-eluting stent group and 11.4% of the lesions in the sirolimus-eluting stent group. Target lesion revascularization was performed in 14.7% of the lesions treated with paclitaxel-eluting stents and 6.6% of the lesions treated with sirolimus-eluting stents.

Therefore, the paclitaxel-eluting stent is associated with a greater late luminal loss (loss of artery opening when compared to the lumen post-implantation) and is less effective in reducing restenosis in small coronary vessels than the sirolimus-eluting stent.

A 2005 study on individuals with diabetes came to the same conclusion.
A 2005 meta-analysis also came to the same conclusion.

Dr. David J. Moliterno, a cardiologist at the University of Kentucky in Lexington stated that, "the large majority of patients...will have extremely terrific outcomes with either stent."

However, the Cypher stent may be useful in more complex cases, such as insulin-dependent diabetics, those with kidney disease or patients who have already had a stent implanted and now require second procedure. [And, now, in patients who have stenoses in small arteries.]

He noted that it's unlikely that the components influencing the differences in outcomes will ever be identified, since new stents with various stent struts, polymers and drugs are under development.

"Because the rate of failure is so low, future studies will need to be either very large or among particularly high-risk patients to discern a possible difference between future generation stents," he said.


Friday, January 27, 2006

Hormone replacement therapy timing and heart disease

Women who began hormone replacement therapy (HRT) within four years of menopause had about a 30% lower risk of heart disease than did women who never used hormones, said Francine Grodstein, Sc.D., and colleagues at Brigham and Women's Hospital here.

However, when therapy was initiated 10 or more years after menopause there was no significant association with coronary heart disease, the researchers reported in the January issue of the Journal of Women's Health.

"This study helps to untangle some of the confusion about the heart-protective effects of hormone therapy by indicating that the timing of starting hormones relative to a woman's age and onset of menopause plays a key role," said Joann E. Manson, M.D., Dr.P.H., also of Brigham and Women's Hospital, a co-author.

In older women, existing damage to vessels may be the reason HRT does not protect them from heart disease," said researcher Dr. JoAnn E. Manson, the chief of the division of preventive medicine at Brigham and Women's Hospital, in Boston. "If a blood vessel already has advanced atherosclerosis, hormone therapy may be more likely to cause a clot. However, if the blood vessel is open, the increase in clotting risk usually will not translate into a heart event, and some of the benefits may predominate as improvement in cholesterol, improvement in insulin sensitivity and antioxidant effects. Estrogen may actually delay the development of artherosclerosis in those women."

This is welcome news for those newly-menopausal in need of therapy because of troubling menopausal symptoms or osteoporosis. Concerns had been raised about an increased risk of stroke or no heart disease benefit, so women of all ages had stopped taking HRT. Further analysis of these earlier studies indicated that the study participants were older, had never been on HRT, and were already at risk. Still, the study authors cautioned that their results do not yet support hormone therapy for prevention of coronary heart disease.


The fruit and vegetable way to cut stroke risk

Eating more than the recommended five portions of fruit and vegetables a day can cut risk of stroke, a new study says.

People who ate three to five cut the risk by 11% compared with those eating fewer than three, the Lancet reported in a pooled analysis of studies involving 257,000 people. It was 26% lower for people who ate more than five servings.

Professor Graham MacGregor, who worked on the study, said: "It is a very important finding because it really shows that the quantity of fruit and vegetables you should be eating is more than five a day."

Researchers suspect that potassium may be the most important factor in preventing stroke.

"We know that if you give people additional potassium it lowers blood pressure. By increasing to five servings a day from three you would increase your potassium intake by about 50%."

Also, you should consider eating a variety of colorful fruits and vegetables to take advantage of the many health-promoting phytochemicals. Here's an easy-to-read chart.

What 7 servings a day looks like - click here.
What 9 servings a day looks like - click here.

You can do that. It's a piece of cake....
Oops. Shouldn't have said that. diseases

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Thursday, January 26, 2006

Heart attack warnings go unnoticed

Most heart attack victims wait two or more hours after symptom onset before seeking medical help, often because they do not realize they're having a heart attack.

According to a new Harris survey, many U.S. adults lack knowledge about heart attack warning signs beyond the so-called "Hollywood Heart Attack." That knowledge gap and the “wait and see” approach, may be factors in heart disease being the number one killer of Americans.

**The survey says only 40% of U.S. adults would seek medical attention if they experienced some common, "non-Hollywood" heart attack symptoms (sickness to the stomach, lightheadedness, and pain or soreness in the arm, back or neck) for several minutes. The majority (59%) would wait and see if the symptoms passed, while only 14% would call 9-1-1.

**While 85% of U.S. adults recognized chest discomfort as a heart attack warning sign, significantly fewer adults are aware that discomfort in the neck (36%), back (32%), jaw (30%) or stomach (23%) are also symptoms of a heart attack.

**Less than half of U.S. adults (48%) realize that a heart attack can be stopped once it has begun.

"Tragically, many patients, expecting to experience sudden, crushing chest pain, don't recognize the less dramatic symptoms of a heart attack, don't seek prompt treatment and, therefore, don't receive powerful life-saving therapies in time. It is essential that Americans become familiar with all of the heart attack warning signs, because every second counts when it comes to a heart attack."

The ACT IN TIME campaign, a National Heart, Lung, and Blood Institute education campaign has now begun. Check it out. It's short, concise, and very important.

Women's heart disease - signs and symptoms

A week from National Wear Red Day, we delve further into the topic of women and heart disease.

The most common symptom of a heart attack in men is chest discomfort or pressure. However, in women, it's often not the most prominent symptom and, if chest pain occurs, it may not be severe enough to drive one to call a physician. Women may experience symptoms unrelated to chest pain, like neck discomfort, shortness of breath, dizziness, or fatigue.

For a full list of prodromal symptoms, common symptoms, and atypical symptoms experienced by women, view this page.

See a very interesting short news story on women's heart symptoms, entitled "Women's heart symptoms." Scroll down to the November 4, 2003 entry.

Wednesday, January 25, 2006

Drug-coated balloons with no stent

In a new twist on combining drugs and minimally invasive therapy, early research suggests drug-coated angioplasty balloons keeps narrowed leg arteries open, avoiding the use of a stent altogether.

Restenosis (re-narrowing) is common after conventional balloon angioplasty or placement of bare metal (non-drug-coated) stents, tiny mesh tubes that are left behind in the artery as scaffolding to prop it open. The drug-coated balloon concept has proven effective in opening previously stented coronary arteries. The balloon is coated with paclitaxel, which is used in the treatment of breast and other cancers and also one of the drugs used to coat stents.

"The drug prevents the growth of scar tissue that can cause the vessels to renarrow. Our early results suggest the effects of drug-coated balloons are by far superior to uncoated balloons. Careful analysis of data and more research are required to confirm the findings and explore additional applications."

Coating the balloon with the drug allows more of the drug to come in contact with the plaque than is the case with stents. The drug covers the balloon and is then transferred to the entire artery surface that comes in contact with it. Because stents are mesh, not solid, drug concentration is highest on their struts. Tissue that comes in contact with the struts receives much more of the drug than the tissue that doesn't.

Drug-coated stents are also called drug-eluting stents, because the stent continues to release the drug for about 30 days after placement. In the case of drug-coated balloons, the drug is delivered to the vessel wall immediately, in one dose. Early research on animals suggests that the effect persists in spite of rapidly decreasing drug concentration.

Spraying the balloon with a drug is a new and exciting way to treat stenosis. We know that the rate of retenosis in a treated artery without a stent or with an uncoated stent is unacceptably high. Researchers have also found some long-term problems with coated stents. I'm looking forward to upcoming research on this new strategy to attack those nasty blockages.

Here is a short interview with the researcher who performed the first study of drug-coated balloons.

Diagnosis: Cardiovascular disease in women. Treatment: Often Neglected.

The American Heart Association wants women to take the following message to heart: cardiovascular disease (CVD) is the No. 1 killer of women, and the risk increases as you age.

"One in three women over the age of 50 will die of cardiovascular disease. CVD kills more women each year than all forms of cancer, including breast cancer, and the next five leading causes of death combined. Men have more heart attacks than women, but women have a higher death rate from heart attacks."

"Women over 50 have a number of risk factors for heart disease, including high blood pressure and high cholesterol. They can benefit from preventative therapy to the same degree as men. Yet research shows they are less likely to be evaluated, less likely to receive treatment and have a worse prognosis once they are diagnosed, because their disease is often more advanced."

To help encourage women to take charge of their heart health, the AHA has shifted the focus of its 3-year-old "Go Red for Women" educational initiative from public awareness to public action. Go Red, which debuted in 2004, was designed to publicize the risks associated with heart disease.

Women and heart disease. See two women who struggled to get their doctors to listen. Click "Launch" the video: Are men and women diagnosed differently?

Pulse of the Heart will be posting news and information on heart health for women over the next week, leading up to National Wear Red Day, February 3rd.

Tuesday, January 24, 2006

The benefits of antioxidants

See a very good, up-to-date, video.
Scroll down to the January 20, 2006 entry.

Erectile Dysfunction Predicts Coronary Heart Disease

Erectile dysfunction (ED) is an independent predictor of severe coronary heart disease among men suspected of cardiovascular disease, according to investigators here.

UCLA researchers found that the more severe the ED, the more severe the heart disease. Studies in the US and Canada have found that men with ED are more likely to have diabetes and high blood pressure.

To get an erection, blood vessels have to dilate and constrict at the right time. The same process that causes fatty deposits to build up in arteries of the heart also affects the blood vessels in the penis. The result: the penis is unable to fill and hold the extra blood needed to maintain an erection.

The finding suggests that questioning about sexual function should be a routine part of a physician's exam to identify patients in need of a further workup.

Monday, January 23, 2006

Walk away from depression

We know that depression and heart disease are intricately linked.

A study conducted in Baltimore found that of individuals who were free of heart disease, those who had a history of depression were four times more likely than those who did not to suffer a heart attack in the next 14 years.

Now, a new study indicates that just 30 minutes of brisk walking can immediately boost the mood of depressed patients, giving them the same quick pick-me-up they may be seeking from cigarettes, caffeine or binge eating.

Researchers at the University of Texas at Austin found that people suffering from depression who walked on a treadmill for 30 minutes reported feeling more vigorous and had a greater sense of psychological well-being for up to an hour after completing the workout.

Those patients and another group that sat quietly for 30 minutes both reported reductions in negative feelings such as tension, depression, anger and fatigue. But only the group that exercised said they felt good after the session.

"People shouldn't feel like the only thing they can do is take their medicine and wait till they feel better. This kind of shows there are things you can do to help yourself in the short term."

You've probably seen exercisers using those elliptical machines with the pedal arms. The good workout you get on these devices can be duplicated in the great outdoors with the use of ski poles.

So, how about trying some Nordic walking? Learn how to do it by watching this video. Click on the January 20, 2006 entry.

Cognitive loss after bypass surgery

Minimizing trauma to the body's largest artery – the aorta – during heart bypass surgery can significantly reduce cognitive loss that often follows the operation, a team from Wake Forest University School of Medicine reported today.

Surgical technique is the primary cause of later thinking -- cognitive -- problems in coronary artery bypass graft patients, concluded the research team.

In the new study of 237 patients, the team compared the standard method of coronary artery bypass using the heart-lung machine with surgical techniques that minimized movement of the aorta while still using the machine. Movement was reduced by using a single clamp that exerted significantly less force on the aorta than the standard cross clamp. Surgery without the machine was also compared.

Six months after surgery, only 32% of the patients who didn't use the machine and 30% of the patients who had minimal aortic movement had deficits, suggesting less permanent injury in both groups. But 57% of the patients who had the traditional surgery still had deficits at 6 months, the researchers reported.

Other studies have shown that inflammation (our old enemy) increases the risk of cognitive impairment, possibly as a result of surgical stress. And, the preventive administration of the "smart drug", Instenon, significantly diminished the risk of cerebrovascular complication.

Would statins help? We know they're anti-inflammatory, however, in one study preoperative statin therapy did not decrease the inflammatory response to cardiopulmonary bypass or the cognitive dysfunction commonly seen after cardiac surgery.

So, if in need of bypass surgery, know the risks and discuss ways to minimize them with your doctor. Ask these questions:

  1. Is the surgery likely to prolong my survival?
  2. Are there any viable alternatives, such as medication, angioplasty, or stenting?
  3. If I must have bypass surgery, is there any reason I can’t have some form of minimally invasive surgery where the bypass pump is avoided?
  4. What can be done pre-operatively or intra-operatively to minimize my risks?

Sunday, January 22, 2006

Drugs work together to fight plaque

Mice were fed a diet to raise cholesterol. They were then treated with the calcium antagonist, amlodipine (Norvasc), atorvastatin (Lipitor- a cholesterol-lowering drug), or both.

After 31 weeks, atherosclerosis in the aorta was quantified. Treatment with amlodipine resulted in a 43% reduction of lesion area as compared with the untreated group. Treatment with atorvastatin resulted in an 80% reduction of lesion area as compared with the untreated group. Combined treatment with amlodipine and atorvastatin decreased the lesion area by 93%, significantly more than either treatment alone.

Researchers concluded that atorvastatin had a strong anti-atherosclerotic effect, whereas co-treatment with amlodipine enhanced this effect significantly.

This synergistic effect is good news for those treated for high blood pressure and high cholesterol.

Soy lowers cholesterol? Not so fast.

An American Heart Association committee reviewed a decade of studies on soy's benefits and came up with results that are now casting doubt on the health claim that soy-based foods and supplements significantly lower cholesterol.

The committee members reviewed 22 studies and found that large amounts of dietary soy protein only reduced LDL, or "bad" cholesterol, about 3 percent and had no effect on HDL, or "good" cholesterol, or on blood pressure.

The findings could lead the Food and Drug Administration to re-evaluate rules that currently allow companies to tout a cholestorol-lowering benefit on the labels of soy-based food. Nutrition experts say soy-based foods still are good because they often are eaten in place of less healthy fare like burgers and hot dogs.

Still, the Heart Association statement notes that soy products like tofu, soy butter, soy nuts and some soy burgers should be heart-healthy because they contain a lot of polyunsaturated fats, fiber, vitamins and minerals and are low in saturated fat.

Hey, I'll eat the tofu anyway, if dinner looks like the one pictured. Besides, reducing heart disease risk is not just about lowering cholesterol. It's also about oxidized cholesterol, and beans, like soy, have antoxidants to help block LDL oxidation.

Saturday, January 21, 2006

Cardiac "patch" for damaged hearts

Stem cells grown within a defined area show promise for use as a cardiac "patch" that provides a living bridge over an infarct in the myocardium according to a report in Tissue Engineering.

The three-dimensional scaffold populated with human fibroblast cells and applied as a patch to mouse heart muscle damaged by a heart attack improved heart function and stimulated the formation of new blood vessels that supply oxygen and essential nutrients to the heart.

"Too often, those who have lost cardiac muscle go on to develop congestive heart failure as a result of lost muscle mass after a heart attack. This work represents an important step in the control of cardiac tissue regeneration that is designed to invigorate local regions of weakened cardiac muscle."

The NIH team expects to enter clinical trials within the next 10 years.

Best buy in exercise bikes - Consumer Reports

Consumer Reports recently tested eight traditional and recumbent exercise bicycles:

Upright Best Buy: Schwinn Model 113 - $400
Recumbent Best Buy: Nordic Trak SL-728 - $500

Read more here.

Diabetes drug downside

People with type 2 diabetes are often prescribed drugs to boost their production of insulin. The controversial belief that these so-called sulfonylurea drugs increase mortality in patients with diabetes now gets support from a new study by researchers in Canada.

At higher daily doses, sulfonylurea-type drugs were associated with an increased risk of death.

"Clinicians should carefully assess the need for sulfonylurea therapy in subjects at high risk of cardiovascular events -- particularly now, when several other classes of antidiabetic oral medications are available," the investigators conclude.

Sulfonylureas promote insulin release by binding to potassium channels in pancreatic cells, keeping these channels closed. The possible link to cardiovascular risk? This class of drugs also binds to the same channels in cardiac muscle interfering with these cells' ability to withstand brief periods of ischemia.

"This evidence, taken within the context of observations collected over the last 30 years, suggests that clinicians should carefully assess the need for sulfonylurea therapy in subjects at high risk of cardiovascular events-particularly now, when several other classes of anti-diabetic oral medications are available."

One diabetic "medication" I like is the nonprescription "drug" exercise! A daily intake of exercise significantly lowers high glucose readings. And, a recent study indicates that it's STRENGTH TRAINING that provides the benefit.

In the 4 month study, a significant decline in Hb A1c (an important marker for diabetes control) was only observed in the strength training (6 sets per muscle group per week) group, but not the endurance training (3x per week for 30 minutes for) group. Blood glucose and insulin resistance improved significantly in the strength training group, whereas no significant changes were observed in the endurance training group.

The researchers concluded that strength training was more effective than endurance training in improving glycemic control.

So, no matter what medication you take (and you should talk to your doctor about the options), try adding exercise, especially strength training exercise, to your daily regimen.

Friday, January 20, 2006

Stressful work linked to heart disease

People who suffer from chronic stress at work have an increased risk of developing heart disease and diabetes, according to a new study.

Men who held stressful jobs for 14 years were almost twice as likely to be obese, have insulin intolerance, high-blood pressure and high cholesterol than those not exposed to stress.

The mechanism underlying the relationship between work stress and metabolic syndrome remains unknown. The authors posit that the effects of stress on the autonomic nervous system, neuroendocrine activity, biological resilience, and adrenocortical function may be involved.

Professor Peter Weissberg, medical director of the British Heart Foundation, said people can protect against heart disease - even if they cannot give up work. He said: "The findings of this study support the BHF's view that regular exercise and a sensible diet should help to defend against developing heart disease, regardless of the stresses of their daily life."

If you have a stressful job, it's even more important to follow a healthy diet and regular exercise program. As evidenced in an earlier study of 15 obese men who had metabolic syndrome (and were placed on a high-fiber, low-fat diet in a 3-week residential program where food was provided and daily aerobic exercise was performed), 9 of the 15 were no longer positive for metabolic syndrome post-intervention. The researchers concluded that intensive lifestyle modification may improve coronary risk factors in men with metabolic syndrome factors.

Exercise your funny bone to benefit heart

A new study shows that laughter increases vascular blood flow, proving right the old adage that laughter is the best medicine.

Measurements were taken of the brachial artery in the arm while subjects watched funny movies. Researchers discovered a 22 percent increase in blood flow when laughing, an amount equivalent to that which results from light exercise or drugs that lower cholesterol.

On the other hand, watching Saving Private Ryan decreased blood flow by as much as angry memories or mental calculations, 35%. Researchers noted that, " at the very least, laughter on a regular basis, will undo some of the excess stress we face in our everyday lives. Patients at risk for cardiovascular disease should loosen up a bit."

Exactly why laughing might give a jolt to the circulation isn't clear. It's possible that it counters the effects that stress hormones can have on blood vessel function. In addition, laughter may spur the body's production of nitric oxide, a chemical that helps dilate blood vessels.

Thirty minutes of exercise three times a week, and 15 minutes of laughter on a daily basis is probably good for the vascular system," said Dr. Michael Miller of the University of Maryland School of Medicine in Baltimore.

It's time to laugh! Once here, click on "Play Video." It's a classic and still funny. (As usual, a broadband connection is a must.)

Thursday, January 19, 2006

Moderate drinking cuts stroke risk

NEW YORK - A drink or two a day may decrease the risk of ischemic stroke, researchers said.

Moderate drinkers, defined as those who consumed at least one drink per month but no more than two per day, had a 33% reduced risk of ischemic stroke compared with individuals who didn't drink.

"Although alcohol consumption should not be recommended to those who do not drink, because of its potential adverse effects, our data support the view, endorsed by national stroke prevention guidelines, that among those who are moderate drinkers, continued consumption may reduce stroke risk," they concluded.

Those who drank more than two drinks daily did not have an increased risk for ischemic stroke, although there was a non-significant trend toward elevated risk of hemorrhagic stroke.

In an editorial, Larry B. Goldstein, M.D., of the Duke University Medical Center, stated that non-drinkers should not be advised to consume alcohol to prevent stroke, and he added that heavy drinkers should be told to reduce or eliminate their consumption.

The first hours of a stroke are so important. Know the symptoms of "brain attack" :

-unexplained, sudden numbness or weakness of the face, arm, or leg
-trouble talking or understanding
-sudden vision problems
-sudden walking problems
-loss of balance or coordination
-unexplained and sudden headache
-sudden nausea, vomiting, and fever
-loss of or decreased consciousness

Recognizing these symptoms early is crucial. Why? See the video. (Click "Launch" the video -here.)

Cutting edge stroke treatments. See the video. (Click "Launch" the video - here.)

Aspirin use on the rise

Compared to the 1999 data, prevalence of aspirin use in 2003 was up by 20 percent overall, 12 percent for people with cardiovascular disease and 36 percent for those with diabetes.

“The implication is that doctors and the media and paid advertising by (aspirin manufacturers) have had a positive impact."

Aspirin therapy provides significant protection against cardiovascular events, but it works in different ways depending upon gender. Aspirin protects women against ischemic strokes, but not myocardial infarction (MI) or death, while it affords men protection against MI, but not strokes or cardiovascular mortality, according to a new study. This study involved meta-analysis so the results should be cautiously interpreted as the analyzed studies were not uniform.

Does your aspirin work? A new study indicates that, for some individuals, it may not. Researchers discovered that many patients who are prescribed low-dose (75 mg) enteric-coated aspirin for secondary prevention of cardiovascular events have persistent clotting activity. Younger and heavier patients and those with a previous heart attacks are most likely to have an inadequate response to treatment. When given a higher dose, they all responded appropriately. Discuss the dosage with your physician. If there ever was a wonder drug, this is it.

Wednesday, January 18, 2006

Cocoa compound improves blood flow

A new study identifies the flavanol, (-)epicatechin, as one of the bioactive nutrients in cocoa that can improve the ability of blood vessels to relax.

The researchers demonstrated that the relaxation response mediated by cocoa flavanols is dependent on nitric oxide, a key signal released by the inner lining of blood vessels essential for normal blood vessel function and healthy blood flow.

"Pinpointing specific nutrients responsible for the observed cardiovascular effects, as we are seeing here with (-)epicatechin, opens up new possibilities for the development of dietary or therapeutic interventions for cardiovascular disease," said co-author Norman Hollenberg, MD, PhD, professor of medicine at Harvard Medical School.

Mars, Inc. provided the flavanol-rich cocoa for the study. Here is some information on their product.

Other foods also contain beneficial flavonoids. Here is a small list of those foods.

In search of the healing power of chocolate from NPR.

Pomegranates - what's all the hype?

When I walked through Costco the other day, I saw this product. Pomegranates are in vogue, so in searching for information, I found this:

In the first nine months of 2005, at least 190 new pomegranate-flavored foods and drinks were introduced in the United States. Sales of pomegranates got a boost from several recent studies touting the fruit's protective benefits against cancer, heart disease and high blood pressure.

Atherosclerosis is enhanced in arteries if disturbed flow exists. So, plaque in arteries causes disturbed blood flow, which causes more plaque development.

To the rescue comes pomegranate juice (PJ). The potent antioxidant and anti-atherosclerotic activities of pomegranate juice are attributed to its polyphenols. An Italian study shows that oral administration of PJ to mice with high cholesterol, at various stages of disease, significantly reduced the progression of atherosclerosis.Thus, artery plaque development induced by disturbed blood flow may be reversed by chronic administration of PJ. This approach may have implications for the prevention or treatment of atherosclerosis and its clinical manifestations.

An Israeli study showed that PJ had potent antiatherogenic effects in healthy humans and in atherosclerotic mice that may be attributable to its antioxidative properties. Researchers saw a reduction in the size of mice atherosclerotic lesions by 44%.

Roger Corder, professor of Experimental Therapeutics at the William Harvey Research Institute in London, says that as a guide, one glass of PJ is equivalent to two glasses of red wine, ten cups of green tea, six cups of cocoa or four glasses of cranberry juice - all of which contain flavonoids.

How to serve a pomegranate.

If you’re interested, you can buy pomegranates at your local market or you can try some pomegranate juice. The Costco product is a concentrated product. As always, consult your physician before taking any dietary supplement, especially if taking prescription medications.

Tuesday, January 17, 2006

Lipitor safe at high doses

Pfizer Inc. on Tuesday said a review of 49 clinical trials showed the highest dose of cholesterol fighter Lipitor was as safe as a placebo and as safe as the lowest dose of the top selling medicine in avoiding side effects, including potentially fatal muscle breakdown. The analysis is published in the current edition of the American Journal of Cardiology.

Physicians may prescribe a high dose of Lipitor to drop LDL cholesterol to a particular target. The PROVE IT trial gave us new targets.

What's good for the heart is good for the head

Older men and women who exercised even modestly three times a week or more reduced their risk of developing dementia, including Alzheimer's, according to a new study.

Seniors who did as little as 15 minutes a day of modest exercise three days a week reduced their risk of developing dementia by about 30%.

Not only did regular exercise cut the risk of dementia, the results suggested it might also help to delay progression of the condition in people who begin to develop symptoms.

Lead researcher, Dr. Eric Larson believes exercise may improve brain function by boosting blood flow to areas of the brain used for memory. And, even if you're 75 and have not exercised before, you can still benefit by starting to exercise now, according to reasearchers.

So, here's another possible link beween vascular and brain health. We've seen this before with the statins which have also been shown to decrease Alzheimer's risk, possibly as a result of increased blood flow.

See an informative video on exercise and dementia. Scroll to the January, 17, 2006 entry.

New Impotence Drug Warning for those with CVD

Impotency drugs such as Viagra and Cialis may be associated with increased risk of damage to the optic nerve in some men with cardiovascular disease (CVD), a British Journal of Ophthalmology study suggests.

Men who had had a heart attack were 10 times more likely to have optic nerve damage if they had taken Viagra or Cialis before their diagnosis.

Men with high blood pressure were also more likely to have optic nerve damage if they had taken these drugs, although this was not statistically significant.

They believe the drugs may heighten the risk of NAION (non-arteritic anterior ischaemic optic neuropathy or reduced blood flow to the optic nerve) in those with vascular disease, who are already more susceptible.

"Any patient who has endured a sudden severe loss of vision, and is prescribed Viagra or Cialis, should tell their doctor first," said ophthalmologist Dr Gerald McGwin, of Alabama University.

As impotence may be a sign of heart disease, a discussion with your physician about the potential risk associated with impotence drugs is suggested.

Monday, January 16, 2006

Weight training - how many sets should I do?

A meta-analysis of existing research on single-set vs. multiple-set resistance training programs was performed.

The review indicates that single-set programs for an initial short training period in untrained individuals result in similar strength gains as multiple-set programs. However, if you want to continue seeing gains beyond this initial period, multiple-set programs are more effective.

So, for the first 16 weeks of your program, one set of an exercise will give you the same gains as multiple sets. Beyond 16 weeks, trained individuals performing multiple sets generated significantly greater increases in strength.

Just starting out? Do one set of each exercise for about 12 repetitions. Weight sufficient to fatigue the muscle at about the 12th repetition will result in optimal strength gains while avoiding injury.

Weight training can favorably modify several risk factors for heart disease and reduce cardiovascular disease incidence.

Diabetes/Metabolic Syndrome Reversal

Obese and overweight individuals suffering from metabolic syndrome and Type 2 diabetes showed significant health improvements after only three weeks of diet and moderate exercise even though the participants remained overweight.

"The study shows, contrary to common belief, that Type 2 diabetes and metabolic syndrome can be reversed solely through lifestyle changes," according to lead researcher Christian Roberts of University of California, Los Angeles.

"The results are all the more interesting because the changes occurred in the absence of major weight loss, challenging the commonly held belief that individuals must normalize their weight before achieving health benefits," Roberts said. Participants did lose two to three pounds per week, but they were still obese after the 3-week study.

The study regimen:
  1. High fiber, low fat diet, no calorie limit.
  2. 45-60 minutes of aerobic exercise per day on a treadmill at 75-80% of maximum heart rate.

"The diet, combined with moderate exercise, improved many factors that contribute to heart disease and that are indirect measures of plaque progression in the arteries, including insulin resistance, high cholesterol, and markers of developing atherosclerosis," Roberts said.

People have a misconception that it takes a long time to reduce health risks associated with certain conditions. This study shows that's not the case.

Just today, in guidelines published by the Heart Foundation of Australia, physicians are urged to draw up exercise plans for patients who have already had heart attacks, strokes and diabetes.

"Patients with heart disease have not been encouraged to do activity, on the basis it may risk their lives," Dr. Roger Allan said. "GPs are concerned that if they prescribe exercise and the patient drops dead, they will be sued. "The guidelines basically say that's not true -- more than half of patients can and should do an exercise program."

If you need some help and motivation, Good Morning America's America Takes It off has begun.

Sunday, January 15, 2006

Oats block build up of artery plaque

The oatmeal was especially good this morning and I decided that I wanted to see HOW GOOD it was for me. So, I went to the USDA site to look for some information from the Agricultural Research Service (ARS). The ARS is headquartered in my backyard in Beltsville and it's where I, and some assistants, monitor a famous bluebird trail (thus my email name, bluebirder). The research performed by the ARS is top-notch, important, and benefits us all.

I found this:

Scientists funded by ARS have discovered that certain compounds in oats hinder the ability of blood cells to stick to artery walls.

The oat compounds are called avenanthramides. The research team recently found that they significantly suppressed adhesive molecules that "glue" blood cells to artery walls. When blood cells stick to—and cause inflammation of—the artery wall, plaques build up. That accumulation—called atherosclerosis—can eventually block the blood vessel. The suppression provided by avenanthramides in oats may prevent this narrowing of the passageways through which blood flows.

These data suggest that the avenanthramides in oats may have great potential to prevent vascular dysfunction and development of atherosclerotic lesions by inhibiting vascular smooth muscle cell growth in arteries.

Oatmeal has a long history in Scottish society because oats are better suited to the short, wet growing season in Scotland than wheat. Hence they became the staple grain of that country.

Samuel Johnson referred, disparagingly, to this in his dictionary definition for oats:
A grain, which in England is generally given to horses, but in Scotland supports the people.

To which his biographer, James Boswell, is said to have retorted:
Which is why England is known for its horses and Scotland for its men.

Caffeine limits blood flow during exercise

In healthy volunteers, the equivalent of two cups of coffee reduced the body's ability to boost blood flow to the heart muscle in response to exercise, according to a new study.

"Whenever we do a physical exercise, myocardial blood flow has to increase in order to match the increased need of oxygen. We found that caffeine may adversely affect this mechanism. It partly blunts the needed increase in flow," said Philipp A. Kaufmann, M.D., F.A.C.C., from the University Hospital Zurich and Center for Integrative Human Physiology CIHP in Zurich.

The participants did not drink any coffee for 36 hours prior to the study testing. In one part of the study, PET scans that showed blood flow in the hearts of 10 participants were performed before and immediately after they rode a stationary exercise bicycle. In the second part of the study, the same type of myocardial blood-flow measurements were done in 8 participants who were in a chamber simulating the thin air at about 15,000 feet altitude. The high-altitude test was designed to mimic the way coronary artery disease deprives the heart muscle of sufficient oxygen.

The caffeine dose did not affect blood flow within the heart muscle while the participants were at rest. However, the blood flow measurements taken immediately after exercise were significantly lower after the participants had taken caffeine tablets. The effect was pronounced in the group in the high-altitude chamber.

The ratio of exercise blood flow to resting blood flow, called the myocardial flow reserve, was 22 percent lower in the group at normal air pressure after ingesting caffeine and 39 percent lower in the group in the high-altitude chamber.

"Although these findings seem not to have a clinical importance in healthy volunteers, they may raise safety questions in patients with reduced coronary flow reserve, as seen in coronary artery disease, particularly before physical exercise and at high-altitude exposure," the researchers wrote. "It may not be as harmless as we thought before, particularly if you suffer from coronary artery disease or if you are in the mountains."

Here's a list of the caffeine content of foods and drugs.

With a study indicating an increase in inflammatory markers, such as c-reative protein, with consumption of two cups of coffee per day, it might be wise to rethink our love affair with this beverage. For it seems that coffee is the number one source of antioxidants in the U.S. diet. That probably means that consumers drink too much and, unfortunately, still do not eat enough fruits and vegetables.

Saturday, January 14, 2006

Low calorie diet makes you young at heart

People whose daily diets are low in calories, albeit sound and well-balanced, appear to have remarkable hearts that retain a youthful vigor for many years after they should have showed signs of aging.

A study of 25 members of the Calorie Restriction Society found that adherents to diets extremely low in calories, but well balanced, had significantly lower levels of inflammatory markers and more flexible ventricles, which translated into better diastolic function, reported Luigi Fontana, M.D., Ph.D., of Washington University here, and colleagues.

The 21 men and four women had been voluntarily sticking to diets containing about 1,400 to 2,000 calories per day for three to 15 years. They were compared with 25 age- and gender-matched controls who ate typical Western diets (about 2,000 to 3,000 calories per day).

"This is the first study to demonstrate that long-term calorie restriction with optimal nutrition has cardiac-specific effects that ameliorate age-associated declines in heart function," said Dr. Fontana.

In healthy humans, Doppler echocardiographic studies have shown that normal aging is associated with a decline in diastolic function, but little or no change in left ventricular systolic function, the investigators noted.

They found that while there were no significant differences in systolic function between calorie counters and controls, people in the calorie-restriction group had diastolic function indices similar to those of younger people. In addition, they had significantly more elastic, less stiff ventricles and lower blood pressure than controls, as well as less inflammation-- less TNF-alpha, C-reactive protein and transforming growth factor-beta1.

Prof Fontana said simply consuming less food is not the answer. Members of the study group also eat what resembles a traditional Mediterranean diet, focusing on vegetables, olive oil, beans, whole grains, fish and fruit. They avoid refined and processed foods, soft drinks, desserts, white bread and other sources of "empty" calories.

For the general public, the researchers recommend a moderate reduction in calories, plus moderate, regular exercise.

See a video on the benefits of the Mediterranean-style diet. Scroll down to the November 28, 2005 entry.

Wine polyphenols and vascular disease

The proliferation of vascular smooth muscle cells is seen in the initiation and development of atherosclerosis.

In France, despite a high intake of dietary cholesterol and saturated fat, the cardiovascular death rate is one of the lowest among developed countries. This "French paradox" has been postulated to be related to the high red wine intake in France.

In vitro results now suggest that resveratrol, a major polyphenol component of red wine, inhibits, in a dose-dependent manner, smooth muscle cell proliferation, which may help to partially explain a beneficial effect of wine drinking and the "French Paradox." The study supports the conjecture that red wine consumption may have a beneficial effect on cardiovascular mortality.

Consider New York wines for their resveratrol content. An analysis of wines showed that the average resveratrol content of all New York wines tested was 7.5 µM, compared with 5.8 µM for non-New York reds and 5 µM for California red wines

Friday, January 13, 2006

Avocado boosts carotenoid absorption

A high intake of carotenoids from dietary sources has been shown to be protective against heart disease.

Dietary fat increases the bioavailability of carotenoids, such as alpha-carotene, lycopene, and beta-carotene. Since most carotenoid-rich fruits and vegetables are low in lipids, it was proposed that by adding a fat-rich avocado to a salad, you would enhance absorption of the beneficial carotenoids.

In fact, bioavailability was increased by up to 15 times when avocado was eaten with the salad. The researchers concluded that adding avocado fruit to a salad can significantly enhance carotenoid absorption. This is attributed primarily to the lipids present in avocado.

More on the avocado.

Try this spinach salad recipe and salad dressing.

Blood Pressure - Dementia Link

Midlife blood pressure was measured in Japanese American men between 1971 and 1974 and signs of dementia were assessed in later in life.

"The risk [for dementia] increased as blood pressure increased. Someone with a systolic blood pressure of over 140 mm Hg, has a higher risk for dementia than someone with systolic blood pressure between 120 and 139 mm Hg, who has a higher risk than someone with systolic blood pressure less than 120 mm Hg."

The findings suggest that "processes leading to dementia begin many years before someone is diagnosed with dementia."

Buy an automated blood pressure device and take regular readings. Then, you have the knowledge to make lifestyle modifications and begin a dialog with your physician on the need for medications.

Don't stop there. Continue taking readings. Why?

  1. Aging itself often increases blood pressure.
  2. Tolerance to medications, prompting adjustment, occurs.
  3. Side effects of one class of drugs may make them inappropriate for you. This doesn't mean you should just stop taking any medication. Another, with fewer side effects, is available and you'll need to monitor how it works.
  4. Once you leave your doctor's office, it's up to you to see if your treatment is effective.

Omron makes devices with Intellisense, a valuable feature.

Amiodarone and Curcumin

As indicated here, amiodarone, prescribed to decrease heart rhythm irregularities, has been associated with the development of lung scarring, or pulmonary fibrosis.

Curcumin, derived from the spice Turmeric, has been found to have protective effects against amiodarone-induced pulmonary fibrosis in rats.

Link to much more on curcumin, including sources.

As always, check with your doctor before taking herbs, over-the-counter medications, etc.

Thursday, January 12, 2006

The tomato vs. hypertension, emphysema

A dietary supplement derived from tomatoes may help treat mildly elevated blood pressure, the results of a small study suggest.

Researchers in Israel found that a daily dose of tomato extract helped lower blood pressure among 31 men and women with mild hypertension. On average, their systolic pressure --the top number in a blood-pressure reading --dropped 10 points, while their diastolic pressure, or bottom number, dipped four points, both statistically significant differences.

People who are already being treated for high blood pressure should talk with their doctors before trying tomato extract.

Eating a diet rich in tomato products and other antioxidant-containing fruits and vegetables is certainly a smart move,the researcher said. But, she added, a person would need to down about four tomatoes to get the nutrients in the one tomato extract capsule used in this study.

In another study, drinking tomato juice completely prevented emphysema in mice exposed to tobacco smoke. The report suggests smokers and non-smokers exposed to second-hand smoke could benefit from daily intake of tomato juice.

Significant destruction of the alveoli in the lungs of the mice not given tomato juice indicated the development of emphysema. The ingestion of tomato juice produced convincing results.
“Smoke-induced emphysema was completely prevented by concomitant ingestion of lycopene given as tomato juice."

Don't smoke.
Drink tomato juice.
Consider a supplement. (There are many manufacturers of tomato-based supplements. I've only included a link to the one utilized in this study.)

Remember, lycopene and other carotenoids, are fat soluble, so drink the tomato juice with some hummus on crackers, a salad with dressing, etc.

You're never too old to benefit from Whole Grains

Older adults who regularly eat whole grains like high-fiber cereals and cooked oatmeal may be less likely to develop a cluster of conditions that raise the risk of heart attack and stroke, a new study suggests.

Researchers found that among 535 adults between 60 and 98 years old, those who ate more whole-grain foods were less likely to develop a group of risk factors known as metabolic syndrome or to die of cardiovascular disease over the next 12 to 15 years.

Metabolic syndrome refers to a cluster of conditions, including high blood pressure, high cholesterol and high blood sugar levels, and abdominal obesity, which raise a person's risk of heart disease, stroke and kidney damage.

Whole-grain eaters were about half as likely to die from cardiovascular disease over the next 12 to 15 years.

According to Sahyoun, replacing refined grains with whole ones -- whole-grain bread rather than white, brown or wild rice instead of white -- is the way to fit in the recommended three servings of whole grains without tacking on calories.

Work your way up (slowly) to 35 grams of fiber per day. More is O.K. Hey, anything more than the average American intake of 12-15 grams per day is O.K.

Try something different: Easy directions for cooking whole grains.

Also, break out of the box, the cold cereal box, and try hot cereal for a change. Check out this great list of hot, whole grain cereals.

More nurses - lives saved

A study in the January/February 2006 issue of the journal Health Affairs concludes that increasing the number of registered nurses and hours of nursing care per patient would save 6,700 lives and 4 million days of patient care in hospitals each year.

The research also finds that for hospitals that use both RNs and licensed practical nurses (LPNs), greater use of RNs appears to pay for itself in fewer patient deaths, reduced lengths of hospital stay, and decreased rates of hospital-linked complications such as urinary arrest and upper gastrointestinal bleeding.

"From a hospital's perspective, increasing nurse staffing is costly. Nevertheless, greater use of RNs in preference to LPNs appears to pay for itself," the authors say.

The cost of changing the RN/LPN mix without changing licensed hours is low relative to other options and the authors estimate such a move would save $242 million over the short-term and $1.8 billion over time.

As you may recall, Gov. Arnold Schwarenegger issued a ceasefire on the issue of mandatory nurse-to-patient ratios after the reform measure to overturn the initiative was voted down in November of 2005. The initiative would have reduced the state’s hospitals’ nurse-to-patient ratios from one nurse for every six patients to one nurse for every five patients, a ratio that Schwarzenegger maintained would put hospitals in a financial bind to recruit, hire and retain more nurses.

Mandatory nurse/patient ratios: A good idea or not?

An important topic? I think so. Not to frighten you, but sometimes individuals go into hospitals to heal, but don't make it out alive. This is not to say that nurse-patient ratios are to blame, but overworked, tired people can make mistakes.

Wednesday, January 11, 2006

Statins need time to work

Endothelium-dependent dilation (EDD) has often been studied in patients with high cholesterol without clear coronary atherosclerosis where an improvement after statin treatment has been documented within a few weeks.

The endothelium is located at the interface between the blood and the vessel wall. It plays a critical role in the mechanics of blood flow.

Endothelial dysfunction, characterized by loss of dilatation or relaxation, has been observed in patients with atherosclerotic diseases such as coronary artery disease. Indeed, a new study indicates that individuals with high cholesterol AND ischemic heart disease (insufficient blood flow to the heart muscle), show no significant improvement in endothelial relaxation with either three months of dietary change or three months of statin therapy. However, EDD is significantly improved after long-term statin therapy.

Sometimes, patience is in order.

Heart drug use suboptimal

Many patients whose lives may depend on agents like aspirin or on drugs that control heart rate and lower cholesterol stop taking them over time.

Not only that, according to L. Kristin Newby, M.D., and colleagues at the Duke Clinical Research Institute here, doctors often stop prescribing drugs that have proven to be effective for secondary prevention of cardiovascular disease.

The recommended medications were aspirin, beta-blockers, lipid-lowering drugs, and, for those patients with heart failure, ACE inhibitors, the Duke investigators reported in the Jan. 17 issue of Circulation, Journal of the American Heart Association.

Only 71% of heart disease patients consistently take aspirin during seven years of follow-up, and adherence to lipid-lowering therapy and beta blockers is even lower. The evidence for aspirin’s benefit is so robust and the drug is so well tolerated, that Dr. Newby said she would have expected upwards of 90% of patients to be taking the drug.

"Substantial improvements in the care of coronary artery disease patients and in their outcomes could result from efforts focused on improving long-term adherence to proven therapies.”

Doctor-patient relationships should be improved. Merely using reminders to boost patient compliance may not work. Mail and telephone reminders to encourage patients to take their prescription medication as directed may be a pointless exercise, a new study suggests. "Doctor-patient relationships drive compliance, not postal and telephone reminders."

Fewer shocks with added drug

The experience of an electric shock by an implanted defibrillator can prompt feelings of anxiety, depression, or fear. Medications can decrease the arrhythmias that lead to the electric shock.

The addition of Cordarone (amiodarone) to beta-blocker therapy after implantation of a cardioverter-defibrillator (ICD) significantly reduces the risk of shock, but the side effects of the drug may outweigh this benefit.

In the study of 140 patients, Forty-one beta-blocker patients had shocks during the 12 months of treatment versus 12 patients randomized to beta-blocker plus Cordarone.

Freddy Abisama, M.D., director of the electrocardiography laboratory at the Ochsner Clinic Foundation in New Orleans, said he doubts the results will have a major impact on clinical practice because he and other electrocardiologists are looking at the bottom line. "Amiodarone does cut down on the number of shocks, but it does so at a significant price," he said.

Your doctor will explain the risks and benefits of amiodarone therapy. However, the benefit of implanted ICDs is not questioned. Studies have shown, for some time now, that implanted defibrillators are effective in reducing sudden cardiac death. Now, these same benefits hold true for women.

Normal cholesterol. Normal blood pressure. Overweight. O.K.?


Middle-aged people who are overweight but have normal blood pressure and cholesterol levels may be kidding themselves if they think their health is just fine.

Northwestern University researchers tracked 17,643 patients for three decades and found that being overweight in midlife substantially increased the risk of dying of heart disease later in life — even in people who began the study with healthy blood pressure and cholesterol levels.

Now we have a long-term study,’’ said Ramagopal Tumuluri, an interventional cardiologist who practices at St. Luke’s Medical Center in Milwaukee. “In our hearts, we always knew this was true.’’ The findings suggest that obesity might work by causing adverse metabolic changes beyond raising blood pressure and cholesterol, he said.

People who had been obese at midlife but were otherwise healthy were 43 percent more likely to die from heart disease after age 65 than normal-weight people. Participants who were modestly overweight but had normal blood pressure and cholesterol still ran a higher risk than the normal-weight people.

In the study, obesity was defined to mean a body mass index greater than 30. Overweight meant a body mass index of from 25.0 to 29.9.

"Every pound (kg) that you put on really does rob you later on in life of health, as well as (increases the) chances you're going to be hospitalized more, and perhaps even die sooner," said study researcher Robert Kushner.

If you desire to lose weight, web diet advice may be just the ticket for you. Or, you can try the Discovery Health National Body Challenge. The Discovery Health Channel's National Body Challenge is a FREE eight-week, comprehensive fitness and weight-loss challenge that provides the tools and inspiration, online and on television, to get in shape, shed extra pounds and adopt a healthier lifestyle. The Challenge begins on Jan. 14, 2006, and continues for eight weeks, ending on March 11, 2006.

(Basic weight loss guidelines)