Friday, March 31, 2006

Fiber cuts CRP

A fiber-rich diet may help control levels of a blood protein linked to an increased risk of heart disease, new research suggests.

In a study of 524 healthy adults, investigators found that those with the highest fiber intake had lower blood levels of C-reactive protein (CRP) than those who ate the least fiber. CRP is a marker of ongoing inflammation in the body, and consistently high levels of this protein have been identified in previous studies as a risk factor for future heart disease.

The new findings support the general recommendation that adults get 20 to 35 grams of fiber per day, in the form of fruits, vegetables, beans and whole grains. Study participants with the highest fiber intake typically got about 22 grams per day

Compared with subjects who ate the least fiber, those who ate the most were 63 percent less likely to have an elevated CRP number.

"This study," the researchers write, "suggests that a diet high in fiber may play a role in reducing inflammation and, thus, the risk of cardiovascular disease and diabetes."

What else lowers CRP?

Thursday, March 30, 2006

What good is faith if it is not translated into action? (Gandhi)

The common plea to "pray for me" doesn't seem to matter in the outcomes of patients having coronary artery bypass surgery (CABG), according to a multicenter study led by a Harvard group.

In a six-hospital randomized study of the clinical effects having others pray for them, there was no benefit. "Intercessory prayer itself had no effect on complication-free recovery from CABG," found Herbert Benson, M.D., of the Mind/Body Institute of Harvard's Beth Israel Deaconess Medical Center here, and colleagues. The prayers all came from persons unknown to the patients. The prayers that were offered were standardized. There was an average of 70 strangers praying for each prayed-for patient.

In fact, the complication rate was significantly higher for the 352 of 601 patients (59%) who were confident that others were praying for them, compared with the 315 of 604 (52%) of patients uncertain of such prayers. The complications were primarily atrial fibrillation.

The authors addressed an important limitation of the study. "We did not request that subjects alter any plans for family, friends, and/or members of their religious institutions to pray for them," they wrote.

"At enrollment, most subjects did expect to receive prayers from others, regardless of their participation in the study. We also recognize that subjects may have prayed for themselves. Thus, our study subjects may have been exposed to a large amount of non-study prayer, and this could have made it more difficult to detect the effects of prayer provided by the intercessors."

Nevertheless, the study was still well-controlled, long term, and had many participants.

Paul Kurtz, professor emeritus of philosophy at the State University of New York at Buffalo, and chairman of the Committee for the Scientific Investigation of Claims of the Paranormal, had a blunt response when asked why he thought the study found no effect of prayer.

"Because there is none," he said. "That would be one answer."

He added that while he tries to keep an open mind, he's seen no good evidence for such an effect in past studies. The new work, he said, "gives added emphasis to those who have been skeptical."

Dr. David Stevens, executive director of the Christian Medical and Dental Associations, said he believes intercessory prayer can influence medical outcomes, but that science is not equipped to explore it.

As for the new study, he said, "I don't think ... it's going to stop people praying for the sick."

I suggest that we spend time with those fighting disease. We call them often. We email them frequently. We visit and spend quality time with them.

Studies show that it may very well be the social support that benefits individuals who are regular churchgoers. Frequent church attendees have almost three times as many social support contacts as non-attendees. So, if you want to help, how about spending time with your friends and loved ones when it's most needed?

There's an old African proverb: "When we pray, we move our feet."

Let's act to really benefit others.

Wednesday, March 29, 2006

Exercise after a high-carb meal

The magnitude and duration of after-meal blood glucose elevation seem to be important risk factors for diabetes Type 2 and coronary heart disease.

Researchers investigated whether post-meal light physical activity might reduce this blood glucose increase.

  • Day 1 - Blood glucose was determined while resting, before meal, and each 15 min for the next 2 hours after ingesting a high carbohydrate meal of cornflakes.
  • Day 2 was similar to Day 1 but included light bicycling exercise for 30 min after finishing the meal.

Results:

In all trials, irrespective of age and training condition, light bicycling for 30 min after the carbohydrate meal blunted the rise in blood glucose. The results demonstrate an acute blood glucose reducing effect of light physical activity and of a magnitude similar to that obtained by hypoglycemic (diabetes medications or sulfonylureas) drugs, even after intake of a large dose of high glycemic food.

A great prescription: take a leisurely walk or ride a bike after a high carbohydrate meal to prevent a rise in blood glucose. (Glucose levels peak at 1 hour after the start of the meal and then return to preprandial levels within 2–3 h.)

In a study of patients with type 2 diabetes with secondary failure of sulfonylurea therapy, researchers showed that improvement of postprandial hyperglycemia, using insulin lispro (Humalog) at mealtime in combination with a sulfonylurea, not only reduced 2-h postprandial glucose excursions, but also reduced both fasting glucose and A1C levels from 9.0% to 7.1% Subjects also benefited from significantly decreased total cholesterol levels and improved HDL cholesterol concentrations.

A stunning result. Lower the after-meal glucose (by the use of insulin in this study) and you significantly improve A1C levels, currently the most important marker for diabetes control. If we could burn some carbohydrates with exercise after a high carbohydrate meal, perhaps we might remain non-diabetic, or if we are diabetic, cut medication dosage or even become non-diabetic.

Tuesday, March 28, 2006

Do cardiologists practice what they preach?

A new study surveyed all cardiologists in a large coalition of cardiology groups. A 1-page, 25-item anonymous questionnaire containing was used. Data from returned questionnaires were analyzed and compared with those in national databases.

Eight hundred surveys were sent, and complete data were available for analysis on 471 (59%).

Results:

  • The average body mass index (BMI) was 25 and 8% were obese BMI >/= 30;
  • 1.3% were active smokers;
  • 89% exercised >/=1 time/week;
  • 72% had >/=1 alcoholic drink/week. Red wine was the most frequently consumed alcoholic beverage;
  • Cardiovascular risks included dyslipidemia (28%), hypertension (14%), and diabetes mellitus (0.6%);
  • Four percent had experienced coronary events;
  • Compared with matched cohorts from the United States population, cardiologists reported lower rates of hypertension, dyslipidemia, and diabetes mellitus, and the rates of smoking and obesity were 1/18 and 1/3 those of the US population, respectively;
  • Aspirin and statins were each taken daily by about 1/3 of the participants.
  • A cardiologist with dyslipidemia was 5 times as likely to be treated and a cardiologist with hypertension was almost twice as likely to be treated as an American adult man with either of these disorders, respectively.

In conclusion, cardiologists appear to follow healthier lifestyles than the general adult US population.

Of course, people who tend to be healthier will more likely respond to these surveys, however they were anonymous responses, and they still had a pretty good number of returns. So, I'll take it with a grain of salt, but it's still nice to see that they practice what they preach.

Oh, and I still want THE specialist, a cardiologist, to listen to my heart.

Accoding to a new study, cardiologists are better than medical students, residents, and other practicing physicians at performing a bedside heart examination and in accurately identifying abnormal heart sounds, according to the findings of two studies reported in the Archives of Internal Medicine.

A total of 100 patients were each evaluated by an internal medicine intern, internal medicine resident, cardiology fellow, and cardiology attending. Their results were compared against those obtained by a phonocardiographic device, a machine that listens to and analyzes heart sounds.

Only the results obtained by cardiology fellows and attendings showed significant agreement with the phonocardiographic results. Moreover, the third heart sounds (the presence of a third heart sound often indicates important heart disease that requires further workup) identified by cardiology fellows and attending were better than those detected by residents and interns in distinguishing various heart abnormalities.

Monday, March 27, 2006

Stroke risk factors - control 'em and you win.

Most data on favorable levels of risk relate to coronary heart disease, not stroke. This population-based, 12-sample, Italian study a with 10-year follow-up, assessed the relation of a low risk profile to stroke and implications for prevention.

Results:
  • No strokes occurred in low risk participants, and stroke incidence was low with borderline elevation of only one risk factor.
  • Four modifiable risk factors--elevated blood pressure, smoking, diabetes, and high total cholesterol/high density lipoprotein cholesterol ratio--related independently to stroke risk.
  • For those at low risk or who had only one unfavorable (but not high) risk factor, the stroke rate was 76% lower than for high risk participants.
  • For all persons not at high risk, the stroke rate was 57% lower than for those at high risk.
  • In sum, favorable risk factor levels assure minimal stroke risk.

Cut stroke risk with fruits and vegetables.

Cut stroke risk with statins.

Cut stroke risk with antihypertensives.

Cut stroke risk with exercise.

Sunday, March 26, 2006

Cut cholesterol early for lifelong benefit

Research from UT Southwestern Medical Center indicates that lowering "bad" blood cholesterol earlier in life, even by a modest amount, confers substantial protection from coronary heart disease.

The new findings found that people with genetic variations affording them lower low-density lipoprotein (LDL) cholesterol in their blood from birth were significantly less likely to develop coronary heart disease later in life than those without the variations.

Based on 15 years of data tracking more than 12,000 multiethnic subjects ranging in age from 45 to 64, the researchers found that people who had cholesterol-lowering genetic variations that lowered their LDL level by about 40 milligrams per deciliter were eight times less likely to develop coronary heart disease than those without the mutations.

"These data indicate that a moderate, life-long reduction in LDL cholesterol is associated with substantial reduction in the incidence of coronary events, even in populations with a high prevalence of other cardiovascular risk factors.'

'This study demonstrates the great importance of high blood cholesterol in causing coronary heart disease."

A summary of the study, which is to be published in the New England Journal of Medicine dated March 23, called the findings “dramatic”.

"These new findings suggest the need to redouble our efforts to reduce LDL cholesterol levels in younger persons by promoting healthy diets and reducing obesity. Even small successes will probably be leveraged for later gains in lowering the risk of cardiovascular disease."

Another new study shows that by giving cholesterol-lowering agents within 48 hours of a stroke, you can cut mortality risk by 80%.

Don't just take a drug. Cut cholesterol naturally and get plenty of healthy phytochemicals to boot with the Portfolio diet.

Friday, March 24, 2006

Fat not good, even if fit

A large, new study concludes that while both fitness and fatness are important, no amount of physical activity can erase the risks of being overweight.

Researchers at Brigham and Women's Hospital in Boston measured a variety of risk factors for heart disease among more than 27,000 healthy middle-age women participating in the ongoing Women's Health Study.

Being either overweight or inactive each independently raised risk factors for heart disease, the researchers found. While women at any weight reduced their risks by exercising, being overweight appeared to be worse than being inactive, the researchers found. Even thin couch potatoes had lower risks than active women who were just a little overweight, the researchers found.

Compared with normal weight women, ''women who were overweight or obese had 2 to 10 times increased levels of risk factors that increase women's risk for heart attack and stroke, such as cholesterol and inflammation,'' Mora reported. Women who were physically inactive, whether they had normal weight or elevated weight, also had 5 to 50 per cent higher levels of these risk biomarkers, she added.

"The message should really be to get out there and be active no matter what you weigh, even if it's just for 30 minutes a day. Both are important."

Need another reason to exercise?

Sudden cardiac death during exertion is an extremely rare occurrence in women, and regular moderate to vigorous exercise may significantly lower the long-term risk, accoridng to a new study.

Thursday, March 23, 2006

Omega 3s and your heart - link severed?

Heart experts urged consumers to continue eating oily fish and foods high in omega-3 fatty acids despite research showing they may have no clear health benefits.

A review of 89 studies published by the British Medical Journal showed no strong evidence that omega-3 fats reduced deaths from cardiovascular disease. The few studies at low risk of bias were more consistent, but they also showed no effect of omega 3 on total mortality or cardiovascular events. But, Dr. Mike Knapton, of the British Heart Foundation, said more research is needed before people change their eating habits.

"To understand the effects of omega 3 fats on health, we need more high quality randomised controlled trials of long duration that also report the associated harms," they conclude.
"We are faced with a paradox," says Eric Brunner in an accompanying editorial. Health recommendations advise increased consumption of oily fish and fish oils. However, industrial fishing has depleted the world's fish stocks by some 90% since 1950, and rising fish prices reduce affordability particularly for people with low incomes.

"Whatever amount of oily fish you consume, the impact on your risk of heart disease is negligible compared to the benefits of quitting smoking, doing regular exercise and eating a diet low in saturated fats," Knapton added.

Though we await controlled research, his last statement is so true. Cut the saturated and trans fat. Lose weight and exercise. Eat 8-10 servings of fruits and vegetables per day.

The fish will thank you, too.

Wednesday, March 22, 2006

Angina missed in women

Women with chest pains may be dying of heart disease unnecessarily because doctors underestimate the severity of their condition, research suggests.

A team from University College London found that angina - often the first sign of heart disease - affected women at the same rate as men. They studied the records of over 100,000 angina patients aged 45-89 years.

Researchers determined that women diagnosed with angina were less likely to be given follow-up tests to confirm their condition, such as angiograms or treadmill exercise electrocardiograms (ECGs). Without these tests patients do not qualify for surgical treatments, such as bypass operations.

The study also uncovered evidence that even when women were sent for ECG tests, the scans sometimes failed to pick up abnormalities.

"As women tend to be protected from angina until after the menopause, it has traditionally been thought of as a predominantly male affliction. This study confirms that after the age of 45 years women get as much angina as men but worryingly, they tend to fare worse than men when they get it. Women with angina should receive prompt and appropriate treatment to reduce their risk of suffering a heart attack."

----------

Most patients with angina complain of chest discomfort rather than actual pain. The discomfort is usually described as a pressure, heaviness, squeezing, burning, or choking sensation. Anginal pain may be localized primarily in the epigastrium (upper central abdomen), back, neck, jaw, or shoulders. Typical locations for radiation of pain are arms, shoulders, and neck. Angina typically is precipitated by exertion or emotional stress, and exacerbated by having a full stomach or cold temperatures (the "4 Es": exertion, emotion, eating and extreme temperature). Pain may be accompanied by sweating and nausea in some cases. It usually lasts for about 1 to 5 minutes, and is relieved by rest or specific anti-angina medication. Chest pain lasting only a few seconds is normally not angina.

Get treatment if you have any of these symptoms. Pain is a wonderful warning system. Unfortunately, denial is often the first response to these symptoms...and it could be your last.

Tuesday, March 21, 2006

In-stent restenosis - the best treatment, by far

Insertion of stents that release the drug paclitaxel to treat stenosis within an implanted bare-metal stent in a coronary artery (in-stent restenosis or ISR) reduces the risk of subsequent re-narrowing within the stent, when compared with treatment using intra-coronary radiation (VBT), according to a new study.

"Although the initial success rate is high following repeat percutaneous coronary intervention for in-stent restenosis lesions, subsequent recurrence rates are further increased and refractory restenosis remains the single most common reason for referral to coronary artery bypass graft surgery after bare-metal stent implantation," the trial authors noted. "Identification of the optimal therapy for bare-metal in-stent restenosis carries significant public health implications."
  • We know that restenosis occurs in 10% to 50% or more of patients following implantation of the old bare-metal stents.
  • Drug-eluting (releasing) stents have been demonstrated to safely reduce restenosis compared with bare-metal stents.

Results of the study:

Paclitaxel-eluting stents reduced the 9-month composite rate of major adverse cardiac events by 43% compared with VBT. Patients with paclitaxel-eluting stents had a 53% lower rate of angiographic restenosis at 9 months, compared with VBT.

"The results from this trial in concert with other studies, indicate that drug-eluting stents should now be considered the treatment of choice for most patients with ISR of previously implanted bare-metal stents.

(Head-to-head trials of drug-eluting stent–in–drug-eluting stent -with the same vs. a different antiproliferative agent-will be needed.)

Looks like they just put the nail in the coffin for brachytherapy treatment for restenosis. ISR, the gold-standard for treatment of in-stent restenosis, popular in the late 1990s, may now have to bow out. But, it should be noted:

"There may remain a small fraction of patients with in-stent restenosis who will be better served with brachytherapy. These would include patients with bifurcation restenotic lesions; vessels or lesions with excessive calcification, tortuosity, or angulation; and other scenarios that may make repeat stenting unsuitable or lead to an increased risk of procedure-related ischemic events. In other words, vessels hard to reach or those with hardened, calcified plaque.

Monday, March 20, 2006

Periodontitis and heart disease - more bad news

Patients with periodontitis, especially infections causing a high concentration of pathogens in the blood, have an increased risk of coronary heart disease (CHD), according to findings published in the Archives of Internal Medicine.

DNA testing in 789 subjects, including 263 patients with stable CHD and 526 without CHD, was used to analyze subgingival biofilm samples for pathogens that cause periodontal disease: Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola.

The results of analyses that considered other potential risk factors found a significant association between high levels of periodontal pathogen and the presence of CHD. A significant association was also found between the number of A. actinomycetemcomitans in periodontal pockets and CHD.

A potentially prominent role for A. actinomycetemcomitans is supported by the recent finding that high levels of A. actinomycetemcomitans antibodies also predict an increased risk of stroke.

Brush, floss, make regular visits to the dentist, and......drink red wine? Researchers say red wine may help keep gums healthy and strong.

Sunday, March 19, 2006

Exercise intensity and body composition

The aim of a new study was to compare the effect of two exercise training programs, one of low and one of high intensity, on body composition.
  • Group one: 4x week exercise on treadmill at 45% of V.O 2 max for three months, spending 370 calories per exercise session.
  • Group two: same frequency but greater intensity - 72% of V.O 2 max.
  • No dietary intervention

Results:

  • Body mass decreased significantly in both groups but more in the low-intensity than the high-intensity group.
  • The decrease in fat mass was significant in both groups, but not significantly different between them.
  • Fat-free mass (muscle) did not change significantly in either group, although the difference between groups tended to be significant.

In conclusion, exercise training at 45 % of V.O 2 max produced a higher weight loss than at 72 % of V.O 2 max and the higher intensity tended to maintain muscle, possibly, in part, through the smaller weight loss. Thus, both programs may prove useful in eliciting favourable changes depending on which target (weight loss or maintenance of muscle) is of higher priority.

Do both! Exercise at a lower intensity 3 days per week and a higher intensity 3 days per week. Remember, to burn the same number of calories, you'll have to exercise longer on the low intensity days. If there's no need to lose weight, it's probably still a good idea to back off the intensity to give you variety and to avoid injury.

Saturday, March 18, 2006

Blood pressure drugs cut Alzheimer's risk

Taking medications to lower blood pressure, particularly those known as diuretics, may be associated with a lower incidence of Alzheimer's disease (AD), according to a new study.

In a study of nearly 4,000 residents of Cache County, Utah, elderly individuals who were using antihypertensive medications at the beginning of the study were significantly less likely to have developed AD than those who were not at the end of the study, three years later. This relationship persisted when the researchers controlled for other factors, including gender, age, high cholesterol, diabetes and genetic risk.

When antihypertensives were broken down by type, diuretics were most strongly associated with a lower incidence of AD. More specifically, potassium-sparing diuretics, which contain additional components to preserve levels of the mineral in the body, were related to a more than 70% reduction in the risk of AD.

Beta blockers and antihypertensives known as dihydropyridine agents also were linked to a slightly protective effect against AD, while ACE inhibitors did not appear to be associated with the risk of developing the condition.

"Findings suggest that increased potassium levels may be associated with a reduced risk of dementia," study authors write. "Consistent with this idea are observations that low potassium concentrations are associated with oxidative stress, inflammation, platelet aggregation and vasoconstriction, all of which are possible contributors to AD pathogenesis."

That is a significant reduction, indeed.


  • We know that a high potassium diet protects against stroke and many small, undetected strokes may affect memory.
  • Adults should consume 4.7 grams of potassium per day. However, most American women 31 to 50 years old consume no more than half of the recommended amount of potassium, and men's intake is only moderately higher. African Americans generally get less potassium than whites, and because they have a higher prevalence of elevated blood pressure, increased potassium intake may have particularly significant benefits for them.
  • Potassium-sparing diuretics include Amiloride, Spironolactone, and Triamterene. These drugs are much weaker than the thiazides or the loop diuretics (potassium-wasting diuretcis). Even though they do not work quite as well, potassium-sparing diuretics do not reduce potassium levels nearly as much as other kinds of diuretics do. They may be used in combination with other diuretics, one example being Hydrochlorothiazide.
  • Diuretics can be used by themselves but many people with hypertension require more than one medication to effectively control their blood pressure. Because of this, diuretics are often put together into a single tablet or capsule with drugs from other classes of antihypertensives. For example, HCTZ has been combined with various ACE inhibitors, beta blockers, and angiotensin receptor blockers (ARBs). Examples include Avalide and Hyzaar.

This study indicates that while high blood pressure is thought to raise the risk of Alzheimer's, "the protective effects of these antihypertensive medications may be independent of their ability to control blood pressure." Maybe it's the potassium. Maybe, something else.


Eat like your ancestors - Up the Potassium!



Friday, March 17, 2006

Your waistline: clue to heart disease

A new study finds that waist measurements are a better indicator of cardiovascular disease (CVD) than body mass index (BMI).

Data from 170,000 participants in the International Day for the Evaluation of Abdominal Obesity (IDEA) study show that a patient's waist circumference is directly associated with risk of CVD independent of the patient's BMI.

The study revealed a relationship between both BMI and waist circumference with physician-reported CVD and risk factors. Both were strong predictors, reported Dr Haffner. However, the association between waist circumference and CVD was stronger than for BMI. "The bigger the waist, the stronger the risk of vascular disease."

The study found that in men, the risk of heart disease increased by between 21 and 40 per cent for every 14cm (5.5in) increase in waist size. In women, the same increase in heart disease risk occurred for every 14.9cm growth in waist size.

The researchers say that fat deposited deep inside the abdomen, which is seen in an expanding waist, secretes toxins into the bloodstream, raises cholesterol and increases the body's resistance to insulin, essential for controlling blood sugar.

The study confirms the importance of measuring waist circumference, alongside current measures such as BMI, blood pressure, blood glucose and lipid levels, in identifying patients in a primary care setting who are at increased cardiometabolic risk.

To determine your waist circumference, locate the upper hip bone and place a measuring tape around the abdomen (ensuring that the tape measure is horizontal). The tape measure should be snug but should not cause compressions on the skin.

Is waist circumference a bigger predictor than fitness level? In this study of 50=95 year olds, adiposity and fitness continue to be significant predictors of insulin sensitivity into old age, with abdominal obesity being the most important single factor.

Now, there's evidence showing that the fastest way to burn off belly fat is with a combination of weight-training and aerobic exercise.

Some evidence for this comes from a six-month study of thirty obese women. They were separated into three groups: a control group, an aerobic exercise group and a combined exercise group.
  • The aerobic group did one hour of cardiovascular exercise (60-70% maximum heart rate) six days a week.
  • The combined exercise program involved weight training (3 days a week, Monday, Wednesday, Friday) and aerobic exercise (3 days a week, Tuesday, Thursday, Saturday).

The combined exercise group lost almost three times more abdominal subcutaneous fat and 13% more visceral fat than the aerobic-only group.

Time to go to the gym?

Thursday, March 16, 2006

Cut heart disease events 75% by following guidelines

As many as 2 million cardiovascular adverse events could be prevented each year if patients with high cholesterol and high blood pressure were diagnosed and prescribed the proper regimens, and if these patients adhered to their treatments.

Scientists analyzed data from the National Health and Nutrition Examination Survey (NHANES). The researchers used the Framingham Heart Study risk algorithm, which estimates total coronary heart disease (CHD) risk.

"We projected the 10-year risk of heart disease and the number of heart disease events, and what would happen if blood pressure were normalized."

Approximately one-fifth to one-half of coronary heart disease events could be prevented in US adults if hypertension was controlled. "This increases to 55% to 68% of coronary heart disease events preventable with additional optimal control of lipids.

If patients controlled blood pressure, LDL cholesterol and HDL cholesterol, a 75% decrease in the number of coronary heart disease events in the United States may oocur.

The Framingham Risk Assessment tool. Are you at risk?
See the fascinating Framingham timeline.

What drives compliance? What type of prodding is needed for individuals to take medications regularly? Mail and telephone reminders to encourage patients to take their prescription medication as directed may be a pointless exercise, a study suggests.

"According to patients, the telephone and postal reminders did very little to improve their compliance or encourage risk-reducing lifestyle changes." Doctor-patient relationships drive compliance, not postal and telephone reminders."

Tell your doctor to get on your case. His or her work may still be needed once you leave the office. It's likely that he or she has needed the motivation from others at some time in their lives, too.

Wednesday, March 15, 2006

Already have a low LDL? Lower risk further by raising HDL.

A sub-analysis of Torcetrapib/Atorvastatin Clinical Trial Program found that patients treated to LDL cholesterol levels that were below current medical guidelines showed a direct relationship between HDL cholesterol levels and the frequency of cardiovascular events.

"Clinicians know that HDL is important, but many think that it ceases to be important if we get LDL levels to below 100 mg/dL," chief investigator Philip Barter, MD, director of the Heart Research Institute in Sydney, Australia, stated.

"Our study, in which half the population achieved LDL levels below 80 mg/dL, clearly shows that even if LDL is low, HDL is still important," Dr. Barter said.


The study showed that every 1 mg/dL increase in HDL cholesterol concentration was associated with an approximate 2% reduction in the relative risk of a major cardiovascular event, even in those with LDL levels below 80 mg/dL.

Results indicated that 10% of such patients (those wwith LDLs below 80 mg/dL) with HDL levels below 38 mg/dL had a major event compared with 5% of those with HDL levels 55 mg/dL or higher. In addition, there was a 31% reduction in the risk of major events for every 1.0 reduction in the LDL-HDL cholesterol ratio.

"While lowering LDL cholesterol remains a critical focus in cardiovascular disease prevention, the TNT sub-analysis suggests that HDL cholesterol may also provide important therapeutic benefits that may result in further reductions in cardiovascular risk."

"If you look at all the LDL cholesterol–lowering studies, only 35% to 45% of patients benefit with a reduction in cardiovascular disease risk, so clearly other factors are at play."

This is why pharmaceutical companies are rushing to bring new drugs that raise HDL to the market.

Tuesday, March 14, 2006

Statins and kidney function: more incredible news

Patients with coronary heart disease (CHD) and elevated cholesterol who took Pfizer's cholesterol- lowering medicine Lipitor experienced improved kidney function, and those improvements were significantly greater among patients taking the highest dose (80 mg).

An estimated 20 million Americans suffer from chronic kidney disease (CKD). In people with CKD, the kidneys cannot effectively filter the toxins from the blood, which can lead to kidney failure. People with elevated total cholesterol and high LDL cholesterol, or "bad" cholesterol are often at an increased risk of developing kidney dysfunction.

"We anticipated that atorvastatin might provide a protective effect and slow the typical decline in kidney function in this patient population, but we didn't expect to see this level of improvement."

Pfizer said that 8.5 percent of patients taking its 80-milligram dose of Lipitor had a significant improvement of kidney function, compared with a 5.6 percent improvement in patients taking the 10 milligram dose.

(In renal patients, the glomerular filtration rate (GFR) is used. This is calculated by comparing urine creatinine levels with the blood test results. It gives a more precise indication of the state of the kidneys. The GFR is expressed in ml/min. For most patients, a GFR over 60 ml/min is adequate. But, if the GFR has significantly declined from a previous test result, this can be an early indicator of kidney disease requiring medical intervention. The sooner kidney dysfunction is diagnosed and treated, the greater odds of preserving remaining nephrons, and preventing the need for dialysis.)

GFR naturally declines with age. Patients in the study did not experience a decline in GFR. Fifty percent of patients taking Lipitor 80 mg were no longer classified as having chronic kidney disease.

Startling! What a week for statin research. It doesn't get much more exciting than this!

Monday, March 13, 2006

Breakthrough for high-risk individuals

Aggressive statin therapy with Crestor (rosuvastatin) can dramatically lower LDL levels, raise HDLs by an unprecedented amount, and even partially reverse coronary artery plaques volume, showed results of the ASTEROID trial that were revealed today.

Patients with coronary artery disease who took 40 mg of Crestor over two years had a mean reduction in LDL from 130 mg/dL to 60 mg/dL, a 53% drop, and a mean increase in HDL from 43 mg/dL to 49 mg/dL, an [astounding] 14.7% rise.

ASTEROID (A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden) was a prospective, open-label trial with blinded endpoints.
The trial was designed to answer the question of whether 24 months of intensive therapy with Crestor could result in regression of coronary atherosclerosis, as measured by intravascular ultrasound.

The authors found that in the 349 patients who were available for follow-up at 24 months, mean LDL declined from 130.4 mg/dL to 60.8, a mean reduction of 53.2%. Mean HDL went from 43.1 mg/dL at baseline to 49.0 mg/dL, an increase of 14.7%.

Depending on the efficacy parameter, coronary artery disease was seen to regress in 64% to 78% of patients, and was seen in both men and women, in older and younger patients. Total atheroma volume reduction: 6.8%.

"Coronary atherosclerosis has traditionally been considered a chronic disease for which therapy could slow, but not prevent, progression," the study authors said. "We now know that maximally intensive lipid lowering can partially reverse the atherosclerotic disease process."

"While there will still be skeptics out there, and may be skeptics in this room still, I think the data does show regression, reversal, and I think it's a very exciting finding scientifically," said Roger S. Blumenthal, M.D., of Johns Hopkins at a briefing.

Dr. Blumenthal and his Hopkins colleague, Navin K. Kapur, M.D., wrote an editorial accompanying the ASTEROID study results in JAMA. Limitations? "While the results of this study are exciting, they are tempered by the lack of a control group receiving a somewhat less intensive LDL-C lowering regimen, the absence of paired intravascular ultrasound measurements in less diseased coronary segments to demonstrate reproducibility of atheroma volume measurements, and exclusion of patients with coronary stenoses measuring greater than 50% throughout a target segment."

While intravascular ultrasound-documented atherosclerotic regression is an intriguing finding, clinicians must remember that this may not be the best measure of the treatment's effect on hard cardiovascular end points.

"Nevertheless, the pioneering work has revolutionized the current approach to understanding the anatomy and pathophysiology of coronary atherosclerosis as well as its responsiveness to medical therapy. The results of several ongoing trials will help determine what agent or combination of pharmacologic agents is most efficacious in the long-term management of at-risk patients."

Though Crestor is one of the strongest statin drugs on the market for cholesterol, concern over side effects has played a roll in its lower than expected market share. However researchers said that patients in this study did not suffer any significant side effects.

"We were taking away many years of accumulation of cholesterol plaque in the coronary arteries and we've never been able to achieve that before with a statin therapy,” said Dr. Steven Nissen of Cleveland Clinic.

A real breakthrough.

Sunday, March 12, 2006

DVT: BIG killer

March is DVT Awareness Month.

Deep-vein thrombosis (DVT) is a common but serious medical condition that occurs in approximately two million Americans each year. DVT occurs when a thrombus (blood clot) forms in one of the large veins, usually in the lower limbs, leading to either partially or completely blocked circulation. The condition may result in health complications, such as a pulmonary embolism (PE) and even death if not diagnosed and treated effectively.

According to the American Heart Association, DVT affects up to two million Americans annually. Of those who develop PE, up to 200,000 will die each year-more than from breast cancer and AIDS combined. Yet, a national survey sponsored by the American Public Health Association found that most Americans (74 percent) are unaware of DVT.

Symptoms of DVT may include pain, swelling, tenderness, discoloration or redness of the affected area, and skin that is warm to the touch. However, as many as half of all DVT episodes produce minimal symptoms or are completely “silent.”

Because a number of other conditions – including muscle strains, skin infections, and phlebitis (inflammation of veins) – display symptoms similar to those of DVT, the condition may be difficult to diagnose without specific tests.

DVT was first linked to air travel in 1954 and recent studies have suggested that it can increase the risk of a fatal clot by up to four times. Until today it was widely thought that it was brought on by long periods spent in cramped seats without exercise.

In an interesting new study, researchers discovered that DVT on flights may be caused by poor air quality.

Research from the World Health Organisation (WHO) published in The Lancet suggests "the low pressure and low oxygen environment during air travel may contribute to the development of DVT in some susceptible individuals".

The WHO research involved 71 health volunteers who were tested for possible blood clotting before, during and after an eight-hour flight.

The same volunteers were tested during eight hours of sitting in a cinema and during eight hours of regular activities.

The authors found increased concentrations in markers during flight compared to the other two situations. "Activation of coagulation (clotting) occurs in some individuals after an 8-hour flight, indicating an additional mechanism to immobilization underlying air travel related to thrombosis."

The study also found that that 43 per cent of those with the factor V gene (a clotting factor) who were taking the Pill were showing early signs of possible clotting. This compared with 9 per cent of those with one risk factor and 10 per cent of those with no risk factors.

What to do now?

The authors advised air travelers to avoid taking sedatives or drinking too much alcohol during flights to reduce the risk of DVT. Compressive stockings that improve blood flow could also help.

Complete the Risk Assessment Tool to determine your risk for a dangerous DVT.

David Bloom's DVT

Saturday, March 11, 2006

Portfolio diet attacks cholesterol

Cholesterol-lowering foods such as soy protein, almonds, plant sterol enriched margarines, oats and barley may reduce cholesterol levels more effectively when eaten in combination, says a new study.

After 12 months, more than 30 per cent of the participants had successfully adhered to the diet and lowered their cholesterol levels by more than 20 per cent. This rate is comparable to the results achieved by 29 of the participants who took a statin for one month under metabolically controlled conditions before following the diet under real-world conditions.

"The benefit of statins to individuals at high risk for cardiovascular disease is not in question here. Emphasizing diet changes in general can boost the success rate of statins while providing additional health benefits and a possible alternative for those for whom drugs are not a viable option."

"Taking a pill may give people the false impression that they have nothing further to do to protect their health and prevent them from making serious lifestyle changes."

Basics of the Portfolio Eating Plan:

Along with 5-10 servings of fruits and vegetables per day, the portfolio diet recipe for lower cholesterol focuses on four kinds of food:
  • The portfolio diet substitutes soy-based foods for meat. "We are looking at soy-based meat substitutes such as soy burgers, soy hot dogs, and soy cold cuts," Jenkins says. "And we also used soy milk as a dairy substitute."
  • The portfolio diet incorporates as much sticky fiber as possible. Those on the portfolio diet take three daily servings of the natural psyllium product Metamucil -- many use it to thicken their soymilk. Oats and barley replace other grains; preferred vegetables include eggplant and okra.
  • The portfolio diet replaces butter and margarine with plant sterol-enriched margarine. U.S. brands include Benecol and Take Control and brands in other countries are Becel and Flora pro-activ. Plant sterols are also available in capsule form as dietary supplements.
  • The portfolio diet includes nuts. Study participants ate a handful of almonds every day. The Almond Board of California backs portfolio diet research and offers portfolio diet recipes on its web site. However, other tree nuts also help reduce cholesterol.

Detailed information on the The Portfolio Eating Plan

Friday, March 10, 2006

ED : predictor of heart disease

Recent evidence suggests a strong link between erectile dysfunction (ED) and atherosclerotic vascular disease. Researchers sought to predict heart disease occurrence by erectile dysfunction incidence.

Stress myocardial perfusion single-photon emission computed tomography (MPS) is a widely used noninvasive imaging modality that allows diagnosis of coronary heart disease and stratification of cardiovascular risk. Stress test results and patient characteristices were correlated with ED.

  • Patients with ED exhibited more severe heart disease and dysfunction of the left ventricle.
  • Patients with ED exercised for a shorter period of time and reached a lower maximal intensity level.
  • ED proved to be and independent predictor of severe heart disease.

The results suggest that questioning about sexual function may be a useful tool for stratifying risk in individuals with suspected coronary heart disease.

The Second Princeton Consensus on Sexual Dysfunction and Cardiac Risk has recently been released.

"Any asymptomatic man who presents with ED that does not have an obvious cause (e.g., trauma) should be screened for vascular disease and have blood glucose, lipids, and blood pressure measurements. Ideally, all patients at risk but asymptomatic for coronary disease should undergo an elective exercise electrocardiogram to facilitate risk stratification. Lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease, is literature-supported."

"The recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise."

Austrian researchers note a relationship between high blood levels of homocysteine, an amino acid marker for heart disease, and erectile dysfunction. The researchers found that 20 of the 30 patients with erectile dysfunction they studied also had high homocysteine levels. "We also found that men with erectile dysfunction have higher levels of C-reactive protein [another blood marker for heart disease risk]."

"Don't just write erectile dysfunction off as being tired or being stressed."

What a perfect early warning sign! As we know, some individuals never feel "normal" chest discomfort and many, unfortunately, experience cardiac arrest as a first symptom. Now, men have a real canary in a coal mine right on their persons.

But, this is not just a story about men. Vasculogenic female sexual dysfunction may be related to atherosclerosis as indicated in this study. So, the ladies should also be alerted to changes in sexual function.

Thursday, March 09, 2006

Lower cholesterol with plant sterols

A pill of plant sterols can help lower cholesterol, according to a new study appearing in the Feb. issue of the American Journal of Cardiology.

In the study, researchers from Washing University School of Medicine in St. Louis followed 26 patients who were using the heart healthy diet recommended by the American Heart Association and taking statin drugs to control cholesterol to understand how intake of plant sterols affects cholesterol. Half of the participants were assigned to take four sterol pills twice a day while another half to take placebo pills.

Those who took plant sterol tablets lowered low density cholesterol or bad cholesterol on average by 9 percent. The total cholesterol was reduced by 6 percent. The cholesterol reduction was particularly significant among those who started with higher levels of bad cholesterol.

Researchers believe that plant sterols, similar structurally to cholesterol, reduce the adsorption in the gut by competing with cholesterol to get absorbed and transported into the body.

The highest amounts of plant sterols are found in broccoli, Brussels sprouts, cauliflower and olives.

Another study also showed significant cholesterol reductions with 2.2 grams of plant sterols per day. (A typical American diet provides approximately 0.25 g of plant sterol per day.)


Two easy ways to get plant sterols:

Benecol
Take Control

Look for more plant sterol-containing-products in the future.

Wednesday, March 08, 2006

Pollution and hospital admissions for heart disease

Short-term exposure to ultrafine particulate air pollution increased the risk of Medicare-age hospital admissions for cardiovascular and respiratory ailments, according to a national database study detailed in this week's Journal of the American Medical Association.

Evidence for the health risks of inhaling particles as fine as 2.5 µm in aerodynamic diameter (PM2.5) came from a database of hospital admissions for 11.5 million Medicare enrollees. A new standard for small particles of less than or equal to 2.5µm was established in 1997 by the Environmental Protection Agency in response to growing evidence of adverse health effects from chronic exposure to airborne pollution. But the EPA also maintained the former indicator of PM10 for particulate matter. The PM10 for airborne particles does not protect public health with "an adequate margin of safety."

Hospitalizations included a primary diagnosis of cerebrovascular disease, peripheral and ischemic heart disease, heart rhythm irregularities, heart failure, chronic obstructive pulmonary disease, and respiratory disease. The largest association was with heart failure.

Cardiovascular effects may reflect neurogenic and inflammatory processes. Animal studies suggest that particulate matter may accelerate the development of atherosclerosis, the researchers said.

Ah. More evidence of the deleterious effects of urban air pollution. You think you're doing everything right: exercising, keeping weight down, eating right, taking prescribed medications, but WHAM! You boost your risk with every breath you take.


EPA Air Pollution Hearing Draws Outcry From Experts, Public Local Citizens And Advocates Call On Administration To Heed Science, Protect Public Health

How does air pollution cause heart disease?

Send a letter to the EPA in support of stronger air pollution standards.

Tuesday, March 07, 2006

Aspirin: more people can benefit

Taking aspirin to prevent coronary heart disease is beneficial and cost-effective for a wider range of men than is often recognized, a study from the University of North Carolina at Chapel Hill has found.

Compared to no treatment, taking aspirin was less costly and more effective for preventing heart attacks and other events in men whose 10-year risk for coronary heart disease was 7.5 percent or greater. Before this analysis, most experts felt aspirin was beneficial in men with a 10-year risk of heart disease of 10 percent or greater, "Our analysis suggests that it is also beneficial for men between 5 percent and 10 percent risk."

The study also found that adding a statin, or cholesterol-lowering, drug to aspirin therapy became cost-effective only when the patient's 10-year risk for coronary heart disease was higher than 10 percent. "People should find out their cardiovascular risk and make decisions about preventive treatment based on that risk.

The study also showed that aspirin was not effective for men whose 10-year risk was below 5 percent, because the chance of adverse effects from bleeding cancelled the benefit from prevention of coronary heart disease events.

Is your chance for getting heart disease above 5% over the next 10 years? Click here to find out. (The test is for those who have not been diagnosed with heart disease.)

Monday, March 06, 2006

Rice Bran Lowers Blood Pressure

Scientists in Japan have shown that the waste product of rice processing, called rice bran, significantly lowers blood pressure in rats. Adding rice bran to the diets of hypertensive, stroke-prone rats lowered the animals’ systolic blood pressure by about 20 percent and, via the same mechanism, inhibited angiotensin-1 converting enzyme, or ACE.

It’s still not clear whether simply eating more brown rice, which retains some of its bran, would reduce the risk of heart disease. However, previous research in humans, as well as animals with high cholesterol, does suggest that certain fractions of rice bran can lower levels of unhealthy LDL cholesterol.

Researchers conclude that rice bran fractions appear to have a beneficial dietary component that improves hypertension, hyperlipidemia, and hyperglycemia.

In fact, it may be the rice bran oil, and not the fiber that lowers cholesterol. And, tocotrienols, from rice bran, may reduce atherosclerotic lesion size.

It wouldn't hurt to eat more brown rice.

You can ask your doctor about supplementing with tocotrienols.

Sunday, March 05, 2006

Marital spats and heart disease

Marital spats do not just produce harsh words and hot air - they can harden your arteries too, a study suggests.

The cause of the damage differs depending on your gender: arterial disease in women was linked to either partner demonstrating hostility, but in men it was linked to either showing controlling behaviour.

It was found that the wives who made the most hostile comments during a family discussion had a greater the degree of artery calcification, which indicates that plaque is building up in the arteries that supply blood to the heart.

Husbands who displayed more dominance or controlling behaviour, or whose wives displayed such behaviour, were more likely than other men to have more severe hardening of the arteries.

"If someone said, 'what's the most important thing I can do to protect my heart health?', my first answers would be 'don't smoke', 'get exercise' and 'eat a sensible diet'," study authors stated. "But somewhere on the list would be 'pay attention to your relationships.' "

See an interview about the study with Dr. Emily Senay. Click on the CBS NEWS video.

Shoot for a healthy marriage. It's good for your health.

Saturday, March 04, 2006

Antidepressants Boost Heart Patients' Death Risk

In a surprising finding, patients with coronary artery disease who take commonly used antidepressant drugs may be at significantly higher risk of death, Duke University Medical Center researchers have found.

Researchers found that heart patients taking antidepressant medications had a 55 percent higher risk of dying. Previously, Duke researchers reported that the presence of depression is an important risk factor for heart patients. This new finding of the risk from anti-depressants raises issues about the optimal way to treat depression in cardiac patients, the researchers said.

According to Duke team leader Lana Watkins, Ph.D., the researchers believe their findings add further support for the potential role of non-pharmocological approaches to treating depression, such as exercise, in reducing the risk of death in depressed heart patients. She said that physicians caring for heart patients who are taking antidepressants should monitor patients closely. Reasons for the association are not clear.

This is an intriguing study, though a placebo-controlled study is needed to help prove causation. However, one thing we do know is that exercise is a very good mood-booster.

Friday, March 03, 2006

Lipid profiles and the Framingham study

The current cholesterol treatment guidelines have designated low-density lipoprotein (LDL) cholesterol as the major target for the treatment of dyslipidemia.

But what about HDL and total cholesterol?

This report, from the long-running Framingham study, examined the influence of the total/HDL cholesterol ratio on coronary heart disease (CHD) risk at high, medium, and low levels of total and LDL cholesterol. This tests whether the level of the components of the total/HDL cholesterol ratio need to be taken into account in assessing dyslipidemic risk and response to treatment.

Results:

  • Little difference was found in the effect of the total/HDL cholesterol and LDL/HDL ratios as predictors of the risk of CHD. It thus appears that the ratios can be used to determine CHD risk efficiently, irrespective of the LDL cholesterol level, particularly in men.
  • It appears that when the total/HDL or LDL/HDL cholesterol ratio is favorable, the level of the lipids that compose the ratio on CHD risk has little influence. This suggests that a favorable ratio justifies a conservative approach for elevated lipids (with diet, exercise, and weight control), rather than aggressive drug treatment.
  • In men, the LDL cholesterol level reflected the lowest risk factor (relative risk 1.9), and the total/HDL cholesterol ratio predicted the greatest risk (relative risk 2.9).
  • In women, LDL cholesterol imparted the highest risk of the individual lipids (relative risk 3.9), and this was not exceeded by the lipid ratio (relative risk 3.8).

The total/HDL ratio is very important for both sexes and indications are that the total/HDL and LDL/HDL ratios are more powerful predictors than the lipids from which they are comprised. The total/HDL ratio appears to predict CHD equally well at low and high total cholesterol values.

More reason to raise the HDL as modest increases cut risk significantly.

Clinical strategies to elevate HDL.

Thursday, March 02, 2006

Statins and HDL

Continuing the discussion of the role of HDL cholesterol and heart disease, we have a study that indicates treatment with a cholesterol-lowering statin can significantly reduce the risk of heart disease and death only in those elderly individuals with low HDL.

Researchers examined the role of lipoproteins including high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol in persons over the age of 70, and found that HDL was a better predictor of cardiovascular risk and treatment benefit than LDL in this group.

In the study, at-risk men and women aged 70 and older were given a statin or placebo. Those with initial HDL cholesterol levels below 45 mg/dL who received statin therapy were one-third less likely to have a non-fatal heart attack or die of heart disease. In contrast, men and women with higher levels of good cholesterol did not appear to benefit from statins.

“We did not expect the benefits of statin therapy to vary according to starting HDL level. Also, unlike statin studies in younger persons, LDL was not what mattered."

“Since we knew from epidemiological studies that LDL has virtually no association with coronary risk in the elderly and also that a statin’s primary effect is to lower LDL, some questioned whether the drug would do any good at all in this age group.”

At the start of the study, two groups had average HDL levels of 50 mg/dL, average LDL levels of 147 mg/dL, and average total cholesterol levels of 221 mg/dL. At 3.2 years follow up, researchers found no association between baseline LDL levels and the risk of a coronary event in either the statin or placebo groups.

“If statin therapy could be targeted to at-risk elderly with low HDL levels who would benefit most, fewer people would have to be treated — a substantial time and cost saving,” said Packard.

So why do statins help only those elderly with low HDL levels?

“Since low HDL is associated with high inflammation, itself a risk factor for heart disease, and we know statins have anti-inflammatory properties, [the] working hypothesis is that statins block inflammation and thereby reduce the deleterious effects of low HDL, researchers said.

In another interesting study, HDL, not LDL cholesterol levels influence short-term prognosis after acute coronary syndrome (ACS). The finding suggests that the clinical benefit of the statin, atorvastatin, after ACS is mediated by qualitative changes in the LDL particle and/or by non-lipid-lowering effects of the drug.

Are they referring to inflammation reduction? Is this why a high HDL is so effective and why many biotechs are focusing on raising HDL?

What can you do naturally, now, to raise HDL?

So, let's do an unscientific study. Your homework for the weekend: Ask somebody, over age 70, without heart disease, and not on a statin, what his or her HDL level is. Let us know.

Wednesday, March 01, 2006

Targeting HDL

There is substantial evidence from clinical trials that lowering low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular risk. There is less evidence for the salutatory effects of raising high-density lipoprotein cholesterol (HDL-C).

Study authors identified a cohort of all 6928 patients in an urban primary care practice who had two or more lipid measurements between January 1985 and December 1997.

  • Adjusting for other risk factors, a 10-mg/dL higher initial HDL-C was associated with an 11% lower risk of coronary events.
  • A 10-mg/dL increase in HDL-C between lipid measurements was associated with a 7% lower risk of events.
  • Neither initial or change in triglycerides nor LDL-C predicted subsequent coronary events.

CONCLUSION: High-density lipoprotein cholesterol measurements and change in HDL-C predicted major adverse coronary events in this urban practice, which provides support studying interventions targeting HDL-C for cardiovascular risk reduction.

A very interesting study, don't you think? LDL change had no effect, but HDL did? Treatment has focused on lowering LDL, but now companies are moving research dollars toward raising HDL cholesterol and, I suspect, we will all benefit.

See a previous post on raising HDL.