Nov
01
2003

Stroke Risk Increases With Carotid Artery Disease

An important study about the risk of strokes and mini-strokes (called”transient ischemic attacks”) was published in the Oct. 27 edition of the Archives of Internal Medicine. Dr. Daniel J. Bertges and his group followed 1,004 patients between 1988 and 1997 with ultrasound studies of the carotid arteries (carotid artery duplex ultrasound scans). The studies took place at the Pittsburgh Veterans Affairs Medical Center/University of Pittsburgh School of Medicine. Patients were followed with regard to events such as strokes on the side of where the narrowed carotid artery was.

Reversible mini-strokes (medically correct term:”transient ischemic attack” or TIA) were also registered. A total of 1,701 narrowed arteries (called “stenotic arteries”) were found with this ultrasound method. All of the patients initially had no symptoms of the carotid artery stenosis (no dizziness, no fainting, no absence spells or symptoms of TIA or stroke). In 75% of the patients the carotid stenotic lesions were less than 50% meaning that the carotid artery blood flow was acceptable.

Here are some of the risks as the study went on over the years: both TIA and CVA risk in a given patient occurred at a rate of 3.3% per year. Regarding a specific involved artery the risk of developing a TIA as a result of this was 2% per year and the risk to develop a stroke was 2.1% per year. The investigators found that two main factors determined the ultimate progression into a TIA or a stroke and they were as follows. First, if the artery was severely stenosed at the outset, the probability was high that this would progress and be the cause of a stroke. Secondly, the degree of progression when checked with a follow-up duplex ultrasound was another important factor in terms of leading to a subsequent TIA or stroke.

Stroke Risk Increases With Carotid Artery Disease

Carotid artery clot can cause stroke

The composite risk of developing either a TIA or a stroke with a worsening stenotic carotid artery lesion was 1.68-fold. To develop a stroke alone in this scenario the risk was 1.78-fold. Clinical risk factors were of no help in predicting which cases would go on to develop TIA’s or strokes. However, the finding of further progression of a stenotic carotid artery lesion documented on serial duplex ultrasound studies was highly significant.

The authors concluded that there is value in doing serial carotid artery duplex scan studies in the same patient to screen for progressing stenotic lesions in the carotid arteries. When a stenotic lesion is significant enough or progressing fast, intervention by a cardiovascular surgeon with carotid endarterectomy can be done to prevent a stroke or TIA.

Here is a link to a chapter on strokes from the Net Health Book.

Last edited October 26, 2014

Oct
02
2003

Better Recovery From Strokes Through Early CAT Scans

In the September 2001 issue of the American Journal of Neuroradiology (Am J Neuroradiol – 01-SEP-2001; 22(8): 1534-42) a group of clinicians from the Foothills Hospital in Calgary/Alberta had published an article with a scoring system for CAT scans (also abbreviated CT scans) that would be done on every patient with a stroke. By utilizing early CT scans and this scoring system an ischemic stroke (due to a blood vessel that closed off in the brain) could be rapidly assessed. Within 3 hours of the beginning of the stroke the treating physician would know whether the patient would benefit from clot-busting drugs (TPA or tissue plasminogen activator) or not. Dr. Pexman and co-workers had noted that patients with an Alberta Stroke Program Early CT Score (ASPECTS) of less than 7 had a poor survival rate or an outcome with high dependency on caregivers. Patients with a score of 7 to 10 had a much better survival chance and were ideal candidates for the clot-busting therapy. The brain of the stroke patient depicted by CT scans using this method is divided into 10 regions and the findings are systematically evaluated by the radiologist and an ASPECTS score is obtained. Dr. Michael Hill, an assistant professor at the University of Calgary, and one of the co-workers of this initial study has now completed a further follow-up study together with Dr. A.Buchan, director of the Calgary Stroke Program. The results were published in the August 2003 issue of the medical journal “Stroke”. They found that ischemic strokes (from clots in the middle cerebral artery) have the best outcome when detected by CT scan early (within 3 hours of the beginning of the stroke) and if thrombolysis therapy with TPA, the clot-busting drug, is done before 6 hours after the beginning of the stroke.

Better Recovery From Strokes Through Early CAT Scans

CT Scan of Ischemic Stroke

The lack of blood circulation from a stroke,which closed the middle cerebral artery, is shown in this link. What does that mean in practical terms? Let us assume a patient is suddenly losing all of the strength and movement in one arm and losing speech as well. An emergency CT scan is done right away and it is determined that the patient has had a stroke in the middle cerebral artery. Let us say that the ASPECTS score was between 7 and 10. This patient’s physicians would likely treat the stroke with the clot-busting medicine mentioned being confident that there likely will be a good outcome. In the past, before this therapy was available, many of these patients would end up with a permanent arm palsy without much function and sustain a permanent speech deficit as well. After the clot-busting therapy many of these patients who have a good outlook will now have a considerable, if not full return of function in their arm and regain their speech as well. Unfortunately, the opposite is true as well: those with a poor ASPECTS score below 7 will not be candidates for the clot-busting therapy and will tend to do poorly. This scoring system of early CT scans with strokes (ASPECTS) is already being used in several countries such as Canada, the US, Australia and Europe. “Early detection and intervention in stroke is critical to achieve a positive outcome” said Dr. A.Buchan, director of the Calgary Stroke Program, who is also a professor in the department of clinical neurosciences of the University of Calgary/Alberta. Here is a link for more background on strokes.

Last edited October 26, 2014

Aug
01
2003

Modify Risk Factors For Erectile Dysfunction (ED) In Elderly Men

Erectile dysfunction (ED, impotence) is a subject that is difficult to research because of its personal nature. Very few good studies are available regarding the question as to how common it would be among older men.

A team of medical experts under Dr. Constance G. Bacon from the Harvard School of Public Health and other institutions have investigated this problem in men older than 50 years and published the results in the August 5, 2003 issue of the Annals of Internal Medicine.

31,724 men aged 53 to 90 years were taking part in the Health Professionals Follow-up Study. Since 1986 they had been filling out detailed questionaires biennially. In 2000 detailed questions about sexual function were also included. Erectile dysfunction was defined as “having poor or very poor ability to have and maintain an erection sufficient for intercourse without treatment during the past 3 months”. The investigators found that about 1/3 of the men above the age of 50 had a sexual dysfunction. Such factors as orgasm, ability to have intercourse, sexual desire and overall sexual function were all affected more and more with every year after the age of 50. When this was further analyzed using multivariate analyses an interesting pattern of reasons for this emerged. The following factors were identified to be independent risk factors for the development of erectile dysfunction.

Modify Risk Factors For Erectile Dysfunction (ED) In Elderly Men

Modify Risk Factors For Erectile Dysfunction (ED) In Elderly Men

Each of the factors from this table is an independent risk factor and can be managed separately. For instance, the investigators found that a higher level of physical activity was associated with much less ED. The best group (men with no ED) was found among those who were always conscious about disease prevention and who had none of the conditions listed in this table or other chronic medical conditions. Leanness and physical activity were associated with good sexual functioning in this study.

Risk factors leading to erectile dysfunction (ED)
Symptoms: Comments:
increasing age
aging likely affects the blood supply to the swelling bodies of the penis; it also clamps down on testosterone production of the testicles
smoking accelerates aging and hardening of arteries
diabetes mellitus affects circulation and nerve impulse transmission
stroke
interferes with brain centers of arousal
antidepressant medication anticholinergic side-effect interferes with penile erection
beta-blocker medication reduction of libido (likely at the brain level from sympathetic nerve block)
alcohol consumption alcohol is a nerve poison that interferes with pudendus nerve function (lack of erections)
TV viewing time due to prolonged sitting there is a chronic lack of exercise that leads to nerve conduction and circulatory problems resulting in ED

This summary is based on a paper published in the medical journal of Annals of Internal Medicine 2003;139:161-168 by Dr. Constance G. Bacon and co-workers.

Here is a brief chapter on erectile dysfunction from Dr. Schilling’s web-based free Net Health Book.

Last edited October 26, 2014

Aug
01
2003

Reduction Of Complications After A Stroke

Following an acute stroke, it used to be taught in medical school that lowering the blood pressure would be something to avoid for fear that this would lower circulation to the brain and could make a stroke worse. A new study, called ACCESS (Acute Candesartan Cilexitil Therapy in Stroke Survivors), is proving this teaching wrong and demands a 180° turnaround.

Dr. Joachim Schrader has pablished this landmark study recently in the Medical Journal “Stroke” (Stroke – 01-JUL-2003; 34(7): 1699-703). This study followed 339 stroke patients after an initial angiotensin type 1 receptor blocker was given right away versus a control group who got it only 1 week later. In other words, the test here was to see what would happen, if treatment would be started right away during the acute phase of the stroke. Up to now this was only done in the stable period after 1 or 2 weeks (the conventional approach). The 1 year follow-up data showed that the overal death rate from all causes (summing up all complications) was 47.5% less in the treatment group than in the control group. In other words by using intervention with this newer type of blood pressure lowering medication, such as the angiotensin type 1 receptor blocker candesartan (Atacand), complications such as extension of the stroke or heart problems and other complications were averted. The end result were fewer deaths and better quality of life in those who survived.

The Medical Post in its July 29, 2003 edition (p. 1 and 54) interviewed Dr.Ashfak Shuaib, professor of neurology of the University of Alberta in Edmonton, regarding the significance of this study. He felt that there likely would be a new hormonal effect on the brain from the lining of the arteries in the brain that gets blocked and that leads to an increase of blood supply to the brain.

Reduction Of Complications After A Stroke

Reduction Of Complications After A Stroke

This in turn would rescue the brain tissue around the stroke preventing the late complications. He said that this line of research would be very solid data, but that it would have to be confirmed by an independent study from other investigators. Dr. Shuaib’s group of researchers are planning an imaging study where they will study the blood flow following strokes under the same conditions using candesartan (Atacand).

Link to a chapter on stroke of the Net Health Book.

Last edited October 26, 2014

 

Jul
01
2003

High Blood Pressure On The Increase In The US

High blood pressure on the rise

Dr. Hajjar, of the University of South Carolina in Columbia and Dr. Kotchen, of the Medical College of Wisconsin in Milwaukee have compared a large group of people in the US in the years 1999-2000 with prior studies in 1988-1991and 1991-1994 where peoples’ blood pressures were measured.

The latest study involved more than 5000 people, the prior studies more than 9000 people each. Almost 29% of the population has a blood pressure of 140/90 or higher in the latest study.

Compared to the 1988-1991study this is a significant increase of 3.7%. More than half of this was explained on the basis that the population’s weight (measured by body mass index calculation) had increased. The sub groups who had the largest increase in blood pressure were as follows:

1. diabetics with high blood pressure. In this high risk group only about 25% had a blood pressure readings of less than 130/85, which is the target value.

2. Mexican Americans had a significantly poorer awareness and control of their elevated blood pressures than the non-Hispanic whites and non-Hispanic blacks.

3. Women as a group were poorer in blood pressure controlling than men.

4. People above the age of 60 had a much higher rate of uncontrolled blood pressure as well.

The study concluded that by concentrating campaigns and efforts on these four target groups significant gains could be made in terms of control of blood pressure, reduction of strokes, heart attacks and kidney damage.

Here are some links regarding high blood pressure, prevention of strokes and heart attacks to various chapters of my nethealthbook.com:

High blood pressure link

Heart attack link

Stroke link

Last edited October 26, 2014

Jun
01
2003

Exercise Saves Lives In Women Over 65

A recent study released in the Journal of the American Medical Association (JAMA Vol. 289 No. 18, May 14, 2003) has found a profound effect of exercise on the survivial of elderly women. Dr. Gregg et al. have followed 9518 women aged 65 or older for a total of 12.5 years with a follow-up visit in between at about the 6 year point. They found that women who exercised (walking, aerobics etc.) and who were compared with a control group who was sedentary (no form of exercise), had the following improved survival rates.

These findings were independent of other factors up to an age of 75 years. In other words, age, smoking, weight and a number of pre-existing diseases did not influence these improved survival figures from the effect of exercise. However, when a woman had a significant chronic disease or was older than 75 years of age, the survival improval from exercise was not as strong as indicated in the table above. Also, the follow-up visits showed that those women who exercised continually, had the highest survival advantage.

Exercise Saves Lives In Women Over 65

Exercise Saves Lives In Women Over 65

The bottom line: increasing and maintaining a physical exercise program will likely lead to a longer life. At the same time the exercise program needs to be started early enough to be of benefit to those who are older than 75 years of age.

Disease and death rate reduction from exercise in women aged 65 and over
Reduction of:
Effect of risk reduction:
overall death rates 48%
cardiovascular disease 36%
cancer 51%

Some of the Associations that were contributing to this important study were: The National Center for Chronic Disease Prevention and Health Promotion (Atlanta, Ga), the Graduate School of Public Health, University of Pittsburgh (Pittsburgh, Pa), the Prevention Sciences Group, Departments of Medicine and Epidemiology and Biostatistics, University of California (San Francisco) and the University of Minnesota and Section of General Internal Medicine, Veterans Affairs Medical Center, Minneapolis.

Here is a fitness link: http://www.nethealthbook.com/articles/fitness.php

Last edited December 9, 2012

May
01
2003

Blood Clot Dissolving Therapy Saves Lives

Clot dissolving therapy (fibrinolytic therapy) has saved many lives when it is applied fast enough with patients who have a heart attack. In younger patients up to age of 65 to 70 years this method was applied without questioning by the treating physicians.

Several studies have shown that elderly patients have more complications such as strokes, where there can be a brain hemorrhage causing another disaster, namely a stroke from a hemorrhage as a side-effect of the clot dissolving medicine. It’s a case of too much of a good thing overthinning the blood. A new study from Sweden, which was published in the Archives of Internal Medicine on April 29, 2003 (Arch Intern Med 2003;163:965-971) showed that elderly patients with a heart attack can also benefit from this clot dissolving therapy. The main investigators, Drs. Ulf Stenestrand and Lars Wallentin, have followed 6,891 patients who have sustained their heart attacks between 1995 and 1999. They were at least 75 years of age and older, but not older than 85 years. Of these patients 3,897 received fibrinolytic therapy and 2,994 did not. Combined survival statistics and statistics of whether or not the patients suffered a stroke as a result of the clot dissolving therapy were recorded over the next year.

There was a drop of 13% of deaths and of strokes in the treatment group when compared to the controls. There were some other ways that the investigators analyzed the data statistically, but the treatment group was always better off.

Blood Clot Dissolving Therapy Saves Lives

Blood Clot Dissolving Therapy Saves Lives

The investigators concluded that there is no reason to withhold this clot dissolving treatment from elderly patients as the practice had been up to then. Until randomized studies with more details can be done, they stated, one should treat elderly patients who have acute heart attacks until the age of 85 with clot dissolving treatments.

Here are some links that may be of interest:

This link explains what a heart attack is.

Last edited December 9, 2012

Apr
01
2003

Older Americans Need More Knowledge About High Blood Pressure

A telephone survey of 1,503 Americans age 50 or older was published recently by Dr. Brent Egan from the Medical University of South Carolina, Charleston, in the March 24, 2003 issue of the Archives of Internal Medicine. Although 94% had their blood pressure measured at least once in the past year, only 46% knew how much it was. Of all the patients who knew that they had a systolic blood pressure of 140 mm mercury or higher, 30% did not know that this was abnormal and was called “systolic hypertension (high blood pressure)”. 20% of patients with established high blood pressure did not take their medication or had on their own reduced the amount of medication they should have taken. In this group only about 1 in 5 complained that the cost of the medication would have been the reason for stopping the blood pressure pills.

Below are some more general results regarding this study in table form.

Apart from the remarks on the importance of education mentioned in the table I would like to stress how important it is for patients with high blood pressure to learn how to measure their own blood pressure at home.

Older Americans Need More Knowledge About High Blood Pressure

Older Americans Need More Knowledge About High Blood Pressure

The method of how to do this is not as important as the fact that you buy and use some kind of home blood pressure measuring device (either the conventional bood pressure cuff or the more expensive electronic device). You can measure and record your own blood pressure either daily or 3 to 4 times per week and bring this record with you to the doctor’s office with your next check-up. With this method you will gradually learn what life style factors bring your blood pressure up and how much medicine you need to take to control the blood pressure at all times. This will prevent major events such as heart attacks and strokes and preserve eye-sight and kidney function.
Here are the results of a telephone survey regarding older Americans and their understanding of high blood pressure (modified from March 24, 2003 issue of Archives of Internal Medicine).

Results of a telephone survey regarding older Americans and their understanding of high blood pressure
(modified from March 24, 2003 issue of Archives of Internal Medicine)
Findings:
Comments:
Older Americans have a higher rate of high blood pressure, particularly high systolic blood pressure This makes it even more important that they learn more about it and that they learn to measure
their blood pressure at home.
Older Americans are not as educated about high blood pressure than the younger generation Likely related to upbringing and different interests; in the past healthcare was left to physicians and nurses. Now we realize that only we can look after ourselves, the physicians
and nurses are “health consultants” whom we hire to advise us.
Older Americans prefer an integrated approach to the treatment of high blood pressure utilizing traditional, complementary and alternative treatments The authors concluded that a combination of education and holistic management strategies likely would work best. This needs to include new research on identifying the
most effective treatments. I would like to add that weight loss (in case of increased BMI), exercise and a zone-like diet would help complement traditional drug regimens
very effectively as well.

Here are various useful links regarding related topics.

Link regarding body mass index (BMI) .

Link regarding high blood pressure(hypertension)

Last edited December 9, 2012

Apr
01
2003

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

It has been known for some time that flu shots would be beneficial. But it was not known until now whether in larger field studies people who are 65 years or older would benefit significantly and to what degree from yearly influenza vaccinations (“flu shots”).

The April 3rd, 2003 issue of The New England Journal of Medicine published the answer to this question. Dr. Nichol from the University of Minnesota, Minneapolis, and his collegues have followed 140,055 patients of whom 55.5% were vaccinated against the flu in the 1998/1999 flu season.

They also followed 146,328 subjects during the 1999-2000 flu season of whom 59.7% were vaccinated against the flu. Below is a breakdown how they fared when compared to non-immunized controls (see table).

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

The examiners of this study concluded that high risk patients (asthma patients, patients with diabetes, cancer, elderly patients, arthritic patients and patients with high blood pressure) should have a yearly Flu vaccination.

Patients after Flu vaccinations. How did they do?
(based on 1998/99 and 1999/2000 flu seasons)
Complications: Observation:
Comments:
Heart disease: reduced 19% this included heart failure and heart attacks
Hospitalization for stroke: reduced 16% to 23% often hospitalization for stroke patients can be weeks and months, often resulting in other complications due to bacterial superinfections, falls or clots
Pneumonia and
influenza rate:
reduced
29% to 32%
this can lead to heart attacks and deaths from bacteria in the blood
Death rates: reduced 48% to 50% all of the deadly complications from getting the Flu remarkably reduced by Flu shots!

However, in my opinion anybody would benefit from regular Flu vaccinations as this boosts the immune system in general protecting against other infections and colds as well.

Here is a link to a chapter on the flu in Net Health Book.

Last edited October 25, 2014

Jan
01
2003

Framingham Study…Obesity And Smoking Lead To Loss Of Life

The Netherlands Epidemiology and Demography Compression of Morbidity Research Group has published an important medical research paper in the Jan. 7, 2003 edition of the Annals of Internal Medicine (Ann Intern Med 2003;138:24-32).

The lead researcher, Dr. Anna Peeters, explained that the group has revisited the Framingham Heart Study 40 years later and analyzed survival statistics of the group of men and women who enrolled in this longterm study between 1948 and 1951. The population at the beginning of the study was aged between 30 and 49. The snap shot, after 40 years had elapsed, is the subject of this analysis. In order to make it easier to understand, I have tabulated the data as seen below.

This study shows that life style choices do matter: being overweight shortens your life by 3 years on average, being obese shortens it by 6 to 7 years.

Add the risk of smoking, and you end up shortening your life by 7 years in the case of being overweight (4 years more than without smoking) or more than 13 years, if you are obese.

Framingham Study...Obesity And Smoking Lead To Loss Of Life

Framingham Study…Obesity And Smoking Lead To Loss Of Life

This study was based on 3,457 participants who 40 years ago had a life expectancy of 85 years, if they were in the normal weight category and did not smoke.

The death rates were much higher than the researchers expected. The researchers from the Erasmus Medical Center in Rotterdam stated as a conclusion: ” just think about two things: Don’t get fat and don’t smoke”.

Years of life lost 40 years after Framingham Heart Study Was Started:
Non-smokers: Smokers:
  Male Female   Male Female
overweight *: 3.1 3.3 overweight*: 6.7 7.2
obese** : 5.8 7.1 obese ** : 13.7 13.3
* overweight:BMI25 to 29.9 ** obese:BMI = 30 and higher

Here are some links to my Internet based Healthbook regarding risks for heart attacks and strokes:

Heart disease: http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Strokes: http://www.nethealthbook.com/articles/cardiovasculardisease_strokeandcerebralaneurysm.php

Two things will lead to a normal weight (as you likely have heard before):

Proper nutrition…

http://www.nethealthbook.com/articles/nutrition.php

…and proper exercise (fitness):

http://www.nethealthbook.com/articles/fitness.php

Last edited December 10, 2012