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Lowering Cholesterol Aggressively Saves Lives

A 5-year multinational prospective study ("Treating to New Targets or TNT Study" involving top cardiologists from around the world has found significant benefits in using higher doses of statins. They investigated the effects of increasing the statin concentration (a cholesterol lowering medication) and have now come to new insights how to approach the metabolic syndrome, which is the metabolic derangement associated with obesity.

5-Year Study Shows Further Reduction of Major Cardiovascular Complications In Patients (Expressed as %) With Metabolic Syndrome Using Higher Doses of Atorvastatin (P. Deedwania et al. Lancet 368, No. 9539: 919-928, Sept.9, 2006)

Of 10,001 patients aged 35–75 years with clinically proven heart disease 5,584 patients had metabolic syndrome at the same time. Half of them were put on 10 milligrams of Atorvastatin (brand name: Lipitor, made by Pfizer Inc.), the other half on 80 milligrams per day. They were followed for 5 years and many questions were asked, blood tests done and statistics kept. Of particular concern was whether survival rates and numbers of heart attacks or strokes would be different for the various groups. The major focus of interest was on people who were over weight or obese.

As the image above shows, percentages of complications (heart attacks and strokes) were used as clear end points of cardiovascular complications to measure the response to the statin. The results showed that two subgroups of obese patients, those who have at the same time diabetes and those who don't, were both benefitting from the higher dose of Lipitor in an equal manner (about a 30% relative reduction of risk).

The amazing result was that dosage of the statin mattered very much. In the past it was thought that taking a pill for high cholesterol was all that mattered. However, now we know that physicians need to watch the blood level response of the bad cholesterol (LDL cholesterol) and titrate the abnormal levels down to a normal level by using adequate dosing. The authors came to the conclusion that metabolic syndrome patients with heart disease, and particularly those where diabetes was present at the same time, would need more intensive statin therapy (higher dosage) than patients who were only having cardiovascular disease. The new goal post for lowering the low-density lipoprotein cholesterol (LDL cholesterol) of 1.8 mmol/L (70 mg/dL) was recommended.

This study showed that there was a 44% increase in absolute risk for an adverse outcome in coronary heart disease patients who also have metabolic syndrome than those without metabolic syndrome. This justifies a very aggressive treatment with Lipitor down to the new target blood values indicated above that your doctor needs to monitor. In high risk patients for heart attacks and strokes where more than 3 cardiovascular risk factors are present the patient's outlook (longer survival) can be improved by several years. This was shown with treatment using the higher dose of Lipitor when blood levels and cardiovascular complications were compared between 5 years of treatment and the treatment results after the first year of the study.

From: The Lancet 2006; 368:919-928 (09 September 2006)

Successful Gene Therapy For Melanoma

Scientists at the National Cancer Institute in Bethesda, Md. have developed a modality of gene therapy to treat patients with melanoma.
The therapy alters the patients' own lymphocytes to recognize and attack cancer cells. Dr. Steven Rosenberg and his team developed the new technique by drawing a blood sample containing normal lymphocytes from an advanced melanoma patient. Next the cells are infected with a retrovirus, which delivers genes that target specific receptors on T cells. Once the cells are infused back into the patient, these receptors attach themselves to the molecules on tumor cells and activate the lymphocytes to destroy the cancer cells. This method is called "adoptive cell transfer". In early experiments there seemed to be little or no benefit, but researchers refined the methods and found valuable and promising aspects regarding the treatment of melanoma patients. It is crucial to administer the cells in their most active growth phase. This was shown in a group of 14 patients, where 2 terminal melanoma patients experienced cancer regression. Dr. Jeffrey Medin, head of the clinical research program in gene therapy at the Ontario Cancer Institute in Toronto agrees that this new therapy is a breakthrough as it has virtually brought terminal patients "back from the brink". It is also exciting to see that the researchers could refine the techniques in order to create a more successful therapy. As a result the method will be more applicable to other cancers and broader populations. Although adoptive cell transfer has only been used in melanoma patients so far, the researchers have shown ways to engineer cells of the immune system in a similar way to attack breast, liver cancer or lung cancers.

The Medical Post, September 19, 2006, page 1 and 61

Good Nutrition Is Gender Specific

It is well known that various health concerns are related to the gender of a person, but there are findings that suggest that even nutrition has to be tailored to the needs of males or females.
Calcium is known to be beneficial to bone health, and while high calcium diet may protect a woman from osteoporosis, it does not have the same evidence for men. As a matter of fact, high calcium intake in males may increase their risk of prostate cancer. For the male it means that calcium should be used in moderation and vitamin D intake could help to offset some risks.
Fat choices, mostly sources of monounsaturated fats in the form of olive oil are important for both, men and women, and for both the omega-3 fatty acids that are found in fish are excellent. Men, especially those with a risk of prostate cancer, should be cautious about loading up on flaxseed and canola oil. Alpha-linolenic acid in these two oils may be a problem for the prostate.
Iron is also emphasized in healthy nutrition, but men need less than women. In the presence of an abnormal gene, excessive iron can accumulate to harmful deposits in various organs.
Social habits, for example the drinking of alcohol seem to have more grave implication to women than to men. The glass of wine that may help reduce the risk of heart attacks and certain strokes may seem harmless enough, and average men don't seem to develop health problems, as long as the alcohol intake is low. Larger amounts will increase the risk of many ills for males and females alike, but even low doses of alcohol may increase a woman's risk of breast cancer.
"Super Foods" have made headlines, and all of them are known because of their high content in antioxidants. A recent study from the University of Oslo, Norway, under Dr. Bente Halverson examined, which of them are ranking highest. At the top are, in the order of strength: blackberries, grape juice from Concord grapes, artichoke hearts, walnuts and strawberries. The researchers came up with a list of high oxidant foods on the basis of typical serving sizes. These are the winners among the super foods and spices: blackberries, walnuts, strawberries, artichokes, cranberries, brewed coffee, raspberries, pecans, blueberries, ground cloves, grape juice and unsweetened baking chocolate. Males as well as females of all age groups will benefit from those.
Dr H. Simon, associate professor of medicine at Harvard Medical School points out that there are fundamental facts in nutrition that apply to everyone. But there is also a fine print, which varies according to gender, age and medical conditions.

The Medical Post, September 19, 2006, page 25

Kidney Transplant Tourists At Risk

Long waitlists for a kidney transplant have caused some people in need of the procedure to venture overseas. Many kidney recipients are reluctant to share information about the source of human organs transplanted overseas, but this is just one problem. Once the patient returns home, proper follow-up care is often hindered by the fact that there is a lack of communication between the foreign transplant team and the physician in North America.
There may be a sheet of paper stating that the kidney transplant went well. Often important information about what medications were given at the time of transplant is missing, and there is little or no information about the donor.

A Canadian study found that 33% of the patients who went abroad came back without medical documentation. The other 67% had often-incomplete records. A study that was presented at the World Transplant Congress in Boston showed, that one third of the patients required immediate hospitalization upon their return, primarily for sepsis. More worrisome is the fact that many of the patients had poor long-term outcomes due to sepsis, systemic fungal infections and compromised grafts. All of them had received their kidneys from non-biological or emotionally related donors. Dr. R. Prasad of the University of Toronto examined the three-year graft survival at the Toronto center. Where patients received the kidney from a relative, the results were best, as the graft survival was 98% over 3 years. Patients you received a kidney from an emotionally related donor had an 86% success. In the patient group who went abroad and underwent non-biological or emotionally related kidney transplantation the 3- year graft survival
dropped to 62%.

The Medical Post, September 1, 2006, page 19

Antiviral Drugs Not For Flu Prevention

With the arrival of the fall and winter season concerns about viral illnesses crop up. The most common ailment is the flu, which occurs seasonally. Prevention measures come in the forefront, and over-the-counter remedies and herbal supplements make their appearance.
Yet at this point the most effective measures remain very basic: good hygiene, hand washing, non-exposure to people who have the flu and non-sharing of personal items that could carry the virus. Flu shots for flu prevention remain the single most effective way to prevent widespread epidemics.
Antiviral agents zanamivir (also known as Relenza) and oseltamivir (Tamiflu) have come under discussion. They have been very effective in the treatment of influenza symptoms. It is not too late to treat with oseltamivir after the patient has been infected with the flu, as the drug prevents lower respiratory tract complications. For the symptomatic relief of influenza 75 mg per day were 61% effective, and 150 mg were 73% effective. Using the drugs strictly as a prophylaxis proved to be a fallacy. Results showed that neither zanamivir nor oseltamivir prevented influenza-like illnesses.
Even though both antiviral agents are not 100 % effective, they still can be useful in the setting of a flu pandemic. They are also of help in population groups with chronic health problems or immunocompromised persons to whom any viral infection can be serious.

The Medical Post, September 1, 2006, page 61

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