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Stop That Heart Attack

There is a window of opportunity for the patient who is rushed to hospital with a heart attack.

To be precise: if the patient is brought to hospital without delay, and there are changes in the ECG, which traces the heartbeat, and there are changes that point to the possibility of a heart attack, there is a chance to administer medication that prevents blood clots. If these "clot busters" are administered within one hour, as many as 25 % of heart attacks in the making can be aborted.
Dr. Paul Armstrong, professor of medicine at the University of Alberta, explains, that the aborted heart attack (or "aborted MI") is a new term in cardiology. If treatment is received early, the patient will avoid heart muscle damage. Even if the treatment with the anti-clotting medication is given after only two hours, the patients still have a more favorable outcome. Patients with aborted heart attacks also have smaller infarcts than those who go on to have a full-blown MI (or heart attack). Dr. Armstrong points out that it is important to not only watch out for known high-risk factors (previous coronary artery bypass surgery, hypertension and diabetes), but that it is important also to pay close attention to treating the patient early.

The Medical Post, July 27,2004, Vol.40, No. 29,pg.8.

Epstein-Barr Virus Linked With MS

MS, the debilitating and at times fatal disease which affects about 50,000 Canadians continues to be a puzzle to medical researchers. New findings are shedding new light on this illness and may help to unravel its complexities and bring more effective treatment to patients.

Dr.Brenda Banwell from the Department of Pediatrics and the Pediatric MS Clinic at The Hospital For Sick Children in Toronto found that 83 % of children with a diagnosis of MS showed evidence of a previous Epstein-Barr virus infection. (Healthy controls only showed a rate of 42 %).

No differences were found for other viruses (like herpes, parvovirus, chicken pox). Researchers have yet to determine, whether there is a link between Epstein-Barr virus infections and MS, or whether MS patients are more susceptible to Epstein-Barr infections.
With regard to MS treatment amazing improvement has been demonstrated on MS patients who were treated with the cholesterol-lowering drug simvastatin. A reduction of MS induced brain lesions by 44 % was achieved in patients treated with the drug, and animal experiments show similar results. Researchers are cautioning MS patients that more investigations will be needed, till this treatment will become a new standard in the treatment of MS.

Link to more information on multiple sclerosis.

Parkhurst Exchange, Vol.12, Nr.8, August 2004,page26

Green Vegetables Preserve Brain Function

Popeye needed spinach for a bulging biceps, but new research points to more exciting possibilities. The regular intake of green leaf vegetables and cruciferous vegetables (broccoli, cauliflower and cabbage) is associated with a preservation of cognitive function.In the Nurses' Health Study starting in 1984 women were asked to fill out food-frequency questionnaires. They were asked about their usual intake of a specified portion of food items, including 15 fruits and 28 vegetables. At a later date, between 1995 and 2001, researchers decided to ask the oldest participants (70 years and older) to participate in a cognitive function study. The tests were repeated 2 years later.

The main finding of the study is that women with the highest intake of green, leafy vegetables had the least decline in their cognitive function, when compared to those with the lowest intake. The vegetable lovers, who consumed five serving of cruciferous vegetables, like broccoli, cabbage and cauliflower had less decline in their cognitive function. On the other hand the highest decline showed up in the group that averaged only 2 servings per week. These findings were significant enough to be presented at the ninth International Conference on Alzheimer's Disease by Dr. Jae Hee Chang, a researcher at the Channing Laboratory of Harvard Medical School. The effect may seem modest, but nutritional habits can obviously delay or prevent the onset of dementia. This effect seems to be independent from the beneficial effect of bioflavonoids that vegetables also contain.

The Medical Post, August 17, 2004, page 8

Second Hand Cigarette Smoke Kills

A recent publication in the British Medical Journal was reviewed in the Aug.10 issue of The Medical Post. The study was concerning detailed census data from New Zealand where two cohorts of the population were compared in 1981 and 1996. The 1981 study involved 286,796 people, the 1996 study involved 382,462 people. Both cohorts were further classified into exposure to second hand smoke and non-exposure meaning that they lived in a smoke-free home (controls). I have elected to show the results in a graph below for ease of reference. The authors Dr. Tony Blakely and others from the University of Otago had followed each cohort for 3 years and recorded death rates (mortality rates) for each of the subgroups. They pointed out that there was a

Mortalitiy rates in % as a function of exposure to second hand smoke in New Zealand Study

15% increase in premature death for those exposed to second hand smoke when compared to the controls who were not exposed.

Comments: 1. The mortality in the 1996 study (in blue bars in the graph) for males is what the authors quoted (15.1%). However, for females, the death rate was even higher with regard to exposure to second hand smoke: mortality was 26.7% higher when the exposed group is compared to the controls.

2. The 1981 study (green bars in the graph) had a much higher overall mortality than the overall mortality in the 1996 study (blue bars). This likely is due to the 15 year interval between the two study groups and the fact that during that time in New Zealand as in many other industrialized countries the death rate from cigarette smoke exposure has declined significantly.

One such study indicates a reduction between 1981 and 1997 of 38% in all preventable deaths, which includes death as a result of exposure to cigarette smoke. The average death rate reduction in the New Zealand study over the 15 years was 31.7% for men and 29.35% for women when the exposed groups and control groups were pooled.

3. The controls and the relationship of the subgroups within the 1996 study (the blue bars) were very consistent , but were not consistent within the 1981 study (green bars).

For instance, the controls of death rates should always be smaller in both males and females when compared to the groups that were exposed to second hand cigarette smoke. In the 1996 study this was the case, but in the 1981 study this was not the case. This may indicate that there were other negative factors included in the 1981 study leading to premature death or that the controls were simply also exposed to cigarette smoke in the past.

Conclusion: This is an important study as it is based on large numbers and it shows that even relatively small concentrations of cigarette smoke in the environment make a measurable difference in terms of death rates among the population. It also confirms the fact that the death toll has been reduced by about 30% in the population within 15 years (between 1981 and 1996), because many people have quit smoking during that time period and this is measurable as indicated above (green bars higher on average than blue bars).

The Medical Post, Aug. 10, 2004, page 48

Calcium Prevents Kidney Stones

Forget what your grandmother may have taught you about kidney stones. In the past there may have been a bias towards thinking that calcium may be one of the causes of kidney stones. But Dr. Curhan and collegues from the Channing Laboratory, Department of Medicine, Brigham and Womens' Hospital, Boston, MA put this question to the test. Other food factors were also examined in this Nurses Health Study II, which was published recently in the Archives of Internal Medicine (in April of 2004) and reviewed by The Medical Post (Aug. 24, 2004 edition).

Relative risk of developing kidney stones from exposure to different foods in younger nurses

I have summarized the results in the bar graph here. What is shown is the cumulative risk for developing kidney stones in a population of 96,245 nurses aged 27 to 44 over eight years without a history of kidney stones in this prospective study. At the same time detailed records were kept regarding food and health habits. The risks between the highest and the lowest quintile regarding various food groups were computed, which is an accepted way to tease out the effects of the food group studied. Dr. Curhan and his collegues found that calcium protects from getting kidney stones as does meat. Sugar is a risk for stone development. Fluid intake has a protective effect as uric acid and other stone forming substances are kept in solution preventing kidney stone formation. Phytates that are found in soybeans, beans and peas have a protective effect. The control value of the study was the average risk for the population, which was set at 1.0 meaning that there is no added risk to develop kidney stones.

Conclusion: Contrary to popular belief calcium and meat as well as phytones have a protective effect against the development of kidney stones. Fluid intake is protective as well. On the other hand sugar is a risk factor for kidney stones, a fact that seems to not be generally known.

Dr. G.C.Curhan et al., Arch Intern Med 2004 Apr 26; 164 (8), pp. 885-91 and The Medical Post, Aug. 24, 2004, p.17

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