Jul
01
2007

Estrogen In Early Menopause Saves Lives

Introduction

In the June 21, 2007 issue of the New England Journal of Medicine a randomized study of  8.7 year duration the question was examined whether postmenopausal women following hysterectomy would have a higher risk with estrogen replacement therapy than controls who did not take estrogen therapy. The lead author was Dr. JoAnn E. Manson of Harvard Medical School and the method chosen to examine the heart disease risk was a CT of the heart to measure calcium  in plaque of coronary arteries.

Previous research had shown a good correlation of calcification of coronary arteries with the degree of hardening of coronary arteries as shown in this image.

Various doses of estrogen were used and overall there was a reduction of calcium scores in all of the groups ranging from 22% to 31% when the calcium scores of the estrogen treated patients were compared to the non treated controls. This translated into 36% to 64% less heart attack rates when the treated groups were compared to the controls not treated with estrogen.

Discussion regarding estrogen replacement therapy

The discussion regarding estrogen replacement therapy following menopause is not finished, but women can be reassured that the cardiovascular risk appears to not be as straight forward as research seemed to suggest in the recent past. There likely was a bias in these retrospective studies and the present prospective study is much stronger having been done over 8.7 years following randomization. As this study was done on patients who had previous hysterectomies, there is no concern about uterine cancer. Breast cancer risk was not examined in this study.

Estrogen In Early Menopause Saves Lives

Estrogen In Early Menopause Saves Lives

The authors concluded that low dose estrogen replacement with 0.625mg of conjugated estrogen (Premarin) appears to be safe and has the most beneficial effect on coronary artery health when taken between the ages of 50 and 59. However, the authors also cautioned that estrogen would have multiple effects and may have negative effects on the cardiovascular system in some other way.

Reference: N Engl. J Med. 2007;356:2591-2602

Comment

Comment on Nov. 18, 2012:  The real problem of this study is that the authors took the wrong “hormone replacement”, namely Premarin, which is a non-bioidentical estrogen concoction from horses, which translates into an ill fitting key. The human body’s estrogen receptors do not fit this “key”. The proper experimental set-up would have been to use bio-identical estrogen hormones, which are usually given as a cream and would be the perfect key for the human estrogen receptors. This would have to be balanced with bio-identical progesterone to achieve a balance the way it is in a younger woman. We know from other studies that this prolongs life by preventing coronary artery disease, prevents Alzheimer’s disease, prevents strokes and does not cause uterine cancer or breast cancer. Women on bio-identical hormone replacement also retain their normal sex drive.

See this chapter on menopause in the Net Health Book.

Apr
01
2007

Red Meat Linked To Heart Disease In Diabetics

Red meat is one of the sources of protein, but doctors from the Harvard School of Public Health reporting in the January edition of Diabetes Care, that a type 2 diabetes diet should be lean in red meat.

Type 2 diabetics are at risk for subsequent coronary heart disease (CHD), and intake of iron rich food was significantly associated with a greater risk of fatal CHD. The results come from a prospective study of 6,161 women from the Nurses’ Health Study. All of these patients reported a diagnosis of adult onset diabetes, and they were followed between 1980 through 2000, which amounts to an impressive 54,455 person-years follow-up. Attention was paid to the food questionnaires, which were monitored for the consumption of iron and red meat such as beef, pork or lamb as a main dish, also for the use of beef in roast beef sandwiches and mixed dishes, hamburger, hot dog, processed meat and bacon. Note was also taken of other nutrients such as seafood and poultry.
Women with diabetes who ate the most iron in the form of heme found in red meats had a 50% increased risk of total coronary heart disease as compared to those with the lowest intake. The risk ratio with women was more obvious in post menopause when compared with pre menopause.

Red Meat Linked To Heart Disease In Diabetics

Red Meat Linked To Heart Disease In Diabetics

While lean beef may be a good protein food to the average population, type 2 diabetics might choose to cut back on red meat and processed red meat sources and replace it with a heart-friendlier choice. Fresh seafood, rich in omega -3 fatty acids, would rank high on the list of a healthy eating plan.

Reference: The Medical Post, February 20, 2007, page21

Last edited December 5, 2012

Mar
01
2007

Pancreatitis Can Occur With Statin Use

Drug safety is a concern in the administration of prescription medications and non- prescriptions and any new drug that hits the market has undergone a rigorous screening procedure before its release. Side effects still can occur, and all of the possible ones have to be listed. For physicians it always remains a matter of careful judgement, whether the benefits of a prescription outweigh the disadvantages of any side effects. It is also a concern for the patient to be fully informed. Despite all precautions there are still surprises: some drugs have been taken of the shelves, because the side effects showed up after some time and the risk for the patients were too much. There may be the sense of false security about a prescription drug that has been on the market for a long time that all is known about possible side effects, but researchers and physicians remain alert to the fact that there may be adverse drug reactions that have not been observed.Statins, which are used for lowering high cholesterol levels, have been researched in a review of case reports and observational studies led by Dr.Sonal Singh of Wake Forest University in Winston-Salem, N.C. The authors reported in the December issue of Drug Safety that there have been numerous case reports in which statins have been implicated in acute pancreatitis. It appears to be a genuine adverse reaction, but it remains rare. The researchers estimate that there would be one case of acute pancreatitis in 300,000 patients treated with statins for a year.

Pancreatitis Can Occur With Statin Use

Pancreatitis Can Occur With Statin Use

The review suggested that pancreatitis can occur in high and low statin doses, but it is more likely to happen after many months of therapy. Due to the low incidence and mild severity in the majority of cases, statin therapy is still considered safe.
The first line of defense in the treatment of high cholesterol remains a proper diet and an active lifestyle. Statins are needed for patients with familial hypercholesterolemia and those where diet and lifestyle choices have not been successful enough.

More information about:

1. Statins: https://www.askdrray.com/statins-can-hurt-the-consumer/

2. Pancreatitis: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/pancreatitis/acute-pancreatitis/

Reference: The Medical Post, February 2, 2007, page 2

Last edited November 2, 2014

Feb
01
2007

Lycopene Benefits Backed By Science

Lately a lot of attention has been directed to the health benefits of vegetables and fruit. Vitamin C has long been an accepted household term, and nobody questions the benefits. Newer buzz words are the terms “bioflavonoids” and “antioxidants”. Some products are aggressively marketed extolling the above named beneficial substances, but often the consumer is left mildly bewildered by exaggerated claims. Often the sale prices of these miracle foods are as lofty as the bold statements that go along with them.
For any shopper it is important to know that some of the most beneficial foods are not high priced items, but very common staples. Take tomatoes, for instance. They are a significant source for the substance lycopene, which lately has received a lot of attention. Lycopene and its dietary sources as well as its benefits have been researched world wide, and the results are now in. It is responsible for the red color in fruit or vegetables, such as tomatoes, and its isomeric form 5-cis-lycopene is the most stable form having the highest antioxidant properties. Common dietary sources are tomatoes, watermelons, pink guava, pink grapefruit, papaya, apricot and other fruit. In the Western diet tomato-based foods account for about 85% of dietary sources of Lycopene. Studies have shown that lycopene is more efficiently absorbed from processed tomato products compared to raw tomatoes. Once it is absorbed it is distributed throughout the body. The highest levels showed up in the testes, the adrenal glands, prostate, breast and liver.
Research going back to 1995 showed an inverse relationship between the consumption of tomatoes and the risk of prostate cancer. A follow up publication in 1999 showed that the same inverse relation of lycopene intake and cancer also included breast, cervical, ovarian, liver and other organ sites. Further studies have followed these initial publications, and the great majority of them suggest that an increased intake of lycopene showed an association with a significant reduction in the risk of many cancers.
Coronary heart disease and lycopene benefits were also examined. The strongest population based evidence comes from a multi center case control study in Europe (EURAMIC). 662 Cases and 717 controls were recruited from 10 different European countries, and there was a significant relationship between levels of lycopene in fatty tissue and the risk of myocardial infarction. Lower lycopene levels were associated with a higher risk of heart attacks.Lycopene was also shown to decrease levels of oxidized LDL (LDL or low density lipoprotein is known as the “bad” cholesterol). Another small study showed that lycopene was reducing total cholesterol levels and as a result was lowering the risk of coronary heart disease (CHD).
The list of benefits does not end here: the dietary oxidant reduces oxidative stress and levels of bone turnover markers, meaning that it may contribute to the bone health, especially reducing the risk of osteoporosis in postmenopausal women.

Lycopene Benefits Backed By Science

Lycopene Benefits Backed By Science

For people with mild hypertension (high blood pressure), consumption of lycopene resulted in significant reductions of systolic and diastolic blood pressures.
Infertility in males was significantly helped by lycopene intake. In a study infertile man received 8 mg lycopene per day in capsule form. Laboratory tests confirmed an increased sperm density along with functional sperm concentration and mobility. This treatment protocol with lycopene supplementation resulted in a success rate of 36% pregnancies in their partners.
Pregnant women with pre-eclampsia who were treated with lycopene supplement significantly improved, which was shown by decreased diastolic blood pressure, the reduction of pre-eclampsia and a decrease of intrauterine growth retardation, resulting in a healthier mother and baby.
Future research is pending surrounding lycopene in metabolic and inflammatory diseases and in its role of possibly preventing neurodegenerative diseases such as Alzheimer’s disease. Other inflammatory conditions such as arthritis and emphysema will likely also be shown to benefit from lycopene. Preliminary data has already indicated this.
The Food and Drug Administration (FDA) of USA has recently approved lycopene as a safe “natural coloring agent” and a Generally Recognized as a Safe (GRAS) component. The Department of Nutritional Sciences , Faculty of Medicine, University of Toronto, c/o Dr. A.V. Rao et al. who completed this meta analysis of the recent literature have recommended that we all consume a regular daily lycopene dose in our food and supplements as part of our diet for good health.

More info about lycopene and prostate cancer: http://nethealthbook.com/news/lycopene-reduces-prostate-cancer-risk/

Reference: The Whitehall-Robins Report, December 2006, Volume 15, No.4

Last edited November 2, 2014

Feb
01
2007

Mechanical Heart As Transplant Alternative

The device called HeartMate II (see image) is comparable in size and weight to a D-size battery, and it is the latest development to assist the left side of the heart. Older models were pulsating in nature, whereas the HeartMate II produces a continuous flow of blood. As a result of this, recipients of the device no longer have a discernible pulse, nor can their blood pressures be taken with the cuff around the arm. The leg muscles can naturally produce a surrogate pulse, and in the three years of human testing there have not been any problems related to the lack of pulse. It has been implanted at selected American test sites, and recently a 65 year old male patient has become the first Canadian to be implanted with the device at McGill University Health Center. Dr. Renzo Cecere, the heart surgeon involved, is very enthusiastic with the outcome. The patient made an exemplary recovery and stated that he feels more alive than he has in years, which is impressive, as in the past he could hardly take a step. He suffered of end stage left ventricular failure, and at this point only patients with this condition can enroll in the HeartMate II clinical trials.
Dr.Cecere foresees the device being appropriate for many Canadians. The longevity of the “mechanical heart” (it is good for 10 years) will make it a true alternative to a heart transplant. Some patients cannot receive a transplant because of age or medical conditions. Patients with a history of cancer would be the ones who could not be treated successfully with a heart transplant. The anti-rejection drugs that have to be taken on an ongoing basis produce immunosuppression, and this can revive a cancer in remission.

Mechanical Heart As Transplant Alternative

Mechanical Heart As Transplant Alternative

So far the biggest known risk factors are bleeding, as patients have to take small amounts of blood thinners. Another risk is infection.
At this point the cost for the HeartMate II amounts to about $100, 000, and it does not have the Health Canada approval for general use yet.

More information about congestive heart failure: http://nethealthbook.com/cardiovascular-disease/heart-disease/congestive-heart-failure/

Reference: National Review of Medicine, January 15, 2007, page 36-37

Comment Nov. 15, 2012: The device was approved by the FDA in April of 2008.

Last edited November 2, 2014

Jan
01
2007

Ballroom Dancing Improves Heart Health

It has been pointed out that there is not such a notion “It’s too late now to think of an exercise program”.
Researchers led by Dr. Romualdo Belardinelli, director of cardiac rehabilitation from the Lancisi heart Institute in Ancona, Italy took a close look at 110 patients with stable chronic heart failure. The average age of the patients was 59 years and 89 of them were men. The group was assigned different physical activities. Forty-four patients used an exercise bike or exercise treadmill three times a week for 8 weeks. Forty- four other patients chose to participate in 21-minutes of ballroom dancing consisting of waltzes (alternating slow and fast) three times per week. A third group of 22 patients had no exercise. Heart rates during exercise training and dancing were similar at 110 respectively 113 beats per minute. Cardiopulmonary fitness improved at a similar rate in both groups. Oxygen consumption increased by 16 % in the exercise group and by 18% in the dance group. In other words, exercise fitness had significantly improved in these two groups.

Quality of life as measured by the Minnesota Living With Heart Failure Questionnaire improved significantly more in the ballroom dance group, particularly in the emotional domain.

Ballroom Dancing Improves Heart Health

Ballroom Dancing Improves Heart Health

The findings are not just of significance to patients with heart failure. It is the observation that ballroom dancing seems to be a more effective way to get people into an exercise program who otherwise would not be interested in this. For some people it is simply more enjoyable to dance and enjoy social interaction as an additional benefit than running on a treadmill.

More information is available about:

1. Fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

2. Health for adults: http://nethealthbook.com/health-adults/

3. Health for seniors: http://nethealthbook.com/health-seniors/

Reference: The Medical Post Dec. 19, 2006, page 17

Last edited November 2, 2014

Nov
01
2006

Eat Your Salad Greens, But No Spinach

Spinach has traditionally been regarded as a healthy, green leafy vegetable and a valuable source of vitamins and minerals, in particular iron. The tedious chore of cleaning the tender greens and removing soil and sand traces has been taken care of by packinghouses. As a result, the consumer could purchase ready to eat spinach in plastic bags. These greens were a welcome ingredient for spinach salads or other dishes.
Lately all spinach has been recalled from the world’s largest producer of organic produce. Natural Selection Food has recalled a total of 34 brands that were distributed nationwide, and some of which were available also in Canada. Consumers are still being warned not to eat fresh spinach from the U.S., even though there have been no reported cases of ill effects or diseases in Canada itself. Problems have surfaced in September in form of food borne illness in the U.S. The culprit seems to be contamination with E. coli 0157:H7. Food borne illness can be serious. So far there have been 109 cases of illness in the U.S. and possibly two deaths. The worst affected area so far is Wisconsin, where 29 illnesses were reported and one person died of the disease.
As a result of this alert, salad mixes that contained a variety of greens including spinach leaves have also been pulled from the shelf. It should be mentioned that washing the spinach leaves does not make it safe to consume, as the E.coli bacteria stick to the leaves.
While it seems good-bye to spinach leaves for now, it remains important to eat your greens. Researchers at University of California in Los Angeles and colleagues at Louisiana State University analyzed the salad consumption based on the intake of salad, raw vegetables and salad dressing on 9,406 women and 8,282 men. The researchers also found from their studies that daily consumption of salad and raw vegetables is not the norm in any population group and even less prevalent among African Americans.

Eat Your Salad Greens, But No Spinach

Eat Your Salad Greens, But No Spinach

There were data from lab tests on serum nutrient levels, and it showed that consumption of salads was positively associated with above-median serum micronutrient levels of folic acid, vitamin C and E, lycopene, and alpha carotene and beta carotene. All of these nutrients are important for healthy daily functioning. They are weapons that help fight infection, heart disease and cancers. The consumption of salad and raw vegetables remains the most effective strategy for increasing the intake of important nutrients.

Reference: The Medical Post, October 3, 2006, page 21

Here is a follow-up on this story: Apparently the outbreak was caused by a wild boar and by a nearby cattle field:  http://www.foodsafetynews.com/2009/09/meaningful-outbreak-7-dole-spinach-e-coli-outbreak/#.VFaWXPTF-88

More information about food safety: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/food-safety/

Last edited November 2, 2014

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Oct
01
2006

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.

Good Nutrition Is Gender Specific

Everybody needs to find healthy food

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.

More information about nutrition: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/

Reference: The Medical Post, September 19, 2006, page 25

Last edited November 1, 2014

Oct
01
2006

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. 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.

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)
 

 

 

 

 

 

 

 

 

 

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.

More information on:

1. Treatment of a heart attack: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/treatment-heart-attack/

2. Metabolic syndrome and obesity: http://nethealthbook.com/hormones/metabolic-syndrome/

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

Last edited November 1, 2014

Aug
01
2006

New Screening For Cardiovascular Disease

Checking out the patient’s heart disease risk factors used to be very basic. Lifestyle questions were one aspect: was the patient smoking? Did he have a lack of exercise? Did he have a risk of heart disease in the family? The patient’s diet was analyzed and the body weight was assessed. Cholesterol and triglyceride levels were the basic labs that provided more information. The risk factor assessment, as exemplified by criteria from the Framingham study, made a lot of sense.

In the meantime cardiologists are concerned that all these points are no longer sufficient in identifying individuals at risk for heart disease. Dr. Morteza Naghavi, president for the Association for the Eradication of Heart Attacks, is concerned that it is not only obesity and hypertension that bear the risk for heart attacks, but atherosclerosis. A lot of heart attacks occur in the low- and moderate risk groups. As far as he is concerned, every man aged 45-75 and every woman from 55-75 needs to be screened. We are better equipped to do something for people who have a high plaque burden (deposits in the blood vessels.) Statins are the medication of choice to help these patients.

Screening techniques have become less invasive, as imaging technology has made large progress in recent years. The condition of the carotid artery can be assessed by ultrasound (carotid intima-media thickness or CIMT). Coronary calcification score (CACS) can be measured by CT scanner. The tests are done in a few minutes, and the cost at the most is a few hundred dollars. A patient would only be screened every five years. Screening procedures work and save lives, as demonstrated in the screening for breast cancer. The SHAPE team (The Screening for Heart Attack Prevention and Education) has calculated that the screening cost is even better than breast cancer screening. There are other tests that improve the sensitivity of traditional criteria, like the blood test for C-reactive protein, but in assessing the patient’s risk, it does make sense to go to the source of disease. The striking color image that demonstrates the atherosclerotic burden will allow the patients to see the problem with their own eyes.

New Screening For Cardiovascular Disease

New Screening For Cardiovascular Disease

It may be a healing shock that has a beneficial effect on the compliance of patients. Test results of laboratory work are words, but here a picture is worth a thousand words when it comes to encourage the patient to actively work on prevention.

More information on heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Reference: National Review Of Medicine, July 30, 2006, page 7

Last edited November 1, 2014