May
01
2004

Age-Related Macular Degeneration Can Be Postponed

In a well-controlled study that was published earlier in 2004 Dr. Johanna M. Seddon

has shown that age-related blindness (AMD) is caused from an inflammation in the blood vessels, which is associated with an elevated blood marker, called C-reactive protein (CRP). The authors of this study also showed that the dry form of AMD would tend to deteriorate with age and/or from smoking cigarettes into the more serious wet form, a common cause of blindness.

The inflammatory component of cardiovascular disease is known to be controlled by the use of aspirin (ASA) or the statins, medication that is known to lower the bad LDL cholesterol. It is with this background that the author of the study that I am reviewing here, Dr. Jacque L. Duncan from the University of California at San Francisco, has examined the effects of ASA and of statins on AMD. 326 patients with AMD (204 with dry AMD, 104 with wet AMD from blood vessels forming underneath the retina and 18 with geographic atrophy) were followed between January 1990 and March 2003. Patients were at least 60 years old or older and followed at the San Francisco VA Hospital Eye Clinic.
Dr. Duncan found that patients with blindness due to wet AMD used ASA or statins significantly less than patients with stable AMD. Moreover, he found that patients who had AMD and took statins were 49% less likely to develop wet AMD and if they took ASA the were 37% less likely to develop wet AMD.

Age-Related Macular Degeneration Can Be Postponed

Age-Related Macular Degeneration Can Be Postponed

The study also suggests that there is a link between the inflammatory process that leads to heart attacks and strokes on the one hand and the further deterioration to blindness when dry AMD is not treated on the other hand. The notion that inflammation is the missing link in both of these processes is a relatively new finding.

More information about Macular Degeneration here.

Based on article by Dr. Jacque L. Duncan in the American Journal of Ophthalmology 2004;137: 615-624.

Last edited October 26, 2014

May
01
2004

Physicians Use New Technology (GCFP) To Study Blood Flow

Researchers at the Duke University Medical Center have developed a new non-invasive method of visualizing blood flow through blood vessels of patients. It is a modification of the well-known MRI scan technology where a magnetic field realigns the center of hydrogen atoms (protons) during the time of the examination and the differences of the tissue and fluid qualities are reflected in the images created by this technology. This new application depicting moving blood in blood vessels is called “global coherent free procession” (GCFP).

The principle is that the investigator can focus on an area of a blood vessel upstream of the area to be examined and tag a portion of the blood flowing through with an energy pulse. As the blood continues to flow through the area of interest, the protons give off the energy again without any changes to the body fluids or the blood cells and the MRI scanner picks up the images of the blood flow through the blood vessel.
The advantage of this technique is that it is done without any catheters (it is non-invasive), there is no need for any contrast material to be injected and there are no X-rays needed. At the present time this is the only diagnostic technology available for examining a patient’s blood flow through the heart and its vessels in real time, which is very valuable for physicians (cardiologists).
Here is a link to the Duke University publication

Physicians Use New Technology (GCFP) To Study Blood Flow

Physicians Use New Technology (GCFP) To Study Blood Flow

Based on an article in the April 13, 2004 issue of The Medical Post , Vol.40, No. 15, p.5.

PS. When checked on Nov. 5, 2012 this procedure has not been widely accepted in medical circles. It seems to be still more of a research tool.

Last edited December 8, 2012

Mar
01
2004

Ankle Blood Pressure Reveals Diabetic Problems

One of the complications of diabetes is that ity leads to clogged arteries from peripheral artery disease and this can lead to heart attacks, strokes and circulation problems in the legs.

Recommendations were recently given to physicians in the December edition of the medical journal Diabetes Care that circulation problems in diabetics need to be monitored more stringently to avoid needless amputations.

Medically these circulation problems that affect mainly lower legs and feet are known as “peripheral vascular disease” (or PVD for short). PVD can be detected by the physician checking for ankle pulses. Another valuable and very simple test is to measure the blood pressure in the arm and at each ankle (using the stethoscope just under the inside (medial) ankle bone. If there is a major discrepancy between the arm and ankle blood pressure or if the ankle pulse is missing, this would be a sign of possible PVD. With a diabetic patient it would still be important to get the hemoglobin A1C under control through exercise, a low glycemic diet and possibly anti-diabetic medication. But the patient likely would have to be referred to a cardiovascular surgeon for further testing in order to find out whether there would be hardening of the arteries with circulation problems in the lower leg, the ankle or foot.

Ankle Blood Pressure Reveals Diabetic Problems

Ankle Blood Pressure Reveals Diabetic Problems

Dr. Peter Sheehan, the director of the Diabetes Foot & Ankle Center at the New York University school of medicine, stated that many patients and doctors overlook how frequent this condition is. About 33% of diabetic patients who are older than 50 years have PVD, but only a fraction know about it until it is too late. Once a patient has PVD in one of the legs there is a 4-fold risk of getting a heart attack or a stroke, because the hardening of the arteries is happening simultaneously in all of the body’s arteries. If the blood pressure is normal at the ankle, Dr. Sheehan recommends to check it again in 5 years.

Who should have the blood pressure check at the ankle? Here is a table that summarizes Dr. Sheehan’s recommendations.

Which diabetic needs the ankle blood pressure check?
High risk group: Remarks or more detail:
Anyone with leg PVD* symptoms legs tired or hurting when walking
Young diabetics
with other risks
smoking, high blood pressure, high cholesterol, diabetes present for more than 10 years are such risk factors
diabetics 50 years of age and over particularly when the hemoblobin A1C is high and other risk factors are present
*PVD peripheral vascular disease

Why is it so important to screen for circulation problems in the lower legs? Because this is the area where diabetics tend to get problems that often result in amputations of a foot or lower leg below the knee. With early detection of these problems and intervention by a cardiovascular surgeon often disastrous outcomes can be avoided.

More info is available at:

Diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

High blood pressure: http://nethealthbook.com/cardiovascular-disease/high-blood-pressure-hypertension/

Last edited October 26, 2014

Mar
01
2004

Inflammatory Marker Linked To Blindness

Up to now age-related blindness or “age-related macular degeneration” (AMD) as it is medically called, has been a mystery. The retina is the light-sensitive area of the eye similar to the film in a camera. The “macula” is that part of the retina that has the highest visual acuity. Several studies have been conducted lately regarding age-related blindness that shed more light on this important health hazard of old age, studies that one day might even lead to a cure or powerful preventative measures to avoid it from ever developing.

One such study is the one by Dr. Johanna M. Seddon and co-workers published in the Feb. 11, 2004 issue of the Journal of the American Medical Association. Almost 1000 patients with various degrees of age-related degrees of blindness from the Age-Related Eye Disease Study (AREDS) were classified by the degree of their macular degeneration. I have produced the bar graphs below based on these studies.

Four groups were defined, namely those with no AMD who served as controls, those with mild AMD, those with moderate AMD and those with severe AMD who were legally blind. They suspected that an inflammatory marker in the blood stream of these patients, called C-reactive protein (CRP), might be present in the more severe cases of blindness when compared to the control group who did not have any inflammatory changes in the macula. As can be seen by the bar graph above this is exactly what the test results indicated. They also found that smokers (blue bars) tended to have slightly worse blood tests in terms of CRP (more inflammatory substances circulating in the system) within the same severity category of the age-related eye changes.

CRP (mg/L) Levels in Various Degrees of Severity of Age-related Macular Degeneration (AMD)

Inflammatory Marker Linked To Blindness

Inflammatory Marker Linked To Blindness

When the investigators studied the risk for the highest percentile of the CRP tests within various subgroups to show AMD they found several differences as is shown in the next table. First there was a low probability to develop AMD in a person with a normal looking macula and that risk was set at 1.0 as comparison. In contrast a person with a normal looking macula who smokes has a 1.5-fold risk of developing AMD later. Patients with a moderate degree of AMD have about a 2-fold risk of getting a severe degree of AMD later (smoking or not). It seems that once the inflammatory cycle has started, the process of causing a moderate degree of AMD is so strong that the effect of smoking will not add that much in comparison.

This is the first study of this kind that has established that CRP can be used as a screening for the risk to develop AMD. CRP has already been established as a test for monitoring progress in rheumatoid arthritis or to monitor for the risk of developing a heart attack or stroke.

Another study by Dr. Johanna M. Seddon and co-workers was published recently in the Archives of Ophthalmology. 261 people aged 60 years and older with established AMD were followed for 4.6 years and checked for deterioration. 101 patients had deterioration of their AMD.

Risk of Developing Age-Related Macular Degeneration (AMD) in Highest CRP Percentile
 Inflammatory Marker Linked To Blindness1

The authors analyzed the patients’ diet habits and found that increased fat intake was a high risk factor for deteriorating AMD. Both vegetable and animal fat had a 2-to 3-fold increased risk for deterioration of the AMD to a more severe stage (legal blindness). Fish, omega-3 fatty acid and nuts had a protective effect, but only when omega-6 fatty acid (linoleic acid) intake was low in the same group. The studies showed that the risk of age-related blindness was reduced by 40% when patients ate nuts at least once per week. The authors concluded that a “fat conscious diet” would be good for “maintaining good eye health” and at the same time be beneficial for prevention of heart attacks and strokes.

The authors will do further studies to investigate potential ways of helping patients with AMD and to understand the mechanisms of the disease process better.

References: 1. JAMA 2004;291:704-710  2. Arch Ophthalmol – 01-DEC-2003; 121(12): 1728-37

Last edited December 8, 2012

Feb
01
2004

Cinnamon A Natural Insulin Booster For Diabetics

In a recent edition of the medical journal Diabetes Care an interesting article appeared regarding the healing effects of the spice cinnamon. A medical research team in Pakistan (Dr. Khan et al.) in collaberation with a U.S. research team divided a group of 60 comparable diabetics (males and females) in the age range of 45 to 55 and fed one half different concentrations of cinnamon while the other half served as a placebo control. There were three different concentrations of capsules of cinnamon given: 1g, 3 g and 6 g. The placebo control group got capsules with inert material. Here are the results:

The placebo control group showed no change in blood values. The effect documented in this table was achieved after 40 days of cinnamon exposure and was “washed out” after 20 days. Other experiments had found that the substance MHCP (methylhydroxychalcone polymer) is the active ingredient in cinnamon that stimulates insulin and also acts on insulin receptors similar to insulin.

Cinnamon A Natural Insulin Booster For Diabetics

Cinnamon A Natural Insulin Booster For Diabetics

Dr. Richard A. Anderson and his colleagues at the Human Nutrition Research Center of the U.S. Department of Agriculture had already published a number of medical papers on the effects of cinnamon. He was the co-author of this study from the Department of Human Nutrition, NWFP Agricultural University of Peshawar, Pakistan.

Effect of cinnamon on blood values of diabetics
Blood component
investigated:
% Reduction
of blood test:
Blood sugar
level

18-29%
Triglycerides (blood
fat value)
23-30%
LDL cholesterol
(damaging cholesterol)
7-27%
Total cholesterol 12-26%
HDL cholesterol
(protective cholesterol)
unchanged

The interesting observation here is that several cardiovascular risk factors (blood sugar, triglycerides and LDL cholesterol) are simultaneously being reduced with something as simple as cinnamon powder. The authors stated that the cinnamon oil is not effective, only the cinnamon powder or a cinnamon stick dipped into tea (the water soluble component of cinnamon or MHCP). Dr. Anderson also warned not to make the mistake to eat more cinnamon buns or apple pie as there would be unhealthy amounts of sugar, starch and fat added. He suggested that the best to do instead would be to simply sprinkle cinnamon powder over whatever you are presently eating, as this will reduce the risk of getting diabetes or will reduce the risk of a heart attack in diabetics.

This article based on: “Cinnamon improves glucose and lipids of people with type 2 diabetes.” Diabetes Care – 01-DEC-2003; 26(12): 3215-8.

Here is a link to diabetes mellitus (type 2 diabetes).

Last edited December 8, 2012

 

Incoming search terms:

Jan
03
2004

Any Diet A Winner Research Says

 

Dr. Michael Dansinger reported at a recent annual meeting of the American Heart Association about a study where he compared the effect of 4 major diet plans on the lowering of risk factors for heart disease.

Dr. Dansinger is the director of obesity research at the Tufts New England Medical Centre’s Atherosclerosis Research Lab in Boston. Originally, the objective was to see whether any of the following four diets investigated would be superior: the Atkins diet, the Ornish diet, the Zone diet and the Weight Watchers diet. In the table below there are links for each of these diet plans. Briefly, the Atkins diet is a high protein/low carbohydrate diet; the Ornish diet is a vegetarian/low-fat diet; the zone diet is a low-glycemic load/balanced protein/low fat diet; weight watchers is a calorie restricted diet.

160 obese patients were divided into 4 groups and assigend to one of these four diet plans. They were instructed in the type of diet plan they were to follow in 4 couselling sessions in the beginning of the weight loss program. The participants ranged in age from 22 to 72 years of age (average age 50) and had on average starting weight of 220 lbs.

Any Diet A Winner Research Says

Any Diet A Winner Research Says

They were to follow the diet plan for 2 months strictly and were allowed to follow less supervised for another 10 months. To the surprise of the research team under Dr. Dansinger they all lost about the same amount of weight (average of weight loss 10 lbs or 5% of body weight), in other words they were all successful with any of these programs and none was superior. Below are the results in modified tabular form.

Dr. Dansinger indicated that the focus would now have to shift from “which is the best diet plan” to “which is the best diet plan for a particular patient”. The doctor should attempt to fit the weight loss programs that fit patients’ food preferences best and that patients can easiest fit into their lifestyle. This will hopefully lead to the lowest dropout rate. This trial showed that the Zone diet and the Weight Watchers diet had the least dropout rates. But those who stayed on the Atkins or Ornish diet were successful with their weight loss program also, as these may have been fitting these patients best.

Comparison of various diets with regard to weight loss effectiveness
Diets that
were compared:
Reduction of
heart risk (Framingham score):
Dropout rates
over 1 year:
Atkins diet
12.3% 48%
Ornish diet 6.6% 50%
Zone diet 10.5% 35%
Weight Watchers
diet
14.7% 35%

In other words, if the one diet plan does not work satisfactorily, try another one. The common denominator with all food plans was some form of calorie restriction despite all of the differences.

Based on The Medical Post, Dec. 16, 2003 (p. 15).

Here is a link to the Net Health Book’s weight loss and diet chapter.

Last edited December 8, 2012

Jan
03
2004

Old-Fashioned Fish Oil Boosts Heart Health

You do not need to spoil your appetite with the thought of swallowing cod liver oil, but see yourself enjoy a piece of salmon instead. Dr. Jehangir N Din and collegues published an article entitled “Omega 3 fatty acids and cardiovascular disease—fishing for a natural treatment” in the first January edition of the British Medical Journal (BMJ 2004;328:30-35,January 3, 2004). These cardiology researchers from the University of Edinburgh/England have reviewed all of the recent medical literature regarding the beneficial effects of omega-3-fatty acids on heart disease. The following are some facts they found.

The interesting story regarding the omega-3-fatty acids, which have anti-inflammatory qualities, is that they balance the detrimental effects of the omega-6-fatty acids, which lead to inflammation not only in joints, but also in blood vessels. In the standard North American and European foods the omega-6-fatty acids are overconsumed. To counter the bad effects of the omega-6-fatty acids, more omega-3-fatty acids need to be ingested.

Old-Fashioned Fish Oil Boosts Heart Health

Old-Fashioned Fish Oil Boosts Heart Health

So, what should we consume in terms of omega-3-fatty acids? The American Heart Association made the recommendations in the second table below.

Current consumption of omega-3-fatty acids in North America and Europe is low. Recently an expert US panel of nutritionists determined that the US consumption per day is about 0.1 to 0.2 grams per day and should be 0.65 grams per day as a minimum according to the recommendations by the American Heart Association.

Facts regarding omega-3-fatty acids:
Omega-3-fatty acids from fish and fish oils protect against heart disease
Following heart attacks fish oil is helpful in preventing more heart attacks
Hardening of arteries stops when fish oil or fish is eaten regularly
Rapid response critics pointed out that exercise is as important as fish oil
Trials with fish oil showed reduction in death rates from strokes and heart attacks from between 15% and 29% over 2 to 3.5 years (several studies)
The beneficial effects are due to a combination of stabilizing irregular heart beats, preventing clots, countering hardening of arteries, countering inflammation, improving function of lining of arteries, lowering of triglycerides (bad fatty acids) and lowering of blood pressure

The authors of this paper from England disagree and state that at least 1 gram per day would be needed to lower the heart attack risk to the low levels in Asia. The British Nutrition Foundation has recommended to use 1.2 grams of omega-3-fatty acids per day.

Fish or fish oil capsules as a protective effect on blood vessels*
Patients without documented coronary heart disease: Eat a variety of (preferably oily) fish at least twice weekly. Include oils and foods rich in inolenic acid
Patients with documented coronary heart disease: Consume 1 g of eicosapentanoic and docosahexanoic acid daily, preferably from oily fish. Supplements could be considered in consultation with a doctor
Patients with hypertriglyceridemia: Take 2-4 g of eicosapentanoic acid and docosahexanoic acid daily, provided as capsules under a doctor’s care
*As recommended by American Heart Association 

How does that translate into how much fish you would have to eat to get about 1 gram of omega-3-fatty acids per day? To make things simpler I have categorized fish and seafood in the table below based on the data from this article into low, medium and high marine derived omega-3-acid foods. You obviously need to eat more of the low category seafood to achieve 1 gram of omega-3-fatty acid than of the high category seafood.

How much fish and seafood you need to eat to get 1 gram of omega-3-fatty acids…
Concentration of omega-3-fatty acids in seafood: Type of fish and seafood consumed:
Low (eat 1 lbs) Catfish, Haddock
Medium (eat 1/3 -1/2 lbs) Tuna, Halibut, Oyster, Cod, Flounder, Sole
High (eat 2 or 3oz.) Atlantic salmon, Sardines, Rainbow trout, Atlantic herring, Mackerel

Before you overindulge in seafood from the low and medium category, check with your doctor first whether you are allowed so much protein. Some people have protein restrictions due to poor kidney function or because of gout. The authors of this study stated that you should eat a seafood meal with 1 gram of omega-3-fatty acid twice per week. Other sources of omega-3-fatty acids (=alpha-linolenic acid) are plant products such as soy beans,flaxseed, walnuts and rapeseed oil. In Asia fish and soy bean products are consumed in much bigger quantities than in the US.

Last edited December 8, 2012

Jan
03
2004

China Blows Alarm Whistle On Smoking

The risks of smoking are being addressed in China, where roughly 300 million people or one quarter of the population are puffing away. The number is rising by about 3 million new smokers each year, and according to statistics of the WHO 700,000 die each year from smoking.

In November of 2003 China joined the Framework Convention on Tobacco Control (FCTC), a subsidiary of the World Health Organization. As a member China is now obliged to tighten restrictions on cigarette marketing and consumption.
Due to an economic boom in the country foreign tobacco giants are putting their hope into this rising market, as revenue has decreased elsewhere in the world. So far tobacco taxes, which are collected from the 1.7 trillion cigarettes sold in China amount to 8 billion $US or one tenth of government revenue. In the wake of SARS, however, the realization has come to the forefront, that health care cost have a severe impact on the economy of a country. Despite the seemingly enticing short-term gain from tobacco tax revenue, short cuts in health care can economically damage a country in the long run.

Health officials will have a battle with their counterparts in finance, when it comes to implementing tobacco control. In some areas of the country the sale of tobacco products to children has been banned and an attempt has been made to restrict cigarette commercials.

China Blows Alarm Whistle On Smoking

Quit smoking!

Powerful tobacco lobby groups actively undermine these efforts.
It is encouraging to see at least a beginning of public education about the risks of smoking. However, in a nation where cigarette manufacturing and consumption are the highest worldwide, it will be a long and arduous journey to clear the air to better health.

Based on The Lancet 363, No. 9402 (Jan. 3, 2004)

Last edited December 8, 2012

Dec
01
2003

Bystanders Become Lifesavers: Immediate CPR Improves Survival

Cardio-pulmonary resuscitation (=CPR) is known to save lives, but it has been known for some time that it has to be applied as early as possible to save lives on the longterm. In a recent study in Ottawa/Ont., which was published recently in the medical journal Circulation, the OPALS study checked out survival data.

OPALS is an acronym for Ontario Prehospital Advanced Life Support Study. One of the lead authors, Dr. Ian Stiell, emphasized that CPR done by bystanders (such as immediate family members) right in the beginning of a cardiac arrest will double the probability of having a survivor with quality of life that is very good.

Here are some detailed figures from that study. Only 14% to 15% of patients who suddenly collapse and are in need of CPR actually receive CPR. There were 8,091 cases of cardiac arrest that occurred between 1995 and 2000 in Ontario. Only 5.2% (418 patients) survived until the time of discharge from the hospital. 4% (324 patients) survived until the timeline of 1 year after the event. Of these the researchers were able to interview 268 survivors.

Bystanders Become Lifesavers. Immediate CPR Improves Survival

CPR saves lives

The following are a few observations from the OPALS study:

1. 85% of cardiac arrests happen at home.

2. 43% of cases are witnessed by bystanders, so if they all would know CPR about 3-times more unconscious patients could receive CPR (14% to 15% times 3 equals about 43%).

3. 65% of cardiac arrests in the OPALS study occurred in men. The authors recommended that women over 40 should get trained in CPR.

4. Women usually play a more pivotal role in taking care of elderly parents, of their spouse and of children, which puts them more likely into a situation where bystander CPR is required.

5. Family members of heart attack survivors should be encouraged to take a CPR course as the probability of a cardiac arrest is higher in these patients.

6. All 4 links to successful resuscitation are important: CPR by a bystander; defibrillation; rapid access to care; early advanced cardiac life support.

7. Contrary to rumors the long term outlook of successfully resuscitated patients is good and after 1 year the survivors have a quality of life as good as their healthy peers. However, without CPR initially the quality of life is only half as good as those who had someone provide CPR on them. The authors found it difficult to dispel some of the misconception surrounding CPR. Some of the myths are the notions that a person could do some harm by administering CPR or not performing CPR it correctly. They said it is important to be decisive and administer CPR to an unconscious person and call for an ambulance.

Summary: The OPALS study re-emphasized the importance for everybody to learn CPR. You never know when you need this skill. The more people know it, the more lives will be saved.

Here is a link to the University School of Medicine site entitled “Learn CPR – you can do it!

Last edited December 8, 2012

Dec
01
2003

New Cholesterol-Lowering Drug Reduces Inflammatory Marker

With newer knowledge about the process of hardening of the arteries from the ongoing Framingham study it is not surprising that the drug companies are shifting the development of cholesterol-lowering drugs to those substances that will reduce inflammation of the arteries as well. In previous issues of the health newsletter I summarized a paper that was published on the importance of the C-reactive protein (also called CRP) in connection with the diagnosis of heart attacks and strokes. I also reviewed an article that pointed out that both CRP and LDL cholesterol are important in determining who is at risk for developing a heart attack or stroke.

In a press release to Reuters on Nov. 13, 2003 Merck & Co. Inc. and Schering-Plough Corp. announced that ezetimib (Zetia), a new cholesterol-lowering drug that is marketed by both companies, was found by their researchers to lower C-reactive protein (CRP) significantly. At the annual meeting of the American Heart Association in Orlando/Fla. these researchers presented a clinical trial showing that ezetimib when used in combination with small amounts of simvastatin (Zocor) lowered CRP by 33%. However, simvastatin alone lowered CRP only by 14.3%. Dr. Christie Ballantyne, a Baylor College cardiologist, pointed out that this new finding was very important. It was important, because it shows that these drugs do not only lower LDL cholesterol, which according to the Framingham study is a known risk factor for heart attacks and strokes. In addition it has now also been proven to lower CRP significantly at the same time, which is another known inflammatory component produced by the blood vessels also associated with heart attacks and strokes.

New Cholesterol-Lowering Drug Reduces Inflammatory Marker

New Cholesterol-Lowering Drug Reduces Inflammatory Marker

Merck and Schering-Plough are now developing a new formulation containing both of these medications as one pill (Vytorin). This has the advantage to lower the risk on liver cells of Zocor by being able to lower the dose in the pill. The Zocor component will mainly lower the LDL cholesterol in the blood (and the CRP somewhat as well) and the Zetia component will provide the beneficial effect of the CRP lowering (anti-inflammatory component and LDL lowering). There is another advantage of this combination: Zetia works by inhibiting absorption of cholesterol by the gut, Zocor works by inhibiting cholesterol synthesis in the liver cells. Whenever the mechanism of action is different two drugs in combination are usually better tolerated than if both would work through the same mechanism. However, the companies pointed out that more research and clinical trials are needed to check out side-effects of Zetia before it would be submitted to the FDA for approval for general prescription by physicians.

P.S. on Oct. 31, 2012: Read the following article about Zetia and Vytorin (the combination pill): http://www.nytimes.com/2008/01/14/business/14cnd-drug.html?_r=0

Links regarding further information about heart disease (Net Health Book).

Last edited December 9, 2012