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Wednesday, February 18, 2009

Recognizing Signs and Symptoms of Stroke is Key to Treatment

According to a study presented at the American Stroke Associations International Stroke Conference 2009, patients who arrive to hospitals within the "golden hour" (within on hour of symptom onset) were twice as likely to receive the clot-busting drug known as tissue plasminogen activator (tPA).

The study, known as the American Heart Associations Get with the Guidelines-Stroke (GWTG-Stroke) quality improvement program, involved over 100,000 patients treated at various hospitals. Of those people who arrived within the "golden hour," 27.1% received tPA. Whereas, 12.9% of those individuals who arrived at hospitals one to three hours after the onset of symptoms recieved tPA. The drug is approved to be used only within three hours of symptom onset. The study found:

  • 28.3 percent of the patients arrived within 60 minutes
  • 31.7 percent arrived one to three hours after symptoms started
  • 40.1 percent arrived more than three hours after symptoms started

This data demonstrates the importance of recognizing the early signs. Early symptoms of a stroke include:
  • Sudden weakness of numbness on the face, arm, or leg on one side
  • Sudden onset of a severed headache
  • Sudden trouble with speaking
  • Sudden onset of blurry vision or loss of vision in one eye
  • Sudden onset of imbalance or unsteadiness on your feet
Another system that can be used to assess somebody having a stroke is called the F.A.S.T assessment:
  • Face - Does the face seem uneven?
  • Arms - Does one arm drift down?
  • Speech - Does their speech sound strange?
  • Time - Don't Wast It - Call 911
Everyone should be able to recognize the early symptoms of a stroke on themselves as well as on others. If you suspect a possible stroke, call 911 and get to the nearest hospital as soon as possible.

Sunday, February 15, 2009

Statins (rosuvastatin) and Their Use Among Individuals With Normal "Bad" Cholesterol (LDL) Levels

Statins, also known as HMG-CoA reductase inhibitors, are a class of drugs that reduce the level of "bad" cholesterol in your blood known as low-density lipoprotein cholesterol (LDL-c). Statin therapy has been approved for patients who have been diagnosed with vascular disease, diabetes, or who have an increased level of cholesterol in their blood (hyperlipidemia). However, nearly 50% of all heart attacks (myocardial infarctions) occur in individuals with levels of LDL-c (bad cholesterol) are low enought that they would not be required to even take a statin medication.

Because of the high number of individuals how have heart attacks without elevated levels of cholesterol, a group of physicians became interested in determining if statins are useful in people with near normal levels of cholesterol. The authors of the JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial, a paper published in the November 2008 issue of The New England Journal of Medicine, wanted to see if patients without increased levels of "bad" cholesterol (LDL-C) would benefit from the use of statins. The authors decided to use high sensitivity C-reactive protein (an inflammatory biomarker that can predict cardiovascular events) as the variable which could determine patient outcome.

The authors believed that even healthy people with levels of LDL cholesterol below current treatment levels BUT with increased levels of high-sensitivity C-reactive protein might benefit from statin therapy. The study was conducted on men 50 years of age or older and women 60 years of age or older who had a LDL cholesterol level of less than 130 mg per deciliter, a high sensitivity C-reactive protein level of 2.0 mg per liter or greater, and no history of cardiovascular disease. The experimental group received 20 mg of rosuvastatin and the control group received a placebo. Patients were followed for approximately 2 years.

The study found patients on rosuvastatin (marketed by AstraZeneca under the name Crestor) had a significant reduction in the incidence of major cardiovascular events when compared to the placebo group. The study also demonstrated reductions in cadiovascular events for women and black and hispanic populations who took rosuvastatin when compared to placebo. Incidence of myopathy, hepartic injury, and cancer occurred less frequently within the rosuvastatin group than with placebo. The rosuvastatin group experienced a reduction in LDL cholesterol levels by 50% and a reduction in high-sensitivity C-reactive protein levels by 37%.

Whether or not patients with normal levels of LDL-cholesterol but increased levels of high-sensitivity C-reactive protein should be placed on statin thereapy remains uncertain. The question also remains whether or not physicians should be screening individuals for elevated levels of high-sensitivity C-reactive protein. Clearly, patients with normal levels of LDL-cholesterol and increased levels of high-sensitivity C-reactive protein benefit from statin therapy. However, the JUPITER trial did not address if statin therapy was beneficial in patients with both normal LDL-cholesterol and high-sensitivity C-reactive protein levels. This group of patients should be evaluated before all "healthy" patients at an increased age should be placed on statin therapy. For more information regarding critique of the JUPITER trial can be found in the January 2009 issue of the Cleveland Clinic Journal of Medicine.

Currently, some physicians are prescribing statins, specifically rosuvastatin (Crestor), in patients over the age of fifty who do not have increased levels of "bad" cholesterol. Though the benefits discovered in the JUPITER trial were exciting, the long term effects of taking statins in individuals with normal levels of LDL-c are not known.

All patients should continue to lead a life of exercise and maintain a balanced diet in order to keep LDL-cholesterol and total cholesterol at or below normal levels.

Friday, February 13, 2009

The Acai Berry: Promises, claims, studies, and truth

Acai berries grow in the Amazon rainforest located in Brazil. The acai berry is considered beneficial due to its large amount of free-radical antioxidants. Many claims are made regarding the acai berries' ability to improve the immune system, improve digestion, fight aging, protect against coronary artery disease, fight cancer, and even cause weight loss. Numerous media outlets, such as ABC news, Oprah, and CBS news, have all promoted the benefits of this magical berry. However, many of these claims have not been proven scientifically in a controlled study.

In fact, there is a very limited number of published medical papers on the actual benefit of the acai berry. Even nutrition specialists of the Mayo clinic cannot provide actual medical studies supporting the above claims.

In study published in the Journal of Agricultural and Food Chemistry, the authors compared the antioxidant potency of certain fruit drinks distributed in the United States. The study compared pomegranate juice, red wine, berry fruit juices (which includes black cherry, blueberry, concord grapes, cranberry), apple juice, bottled teas, and the acai berry juice. One measure used to compare the juices is the Oxygen Radical Absorbing Capacity (ORAC) which measures the juices ability to absorb free radicals. In this study, the highest ORACs found per juice are as follows:
(micromol of TE/mL)

Pomegranate juice: 25.0 +/- 1.0
Red Wine: 26.7 +/- 3.5
Concord Grape Juice: 30.5 +/- 1.4
Acai Juice: 22.9 +/- 2.8
Cranberry juice: 21.5 +/- 3.1

Click here to see all the values. In a comparison of the various juices' abilities to inhibit LDL oxidation (LDL is a leading part of the mechanism that causes heart disease), pomegranate juice had the highest values at 97.1 +/- 0.0 (for peroxides) and 97.2 +/- 0.7 (malondialdehyde). Wheras the acai berry juice had values at 29.2 +/- 15.5 (for peroxides) and 20.4 +/- 6.7 (malondialdehyde). Overall, the study found pomegrante juice to have the most potent antioxidant abilities followed by red wine and grape juice.

Not to say drinking acai juice is not beneficial, but more extensive studies are needed to validate all of the claims found in the media. At this point, these claims of acai being a new "super food" by such individuals as Oprah and Dr. Perricone are simply not supported. Only the juice manufactures are benefiting (the acai berry spoils within 24 hours from being picked, thus, you cannot get the actual berry in food stores, only as juices at this point).

Nonetheless, all diets should be high in fruits and vegetables, regardless of which one you prefer. Nonetheless, an individual should not put all of their hopes into just one magical berry.

Monday, February 9, 2009

Benefits of Fish Oil (Omega-3 Fatty Acids)

Fish oil (Omega-3 fatty acids) have been shown to reduce the incidence of cardiovascular disease. Essentially, omega-3 fatty acids reduce the formation of plaque found in your coronary arteries. The presence of plaque in the coronary arteries places you at risk for a heart attack (myocardial infarction). The american heart assocation guidlines have recommended at least two servings of fish per week. However, fish oil supplements are available over the counter. Currently, the only FDA approved fish oil is Lovaza. Additional information can be found at the Mayo Clinic site. Or, you can click here or here to read recent scientific studies on fish oil.

Fish oil can be taken to prevent such cardiac events such as death, heart attack, and stroke. In cases of patients with increased triglycerides, even greater levels of fish oil are usually used.

Be sure to ask your physician before taking any supplements.

Saturday, February 7, 2009

Recent Study Analyzes Omega-6 Fatty Acids and the Risk for Cardiovascular Disease

A recent publication in the February 2009 issue of Circulation (Click here to read study)analyzes the issue regarding an intake of omega-6 PUFAs in our diet.

An increased intake of omega-6 polyunsaturated fatty acids (PUFAs) has been thought to reduced coronary heart disease (CHD) and increase levels of HDL (the good cholesterol). Groups have suggested a decrease in the current intake of omega-6 PUFAs is needed.

Linoleic Acid (LA) is the primary dietary omega-6 PUFA. LA must be ingested by an indvidual. Though LA is converted to useful omega-6 PUFA, it can also be metabolized to the omega-6 PUFA known as arachidonic acid (AA). AA is necessary for variety of proinflammatory process that occur within the body. Considering CHD has a proinflammatory component to it, individuals have suggested reducing the intake of linoleic Acid.

However, the publication suggests a reduction in omega-6 PUFA would more likely increase CHD and than decrease CHD.