Every 45 seconds, someone in the United States experiences a stroke. Yet, despite being the third leading cause of death and the leading cause of adult disability in this country, fewer than one in five Americans can recognize a symptom of a stroke. In addition, some people still believe that this condition is simply a "stroke of fate," not realizing that stroke is preventable and treatable.
National Stroke Association is urging people to take charge of their health by knowing the signs and symptoms of a stroke, asking their doctors about stroke prevention and adopting healthy lifestyle habits. A good first step is to have your blood pressure checked. High blood pressure is the number one cause of stroke. Nearly 60 million Americans - 29 million women - have high blood pressure, and almost a third do not even know it.
While a stroke can happen to anyone regardless of age, gender or race – women are uniquely impacted. Consider these facts:
Twice as many women die from stroke than from breast cancer every year.
More women than men die from stroke.
One half of all African American women will die from stroke or heart disease.
Women outnumber men as caregivers to stroke survivors.
4 out of 5 American families will be touched by stroke.
A stroke, or "brain attack," occurs when blood and oxygen flow to the brain is interrupted by a blood clot or a broken blood vessel. This kills brain cells in the immediate area, often causing physical and emotional disabilities including speech problems, memory loss and paralysis.
In addition to high blood pressure, there are several things that can contribute or increase a person’s risk for stroke including cholesterol, diabetes, smoking, obesity and family history. Women have additional risk factors to consider such as pregnancy and using hormone replacement therapy to treat menopause, all of which can increase stroke risk.
But the good news is that stroke is one of the most preventable of all life-threatening health problems, provided you pay proper attention to lifestyle and medical risk factors. Treatment exists to help minimize the effects of a stroke, however it must be given within 3 hours of the first symptom. So it is important for people to be able to recognize the symptoms of stroke and seek emergency medical attention. Recognizing stroke symptoms can be easy by learning to think F.A.S.T.
F=Face Ask the person to smile. Does one side of the face droop?
A=Arms Ask the person to raise both arms. Does one arm drift downward?
S=Speech Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?
T=Time If you observe any of these signs, then it’s time to call 9-1-1.
Studies show that stroke patients who arrive at the hospital by ambulance receive quicker treatment than those who arrive by their own means. But where are the best hospitals to go to for the treatment of stroke? There are numerous hospitals across the country that have been certified as stroke centers, and specialize in the treatment of stroke. This designation goes to hospitals that make exceptional efforts to foster better outcomes for stroke care, and whose quality of care is effectively managed to meet the unique and specialized needs of stroke patients. To find a stroke center in your area please visit www.stroke.org and click on the emergency stroke center locations.
Friday, October 5, 2007
Wednesday, October 3, 2007
Light wine intake = longer life expectancy in men
Drinking a little alcohol every day, especially wine, may be associated with an increase in life expectancy. That’s the conclusion of Dutch researchers who reported the findings of their study today at the American Heart Association’s 47th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.
The researchers found that a light intake of alcohol (on average less than one glass per day) was associated with a lower rate of cardiovascular death and death from all causes. When compared to spirits and beer, consumption of small amounts of wine, about a half a glass a day, was associated with the lowest levels of all-cause and cardiovascular deaths.
"Our study showed that long-term, light alcohol intake among middle-aged men was associated not only with lower cardiovascular and all-cause death risk, but also with longer life expectancy at age 50," said Martinette T. Streppel, lead author of the study and a Ph.D. student in the Division of Human Nutrition at Wageningen University and National Institute for Public Health and the Environment (RIVM) in Bilthoven, The Netherlands. "Furthermore, long-term light wine consumption is associated with a further protective effect when compared to that of light-to-moderate alcohol intake of other types."
Previous studies have shown that light to moderate alcohol intake is associated with a lower risk of cardiovascular death. However, it remained unclear whether a specific beverage was associated with more benefit and whether the use of long-term alcohol consumption was associated with increased life expectancy. Studies such as this cannot definitively show whether the agent being studied has a causal effect on health.
The Netherlands study — called the Zutphen Study — involved a cohort of 1,373 men born between 1900 and 1920 who were surveyed in detail about alcohol consumption seven times over 40 years. The participants, all from Zutphen, an industrial town in the eastern part of the Netherlands, were followed until death or until the final survey taken among survivors in mid-2000. The surveys included drinking habits, dietary habits, body mass index, smoking habits and the prevalence of heart attack, stroke, diabetes and cancer. The statistics on alcohol consumption were adjusted to account for other risk factors.
The researchers found that long-term, light alcohol intake of less than or equal to 20 grams per day (1 glass of alcoholic beverage contains 10 grams of alcohol, 1 ounce = ~30 mL of alcoholic beverage) compared to no alcohol intake was associated with a 36 percent lower relative risk of all-cause death and a 34 lower relative risk of cardiovascular death. The average long-term daily intake of the men throughout the 40-year study was six grams based on any alcohol intake of more than zero and up to 20 grams. The long-term average intake of six grams of alcohol is equal to one four-ounce beer, one two-ounce glass of wine or one one-ounce glass of spirits, daily.
When the researchers looked independently at wine consumption, the associated risk reduction was greater. Participants who drank on average half a glass, or 1.5 ounces, of wine per day, over a long period, had a 40 percent lower rate of all-cause death and a 48 percent lower incidence of cardiovascular death, compared to the non-wine drinkers.
Researchers said life expectancy was 3.8 years higher in those men who drank wine compared to those who did not drink alcoholic beverages. Life expectancy of wine users was more than two years longer than users of other alcoholic beverages. Men with a long-term alcohol intake less than or equal to 20 grams per day had a 1.6-year-higher life expectancy, compared to those who consumed no alcohol.
Most of the previous studies assessed alcohol intake at baseline; however, in this study researchers collected detailed information seven times over 40 years. "Consumption patterns usually change during life," Streppel said. "This enabled us to study the effects of long-term alcohol intake on mortality." Researchers found that the number of alcohol users nearly doubled from 45 percent in 1960 to 85 percent in the 2000 survey. Average alcohol consumption rose and then fell at various points during the study. Users’ consumption was eight grams a day in 1960, then survivors’ consumption was 18 grams a day in 1985, dropping to 13 grams per day in 2000. The percentage of wine users increased during follow-up from 2 percent in 1960 to more than 40 percent among the survivors in 2000. "One can speculate that a protective effect of light alcohol intake could be due to an increase in high-density lipoprotein (HDL) cholesterol, or to a reduction in blood clotting, due to an inhibition of platelet aggregation," Streppel said.
Furthermore, red wine consumption may have an additional health benefit because the polyphenolic compounds contained in wine have been seen in animal to interfere with the formation, progression and rupture of atherosclerotic plaques — the build-up of fatty tissue in the arteries that can result in stroke or heart attack.
"Those people who already consume alcoholic beverages should do so lightly (1 to 2 glasses per day) and preferably drink wine," Streppel said. "The cardio-protective effects of alcohol and wine only held up for light alcohol consumption in middle-aged men. Heavy alcohol consumption may cause accidents and diseases such as cancer and cirrhosis of the liver, even though this was not observed in our study. Since alcohol consumption can be addictive, starting to drink alcohol because of its positive health benefits is not advised."
How alcohol or wine might affect cardiovascular risk merits further research, but right now the American Heart Association does not recommend beginning to drink wine or any other form of alcohol to gain these potential benefits. The association does recommend that to reduce your risk you should talk to your doctor about lowering your cholesterol and blood pressure, controlling your weight, getting enough physical activity and following a healthy diet and quit smoking, if you smoke. There is no scientific proof that drinking wine or any other alcoholic beverage can replace these conventional measures.
The researchers found that a light intake of alcohol (on average less than one glass per day) was associated with a lower rate of cardiovascular death and death from all causes. When compared to spirits and beer, consumption of small amounts of wine, about a half a glass a day, was associated with the lowest levels of all-cause and cardiovascular deaths.
"Our study showed that long-term, light alcohol intake among middle-aged men was associated not only with lower cardiovascular and all-cause death risk, but also with longer life expectancy at age 50," said Martinette T. Streppel, lead author of the study and a Ph.D. student in the Division of Human Nutrition at Wageningen University and National Institute for Public Health and the Environment (RIVM) in Bilthoven, The Netherlands. "Furthermore, long-term light wine consumption is associated with a further protective effect when compared to that of light-to-moderate alcohol intake of other types."
Previous studies have shown that light to moderate alcohol intake is associated with a lower risk of cardiovascular death. However, it remained unclear whether a specific beverage was associated with more benefit and whether the use of long-term alcohol consumption was associated with increased life expectancy. Studies such as this cannot definitively show whether the agent being studied has a causal effect on health.
The Netherlands study — called the Zutphen Study — involved a cohort of 1,373 men born between 1900 and 1920 who were surveyed in detail about alcohol consumption seven times over 40 years. The participants, all from Zutphen, an industrial town in the eastern part of the Netherlands, were followed until death or until the final survey taken among survivors in mid-2000. The surveys included drinking habits, dietary habits, body mass index, smoking habits and the prevalence of heart attack, stroke, diabetes and cancer. The statistics on alcohol consumption were adjusted to account for other risk factors.
The researchers found that long-term, light alcohol intake of less than or equal to 20 grams per day (1 glass of alcoholic beverage contains 10 grams of alcohol, 1 ounce = ~30 mL of alcoholic beverage) compared to no alcohol intake was associated with a 36 percent lower relative risk of all-cause death and a 34 lower relative risk of cardiovascular death. The average long-term daily intake of the men throughout the 40-year study was six grams based on any alcohol intake of more than zero and up to 20 grams. The long-term average intake of six grams of alcohol is equal to one four-ounce beer, one two-ounce glass of wine or one one-ounce glass of spirits, daily.
When the researchers looked independently at wine consumption, the associated risk reduction was greater. Participants who drank on average half a glass, or 1.5 ounces, of wine per day, over a long period, had a 40 percent lower rate of all-cause death and a 48 percent lower incidence of cardiovascular death, compared to the non-wine drinkers.
Researchers said life expectancy was 3.8 years higher in those men who drank wine compared to those who did not drink alcoholic beverages. Life expectancy of wine users was more than two years longer than users of other alcoholic beverages. Men with a long-term alcohol intake less than or equal to 20 grams per day had a 1.6-year-higher life expectancy, compared to those who consumed no alcohol.
Most of the previous studies assessed alcohol intake at baseline; however, in this study researchers collected detailed information seven times over 40 years. "Consumption patterns usually change during life," Streppel said. "This enabled us to study the effects of long-term alcohol intake on mortality." Researchers found that the number of alcohol users nearly doubled from 45 percent in 1960 to 85 percent in the 2000 survey. Average alcohol consumption rose and then fell at various points during the study. Users’ consumption was eight grams a day in 1960, then survivors’ consumption was 18 grams a day in 1985, dropping to 13 grams per day in 2000. The percentage of wine users increased during follow-up from 2 percent in 1960 to more than 40 percent among the survivors in 2000. "One can speculate that a protective effect of light alcohol intake could be due to an increase in high-density lipoprotein (HDL) cholesterol, or to a reduction in blood clotting, due to an inhibition of platelet aggregation," Streppel said.
Furthermore, red wine consumption may have an additional health benefit because the polyphenolic compounds contained in wine have been seen in animal to interfere with the formation, progression and rupture of atherosclerotic plaques — the build-up of fatty tissue in the arteries that can result in stroke or heart attack.
"Those people who already consume alcoholic beverages should do so lightly (1 to 2 glasses per day) and preferably drink wine," Streppel said. "The cardio-protective effects of alcohol and wine only held up for light alcohol consumption in middle-aged men. Heavy alcohol consumption may cause accidents and diseases such as cancer and cirrhosis of the liver, even though this was not observed in our study. Since alcohol consumption can be addictive, starting to drink alcohol because of its positive health benefits is not advised."
How alcohol or wine might affect cardiovascular risk merits further research, but right now the American Heart Association does not recommend beginning to drink wine or any other form of alcohol to gain these potential benefits. The association does recommend that to reduce your risk you should talk to your doctor about lowering your cholesterol and blood pressure, controlling your weight, getting enough physical activity and following a healthy diet and quit smoking, if you smoke. There is no scientific proof that drinking wine or any other alcoholic beverage can replace these conventional measures.
Tuesday, August 21, 2007
Does playing the brain/memory game really help?
Brain and memory training programs are popular, but they don't work well for everyone, says a Universitiy of Michigan psychologist.
New research by Cindy Lustig, a U-M assistant professor of psychology, and colleague David Bissig, a U-M graduate now at Wayne State University—U-M's University Research Corridor alliance partner—reveals what can help make a training program successful, especially for those older adults who could use the most help. Their findings are published in the August issue of Psychological Science.
Programs claiming to "train your brain" are becoming increasingly popular as baby boomers head into their golden years, the researchers say. Even Nintendo has gotten into the game, with a program designed to lower your brain's "age" with repeated playing.
However, not all of these programs have been shown to work, they say. For those that do work, scientists' understanding of how and why they work is very limited. Worse yet, the older a person is and the less memory ability he or she has before training, the less likely that person is to show benefits.
"The bottom line is that in most memory training programs, the people who likely need training the most—those 80 and older and people with lower initial ability—improve the least," Lustig said.
The researchers, who conducted their studies at Lustig's U-M psychology lab, were able to show that the kinds of strategies people use are related to how much benefit they show from training. Accounting for those strategies can eliminate age and ability differences in training success.
Lustig and Bissig took a memory training program that has been used both with healthy older adults and people in the beginning stages of Alzheimer's disease, and asked what was different about people who showed big benefits from training versus those who showed little or no improvement.
The results of the study suggest that in order to improve memory, one needs not only to work hard, but work smart. People in their 60s and 70s used a strategy of spending most of their time on studying the materials and very little on the test, and showed large improvements over the testing sessions.
By contrast, most people in their 80s and older spent very little time studying and instead spent most of their time on the test. These people did not do well and showed very little improvement even after two weeks of training.
One of their conclusions: What matters for memory—and what seems to change as people get older—is not only how much time we spend on trying to remember something, but where we put our efforts.
"My lab is now working on training people of more advanced age and lower education to use the strategies that our most successful participants used, to see if we can boost the performance of these potentially at-risk groups," Lustig said. "A stitch in time saves nine—and studying at the right time just might save your mind."
New research by Cindy Lustig, a U-M assistant professor of psychology, and colleague David Bissig, a U-M graduate now at Wayne State University—U-M's University Research Corridor alliance partner—reveals what can help make a training program successful, especially for those older adults who could use the most help. Their findings are published in the August issue of Psychological Science.
Programs claiming to "train your brain" are becoming increasingly popular as baby boomers head into their golden years, the researchers say. Even Nintendo has gotten into the game, with a program designed to lower your brain's "age" with repeated playing.
However, not all of these programs have been shown to work, they say. For those that do work, scientists' understanding of how and why they work is very limited. Worse yet, the older a person is and the less memory ability he or she has before training, the less likely that person is to show benefits.
"The bottom line is that in most memory training programs, the people who likely need training the most—those 80 and older and people with lower initial ability—improve the least," Lustig said.
The researchers, who conducted their studies at Lustig's U-M psychology lab, were able to show that the kinds of strategies people use are related to how much benefit they show from training. Accounting for those strategies can eliminate age and ability differences in training success.
Lustig and Bissig took a memory training program that has been used both with healthy older adults and people in the beginning stages of Alzheimer's disease, and asked what was different about people who showed big benefits from training versus those who showed little or no improvement.
The results of the study suggest that in order to improve memory, one needs not only to work hard, but work smart. People in their 60s and 70s used a strategy of spending most of their time on studying the materials and very little on the test, and showed large improvements over the testing sessions.
By contrast, most people in their 80s and older spent very little time studying and instead spent most of their time on the test. These people did not do well and showed very little improvement even after two weeks of training.
One of their conclusions: What matters for memory—and what seems to change as people get older—is not only how much time we spend on trying to remember something, but where we put our efforts.
"My lab is now working on training people of more advanced age and lower education to use the strategies that our most successful participants used, to see if we can boost the performance of these potentially at-risk groups," Lustig said. "A stitch in time saves nine—and studying at the right time just might save your mind."
Tuesday, August 14, 2007
Waist-to-hip ratio better predicts heart risk
Waist-to-hip ratio may better predict cardiovascular risk than body mass index
A tape measure, not just a bathroom scale, may help you better assess your heart disease risk.
In a study to be published in the Aug. 21 issue of the Journal of the American College of Cardiology, investigators at UT Southwestern Medical Center found that people with a larger waist-to-hip ratio may be at increased risk for heart disease. The research evaluates the association between different measures of obesity and the prevalence of arterial disease.
“Our study shows that people who develop fat around the middle have more atherosclerotic plaque than those who have smaller waist-to-hip ratios,” said Dr. James de Lemos, associate professor of internal medicine and senior author of the study. “The risk was the same for both men and women who develop abdominal fat.
Prior studies examining the association between obesity and cardiovascular risk reported varied results for overweight subjects who eventually had clinical cardiovascular events. The patients often were evaluated for obesity on the sole measurement of body mass index (BMI), a weight-to-height ratio commonly used in doctors’ offices to gauge obesity. The UT Southwestern findings, however, suggest that BMI alone might not give a clear enough picture of heart disease risk.
“BMI was used as the primary measure of obesity rather than alternative measures such as waist circumference or waist-to-hip ratio,” said Dr. de Lemos. “The latter measures have demonstrated stronger correlations for cardiovascular risk than BMI.”
In the UT Southwestern study, researchers looked at men and women between the ages of 18 and 65. Nearly 3,000 individuals participated in a total of three medical visits each, which included an in-home health survey, blood and urine collection, and a detailed clinical exam complete with abdominal magnetic resonance imaging and coronary artery calcium scans.
Calcium was more likely to be found in the arteries of patients with the greatest waist-to-hip ratio, the researchers discovered. People with the largest waist-to-hip ratio had a twofold increase in the incidence of calcium deposits — a strong indicator of future cardiovascular ailments including heart attacks.
The prevalence of coronary artery calcium was strongly associated with waist circumference and waist-to-hip ratio in addition to high BMI. Hip circumference alone, however, was not a strong indicator for coronary calcium deposits.
“Fat that accumulates around your waist seems to be more biologically active as it secretes inflammatory proteins that contribute to atherosclerotic plaque buildup, whereas fat around your hips doesn’t appear to increase risk for cardiovascular disease at all,” Dr. de Lemos said. “We think the key message for people is to prevent accumulation of central fat early on in their lives. To do so, they will need to develop lifelong dietary and exercise habits that prevent the development of the ‘pot belly.’”
The research was conducted as part of the Dallas Heart Study, a multiethnic, population-based study of more than 6,000 patients in Dallas County designed to examine cardiovascular disease. The multiyear study aims to gather information to help improve the diagnosis, prevention and treatment of heart disease.
A tape measure, not just a bathroom scale, may help you better assess your heart disease risk.
In a study to be published in the Aug. 21 issue of the Journal of the American College of Cardiology, investigators at UT Southwestern Medical Center found that people with a larger waist-to-hip ratio may be at increased risk for heart disease. The research evaluates the association between different measures of obesity and the prevalence of arterial disease.
“Our study shows that people who develop fat around the middle have more atherosclerotic plaque than those who have smaller waist-to-hip ratios,” said Dr. James de Lemos, associate professor of internal medicine and senior author of the study. “The risk was the same for both men and women who develop abdominal fat.
Prior studies examining the association between obesity and cardiovascular risk reported varied results for overweight subjects who eventually had clinical cardiovascular events. The patients often were evaluated for obesity on the sole measurement of body mass index (BMI), a weight-to-height ratio commonly used in doctors’ offices to gauge obesity. The UT Southwestern findings, however, suggest that BMI alone might not give a clear enough picture of heart disease risk.
“BMI was used as the primary measure of obesity rather than alternative measures such as waist circumference or waist-to-hip ratio,” said Dr. de Lemos. “The latter measures have demonstrated stronger correlations for cardiovascular risk than BMI.”
In the UT Southwestern study, researchers looked at men and women between the ages of 18 and 65. Nearly 3,000 individuals participated in a total of three medical visits each, which included an in-home health survey, blood and urine collection, and a detailed clinical exam complete with abdominal magnetic resonance imaging and coronary artery calcium scans.
Calcium was more likely to be found in the arteries of patients with the greatest waist-to-hip ratio, the researchers discovered. People with the largest waist-to-hip ratio had a twofold increase in the incidence of calcium deposits — a strong indicator of future cardiovascular ailments including heart attacks.
The prevalence of coronary artery calcium was strongly associated with waist circumference and waist-to-hip ratio in addition to high BMI. Hip circumference alone, however, was not a strong indicator for coronary calcium deposits.
“Fat that accumulates around your waist seems to be more biologically active as it secretes inflammatory proteins that contribute to atherosclerotic plaque buildup, whereas fat around your hips doesn’t appear to increase risk for cardiovascular disease at all,” Dr. de Lemos said. “We think the key message for people is to prevent accumulation of central fat early on in their lives. To do so, they will need to develop lifelong dietary and exercise habits that prevent the development of the ‘pot belly.’”
The research was conducted as part of the Dallas Heart Study, a multiethnic, population-based study of more than 6,000 patients in Dallas County designed to examine cardiovascular disease. The multiyear study aims to gather information to help improve the diagnosis, prevention and treatment of heart disease.
Tuesday, August 7, 2007
Soluble fiber lowers bad cholesterol
Soluble fiber -- from beans, some fruits and even coffee -- may help lower low-density lipoprotein (LDL) or “bad” cholesterol and blood sugar and may help protect against heart attack and stroke.
The August issue of Mayo Clinic Health Letter explains how to boost soluble fiber in the diet.
Fiber comes in two forms -- soluble and insoluble. Soluble fiber dissolves in water to form a gel-like material. The recommended daily intake of total fiber for women over age 51 is 21 grams. For men over 51, it’s 30 grams.
Fiber supplements, such as Metamucil, Konsyl and others, can boost soluble fiber intake. A typical dose has 2 to 3 grams. Other good sources include:
-- One-half cup of baked beans, cooked black beans, kidney, lima or navy beans provides about 1 gram of soluble fiber. _-- A pear, peach, plum or orange contains about 1 gram of soluble fiber. _-- An apple, mango, one-half of a grapefruit or one-half cup of blackberries each has about _ gram of soluble fiber. _-- Certain vegetables, such as a medium carrot, one-half cup of cooked peas, broccoli or Brussels sprouts, or a medium cooked potato with its skin, contain about 1 gram of soluble fiber. _-- Oats, whether as one-half cup of oatmeal or oat bran or as an ounce of granola, are good for about 1 gram of soluble fiber. _-- Brewed coffee -- A recent analysis showed a cup of brewed coffee contains about 1 gram of soluble fiber.
The August issue of Mayo Clinic Health Letter explains how to boost soluble fiber in the diet.
Fiber comes in two forms -- soluble and insoluble. Soluble fiber dissolves in water to form a gel-like material. The recommended daily intake of total fiber for women over age 51 is 21 grams. For men over 51, it’s 30 grams.
Fiber supplements, such as Metamucil, Konsyl and others, can boost soluble fiber intake. A typical dose has 2 to 3 grams. Other good sources include:
-- One-half cup of baked beans, cooked black beans, kidney, lima or navy beans provides about 1 gram of soluble fiber. _-- A pear, peach, plum or orange contains about 1 gram of soluble fiber. _-- An apple, mango, one-half of a grapefruit or one-half cup of blackberries each has about _ gram of soluble fiber. _-- Certain vegetables, such as a medium carrot, one-half cup of cooked peas, broccoli or Brussels sprouts, or a medium cooked potato with its skin, contain about 1 gram of soluble fiber. _-- Oats, whether as one-half cup of oatmeal or oat bran or as an ounce of granola, are good for about 1 gram of soluble fiber. _-- Brewed coffee -- A recent analysis showed a cup of brewed coffee contains about 1 gram of soluble fiber.
Diets high in choline = risk for colorectal polyps
Diets high in choline may increase risk for colorectal polyps
Contrary to expectations, diets high in the nutrient choline were associated with an increased risk of some colorectal polyps, which can—but do not always—lead to colorectal cancer, according to a study published online in the August 7 Journal of the National Cancer Institute.
Major food sources of choline include red meat, eggs, poultry, and dairy products. Choline is involved in a biochemical process known as one-carbon metabolism. Studies have shown that people with increased intake of other nutrients required for one-carbon metabolism, such as folate, are at a decreased risk for colorectal polyps. This is the first study to examine the association between choline and colorectal polyps.
Eunyoung Cho, Sc.D., of Brigham and Women’s Hospital in Boston and colleagues sent food-frequency questionnaires to women enrolled in the Nurses’ Health Study every two to four years from 1984 to 2002. They then estimated the choline content in their diets.
The researchers had hypothesized that choline intake would decrease the risk of colorectal polyps like folate does. But the results suggest the opposite—greater amounts of choline in the diet were associated with an elevated risk of colorectal polyps.
“Although our results were contrary to expectation based on choline’s role [in one-carbon metabolism], there is a potential biologic basis for the positive association that we observed…Once a tumor is initiated, growth into a detectable [polyp] depends in part on choline availability because choline is needed to make membranes in all rapidly growing cells,” the authors write. However, because this was the first study of choline and colorectal polyps, and other components of diets high in choline may be responsible for the association, the finding needs to be replicated in other studies.
In an accompanying editorial, Regina Ziegler, Ph.D., and Unhee Lim, Ph.D., of the National Cancer Institute in Bethesda, Md., describe the complexity of the relationship between one-carbon metabolism and the development of cancer.
“Clearly, one-carbon metabolism and its role in [cancer development] is more complicated than originally anticipated, and our understanding of the underlying mechanisms is probably incomplete. More research, and caution in developing public health policy and guidance, is warranted,” the authors write.
Contrary to expectations, diets high in the nutrient choline were associated with an increased risk of some colorectal polyps, which can—but do not always—lead to colorectal cancer, according to a study published online in the August 7 Journal of the National Cancer Institute.
Major food sources of choline include red meat, eggs, poultry, and dairy products. Choline is involved in a biochemical process known as one-carbon metabolism. Studies have shown that people with increased intake of other nutrients required for one-carbon metabolism, such as folate, are at a decreased risk for colorectal polyps. This is the first study to examine the association between choline and colorectal polyps.
Eunyoung Cho, Sc.D., of Brigham and Women’s Hospital in Boston and colleagues sent food-frequency questionnaires to women enrolled in the Nurses’ Health Study every two to four years from 1984 to 2002. They then estimated the choline content in their diets.
The researchers had hypothesized that choline intake would decrease the risk of colorectal polyps like folate does. But the results suggest the opposite—greater amounts of choline in the diet were associated with an elevated risk of colorectal polyps.
“Although our results were contrary to expectation based on choline’s role [in one-carbon metabolism], there is a potential biologic basis for the positive association that we observed…Once a tumor is initiated, growth into a detectable [polyp] depends in part on choline availability because choline is needed to make membranes in all rapidly growing cells,” the authors write. However, because this was the first study of choline and colorectal polyps, and other components of diets high in choline may be responsible for the association, the finding needs to be replicated in other studies.
In an accompanying editorial, Regina Ziegler, Ph.D., and Unhee Lim, Ph.D., of the National Cancer Institute in Bethesda, Md., describe the complexity of the relationship between one-carbon metabolism and the development of cancer.
“Clearly, one-carbon metabolism and its role in [cancer development] is more complicated than originally anticipated, and our understanding of the underlying mechanisms is probably incomplete. More research, and caution in developing public health policy and guidance, is warranted,” the authors write.
Friday, August 3, 2007
Should You Take a Statin?
If your annual checkup reveals that your cholesterol levels are high, your doctor may recommend you take a statin—such as atorvastatin (Lipitor), sim¬va¬statin (Zocor), rosuva¬statin (Crestor), prava¬statin (Pravachol), or lovastatin (Mevacor)—to help lower your “bad” LDL cholesterol. Statins also can slightly raise “good” HDL cholesterol and may help lower triglycerides—blood fats that can increase heart disease risk, according to Weill Cornell Medical College. According to the National Cholesterol Education Program (NCEP) of the National Institutes of Health, 11 million Americans take a statin; another 25 million might benefit from one.
Prevention is key
Heart disease is the number-one killer of women, with stroke not far behind. A recent study of more than 2,700 women (Neurology, Feb. 20, 2007) showed that healthy women with no history of heart disease or stroke but with elevated cholesterol are twice as likely to suffer a stroke than women with lower cholesterol levels.
Antonio M. Gotto, Jr., MD, PhD, dean of Weill Cornell Medical College, says statin drugs are a valuable tool in controlling the cholesterol risk factor. For example, the Cholesterol and Recurrent Events (CARE) study showed that women who were heart disease survivors and took Pravachol instead of placebo did better than men in dodging another heart attack.
“Women overall tend to be at lower risk (for heart disease and stroke), but the studies show statins benefit them,” Dr. Gotto says.
Simeon Margolis, MD, PhD, professor of medicine and biological chemistry at Johns Hopkins School of Medicine in Baltimore, agrees that statins can help women keep cholesterol under control. “Initially, women were not well-represented in the studies,” Dr. Margolis says. “But now there is plenty of evidence that keeping cholesterol levels low prevents heart attack and stroke in women the same as it does in men. Young, old, male, female—it works.”
When to start statin therapy
Roughly half of your cholesterol is manufactured in your liver and other organs, with the rest coming from food sources, such as eggs, dairy products, meat, and poultry. The human body needs a certain amount of cholesterol to produce vital hormones and to manufacture bile salts for the digestion of food. But when cholesterol levels are too high, it can adhere to the walls of arteries to form plaque that blocks the flow of blood.
For women who have not had a heart attack or stroke, the NCEP advocates statins for those with LDL cholesterol of 190 milligrams per deciliter (mg/dl) or higher, even if they are not overweight and don’t have a family history of heart disease or any other risk factor, such as smoking, high blood pressure or diabetes. With two or more other risk factors, an LDL reading of 160 mg/dl or higher might justify a statin, according to the NCEP, with the goal of getting it down to 130 mg/dl.
Dr. Gotto likes to see LDL levels below 100 mg/dl, especially with higher-risk individuals, such as heart attack or stroke survivors or women with diabetes. “I think the guidelines are too high,” he says. And Dr. Margolis acknowledges that some cardiologists like to get LDL levels below 70 in their patients.
In addition to lowering LDL levels, statins also have ancillary benefits: they can relax stiff blood vessels, reduce inflammation (which is thought to be a contributor to heart disease), and inhibit clotting that can lead to heart attack or stroke. A link between statins and the possible prevention of osteoporosis also is being studied, according to Dr. Margolis.
What about side effects?
The most common side effects of statins, such as muscle pain, tend to come with the higher doses, Dr. Margolis says. “They go away if you stop the drug.”
Rather than discontinuing the drug, however, some physicians prescribe a different statin or a different dose to see if that reduces the side effect. A lower dose accompanied by another LDL-lowering drug, ezetimibe (Zetia), may help reduce the risk of developing muscle pain, says Dr. Gotto.
In very rare cases, the inflamed muscles can release a protein that damages the kidneys and can even lead to death. Statins also can cause liver problems in some patients, so make sure your doctor tests your liver function at least once a year.
Some women, such as those in frail physical condition, the very elderly, and those of Asian descent, also may be at greater risk for muscle pain side effects.
Lifestyle changes
What about controlling cholesterol through diet and exercise? The NCEP recommends such steps as part of any treatment. Lifestyle changes can lower cholesterol by up to 15 percent, according to Dr. Margolis, but statins may reduce it by up to 50 percent with few side effects, depending on the statin and the dosage.
Nevertheless, it’s a good idea, even if you are taking a statin, to use oils low in saturated fats, such as olive oil; roast or steam foods instead of frying them; eliminate trans fats from your diet (they increase LDL and lower HDL); use egg whites instead of whole eggs; and load up on complex carbohydrates such as oatmeal, bran, vegetables, and fruits. Aerobic exercise, such as a good walk, on most days of the week is also important.
WHAT YOU SHOULD KNOW ABOUT STATINS
Statins must be taken regularly to maintain lower cholesterol levels and can be expensive, even with insurance.
Statins have been shown to reduce heart attack and stroke in both genders.
Statins can lower LDL cholesterol by up to 50 percent. Lifestyle changes, at best, can lower LDL by up to 15 percent.
Muscle pain is reported in as many as seven percent of those who take statins but may ease with reduced dosage or another type of statin.
Prevention is key
Heart disease is the number-one killer of women, with stroke not far behind. A recent study of more than 2,700 women (Neurology, Feb. 20, 2007) showed that healthy women with no history of heart disease or stroke but with elevated cholesterol are twice as likely to suffer a stroke than women with lower cholesterol levels.
Antonio M. Gotto, Jr., MD, PhD, dean of Weill Cornell Medical College, says statin drugs are a valuable tool in controlling the cholesterol risk factor. For example, the Cholesterol and Recurrent Events (CARE) study showed that women who were heart disease survivors and took Pravachol instead of placebo did better than men in dodging another heart attack.
“Women overall tend to be at lower risk (for heart disease and stroke), but the studies show statins benefit them,” Dr. Gotto says.
Simeon Margolis, MD, PhD, professor of medicine and biological chemistry at Johns Hopkins School of Medicine in Baltimore, agrees that statins can help women keep cholesterol under control. “Initially, women were not well-represented in the studies,” Dr. Margolis says. “But now there is plenty of evidence that keeping cholesterol levels low prevents heart attack and stroke in women the same as it does in men. Young, old, male, female—it works.”
When to start statin therapy
Roughly half of your cholesterol is manufactured in your liver and other organs, with the rest coming from food sources, such as eggs, dairy products, meat, and poultry. The human body needs a certain amount of cholesterol to produce vital hormones and to manufacture bile salts for the digestion of food. But when cholesterol levels are too high, it can adhere to the walls of arteries to form plaque that blocks the flow of blood.
For women who have not had a heart attack or stroke, the NCEP advocates statins for those with LDL cholesterol of 190 milligrams per deciliter (mg/dl) or higher, even if they are not overweight and don’t have a family history of heart disease or any other risk factor, such as smoking, high blood pressure or diabetes. With two or more other risk factors, an LDL reading of 160 mg/dl or higher might justify a statin, according to the NCEP, with the goal of getting it down to 130 mg/dl.
Dr. Gotto likes to see LDL levels below 100 mg/dl, especially with higher-risk individuals, such as heart attack or stroke survivors or women with diabetes. “I think the guidelines are too high,” he says. And Dr. Margolis acknowledges that some cardiologists like to get LDL levels below 70 in their patients.
In addition to lowering LDL levels, statins also have ancillary benefits: they can relax stiff blood vessels, reduce inflammation (which is thought to be a contributor to heart disease), and inhibit clotting that can lead to heart attack or stroke. A link between statins and the possible prevention of osteoporosis also is being studied, according to Dr. Margolis.
What about side effects?
The most common side effects of statins, such as muscle pain, tend to come with the higher doses, Dr. Margolis says. “They go away if you stop the drug.”
Rather than discontinuing the drug, however, some physicians prescribe a different statin or a different dose to see if that reduces the side effect. A lower dose accompanied by another LDL-lowering drug, ezetimibe (Zetia), may help reduce the risk of developing muscle pain, says Dr. Gotto.
In very rare cases, the inflamed muscles can release a protein that damages the kidneys and can even lead to death. Statins also can cause liver problems in some patients, so make sure your doctor tests your liver function at least once a year.
Some women, such as those in frail physical condition, the very elderly, and those of Asian descent, also may be at greater risk for muscle pain side effects.
Lifestyle changes
What about controlling cholesterol through diet and exercise? The NCEP recommends such steps as part of any treatment. Lifestyle changes can lower cholesterol by up to 15 percent, according to Dr. Margolis, but statins may reduce it by up to 50 percent with few side effects, depending on the statin and the dosage.
Nevertheless, it’s a good idea, even if you are taking a statin, to use oils low in saturated fats, such as olive oil; roast or steam foods instead of frying them; eliminate trans fats from your diet (they increase LDL and lower HDL); use egg whites instead of whole eggs; and load up on complex carbohydrates such as oatmeal, bran, vegetables, and fruits. Aerobic exercise, such as a good walk, on most days of the week is also important.
WHAT YOU SHOULD KNOW ABOUT STATINS
Statins must be taken regularly to maintain lower cholesterol levels and can be expensive, even with insurance.
Statins have been shown to reduce heart attack and stroke in both genders.
Statins can lower LDL cholesterol by up to 50 percent. Lifestyle changes, at best, can lower LDL by up to 15 percent.
Muscle pain is reported in as many as seven percent of those who take statins but may ease with reduced dosage or another type of statin.
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