How safe is our tap water?

Have you ever wondered how safe is your tap water?

Researchers at the Southern Nevada Water Authority in Las Vegas screened tap water from 19 US water utilities for 51 different compounds between 2006 and 2007. Their comprehensive survey revealed that a large number of pharmacological agents can be found in tap water and some of these are hormonally active. The 11 most frequently detected compounds, albeit at very low concentrations (source: New Scientist) are:

• Atenolol, a beta-blocker used to treat cardiovascular disease
• Atrazine, an organic herbicide banned in the European Union, but still used in the US, which has been implicated in the decline of fish stocks and in changes in animal behaviour
• Carbamazepine, a mood-stabilising drug used to treat bipolar disorder, amongst other things
• Estrone, an oestrogen hormone secreted by the ovaries and blamed for causing gender-bending changes in fish
• Gemfibrozil, an anti-cholesterol drug
• Meprobamate, a tranquiliser widely used in psychiatric treatment
• Naproxen, a painkiller and anti-inflammatory linked to increases in asthma incidence
• Phenytoin, an anticonvulsant that has been used to treat epilepsy
• Sulfamethoxazole, an antibiotic used against the Streptococcus bacteria, which is responsible for tonsillitis and other diseases
• TCEP, a reducing agent used in molecular biology
• Trimethoprim, another antibiotic

The use of pharmacological agents has increased in recent years and most of these compounds are excreted by the body through the urine and end up in our waste water. However, current techniques in waste water treatment seem to be not effective in taking out all the pharmacological agents from the water.

Researchers at the University of Montreal have recently detected the following drugs in the St. Lawrence River:

• bezafibrate, an anti-cholesterol drug
• enalapril, an anti-hypertensive drug
• methotrexate, a chemotherapy drug
• cyclophosphamide, also a chemotherapy drug

The waste water treatment plant in Montreal was able to take out the chemotherapeutic agents but not the cardiovascular drugs.

Increased contamination or improved detection?

The Nevada researchers are quick to point out that the concentrations of the 11 pharmaceuticals were very low, “millions of times lower than in a medical dose, and…that they pose no public health threat.” The concentrations were way below the set federal limits, at least for those with set limits. However, as in most pollution studies, it always ends up with the question whether the presence of these chemicals are due to increased contamination or improved detection. Or both.

Effect on the environment

The Canadian researchers are concerned about the effect of the compounds they detected on the flora and fauna of the St. Lawrence River. Hormonally active compounds can cause endocrine disruptions and have been observed to induce gender anomalies in fish and other aquatic organisms.

Effect on our health

Finally, we also have to ask as to what the long-terms effects of these pharmaceuticals are in our health. Are these compounds carcinogenic? Mutagenic? No data is available so far. Is it worthwhile to take all these chemicals out of the tap water?

According to Nevada researcher Shane Snyder

“the costs of “extreme purification” - far beyond what is needed for safety alone - are huge in terms of increased energy usage and carbon footprint. Ultra-pure water might not even be safe.”

According to a spokesperson from the US Environmental Protection Agency (EPA):

neither this nor other recent water assessments give cause for health concern. “But several point to the potential for risk - especially for the fetus and those with severely compromised health.”

Photo credit: stock.xchng

               

Heart drugs found in the waters of St. Lawrence River

The use of pharmacological agents has increased rapidly during the last decades. Cardiovascular diseases and cancers are the most prevalent chronic conditions in developed countries. Large amounts of chemotherapeutic drugs and medications to manage high blood pressure and elevated cholesterol levels are being used to treat patients everyday. These drugs make us feel better and keep ailments at bay but have we ever wondered where do they end up after being excreted from the body? Although drugs are taken up and metabolized by the human body, a large amount of these are excreted through the urine and the feces.And they eventually end up in our waste water that goes to the water treatment plants.

So far so good. However, how efficient is our water treatment system in filtering out these chemicals?

This was the question that researchers from the University of Montreal wanted to answer. The researchers sampled water in the St. Lawrence River downstream and upstream of the wastewater treatment plant of the city of Montreal. They checked for the presence of chemotherapy products and certain hypertension and cholesterol medications using the “rapid detection method On-line SPE-LC-MS/MS (On-line solid-phase extraction liquid chromatography coupled to polarity-switching electrospray tandem mass spectometry).” The compounds they specifically check for were

• Bezafibrate, a cholesterol-lowering rug
• Enalapril, a drug against hypertension
• Methotrexate, a chemotherapy agent
• Cyclophosphamide, also a chemotherapy agent

These four drugs are routinely prescribed in large amounts by doctors in the area.

The results of the study show that all four drugs were detected in the untreated waters upstream of the water treatment plant. However, only bezafibrate and enalapril were detected downstream in the treated waters leaving the plant. The results indicate the following:

• Large amounts of pharmacological products enter the St. Lawrence River.
• The water treatment system is efficient enough to get rid of the chemotherapy drugs but not the anti-cholesterol or anti-hypertension drugs.

The researchers, however, think that it is too early to conclude about the efficiency of water treatment in taking out chemotherapeutic compounds. It is possible that they might still be there but in very minute amounts undetectable by the current analytical methods used.

According the university press release

“This study was conducted due to the sharp rise in drug consumption over the past few years. In 1999, according to a study by IMS Health Global Services, world drug consumption amounted to $342 billion. In 2006 that figure doubled to $643 billion.”

The next questions to be answered are:

• How do these chemicals affect the aquatic environment and the plants and animals living in it?
• How much of these chemicals are present in our drinking water?

               

Knowing your heart and stroke drugs: statins

Resource post for November

Background

Statin drugs or HMG-CoA reductase inhibitors play a very important role in the prevention of cardiovascular diseases. They are the first line treatment against high cholesterol levels. Statins have anti-inflammatory properties and interfere with the production of cholesterol thus slowing down the formation of plaques on the arterial walls.

According to the US FDA, statin medications

• work in the liver to prevent formation of cholesterol
• are effective in lowering bad cholesterol levels and raising good cholesterol
• are not recommended for pregnant patients or those with active or chronic liver disease
• can cause serious muscle problems

Statins are also said to be the bestselling drugs of all times, raking in billions of dollar in sales every year. Currently available statin drugs are:

• Lovastatin (Mevacor, Altoprev)
• Pravastatin (Pravachol)
• Simvastatin (Zocor)
• Fluvastatin (Lescol)
• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)

Research studies

Recent studies indicate that statins may play a major role in therapeutic areas outside cardiovascular medicine, thus may earn the title of “the aspirin of the 21st century“. Some of these studies are summarized below.

Statins associated with lower risk of death from pneumonia

Pneumonia is a major cause of mortality worldwide, even in developed countries. It has been reported that the incidence of pneumonia is increasing and hospitalization rates in the US and Europe have increased by 20 to 50% during the last 10 years. About 10 to 15% of pneumonia cases result in death.

Does statin use lower mortality rates due to pneumonia? Danish researchers report in the October 27 issue of Archives of Internal Medicine that “individuals who take cholesterol-lowering statins before being hospitalized with pneumonia appear less likely to die within 90 days afterward.”

The researchers studied data from 29,900 patients hospitalized with pneumonia between 1997 and 2004. 4.6% of these patients (1,371) were taking statins before and during hospitalization as anticholesterol treatment.

Death rates within 30 days among statin users were much lower (10.3%) were much lower than non-statin users (15.7%). The same trend was observed after 90 days, with 16.8% mortality rates among statin users compared to 22.4% among non-users.

The mechanism behind this effect of statins is not clear but the authors theorize that

“Statins change the immune response, beneficially affect processes associated with blood clotting and inflammation and inhibit dysfunction in blood vessels. These effects may especially benefit patients with sepsis and bacteremia, which are associated with early death from pneumonia.”

Statins block 1 cause of pregnancy loss in mice

What does statin have to do with pregnancy? Researchers at Cornell University observed that statins can actually prevent antiphospholipid syndrome (APS), an inflammatory condition that causes serious complications in pregnancy ranging from spontaneous abortion, fetal growth problems and even fetal death. The researchers demonstrated this beneficial effect of statins in laboratory mice.

Statins may protect against memory loss

Statins seem to also have protective properties against dementia and other neurodegenerative diseases. This is according to a study by researchers at the University of Michigan School of Public Health. The researchers observed that “if a person takes statins over a course of about 5-7 years, it reduces the risk of dementia by half.” The study studied tracked 1674 older Mexican-Americans did not have dementia for 5 years. Within the follow up period, 130 study participants developed some form of dementia or cognitive impairment. The incidence of dementia was lower among the 452 participants who took statins at some point in the study. This is an interesting development in view of stories about the popular statin drug Lipitor causing memory losses.

Statins lower blood marker for prostate cancer

Men who are taking statins to lower their cholesterol levels have lower prostate-specific antigen (PSA). PSA is a known biomarker for cancer risk. The PSA reduction seems to be related to statin use in a dose-dependent manner. The study followed up 1214 men who were on statins between 1990 and 2006 and monitored their PSA levels. Whether the effect of statins on the PSA levels translates into anticancer properties is not yet clear.

Are statins beneficial or harmful in multiple sclerosis?

A previous study in animals has shown that some statins may be beneficial against multiple sclerosis when combined with other drugs. This was demonstrated by University of California researchers in mice. In another study, Phoenix researchers showed that simvastatin may have some anti-inflammatory effect that counteracts inflammatory components of multiple sclerosis. However, another study indicates that certain doses of stains combined with beta interferon may actually increase the clinical disease activity in patients with multiple sclerosis. “Caution is [therefore] suggested in administering this combination.” The latter study was based on data of 26 study participants.

Statins lower risk of clots in cancer patients

Researchers at the Albert Einstein Medical Center in Philadelphia observed that cancer patients taking statins have lower incidence of blood clots than non-users. Thus, statins “may have a future in preventing blood clots in patients with breast, lung, colon and other solid-organ cancers.”

Caveat

The abovementioned studies show that there are other potential uses of statins aside from lowering cholesterol levels. However, all these results are preliminary. Further and larger studies are needed to further explore these beneficial effects as well as the risks that may be involved. Many people will claim that most of the positive reports about statins are propaganda from the pharmaceutical companies. Conspiracy theories abound. However, if statins can provide health benefits beyond cardiovascular medicine, who are we to say no?

We also have to be aware that like all drugs, statins come with side effects. Most side effects are mild but some can be serious. Myopathy is a potential fatal denegerative disease of the muscles possibly linked to statin use.

Photo credit: stock.xchng

               

CVD News Watch November 7

CVD conference watch

AHA!
The best experts of the heart will be gathering in New Orleans, Louisiana this weekend. The 2008 Scientific Sessions of the American Heart Association run from November 8 to 12. Next week, I will try to bring you a review of the latest heart news from the conference.

CVD exercise watch

President-elect’s workout has predecessors gasping
He is not your typical American - at least as far as the Europeans are concerned. He’s black and he’s skinny. And he works out. Barack Obama is the first African-American to be elected US president. And the Obama fitness workout will probably become a legend.
“The main reason I do it is just to clear my head and relieve me of stress… My blood pressure is pretty low and I tend to be a healthy eater,” the UK Guardian quotes president-elect Obama.

CVD gender watch

Brown Named CEO of the American Heart Association
No, it’s not that kind of gender issue. Nancy Brown will be the next Chief Executive Officer of the American Heart Association, starting January 1, 2009. She will be the first woman to hold the position.

CVD drug watch

Sanofi-Aventis scraps ongoing rimonabant research
It was thought to be the next blockbuster - a drug that can be used to treat obesity as well as cardiovascular disorders. Unfortunately, rimonabant (Acomplia) fell short of these expectations and dealt a big blow to the big pharma Sanofi-Aventis, which announced that it is halting all clinical development programs associated with rimonabant. The downfall of the potential wonder drug is due to safety issues. In one trial, 5 suicides were reported in the rimonabant treatment group compared to 1 suicide in the placebo group. Two weeks ago, the European Medicines Agency (EMEA) announced that “it had asked the company to suspend marketing of the drug, on the grounds that its benefits no longer seemed to outweigh its risks.”

CVD obesity watch

Can Nintendo Wii Tackle Child Obesity?
Nintendo Wii, a program which simulates sports on the computer, is very popular among children and young people. The question is - is it effective against child obesity? This is the question that researchers at the University of Derby (UK) is tackling.
“This study aims to see if young children can lose weight or improve their health by using the Nintendo Wii. There is a lot of discussion that video games are bad for your health and we hope this research will determine if playing on this equipment could actually have physical benefits for children,” according to researcher Dr Michael Duncan.

CVD patient watch

Health of Ted Rogers stabilizes
Ted Rogers, head and founder of the Canadian company Rogers Communications was hospitalized Friday last week for an existing heart condition. The company announced that his condition has stabilized.

               

Know your medications: anti-cholesterol drugs

It’s Cholesterol Awareness Month.

So I think it’s only right that I tackle the topic of drugs used in controlling our cholesterol levels. For a review of the basics of cholesterol and what out cholesterol numbers mean, check out this resource post. In the same post, I have tackled lifestyle changes strategies that can help lower and control cholesterol levels. In today’s post, let us take a look at the pharmacological therapies for high cholesterol levels.

The main types of cholesterol-lowering drugs are summarized below.

Statins 

Statins also known as HMG CoA reductase inhibitors, are the most popular of currently available anti-cholesterol drugs. They act on the enzyme that regulates the rate at which our body produces cholesterol. They are known to be most effective in lowering LDL levels (20 to 55%) and triglycerides to a lesser extent.

Statins currently available in the U.S.include:

• Atorvastatin (Lipitor®)
• Fluvastatin (Lescol®)
• Lovastatin (Mevacor®, Altoprev^TM)
• Pravastatin (Pravachol®)
• Rosuvastatin Calcium (Crestor®)
• Simvastatin (Zocor®)

Statins are also available in combination with other classes of drugs, namely Advicor® (lovastatin + niacin), Caduet® (atorvastatin + amlodipine), and Vytorin^TM (simvastatin + ezetimibe).

Ezetimibe

Selective cholesterol absorption inhibitors reduce the amount of cholesterol absorbed in the intestine. Ezetimibe (Zetia®) is the first inhibitor to be approved. It has been shown to lower LDL levels by about 18 to 25%., moderately lowers triglycerides, and increases HDL levels.

Resins

Resins (also known as sequestrant or bile acid-binding drugs) bind with cholesterol-containing bile acids in the intestines and facilitate their elimination in the stool. These class of drugs can lower LDL levels by about 15 to 30%.

Resins currently available in the U.S. include:

• Cholestyramine (Questran®, Questran® Light, Prevalite®, Locholest®,  Locholest® Light)
• Colestipol (Colestid®)
• Colesevelam HCl (WelChol®)

Niacin

Nicotinic acid also known as niacin is actually a water-soluble B vitamin that can lower LDL levels (5 to 15%) and triglycerides and increase HDL levels. However, its positive effect on out lipid profiles is only achieved in doses higher than when taken as just vitamin supplement. For cholesterol control, niacin should only be taken upon doctor’s orders.

Fibrates

Fibrates or fibric acid derivatives are mostly effective in lowering triglycerides and moderately increase HDL levels. However, they don’t effectively lower LDL levels.

Fibrates currently available in the U.S.include:

• Gemfibrozil (Lopid®)
• Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide^TM)
• Clofibrate (Atromid-S)

[Sources: The National Heart, Lung, and Blood Institute (NHLBI); American Heart Association (AHA)]

As with almost all medications, these drugs should only be taken after discussion with your doctor. Currently, there are no avalaible OTC drugs to control cholesterol levels. There may be drugs sold over the Internet but these offers should be approached with extreme caution (see previous post on this). However, aside from taking medications, lifestyle changes are also necessary in the fight against cholesterol and heart disease.

Coming soon: alternative products and supplements against cholesterol.

Photo credit: drugs by sarej at stock.xchng

               

Older Schizophrenia Drugs Better Than New

By Ray Stone

Recent research has evidence that reveals that a newer class of anti-psychotic drugs may not be as effective in treating patients suffering from the mental condition called Schizophrenia, as older class drugs in treating the illness.

It was hoped that the newer class of drug would result in the patient experiencing less side-effects than those experienced using the older class of drugs. However, with research in this area being scarce, a recent trial has discovered quite the opposite. Claims that the newer class of drug would be more effective than the older class has never been backed up by evidence.

A recent trial involving 227 patients over a 52 week period did not find the newer class of drug to be more effective in reducing the side-effects and improving quality of life. The results showed that patients taking the different drugs showed similar results on a 52 week trial, measuring quality of life and side-effects at exactly the same points in time. It has been found that better quality of life and relief from symptoms from those who took the older class of drug was experienced than those who were taking the new class of drug. Another observation from the trial was that patients showed no preference for one class of drug over the other. There is also no meaningful difference in price between the older class of drug and the new ones.

With such clear evidence suggesting that the newer class of drugs are not as effective as the older class of drug, it would be difficult to see the benefit in prescribing the newer class of drug over the older class drugs. Jeffrey A. Lieberman, M.D., from Columbia University in New York’s College of Physicians and Surgeons, states that newer anti-psychotic medications are “not the great breakthrough in therapeutics they were once thought to be.”

About the Author: R. Stone canada online pharmacy (c) 2006, PerfectDrugRx. All rights in all media reserved. Reprints must include byline, contact information and copyright.

               

Drug Use Among Teens

 

WASHINGTON (AP) - Drug use among teens has dipped nationally in the United States but underage drinking persists, with jumps in California and Wisconsin, according to a study released Thursday.The report by the U.S. Substance Abuse and Mental Health Services Administration, based on interviews of 135,500 people, is the first to document state-by-state drug and alcohol use from 2002 to 2004. Read more