Driving restrictions for patients with ICDs

June 30, 2009 by  

icdICD stands for implantable cardioverter defibrillator. This is a device implanted in patients suffering from heart problems such as coronary artery disease or dilated cardiomyopathy. An ICD is a battery-operated implant that detects and responds abnormal rhythms of the heart or arrhythmias. Once an arrhythmia is detected, the device applies an electrical jolt to restore the heart rhythm back to normal. Over the years, ICDs have saved thousands of lives.

Recently, the European Society of Cardiology (ESC), in conjunction with other European health organizations that included European Heart Rhythm Association (EHRA), and the European Association of Cardiovascular Prevention and Rehabilitation (EACPR) issued a consensus statement that outlined restrictions on driving of motor vehicles by patients with ICDs. ESC made the announcement at the Europace 2009 sessions. The consensus statement was published in the EHRA journal Europace June 13, 2009 online issue.

The restrictions made a distinction between the types of vehicles as well as the type of drivers. Stricter regulations apply to driving trucks, buses and other large professional vehicles compare to small personal vehicles. There are also regulations that apply to patients who spend long periods of time behind the wheel as part of their jobs or professional life.

So what does an ICD actually does to the patient that may cause problems when driving a vehicle?

According to the UK-based Arrhythmia Alliance, most modern ICDs work n 3 ways:

It is feared that at the moment when the ICD applies the electric shock, the patient sitting behind the wheel might lose control of the vehicle he is driving.

According to Dr Johan Vijgen, chairperson of the task force that developed the recommendations

“Driving restrictions vary across different countries in Europe. We hope the document may serve as an instrument for European and national regulatory authorities to formulate uniform driving regulations.”

The restrictions aim to protect the patients as well as other drivers of vehicles.

ICDs had some bad publicity last year mainly due to some product recalls as well as study results that indicated some people have implanted ICDs which they don’t and would never need. The latest restrictions on driving by ICD patients wouldn’t make this device any more popular.


Photo credit: commons.wikimedia.org/wiki/Image:ICD.jpg

Does hot tea cause esophageal cancer?

June 30, 2009 by  
Filed under CANCER

hot-drinkThere is nothing like a hot drink to perk you up in the morning, especially during the cold regions and seasons. And depending on cultural practices, hot beverage can be tea, coffee, milk or hot chocolate. Tea is supposed the second most popular beverage after water and most of the time it is imbibed hot.

Researchers from Iran and the UK looked at how tea drinking habits of a population is linked to risk of esophageal cancer. The province of Golestan in northern Iran is an area with an abnormally high incidence of oesophageal squamous cell carcinoma. Esophageal squamous cell carcinoma is the most common form o esophageal cancer. It is closely linked with tobacco use and alcohol abuse. In the Golestan province, the low prevalnce of these risk factors cannot explain why this region has the world’s highest incidence of this type of cancer. A similar pattern has been observed in a region in China.

The researchers looked at 48 582 participants in a cohort study. From these, 300 participants had histological proven cases of esophageal cancer and 571 matched neighborhood control cases were followed and interviewed on their tea drinking habits.

The tea drinking habits of the people in this province can be summarized as:

  • People in the province, on the average, drink tea at higher temperatures compared to neighboring areas.
  • Tea is consumed in large amounts, similar to amounts of water.
  • Tea consumption starts early in life and lasts for life.
  • 98% of all study participants drank black tea regularly, with a daily average volume of more than a liter.
  • 39.0% of participants drank their tea at temperatures less than 60°C
  • 38.9% drank their tea at 60-64°C
  • 22.0% drank their tea at 65°C or higher.

Statistical analysis shows that drinking hot tea or very hot tea (60°C and above) is associated with an increased risk for developing esophageal cancer.

In addition, the time duration between pouring the tea and drinking it seems to be inversely associated with esophageal cancer risk.

“…compared with drinking tea four or more minutes after being poured, drinking tea two to three minutes after pouring or less than two minutes after pouring (5.41, 2.63 to 11.1) was associated with a significantly increased risk. A strong agreement was found between responses to the questions on temperature at which tea was drunk and interval from tea being poured to being drunk.”

The study results suggests that drinking hot tea, a habit common in Golestan province, was strongly associated with a higher risk of esophageal cancer. However, it isn’t clear whether the association is simply due to the temperature of the drink or the combination of temperature and type of drink. Would drinking hot coffee or other hot beverage have a similar effect? This would definitely be an interesting topic to look into.

So how hot do you want your drink?

Cardiac arrest: what makes the heart stop?

June 29, 2009 by  
Filed under Featured, HEART AND STROKE

artificial-heartResource post for June

The King of Pop Michael Jackson was said to have suffered from cardiac arrest but the actual cause of death is unknown. This statement confused many people – why can’t cardiac arrest be the cause of death? To answer this question, we have to brush up a bit on what we know about cardiac arrest.

What is cardiac arrest?

According to the National Heart Lung and Blood Institute

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops beating. When this happens, blood stops flowing to the brain and other vital organs.

If the heart does not start beating within a few minutes, death occurs.

There many things that can cause the heart to stop or “arrest” and sometimes it doesn’t even have anything to do with heart disease. The heart runs on an internal electrical system that regulates the rate and rhythm of the heart beat. From time to time, the electrical system can have problems, causing abnormal rhythms called arrhythmias. These abnormal heart rhythms can be too slow (bradycardia) or too fast (tachycardia) or it can complete stop. Some arrhythmias can cause the heart to stop pumping blood, causing sudden cardiac arrest.

Now, it is important for us to know that cardiac arrest is not synonymous to a heart attack or myocardial infarction in doctor speak. However, a cardiac arrest may be a complication of a heart attack. Although, people with heart problems have a high risk of SCA, most SCAs happen in completely healthy people with no history of heart disease.

Whatelectricity causes cardiac arrest?

So what can cause the heart to stop beating and lead to cardiac arrest? There are many things that can interfere with the heart’s electrical system and these are:

  • Coronary heart disease (CAD)/Heart attack. Blocked coronary arteries can lead to heart attacks but also interfere with the electrical system of the heart. A large number of SAC cases are due to CAD or heart attack.
  • Electric shock/electrocution. A strong electrical shock can stop the heart. Electrocution and lighting strikes can easily lead to SAC.
  • Respiratory arrest. This can happen when people choke, or drown or can’t breath, cutting off the oxygen supply to the heart.
  • Overdose on certain drugs. It is a know fact that certain drugs can interfere with heart rhythms. This is why new drugs are screened for pro-arrhythmic effects before approval. When taken in excessive amounts, certain drugs complete halt the heart, resulting in SAC.
  • Trauma. A strong sudden blow to the heart, or an injury that damages the heart can also lead to cardiac arrest.
  • Unknown causes. Some cases of SAC cannot be explained, unless an autopsy is conducted.

What are the signs of SAC?

According to the American Heart Association (AHA), the warning signs for SAC are

  • Loss of consciousness
  • Cessation of normal breathingheart-stethoscope
  • Absence of pulse
  • Absence of blood pressure

Death occurs within 4 to 6 minutes after cardiac arrest. It is estimated that 95% of SAC cases result in death.

How can cardiac arrest be reversed?

In SAC, every second counts. To save the patient, it is imperative that the heart be restarted as soon as possible. It can happen that heart function is restored but brain death has already set in due to interruption of blood and oxygen supply.

There are several ways to restore a normal heartbeat:

  • Electric shock using defibrillators, a scene that we often see in emergency rooms. In settings away from hospitals, the use of automated external defibrillators (AEDs) has saved many lives.
  • Cardiopulmonary resuscitation (CPR) is to manually restore the heart beat by applying pressure on the chest region.

According to the AHA

Cardiac arrest can be reversed if it’s treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A victim’s chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. Few attempts at resuscitation succeed after 10 minutes… It’s estimated that more than 95% of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 30-45 percent.

Because SAC is very time critical, waitdefibrillator1ing for emergency services to arrive may be too late. This is why AEDs are available in crowded public places, e.g. airports, sports stadiums, public events where people gather. In Zurich, Switzerland, AEDs are strategically located in telephone booths in the city center. Equally important is bystander awareness. AEDs are designed to be used by almost anybody, even without any medical training. Yet, many people are hesitant to “get involved.” Health groups, including the AHA are campaigning for more active bystander involvement in the prevention of SAC.

Photo credit: stock.xchng

Mobile phone use: if not cancer, then what?

June 29, 2009 by  
Filed under CANCER

cell-headset1This is the third in a series of posts on mobile phone use. Although most studies report that mobile phone use does not cause cancer, it cannot be denied that mobile telephony has changed our lives and is leaving its footprint/handprint in our lifestyle. Here are some of effects of mobile telephony on our health that are not related to cancer:


Some people claim to be “electrosensitive” and reported to suffer from a range of symptoms ranging from headaches to insomnia when exposed to mobile phone radiation.

In 2007, American and Swedish researchers reported that mobile phone use can cause sleeping disturbances, especially the deep phases of sleep. In 2008 however, the German Federal Office for Radiation Protection (BfS) declared that there is no evidence that link mobile phone radiation to ailments described by “electrosensitive” individuals based on current research evidence.

Vehicular accidents

Mobile phone use is significantly linked to increased incidence of traffic accidents, according to the World Health Organization (WHO). In many countries, phoning while driving has been declared illegal. It is therefore recommended to use headsets or speaker phones when driving.

Blood-brain barrier

Some studies report that mobile radiation affects the so-called blood-brain barrier. Mobile phone use has been observed to cause changes in brain activity, reaction times, and sleeping patterns. These effects are small and have no apparent health significance. More studies are in progress to try to confirm these findings., according to WHO.

Medical devices

Mobile phone use has been observed to interfere with certain devices, including aircraft electronics but also medical devices pacemakers, implantable defibrillators, and certain hearing aids. It has been shown for, example, that magnets in phone speakers, headsets and earphones can interfere with pacemakers when worn close to the heart, e.g. in a shirt pocket.

Now, before you dismiss these issues as “nothing”, just because they don’t have anything to do with cancer, a word of caution from the National Cancer Institute:

“…because cellular phone use is still relatively new, cancers that take a long time to develop would not have been picked up by studies done to date so it is important that further studies be conducted.”

CVD News Watch, June 26

June 26, 2009 by  

worldnews2Some sad and not-so-sad news this week…

CVD patient watch

Goodbye, Michael Jackson
Michael Jackson, King of Pop, was pronounced dead at the UCLA Medical Center on Thursday, June 25. He was reported to have suffered from cardiac arrest. The real cause of death is not known. Jackson was preparing for a comeback concert due to start next month. The 50-year old singer leaves behind  three children – sons Prince Michael 7, and Michael Joseph Jackson Jr., 12, and daughter Paris Michael Katherine, 11. Next week, I’ll tackle the topic “What can cause sudden cardiac arrest?”

CVD innovation watch

New low-cost, solar-powered BP device for developing countries
Italian scientists have been testing A new, low-cost, solar-powered blood-pressure-monitoring device. The Omron M1 Plus is meant for use in low-income countries and has been tested in urban and rural settings. Accoridng to Dr Michael Alderman of Albert Einstein College of Medicine, Bronx, NY: “This is very exciting. There are a billion people with hypertension-soon to be a billion and a half. Most of those people are living in low-resource countries, where the ability to intervene is going to be dependent upon identifying patients, so this is a critical tool.”

CVD research watch

Heart study questions diabetes drugs
Why do some drugs that are effective against certain types of diseases lead to heart failure? Swiss researchers may have identified the molecular pathway that explains why the diabetes drugs thiazolidinediones (TZDs) increase the risk of heart failure. The most well-known and controversial TZD is Avandia (rosiglitazone). It seems that TZDs, activate PPAR-Y, a molecule that may play a key role in heart failure.

CVD web watch

CDC Introduces New Website to Help Employers Combat Obesity and Reduce Health-Related Costs
On Thursday, June 25, the CDC introduced LEANWorks!, a website to help employers and businesses address onesity in the workplace. LEAN stands for Leading Employees to Activity and Nutrition. The site privdes a wide range of resources including an obesity cost calculator and tips for setting up a workplace obesity prevention program. More on LeanWorks in Battling Obesity next week.

CVD drug watch

EMEA issues warning on possible clopidogrel-PPI interaction, but is there really a problem?

The European Medicines Agency (EMEA) issued a warning on possible interaction between clopidogrel and proton-pump inhibitors (PPIs). Clopidogrel (Plavix, Sanofi-Aventis/Bristol-Myers Squibb) is an anti-platelet agent indicated for the prevention of blood clots in cerebrovascular disorders. PPIs are indicated for stomach problems such as ulcers, gastroesophageal reflux, and dyspepsia. Since heartburn and stomach ulcers are common side effects of clopidogrel, many users of this drug also use PPI. Recent studies report that the two drugs may interact and interefere with the efficacy of clopidogrel.

News from the cancer side, June 26

June 26, 2009 by  
Filed under CANCER

newspaper1It’s really summer finally! Have a great weekend!

News from the cancer victims

Remembering Farrah Fawcett
I come from a generation who grew up with the TV series Charlie’s Angels (yes, it was a series before the films!), Six Million Dollar Man and Wonder Woman. Of the three original Angels, Farrah Fawcett was probably the most glamorous and sexiest. She was very famous back then and even became more famous when she married, then later divorced “Six-Million” lead star Lee Majors. TV shows come and go. Thirty years later, I was saddened to hear about Farrah’s battle with rectal cancer. She had a successful surgery to remove the tumor but it came back and later metastasized to the liver.

Fawcett appeared in a cancer documentary film last month wherein she shared her own cancer story. Earlier this week, her long-time partner Ryan O’Neal (of the Love Story fame) asked her to marry him and she accepted. One day later, on June 26, Farrah Fawcett succumbed to cancer and moved on to a better place.

News from the cancer researchers

United States and the Republic of Chile Partner to Battle Cancer
The US National Cancer Institute (NCI) and the Ministry of Health of the Republic of Chile have formed alliance “to accelerate progress against cancer in Hispanic populations in the United States and Latin America.” The two  institutions will closely collaborate to to advance cancer research. A 2006 estimate showed cancer as the second leading cause of mortality in Chile.

News from the legislators

Tobacco Regulation Bill Becomes Law
US President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act granting the US FDA regulatory powers over production, sale and marketing of cigarettes and other tobacco products. According to President Obama

“Today, thanks to the work of Democrats and Republicans, health care and consumer advocates, the decades-long effort to protect our children from the harmful effects of tobacco has emerged victorious…This law will save American lives and make Americans healthier.”

News from the toxicologists

EPA Estimates Cancer Risk Associated With Air Pollution
The US Environmental Protection Agency (EPA) reports that some regions of the US face greater health risks from air pollution than others. The agency looked at 181 different air pollutants, including benzene, methylene chloride, and acrolein. 80 of these pollutants which may come from traffic-related or coming from industrial sources are thought to increase cancer risk. The EPA also identified about 600 neighborhoods in the US where people are exposed to higher concentrations of toxic air compared to the rest of the country.

Photo credit: stock.xchng

Pain relievers: do they or do they not prevent Alzheimers?

June 25, 2009 by  
Filed under ALZHEIMER'S

old_man_and_dovesPrevious studies have reported that pain relievers such as the anti-inflammatory drugs (NSAIDs) may prevent the onset of Alzheimer’s disease. This study by American researchers, however, shows a different story.

The researchers looked at 2,736 members of Group Health, an integrated healthcare delivery system, who did not have any form of dementia when they were enrolled in the study. The average age of the study group was 75 years. The researchers then tracked these patient for 12 years, monitored their use of NSAIDs, both as prescription and over-the-counter (OTC) drugs, and their likelihood of developing dementia especially Alzheimer’s disease.

In the study group, 351 participants had a history of heavy NSAID use at the start of the study. Over the follow up period, another 107 participants became heavy NSAID users. “Heavy use was defined as having prescriptions for NSAIDs at least 68 percent of the time in two years.

The results of the monitoring for dementia gave the following results:

  • 476 participants developed Alzheimer’s disease or dementia during the study period.
  • Heavy NSAID users were 66% more likely to develop dementia compared to those who use little or no NSAID.

According to study author Dr. Eric B. Larson, executive director of Group Health Center for Health Studies.

“Although we hoped to find a protective effect, there was none. Thus, for this age group, there’s no basis for taking NSAIDs to prevent Alzheimer’s disease. Our study in this quite elderly population showed more risk of dementia with NSAIDs, especially when used heavily.”

The study results indicate a need to re-evaluate earlier research findings that suggested that NSAID use can delay or even prevent onset of Alzheimer’s disease.

There were, of course, key differences between previous studies and this study. For one thing, the study participants in this study are on average older. This could have a big influence on the results considering that dementia and Alzheimer’s disease are basically an elderly disease, even though there are cases of early onset.

NSAIDs such as Ibuprofen are available over-the-counter are popularly used as anti-fever drugs and pain relievers. In the older population, NSAIDs, marketed in the US as Advil, Motrin and Aleve, are used as pain relievers especially among those who suffer from arthritis. Recently, the US FDA has issued new labelling requirements for OTC drugs including NSAIDs, which should provide warnings about safety, including interaction between NSAIDs and alcohol.


Photo credit: stock.xchng

Obesity and surgery

June 25, 2009 by  
Filed under OBESITY

surgeonObese patients and their doctors may face special challenges when undergoing and performing surgery. Health experts warn that health care provider should not underestimate the risks but on the other hand, should not dismiss obese patients as hopeless cases. The American Heart Association recently released a new Science Advisory on performing surgery on obese patients Let us look at  some of the issues surrounding obesity and surgery.

Proper evaluation is difficult in obese patients.

Performing an evaluation in highly obese patients can be difficult because of many co-existing conditions. Heart problems in particular are easily underestimated during a physical examination. According to lead author Dr. Paul Poirier,

A severely obese patient can be technically difficult to evaluate prior to surgery. For example, severely obese people might feel chest tightness that could be a symptom of their obesity or of an underlying cardiac problem. Doctors need to carefully evaluate severely obese patients before they have surgery.”

Surgery can be difficult in obese patients.

Surgeons report that surgery can be challenging in severely obese patients. There was a big scandal in the UK a few years ago when some health care providers refused to perform surgery on obese patients

Obese patients are prone to complications.

Obese patients are more likely to suffer complications after surgery such as infections, and pulmonary embolism, and are more likely to stay on a ventilator and have a prolonged hospital stay.

Obese patients are not at higher risk for death.

Despite of these, the mortality rates during surgery do not depend on body mass index (BMI). According to Dr. Poirier

“Some surgeons are under the impression that severely obese patients are more likely to die in surgery than people who are not obese, and won’t operate on them as a result. This is not true. Severely obese patients are at increased risk for pulmonary embolism, wound infection and other conditions. But they are not more likely than their lower-weight counterparts to die as a result of surgery.”

The AHA advisory recommends the following:

  • The recommendations are meant for all health care providers, from cardiologists, to surgeons, to anesthesiologists, providing pre-operative evaluation recommendations, as well as recommendations on management and care for obese patients during and after any type surgery, be it a knee replacement or a heart operation.
  • The health care provider should especially pay attention to obesity-related conditions such as:
  • The health providers should take into consideration age, gender, as well as the abovementioned conditions as independent factors for mortality or complication from surgery.
  • Health care providers should advise patients to be as healthy as possible before surgery. This may include losing weight, keeping blood pressure under control (for those with hypertensiotn, or keeping blood sugar level under control (for those with diabetes).
  • Extra, non-invasive tests may be performed if it aid in pre-surgery evaluation, such as ECG or chest X-ray.
  • Surgeons should discuss with patients the risks associated with a particular surgery for a patient their size.

In providing this advisory, the AHA aims to give obese patients the best possible care they deserve.

OTC drugs are not always safe: the safety updates

June 24, 2009 by  
Filed under Featured, HEALTHCARE

cough_medicineOver-the-counter drugs, known as OTC drugs for short, are drugs available at your pharmacists without a doctor’s prescription. Normally, the status of OTC is only granted by drug authorities to drugs whose safety has been well-established over years and years of use. Many of the medications you have in your medicine cabinet at home are OTC, from the pills you take for fever and toothache (acetaminophen, ibuprofen, or aspirin) to your common cough and cold drugs (cough syrup, cold rubs, etc.) to your nutritional supplements. Many of these medicines are even used in children. However, recent studies have reported that some OTC drugs may present some health risks and side effects which are more serious than previously thought. That is why the US Food and Drug Administration (US FDA) has stepped on the safety of OTC drugs. This resource post brings you an update of these safety issues.

OTC drugs for adults

FDA toughens warnings on over-the-counter painkillers
In April this year, the US FDA announced new requirements for labelling OTC anti-fever and pain killer drugs such acetaminophen (also known as paracetamol, marketed as Tylenol) and non-steroidal anti-inflammatory drugs, or NSAIDs (e.g. ibuprofen, aspirin, marketed under Advil, Motrin and Aleve). The drugmakers are required to “more prominently display safety warnings” on the package inserts and labels of the said drugs. Specifically, the FDA are concerned about liver damage that can be caused by these drugs in case of overdose, those with chronic liver problems, and the danger of combining acetaminophen and NSAIDs with alcoholic drinks. There is also the risk of stomach bleeding when taking NSAIDs and the blood thinning drugs aspirin and warfarin.

OTC drugs for teens

drugs1What teens don’t know about OTC medications can hurt them
OTC drugs present risks to teens who are usually start to take their own health care in their hands but still lack the knowledge of proper use of medications. This can lead to complications, inadvertent as well as intentional abuse. A study by researchers at the University of Rochester Medical Center interviewed 100 youths age 14 to 20 years old, with the following results:

  • 44% had ample knowledge about appropriate use of OTC drug.
  • 75% had taken OTC drugs without adult supervision during the previous month.

“This tells health professionals that we need to teach our young people about safe use of over-the-counter pain medications,” says Dr. Karen Wilson, one of the study authors.

OTC drugs for children

In 2007, people were shocked about the news that several little children suffered from serious adverse events, some of them fatal, after taking OTC cough and cold medicines, as reported by the Philadelphia Medical Examiners Office.

In response, the US FDA had a second look at the safety of these OTC drugs. In January 2008, the regulatory body issued new OTC products recommendations which were later updated in October 2008. The new advisory strong advises against the use of OTC cough and drugs in children under cough-syrup-childthe age of 2.

Study finds parents use cough medicines on under-2s despite the warnings
Despite the warnings, an Australian study revealed that 40% parents surveyed still use OTC drugs in under-two’s. Here are some of the figures from the study:

Treat with Care
This year, the OTC drug manufacturers in the US acted responsibly enough by taking the following steps:

  • changing OTC drug labels.
  • launching a large-scale public service campaign called “Treat with Care“.

Treat with Care” is run by the Consumer Healthcare Products Association (CHPA), a not-for-profit association representing the makers of over-the-counter (OTC) products and the consumers who use these healthcare products

For the “Treat with Care” campaign, CHPA had no other than actress Chandra Wilson as their spokesperson. Wilson is best known for her role as the surgeon Dr. Miranda Bailey in the popular medical soap Grey’s Anatomy. In real life, Wilson is a mom of two whose youngest is in the age group affected by the OTC safety issues.

The Treat with Care campaign says:

Photo credit: stock.xchng


Depression in bypass patients: non-drug treatments work

June 24, 2009 by  
Filed under DEPRESSION

depression2It is a known fact -surgery may mend the body but it may also depress the mind. This is especially true with heart surgery. It is estimated that 1 in every 5 patients who underwent coronary artery bypass graft (CABG) surgery suffer from major depression. Many others may suffer from milder forms of depression. However, it is also a known fact that negative feelings are bad for the heart, thus creating a vicious cycle that delays recovery and reduces quality of life.

According to researchers at the Washington University School of Medicine

“Depression around the time of surgery predicts postoperative complications, longer physical and emotional recovery, worse quality of life and increased rates of cardiac events and mortality [death].”

Thus, the researchers conducted a study which involved 123 CABG patients who developed depressive symptoms within one year of surgery. The patients were randomly assigned to three groups, namely:

The depressive symptoms were monitored before the therapies, at 3, 6, and 9 months.

The study results show that the two non-drug treatments helped in resolving the depressive symptoms better compared to standard care.

The percentage of patients who experienced depression remission are:

  • 71% of patients in the cognitive behavior therapy group
  • 57% of patients in the supportive stress management group
  • 33% of patients in the usual care group

Cognitive behavior therapy seems to be the best strategy, not only against cardiac surgery-related depression but also secondary psychological outcomes, such as anxiety, hopelessness, and perceived stress. Supportive stress management also showed some benefits against depression, “but it had smaller and less durable effects than cognitive behavior therapy.” In comparison, current standard care is not seem to be that effective in resolving depressive symptoms among CABG patients. A previous study has shown that although the medical needs of heart patients are usually met by standard care, there are non-medical needs that usually go unmet but are nevertheless just as important in clinical outcomes.

In fact, the American Heart Association (AHA) issued a science advisory this year recommending routine screening for depression in cardiac patients.

Battling stroke by fighting salt: the Portuguese strategy

June 23, 2009 by  

saltPortugal has one of the highest mortality rates due to stroke in Western Europe and this has been attributed to the high salt intake of the population. Many Portuguese traditional food – including the salted fish delicacy bacalhau (salted cod) – contains high amounts of sodium chloride. However, even the normal daily fare such as bread also contains a lot of salt. The result is that the Portuguese population, take in, on the average, twice the amount of the recommended daily salt intake. -the stroke rate there is twice that of coronary disease.

A group of health led by Dr. Luis Martin of the Fernando Pessoa University formed the Portuguese Action Against Salt and Hypertension (PAASH) and conducted studies on Portuguese salt consumption habits and the health consequences. The results show that:

  • An adult consumes on average 11.9 g of sodium per day, two times the recommended daily intake.
  • Portuguese bread contains an average of 19.2 g of sodium per kg, which is 53% more than what is found in bread in other European countries. This highly contributes (21%) to the daily sodium intake.
  • The amount of salt by consumed by the population correlated with blood pressure and aortic stiffness.
  • In 2007, only 29% of the Portuguese population was aware of the health risks of excessive salt consumption

The PAASH advocates saw an immediate need for action to increase awareness and reduce salt consumption. They estimated that “a reduction of just 1 g per day of salt intake would save almost 2500 lives per year in Portugal, which has a population of around 10 million.”

Dr. Martin then started a massive awareness campaign in print and web media, as well as on on radio and TV. They persuaded politicians and well-known celebrities, including star football players and children’s cartoon characters, to help spread the word about the health risks of salt.

Dr. Martin explains the success of

“If they want to influence the people, they must act like politicians. And to get the attention of the politicians, we needed the media. Without the media in Portugal, it’s not possible.”

It seems that the campaign is starting to bear fruit.

  • A recent survey showed that awareness has increased up to 75% of the population.
  • They persuaded the Portuguese Bakery Association to cooperate by coming up with a recipe that provides for lower salt content without losing taste or quality.
  • They lobbied with legislators, resulting in the passing of a law by the Portuguese Parliament that requires food labels to show salt content of food products as well as and limits the sodium content in processed foods to a maximum of 14 g/kg.

With these results, the Portuguese has set a good example to the rest of Europe and the world that health awareness campaigns do work.

Photo credit: stock.xchng

Green tea and prostate cancer

June 23, 2009 by  
Filed under CANCER

green_tea_cupAnother reason to drink green tea – at least for men. A recent study reports that consumption of green tea may slow down the progression of prostate cancer. The study looked at 26 men, aged 41 to 72 years old who were diagnosed with prostate cancer and due to undergo radical prostatectomy.

The study patients were given a daily dose of four capsules of Polyphenon E, which is equivalent to about 12 cups of concentrated normally brewed green tea, for 12 to 73 days until the day before surgery. They were monitored for serum concentrations of the following biomarkers: hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and prostate specific antigen (PSA). HGF and VEGF levels are especially relevant because they are good prognostic indicators of metastasis.

The results showed that consumption of Polyphenon E led to a significant reduction in levels of HGF, VEGF and PSA markers, even up to 30% in some cases.

According to researcher Dr. James A. Cardelli, professor and director of basic and translational research in the Feist-Weiller Cancer Center, LSU Health Sciences Center-Shreveport

“The investigational agent used in the trial, Polyphenon E (provided by Polyphenon Pharma) may have the potential to lower the incidence and slow the progression of prostate cancer”.

Green tea is rich in antioxidant phytochemicals such as polyphenols, catechins and flavanols. It is said that green tea contains more antioxidant compared to other drinks such as black tea, wine or hot chocolate because of the minimal oxidation it undergoes during its production. This is not the first study to demonstrate the health benefits of green tea. Several studies have demonstrated the cardiovascular benefits of green tea.

Another study by Italian researchers “demonstrated that consumption of green tea polyphenols reduced the risk of developing prostate cancer in men with high-grade prostate intraepithelial neoplasia (HGPIN).

Japanese researchers reported that green can prevent lifestyle-related chronic diseases such as cardiovascular disease and cancer.

In 2003, Dutch researchers reported that tea is “the most consumed drink in the world after water, well ahead of coffee, beer, wine and carbonated soft drinks.” Unfortunately, this trend has changed since then as carbonated drinks became more and more popular.

Currently, further studies are being conducted using Polyphenon E, including one in breast cancer patients.

Dr. Cardelli continues to say:

“There is reasonably good evidence that many cancers are preventable, and our studies using plant-derived substances support the idea that plant compounds found in a healthy diet can play a role in preventing cancer development and progression.”

Know your interventions: the mitral clip

June 22, 2009 by  

One of the main causes of heart problems is mitral valve regurgitation (MVR), also called mitral insufficiency. The mitral valve consists of flaps or cusps that separate the left auricle and left ventricle of the heart. A chronic MVR is “a long-term disorder in which the heart’s mitral valve does not close properly, causing blood to flow backward (leak) into the upper heart chamber when the left lower heart chamber contracts. The condition is progressive, which means it gradually gets worse.”

Currently, the standard intervention for MVR is an open heart surgery to fix the valve. However, a less invasive alternative may now be available, an intervention that is also risky and facilitates faster recovery. The new intervention, called percutaneous valve therapy, uses a catheter that is inserted through a blood vessel in the groin up to the heart. A small device, a mitral valve clip, is inserted through the catheter. The clip grasps and tightens the leaflets of the valve, pulls them together and approximates them to reduce leaking. The whole procedure takes two hours, the same duration of an open heart surgery.

The symptoms of MVR, according to Dr. George Hanzel, an interventional cardiologist at William Beaumont Hospital in Royal Oak, Michigan,

“A lot of these patients have shortness of breath. The main thing they have is fatigue, exercise intolerance, shortness of breath and swelling.”

When left untreated, mitral insufficiency can lead to progressive enlargement of the left ventricle, and eventually heart failure.

The mitral valve clip intervention has the following advantages:

  • It can be used in patients who are too weak to undergo surgery.
  • Patients recover more quickly – in weeks rather than months.
  • There are usually less complications.

Currently, the mitral clip procedure is not a standard intervention in the treatment of MVR. It is still in the experimental phase, being tested in several clinical trials.

The most commonly used clip is the Mitra Clip. Preliminary data from trials on the Mitra Clip suggests improved heart function. Last year, results from the Endovascular Valve Edge-to-Edge Repair STudy (EVEREST), indicated a good safety and efficacy profile.

Currently, the trend in medicine is finding less invasive ways of treating illnesses. The message is clear: cutting up is not always the answer.


Mobile phone and cancer Part II: Those who say “Yes”

June 22, 2009 by  
Filed under CANCER

no-cell-phoneLast week, I presented one side of the phone-cancer issue, basically the side that says “No, mobile phone use does not cause cancer.” This week, I am presenting the other side of the coin. But remember, this is not about taking sides. It’s about presenting the whole picture.

Because of the involvement of industry groups in funding the INTERPHONE studies, it is not surprising that many are sceptical of the results that those studies reported. Some independent research studies have also been conducted to investigate the link between RF radiaton – cancer which reported otherwise.

What the research studies say

  • The BioInitiative Working Group is an international working group consisting of scientists and health experts who looked at the published and unpublished evidence on the health effects of ELF. The group came up with the BioInitiative Report that “raises serious concerns about the safety of existing public limits that regulate how much EMF is allowable from power lines, cell phones, and many other sources of EMF exposure in daily life.” The group reported that there is enough evidence showing that ELF can increase the risk for breast cancer, childhood leukaemia, and possibly other cancers. However, the group’s study looked mainly at ELF, the radiation emitted by power lines, but not specifically on RF radiation emitted by mobile phones.
  • A group of Swedish researchers led by Lennart Hardell of the Örebro University looked at the INTERPHONE data and came up with a different conclusion compared to their colleagues. They found an increased risk for brain tumors among 2,162 users of cordless handsets and cellular phones.
  • cell-phone-kidAnother group of Swedish researchers found an association between acoustic neuroma and long-term mobile phone use (10 years or more) but not on the short-term (less than 10 years).
  • In 2008, Israeli researchers found a “positive dose-response trend” between cell phone use and tumors in the parotid gland in a study of 1,266 participants.
  • A 2008 study by Finnish researchers was the first to report that RF radiation can cause changes at the molecular level by altering protein expression in human skin cells.

What some health experts say

Coming up next in this series:

  • Why is a clear cut answer to the mobile phone – cancer question hard to find?
  • What are the other health effects of mobile telephony?
  • How to use your phone properly to minimize radiation exposure


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What’s the latest in heath care, June 20

June 20, 2009 by  
Filed under HEALTHCARE

It’s a little bit late but here it is … your health care updates for this weekend.

doctorsWho’s campaigning for health care?

This family-focused advocacy group is campaigning for a better health care system for America’s families. According to Donna Norton of MomsRising.Org, “a shocking 7 out of 10 working-age women have no insurance, are underinsured, or are in debt because of medical bills.1 And an estimated 5 million children remain without healthcare.”

Who’s been indicted?

International medical device maker and four executives charged in connection with unlawful clinical trials
The global medical device manufacturer Synthes (US entity) is charged with conducting unauthorized clinical trials. Four top executives were also charged in the case.

What’s new in research?

Hysterectomies a stem cell source
Brazilian researchers report in The Journal of Translational Medicine that fallopian tubes removed from women during hysterectomy can be a source of “politically correct” stem cells. The researchers discovered an abundant number of immature cells in the tubes. Currently other viable sources of stem cells aside from human embryos are umbilical cords, menstrual blood, teeth and fat tissue is viable.

What’s to watch out for?

Computer Injuries Show Dramatic Increase
Computer injuries are on the rise and U.S. Census Bureau’s statistics show it is not the back, eye, and finger problems associated with computer work that are increasing. It is actually the accidental injuries. “Not surprisingly children under age 5 had the highest injury rate. The leading cause of injury for children 10 and under and adults over 60 was tripping or falling over computer equipment or its wiring. The most common injuries involved extremities and lacerations were the most common at 39 percent with contusions and abrasions at 23 percent. Young children were more apt to sustain head injuries.

What needs to be improved?

Publics’ Ignorance Of Human Anatomy Revealed
How well do you know your anatomy? British researchers report that many people are not capable of identifying the location of major body organs. This is true even if they are currently undergoing treatment for the said organ. The survey was based on an interview with 722 people who had to identify organs from pictures. Only about half of the answers were right. It is also surprising that many people could not locate properly even the supposedly well-known organs such as the heart, lungs and bladder. This has some consequences in the effectiveness of doctor-patient communication.

Have a great weekend!

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CVD News Watch, June 19

June 19, 2009 by  

worldnews1Some heart(y) news before the weekend starts…

CVD drug regulatory watch

Newly minted FDA commissioner gets an earful of prasugrel
The new US FDA commissioner Dr. Margaret Hamburg is under attack on the issue of prasugel. The regulatory body’s Cardiovascular and Renal Drugs Advisory Committee unanimously recommended the approval of the drug in February of this year based on the results of the TRITON-TIMI 38. However, many health experts are not convinced of the trial results, which they claim are “flawed” and requests the FDA to “stop considering prasugrel  for approval until the completion of additional studies that aren’t flawed.” Prasugel is anti-platelet agent indicated for the treatment of acute coronary syndromes and is a product of Lilly/Daiichi Sankyo.

CVD medical advisory watch

AHA/ASA science advisory recommends use of tPA between three and 4.5 hours after stroke
The American Heart Association and the American Stroke Association jointly issued a new science advisory this month that supports the use of the clot-buster drug tissue plasminogen activator (tPA) to treat acute ischemic stroke even three to 4.5 hours after onset of symptoms. Previously, tPA treatment was only recommended within 3 hours of symptom onset. The new recommendation is based on the results of European Cooperative Acute Stroke Study 3 (ECASS 3). However, despite this “longer time window for treatment“, the advisory strong emphasizes to avoid delays in diagnosis and treatment.

CVD research study watch

 Value of Genetic Testing for Preventing Blood Clots Unproven, According to New AHRQ Study

A new report by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) states that there is insufficient evidence to support the benefit of genetic testing for two gene mutations Factor V Leiden (FVL) and prothrombin G20210A in people with a history of blood clots. Some researchers believe that testing for the mutation can help prevent deep-vein thrombosis by prescribing blood-thinning drugs as prophylaxis. However, the AHRQ study found current research evidence insufficient and calls for addition large, randomized clinical trials.

CVD food issue watch

Heart Attack Grill ‘a taste worth dying for’

“Caution: this place is bad for your health.” Says the sign outside the door. Yet, the Heart Attack Grill in Arizona is cashing in on food that can kill and yet people keep coming. The menu says it all: bypass burgers, flatliner fries, and jolt cola. And the waitresses are dressed like nurses. Next week, I’ll be writing an in depth post on why this overtly unhealthy restaurant is attracting lots of followers.


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Alcohol: brain damage in 6 minutes

June 18, 2009 by  
Filed under ADDICTION

alcohol-bottleEver heard of the expression “letting your drink get into your head?” This figure of speech may actually have some literal truth in it. Alcohol does get to the brain. In just SIX MINUTES. That is how fast it takes for alcohol to travel from the mouth, to the stomach, to the blood, and then to the brain. This is the result of a study by German researchers at the University of Heidelberg. Using magnetic resonance spectroscopy (MRS) techniques, the researchers looked at how fast alcohol is absorbed by the body to affect the brain. Consumption of 3 glasses of beer or 2 glasses of wine is enough to reach the blood alcohol level of 0.05 to 0.06%, the level which many countries consider as the blood alcohol content that impairs the ability to drive. (Mind you, there are some countries with lower alcohol limits for drivers). At this level, the researchers also observed the following changes:

  • The brain reacts very quickly to alcohol. It takes six minutes from the glass to the brain.
  • The harmful effects of alcohol also set in rapidly.
  • The level of creatine, a compound essential in energy metabolism and provides protection to the cells, decreases as the concentration of alcohol increases.
  • The level of choline, which is a component of cell membranes, also decreases.

According to Dr. Armin Biller of the working group for cerebral metabolism at the Department of Neuroradiology at Heidelberg University Hospital

“Our study provides evidence for alternative energy utilization upon alcohol ingestion, i.e. the brain uses an alcohol breakdown product instead of glucose for energy demands…That [choline reduction] probably indicates that alcohol triggers changes in the composition of cell membranes.”

Is the damage to the brain caused by alcohol permanent? Thankfully not. The researchers found that the damage caused by moderate drinking is actually reversible and would be gone by the next day. This means, we can still enjoy a glass of wine every now and then without fearing for our brain cells.

However, excessive alcohol consumption can lead to irreversible damage not only to the liver but to the brain, too.

Dr. Biller continues

“we assume that the brain’s ability to recover from the effect of alcohol decreases or is eliminated as the consumption of alcohol increases. The acute effects demonstrated in our study could possibly form the basis for the permanent brain damage that is known to occur in alcoholics. This should be clarified in future studies.”

The researchers also demonstrated that the effects of alcohol on the brain are not dependent on gender. Males and females are affected in the same way although other factors may play a role, e.g. body mass, stomach contents, as well as individual differences.

So next time you hold a drink in your hand, remember what I’ve just shared with you. Know your limit. That way, you can avoid permanent brain damage.


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Telestroke: delivering stroke care virtually

June 18, 2009 by  

multimedia_icon_setWe can see where health care is going. More and more procedures are automated and remote medical consultation and treatment is catching on. The goal is to make health care delivery faster, more efficient and cheaper. Recently, the American Heart Association published a policy statement that gave “recommendations for the implementation of telemedicine within stroke systems of care.”

Aside from the abovementioned reasons for implementation of telemedicine in general, here are a few specific reasons why virtual delivery of stroke care system may be necessary

  • There is a shortage of neurologists in many rural parts of the United States, making these areas underserved in terms of stroke care.
  • Even in urbanized areas, fewer neurologists are willing to provide 24/7 emergency room coverage for acute stroke care.

This calls for more creative and radical changes in stroke care that will work for patients and doctors alike and telemedicine seems to be the answer. Currently, telemedicine encompasses

In the specific case of stroke telemedicine (telestroke), the following

  • Patients and doctors are can interact through secure web camera video technology that allows remote yet rapid assessment of the patient but still protects patient confidentiality.
  • Medical history is provided remotely, mostly using electronic health records.
  • Neuroimages are displayed on the physician’s local computer and quickly interpreted
  • Diagnosis may be done using the so-called crowdsourcing diagnostics (see below for details)
  • If necessary, treatment including thrombolysis is ordered and monitored.

In fact, in many cases, telestroke diagnosis may prove to be more accurate than “face-to-face” diagnosis. Neurologists can use crowdsourcing diagnostics, a tool wherein doctors enter the symptoms and test results, and a computer software give the most probable diagnosis. This is almost like having access to the knowledge and experience of hundreds of health professionals, making diagnosis faster and cheaper.

Although telestroke is catching on, there are still barriers to overcome before telemedicine in general can become widespread and widely accepted. The authors of the policy statement have identified six major barriers.

(1) Defining medical specialties suitable for telemedicine

(2) Medical licensure and liability laws

(3) Securing the health information being shared

(4) Creating simple processes for requesting and performing the consultation

(5) Developing financial models for reimbursement of telestroke services

(6) Gaining acceptance of remote consultation from patients, physicians, and payers.

These barriers may be daunting, especially the legistation on medical licensure and liability, but the authors feel that they can be overcome with the right approach.

It’s not all bad news for rosiglitazone

June 17, 2009 by  
Filed under DIABETES

capsuleRemember the controversy about the diabetic drug rosiglitazone (market name Avandia)? Remember the issues surrounding the APPROACH Trial – Assessment on the Prevention of Progression by Rosiglitazone on Atherosclerosis in Type 2 Diabetes Patients with Cardiovascular History? The drug was thought to increase cardiovascular risk, which brings to mind the problems faced by Vioxx.

Well, it seems that new trials indicate that it is not all bad news about rosiglitazone. In a late-breaking clinical trial using IVUS technology, rosiglitazone was compared with another diabetic drug glipizide. The trial’s primary endpoint, which is “a significant difference in percent atheroma, or plaque, buildup in coronary arteries“, was not met, but it did bring up some good points about rosiglitazone, especially with the secondary end points. The recent results show that:

IVUS stands for intravascular ultrasound and is the world’s largest study of diabetic patients with established coronary artery disease (CAD). The study involved 672 patients from 92 hospitals in 19 countries worldwide. The effect of diabetic drugs on the progression of CAD was assessed using the intravascular ultrasound technique. This was done by measuring the plaque burden using IVUS in a 40 mm segment of an atherosclerotic artery which hasn’t undergone any intervention because level of plaque build up was considered to be too low to require treatment.

People suffering from diabetes have increased risks for atherosclerosis, heart attack, stroke, and other cardiovascular disorders. Diabetes a metabolic disorder which interferes with blood sugar metabolism due to problems with insulin, the hormone produced by pancreas needed to metabolize glucose in the blood.

About the two drugs:

Rosiglitazone is a member of the thiazolidinedione class of diabetes drugs. It works by making the cells of the body more sensitive to insulin. In addition, the drug also has a positive impact on blood pressure, high density lipoprotein (HDL “good”) cholesterol and has anti-inflammatory properties. However, in 2007, the US FDA issued warnings about rosiglitazone increasing risk of cardiac events.

In a more recent report, the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes) trial reports that rosiglitazone “does not increase overall cardiovascular risk.

Glipizide belongs to the sulfonylurea class of insulin secretagogues. It works by inducing the pancreas to secrete more insulin. It has been on the market for more than 40 years.

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Does your BMI really reflect your health status?

June 17, 2009 by  
Filed under OBESITY

weighing-scale-with-fruitThose who are closely watching their weight are familiar with the term BMI, short for body mass index. Body weight in absolute terms cannot be used as accurate measure of obesity for simple reason that there are short people and there are tall people, and weight can therefore vary relative to height. That’s why scientists use BMI, a numerical value of weight in relation to height, calculated as a person’s body weight divided by the square of his or her height, as a diagnostic tool to evaluate weight problems and health status of a person. Weight status based on BMI (usually expressed in terms of kg/m2) is categorized as follows:

  • Underweight  – 18.5 and below
  • Normal weight – 18.5 to 25
  • Overweight – 25 to 30
  • Obesity class I – 30 to 35
  • Obesity class II – 35 to 40
  • Obesity class III – above 40

This has been like this for years but recently, there have been concerns that BMI may not be an accurate way of assessing a person’s true health status.

Based on BMI measurements, almost one-third of the American population is considered overweight, which is the middle range between normal weight and obesity. Excess weight has been identified as a major risk factor in many chronic diseases, including heart disease, hypertension, hyperlipidemia, diabetes, osteoporosis and certain types of cancer.

Several research studies looked at how BMI is related to mortality rates, were surprisingly inconclusive and sometimes contradictory results. Scientists now think that that BMI may not be the right measurement because:

  • BMI doesn’t distinguish between different types of fat mass. For example, there is the fat mass which is of important health concerns as it is closely linked to type 2 diabetes. However, there is also lean mass, especially muscle tissue, which reduces health risks.
  • BMI does not directly measure the distribution of body fat. Depending on location, fat may have more or less impact on health. Visceral fat or fat at the waist, for example, is more detrimental to health than fat at the hips.

Thus, using BMI as health status indicator does not actually show the complete picture and may miss the health risks that slight overweight may present.

According to lead author Dr. Cora E. Lewis of the University of Alabama at Birmingham

“This larger picture includes important relationships between BMI and other health outcomes, such as cardiovascular disease and its risk factors. Arguably, the most important relationship among the cardiovascular disease risk factors is diabetes, which is significantly more common in overweight than in normal-weight people.”

Considering the increasing number of children who are overweight, health experts are urging researchers and clinicians alike to act now and conduct research that goes beyond just BMI.

Dr. Lewis continues

“Weight gain is progressive and weight loss difficult. Although a young child is unlikely to have a heart attack, overweight children are likely to become overweight or obese adults, which puts them at risk for cardiovascular events as they mature. Achieving and maintaining a healthy body weight is of high importance for all Americans.”

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.