Health Newsletter:August 2003
Related Links:From WebHealth
Contents |
Reduction Of Complications After A Stroke
Following an acute stroke, it used to be taught in medical school that lowering the blood pressure would be something to avoid for fear that this would lower circulation to the brain and could make a stroke worse.
A new study, called ACCESS (Acute Candesartan Cilexitil Therapy in Stroke Survivors), is proving this teaching wrong and demands a 180° turnaround.
Dr. Joachim Schrader has pablished this landmark study recently in the Medical Journal "Stroke" (Stroke - 01-JUL-2003; 34(7): 1699-703). This study followed 339 stroke patients after an initial angiotensin type 1 receptor blocker was given right away versus a control group who got it only 1 week later. In other words, the test here was to see what would happen, if treatment would be started right away during the acute phase of the stroke. Up to now this was only done in the stable period after 1 or 2 weeks (the conventional approach).
The 1 year follow-up data showed that the overal death rate from all causes (summing up all complications) was 47.5% less in the treatment group than in the control group. In other words by using intervention with this newer type of blood pressure lowering medication, such as the angiotensin type 1 receptor blocker candesartan (Atacand), complications such as extension of the stroke or heart problems and other complications were averted. The end result were fewer deaths and better quality of life in those who survived.
The Medical Post in its July 29, 2003 edition (p. 1 and 54) interviewed Dr.Ashfak Shuaib, professor of neurology of the University of Alberta in Edmonton, regarding the significance of this study. He felt that there likely would be a new hormonal effect on the brain from the lining of the arteries in the brain that gets blocked and that leads to an increase of blood supply to the brain. This in turn would rescue the brain tissue around the stroke preventing the late complications. He said that this line of research would be very solid data, but that it would have to be confirmed by an independent study from other investigators. Dr. Shuaib's group of researchers are planning an imaging study where they will study the blood flow following strokes under the same conditions using candesartan (Atacand).
Link to a chapter on strokes of WebHealth : Stroke And Brain Aneurysm
HRT: Findings From The British Million Women Study
In the latest issue of the Lancet (Lancet 2003;362:414-415,419-427) a study from Great Britain was published regarding the risk of breast cancer. Over 1 million women were followed from 1996 to 2001. They were in the age group of 50 to 64. Of these 80% were postmenopausal, and these formed the basis of the study. Dr. Valerie Beral (from the Cancer Research group UK in Oxford) was the lead investigator. About half of the women were on various forms of hormone replacement therapy (HRT), the others were not and served as a control. Risks were always expressed in comparison to the controls without any hormone replacements. Here is a tabular summary of the various hormone replacement therapies and their risks of leading to breast cancer.
| Findings from the British Million Women Study on HRT | |
| Detail of hormone replacement: | Breast cancer risk compared to control: |
| overall risk of HRT for all groups of HRT | 1.66-fold |
| women who stopped HRT the previous year | 1.14-fold |
| estrogen only use currently | 1.30-fold |
| estrogen-progestagen combination | 1.88-fold |
| tibolone users | 1.45-fold |
| combination HRT user less than 5 years | 1.7-fold |
| combination HRT user more than 5 years | 2.21-fold |
| equine estrogen combined with medroxyprogesterone acetate and taken at least 5 years | 2.42-fold |
| death rates from breast cancer associated with current use of HRT | 1.22-fold |
The relative risk of developing breast cancer did not significantly change whether HRT was taken orally, transdermally or through implanted formulations. Dr. Beral's group has estimated that in Great Britain in the past 10 years about 20,000 additional cases of breast cancer were caused by HRT for menopause among women aged 50 to 64. Out of these about 75% were due to the use of the combination of estrogen/progestin. An accompanying editorial by Dr. Chris van Weel stated that "general practitioners should discourage HRT for their patients" and, if used, should last "no longer than 3-6 months". The investigators of this study suggested that "discontinuing HRT should be suggested in as supportive a way as possible, because no one will benefit from panic or over-reaction".
Here is a link to a chapter on menopause from WebHealth. This link deals with breast cancer.
Modify Risk Factors For Erectile Dysfunction (ED) In Elderly Men
Erectile dysfunction (ED, impotence) is a subject that is difficult to research because of its personal nature. Very few good studies are available regarding the question as to how common it would be among older men.
A team of medical experts under Dr. Constance G. Bacon from the Harvard School of Public Health and other institutions have investigated this problem in men older than 50 years and published the results in the August 5, 2003 issue of the Annals of Internal Medicine.
31,724 men aged 53 to 90 years were taking part in the Health Professionals Follow-up Study. Since 1986 they had been filling out detailed questionaires biennially. In 2000 detailed questions about sexual function were also included. Erectile dysfunction was defined as "having poor or very poor ability to have and maintain an erection sufficient for intercourse without treatment during the past 3 months". The investigators found that about 1/3 of the men above the age of 50 had a sexual dysfunction. Such factors as orgasm, ability to have intercourse, sexual desire and overall sexual function were all affected more and more with every year after the age of 50. When this was further analyzed using multivariate analyses an interesting pattern of reasons for this emerged. The following factors were identified to be independent risk factors for the development of erectile dysfunction.
| Risk factors leading to erectile dysfunction (ED) | |
| Symptoms: | Comments: |
| increasing age | aging likely affects the blood supply to the swelling bodies of the penis; it also clamps down on testosterone production of the testicles |
| smoking | accelerates aging and hardening of arteries |
| diabetes mellitus | affects circulation and nerve impulse transmission |
| stroke | interferes with brain centers of arousal |
| antidepressant medication | anticholinergic side-effect interferes with penile erection |
| beta-blocker medication | reduction of libido (likely at the brain level from sympathetic nerve block) |
| alcohol consumption | alcohol is a nerve poison that interferes with pudendus nerve function (lack of erections) |
| TV viewing time | due to prolonged sitting there is a chronic lack of exercise that leads to nerve conduction and circulatory problems resulting in ED |
Each of the factors from this table is an independent risk factor and can be managed separately. For instance, the investigators found that a higher level of physical activity was associated with much less ED. The best group (men with no ED) was found among those who were always conscious about disease prevention and who had none of the conditions listed in this table or other chronic medical conditions. Leanness and physical activity were associated with good sexual functioning in this study.
Here is a brief chapter on erectile dysfunction from WebHealth.
This summary is based on a paper published in the medical journal of Annals of Internal Medicine 2003;139:161-168 by Dr. Constance G. Bacon and co-workers.
Newly Detected Hormone May Help Obesity
At a recent meeting of the Endocrine Society in Philadelphia new findings by British researchers were presented regarding hormone interactions with weight problems. Dr. Simon Aylwin, a consultant from the King's College Hospital in London, England, presented data showing that peptide hormone PYY levels were much lower in patients who were significantly obese versus normal weight controls.
As Dr. Stephen Bloom's research group from Imperial College, London, UK had shown earlier, with a meal rich in calories the gut produces the PYY hormone in a way that with higher amounts of calories in food consumed more of the hormone PYY is secreted into the blood stream. The new information that was discussed at the meeting of the Endocrine Society was the fact that these hormone signals are registered in the hypothalamic tissue, a part of the brain situated just above the pituitary gland. It has been known for a long time that weight is regulated by a satiety centre in the hypothalamus. Now it has been appreciated that there are at least two or more pathways of registering weight related hormone signals: one being the gut related PYY hormone that tells the brain that enough food was consumed in a meal, and secondly leptin hormone signals where the hormone leptin is secreted from the fatty tissues in the body, which tells the satiety centre of the brain that not as much food needs to be consumed when our weight has reached a certain threshold.
Dr. Aylwin measured PYY hormone levels in a number of different groups of patients such as in patients who were obese, in patients who had gastric bypass surgery done and in a group who only had gastric banding done. They observed that the group who had bypass surgery done had a higher than normal response of PYY hormone release as a response to a meal. This enabled them to adhere to low calorie meals without any hunger pangs and this group of patients did well in terms of weight control on the longterm.
In contrast to this the group with gastric banding had a flat response curve to the stimulus of a meal with respect to the PYY hormone as did patients with obesity. The low PYY levels in response to meals likely explains why these patients continue to eat too much making their weight loss efforts more difficult.
Dr. Aylwin explained that with future research efforts new forms of medications could be developped that mimic the effects of the PYY hormone leading to satiety and allowing patients to control their weight easier. Dr. Linda Fish, an endocrinologist from the University of Minnesota, mentioned that for excessive obesity with a body mass index of more than 45 the only effective therapy right now would be the invasive gastric bypass procedure. As this link shows the surgeon makes a laparoscopic gastrotomy (hole in stomach) and an enterotomy (hole in the small bowel) and sows these organs together (anastomosis). Instead of such an invasive procedure many patients might be able to have persistent weight loss with these new medications. In other words, with an anologue type medication that would have the same effect as the PYY hormone, it would allow the obese patient to lose weight persistently without bypass surgery. However, results of this type of research would likely take about 10 years before a new drug would be available to be used safely by the public.
1. This summary is based on an article in the July 15, 2003 issue of the Medical Post (page 50) as well as on the newsdesk article entitled "Obesity-is it all in the mind?" in The Lancet Neurology Volume 2, Number 1, January 2003.
2.Link to related topic (nasal spray for obesity).
Parkinsons Disease From Too Much Meat And Too Little Vitamin B2
Parkinsons disease (correct medical spelling is " Parkinson's disease") is a degenerative disease of the brain stem that presents with symptoms of shaking, tremor and gait problems.
It is a neurological disease of the elderly and often is a cause of disability leading to institutionilisation. New research at the University of Sao Paulo (UNIFESP) in Brazil has found that a diet rich in vitamin B2 and low in meat has helped to improve patients with Parkinsons disease.
It appears that it may not only be useful in alleviating symptoms of existing disease, but even more importantly to prevent this neurological disorder from developinlg. Dr. Cicero Galli Coimbra stated that in Buenos Aires (where the study was done) the consumption of meat is one of the highest in the world as is the rate of Parkinsons disease. Under his guidance a research team found that about 15% of the population do not absorb vitamin B2 adequately. In combination with excessive red meat intake a significant proportion of the population does not absorb enough of this vitamin resulting in Parkinsons disease.
In this study a group of patients with advanced Parkinsons disease were put on a special diet that included milk (which is a good source of vitamin B2). Within one month 18% of their motor function had returned to normal. After the third month of this diet 60% of the motor function had returned. Many had improved so much that they were able to drive a car safely again. Riboflavin (=vitamin B2) is an important ingredient in a number of metabolic processes in brain cells that result in the production of dopamine, a brain hormone that is required for regulating muscle coordination in various parts of the brain. This translates into a stable gait, normal muscle strength, good balance and normal cognitive functioning.
Link to WebHealth's chapter regarding Parkinsons disease.
These findings were reported in the July 15, 2003 issue of The Medical Post, page 31.
