Health Newsletter:February 2008
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Contents |
[edit] Superior Breast Ca Treatment With Anastrozole
The buzzword in the treatment of hormone-sensitive breast cancer used to be Tamoxifen. For years it was the drug of choice for postmenopausal women who had a form of hormone-sensitive breast cancer. It worked well enough, but the new generation of treatment agents, called aromatase inhibitors, has come into the forefront of attention. According to the findings that were presented at the San Antonio Breast Cancer Symposium they are superior to Tamoxifen. Lead study author Dr. John Forbes of the Newcastle Mater Misericordiae Hospital in Australia stated that the aromatase inhibitor Anastrozole-also known as Arimidex- is more effective than the previously used Tamoxifen. Patients have a slightly higher incidence of fractures (10% on Arimidex versus 7% on Tamoxifen) while they are taking the drug, but this difference disappears after the treatment was completed. In addition the effects of the new drug are long lasting. Disease-free survival is increased by 13 % as is time to disease recurrence by 21%. There is also less cancer spread (by 14%) and a lower number of contra lateral cancers (by 42%). Anastrozole is also causing less of the more serious adverse reactions like thromboembolism, stroke like pictures and endometrial cancers. The one side effect that is increased is a higher fracture risk during treatment. The benefits of treatment are maintained, and updated findings show that four years after treatment the patients who took Anastrozole still have less recurrence of disease. Dr. Forbes stated that the “carryover effect is statistically significantly larger”, which makes this new drug treatment superior to Tamoxifen at preventing all forms of recurrence. These findings are the first and only analysis of long-term follow-up from an aromatase inhibitor trial.
The Medical Post, January 8, 2008, page 1 and 53
[edit] Mental Function And Muscle Mass Improved With L-Carnitine
In the aging population a lack of cognitive function and infirmity can overshadow the “golden years” and greatly compromise the quality of life. Mitochondrial dysfunction caused by DNA damage, which is due to aging, is believed to be the culprit for these deficits. Mitochondria are subcellular bodies that are like a motor that generates the necessary energy for muscular and mental processes and one of the constituents is L-carnitine.It is a vital enzyme part which is present in the inner membrane of the mitochondria. The concentration of L-carnitine decreases, as the aging body shows a decrease of muscle mass and an increase in body fat. This process has raised the question whether a correction of L-carnitine levels could reverse some of the physical and mental changes. Two clinical trials from the department of Senescence, Urological and Neurological Sciences at the University of Catania, Italy had some interesting answers to this question. In the first study 84 elderly patients were recruited. They were healthy but complained of fatigue. Initially they were stabilized on a standardized diet according to the National Cholesterol Education Program. In a randomized program they received placebo or L-carnitine capsules of 2 grams per day for 30 days. After this they were assessed again. The persons who had received L-Carnitine gained on an average 2 kg of muscle mass and lost 3 kg of fat mass. Mental and physical fatigue was reduced between 40-45 %.(In the placebo group the change was between 8 and 11 %.) A second study examined 70 persons in a high age group: they were 101 to 106 years old, had no serious disease and did not take steroids or diuretics. After 6 moth of L-carnitine supplementation the plasma carnitine levels were significantly increased. Persons on placebo (fake pills) barely showed any increase.) Muscle mass increased by about 3 kg and body fat dropped by about 2 kg. An even more significant fact was the result of the Mini-Mental State Examination, which increased by 4.6 points out of the possible 30 points. No change was seen in placebo patients. These results are pointing to the benefit L-carnitine may have together with exercise. It could have a role in the prevention of muscle wasting and improve mental functioning even at an advanced age.
The Medical Post, January 8, 2008, page 21
[edit] Diabetes Health Risks Reduced By Statins
Generally statins are considered as a drug treatment for high blood lipid levels. The dietary measures are of great importance, as are lifestyle adjustments. It is known that the elimination of foods with high cholesterol content comes first in an effort to maintain a desirable cholesterol ration. Exercise is also known to boost the “good” HDL cholesterol and decrease the “bad” LDL cholesterol. There are instances, where diet and exercise are not enough to achieve healthy cholesterol blood levels. Some patients have a form of high cholesterol levels that run in their family and often contribute to cardiovascular disease. These patients need all the help they can get: they have to do their part with diet and exercise, and they need statins in addition to that. Another patient population with a higher risk for cardiovascular disease are those with diabetes type 1 and 2.Clinical trials have tried to establish the usefulness of statin therapy for them, and data from 18,686 patients were assessed. In a 4.3 year follow up, there were 3247 major vascular events (strokes or heart attacks would be classified as such).For patients who received statins and had a reduction of LDL cholesterol, there was a significant reduction in vascular mortality (death caused by stroke or heart attack). The long term outlook demonstrated that after 5 years fewer people with diabetes on statin therapy had major cardiovascular events. Due to these findings statins treatment should be considered for patients with diabetes who are at a risk for cardiovascular disease.
The Lancet 2008; 371:117-125, Jan. 11,2008
[edit] CT Angiography Less Invasive
Patients with coronary artery disease often get a warning signal in the form of chest pain or shortage of breath. These early warning signs must be taken serious, as they can also be the signs for a heart attack. Cardiologists have to find out, whether important blood vessels are obstructed, and the standard method so far has been a coronary angiogram. The method is not without risk, and less invasive alternatives have been under discussion. A method using 64-row Multidetector CT Angiography evaluated 291 patients at 9 international centers. Normally they would have been scheduled to undergo invasive coronary angiography for suspected or unknown coronary artery disease. Dr. Julie Miller of John Hopkins University in Baltimore and colleagues found that the alternative CT angiography was highly accurate. The method could detect blockages greater than 50% with a sensitivity of 85 to 90% specifity. The results were equal to invasive angiography to pick up findings where bypass surgery or angioplasty was needed. A second study involved 232 patients in 16 institutions. All of them had typical or atypical chest pain. The head of the investigations, Dr. James Min of the New York Presbyterian Hospital and his colleagues reported that the test detected 82 blockages greater than 50% in 49 patients and 31 blockages greater than 70% in 28 patients. Ct angiography showed a per-patient sensitivity of 93% and a specificity of 82% for blockages greater than 50%. The findings are showing that the method applied in patients with low to intermediate prevalence of coronary artery blockages is a highly accurate alternative diagnostic method to the more invasive angiography.
The Medical Post, January 22, 2008, page 19
[edit] Restless Leg Syndrome And Heart Disease Connected
A good night’s sleep is not only beneficial to general wellbeing but necessary for health. A sleepless night and counting sheep can be bothersome, but regular sleep disturbances have to be addressed by qualified help, which is available in settings of sleep labs and sleep clinics. One difficulty in finding a restful sleep is a condition called restless leg syndrome (RLS) A recent study led by Dr. JohnWinkelman of Harvard’s Medical School division of sleep medicine examined a population of 1,559 men and 1,874 women of the average age of 67.9 years. They filled a detailed questionnaire surrounding RLS and the frequency of this problem. A second questionnaire examined their sleep habits. Women were twice as likely to report restless leg syndrome. After taking into consideration the various parameters of age, sex race, smoking, blood pressure and blood pressure medications and LDL cholesterol levels, there was a statistically finding for patients with restless leg syndrome to have a significantly increased risk for coronary artery disease and cardiovascular disease compared to patients who did not have RLS.The association was stronger in patients who had RLS more than 16 times per month. In addition the associating was greater in those patients who had extremely bothersome symptoms than those whose symptoms were moderately severe. Patients who were older than 65 years of age and who had RSL also had a higher risk of coronary artery disease and cardiovascular disease than those who were younger. More research input is needed to see how frequency and severity of RLS may influence cardiovascular risk. The researchers also stated that since the average patient belonged to a higher age group and 77.4% of the subjects were Caucasian the findings may not translate other ethnic groups and a younger patient population. In the meantime RLS and associated sleep disorders should not be ignored in any age group, as healthy sleep patterns contribute to general health and wellness.
The Medical Post, January 22, 2008, page 2
