ErinPharm Gazette February 2008
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Attention is shifting toward percutaneous angioplasty done by Interventional Radiologists as an alternative to more invasive surgical options. The development of sophisticated magnetic navigation and precise control of wire guided devices to open occluded arteries is a technology coming of age. As surgical teams at major hospital centers develop expertise in this technology intervention will become a less frightening option for many. The general patient population can cooperate in reporting adverse drug events and fulfil an important social function in the monitoring of pharmaceuticals taken by patients. The importance of measuring apolipoprotein A1 plasma levels as well as HDL-cholesterol levels is becoming clear. The use of vitamin D as a cancer protective and vitamin E (with mixed tocopherols) as an aid to combat atherosclerosis is receiving renewed interest.
A review of February 2008. A selection of topics.
This web page is one of a number of ErinPharm web pages designed by me as a synopsis of topics that interest me as well as being a quick reference page for my newsletter subscribers and myself. I have no affiliation of any kind to any pharmaceutical company or medical group. The opinions expressed are my own. I welcome communication and debate. I am an optimist. I look forward to the future with wonder.
The Life Extension Foundation
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Advances in lung cancer therapies are moving ahead. Keep up to date.
University of Kansas research scientist, Dr. Ann Manzardo, is exploring the link between thiamine deficiency and a genetic predisposition to alcoholism.
The first comprehensive map of Genomic copy number variations has been developed. Such copy numbers influence genetic diversity and susceptibility to disease.
The American Cancer Society is your main source of information in the ongoing battle against cancer.
Are you trying to lose weight and have been misled by the multi-billion dollar industry selling pills, potions, and 'magic cures'? You are not alone. A survey backed by a commercial drug company reports that approximately 70% of American dieters have tried scientifically unproven methods to lose weight. That's an astounding number of people who have tried dietary supplements in the form of pills and powders. About half of survey respondents incorrectly think supplements are approved by the federal Food and Drug Administration, while about two-thirds believe such products must carry warning labels for side effects. All that happens is maybe temporary loss of weight and the emptying of your pocket. Resist the temptation to believe in those seductive commercials. The only way you can lose weight and keep it off is by a commitment to a change in lifestyle. I recommend lifestyle changes.
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Keep up to date with advances in the use of statins.
In recent years there has been a surge in minimally invasive methods to treat peripheral artery disease in which a percutaneous angioplasty can open blocked peripheral arteries. For patients in which peripheral artery disease is their major atherosclerotic burden it is an alternative to more invasive surgical options. Surgeons who have a sub-speciality in this area of treatment are known as Interventional Radiologists. During such surgeries a common practice is to insert a stent to keep the artery open. Very little clinical trial data has accumulated so the relative risks and benefits of this practice are not well defined. Now Dr. William Maisal and Dr. Jonathan Bridges from the Medical Device Safety Institute at Beth Israel Deaconess Medical Center in Boston have examined the frequency of adverse events associated with more than one million biliary stents implanted between 2003 and 2006. Records show that 1,036 biliary stent malfunctions occurred during clinical use. Good clinical trials are needed so that physicians and patients can make an educated decisions regarding stent selection and use. As always, before making a decision to go forward with this less invasive option, make sure you have a second or even third opinion, and fully work on lifestyle changes and medical treatment with medications first.
For the patient who is experiencing lower back pain the news that the condition is benign and self limiting does not help in seeking relief. However, a study reviewing the medical literature from the Centre For Quality of Care Research at Radboud University Nijmegen Medical Centre in the Netherlands concludes that intensive patient education for two and a half hours appears to be effective for patients with acute or subacute low-back pain.
Drug injuries and deaths cost more than $136 billion each year in the United States alone. Many patients taking medications are not aware that reporting adverse events associated with the medication is a vital part of the safety profile of a drug once it reaches the marketplace while many physicians are unfamiliar with the reporting process. To help remedy this Medscape has opened the Adverse Drug Events Reporting Resource Center. It is the hope this will facilitate more regular and complete adverse event reports.
Report Adverse Drug Events. Help facilitate drug safety.
The intriguing exploration of HDL and LDL levels along with HDL and LDL particle size advances another step forward with remarkable new data from investigators led by Dr. Wim van der Steeg of the Academic Medical Center, Amsterdam, the Netherlands. These post hoc analyses of the IDEAL data and the EPIC-Norfolk case-control study suggest that therapeutic intervention to obtain high levels of HDL-cholesterol and large HDL particle size without a concomitant rise in apolipoprotein A1 levels are associated with an increased risk of coronary artery disease. The finding supports apolipoprotein A1 as the active component of HDL particles and (quote) "possibly defining the atheroprotective capacity of this lipoprotein fraction". Dr. van der Steeg and his colleagues also found that increased levels of apolipoprotein A1 do not become a significant risk factor even at high plasma concentrations. This raises important clinical implications for those with atherosclerosis seeking to raise HDL-cholesterol levels. At this stage Erinpharm is willing to promote the addition of apolipoprotein A1 and apolipoprotein B along with a lipid profile (HDL-cholesterol, LDL-cholesterol and triglycerides) and C-reactive protein (measuring general bodily inflammation) as a package in blood tests. Since apolipoprotein A1 and apolipoprotein B levels can be expected to range across a spectrum in the general population and particularly since it is already known that a person with a low sub-optimal apolipoprotein A1 level can readily increase that level by very substantial amounts with ingestion of daily mixed tocopherols (as Vitamin E mixed tocopherols or LEF "super booster") it could well be that we already have an inexpensive method of increasing atheroprotection for that segment of the population with low apolipoprotein A1 levels.
It is important to recognise that it is the gamma-tocopherol found in natural vitamin E that is the critically important component of vitamin E and not the alpha-tocopherol found, sadly, in many commercial forms of vitamin E sold in the marketplace.
So increasing Vitamin E intake could be good for some but not for others. A definitive answer is not yet available. From News-Medical Net
In this brief, and important, message from Dr. Henry Ginsberg, Irving Professor of Medicine, College of Physicians and Surgeons, Columbia University, NYC, New York, pointing out that very-low-density lipoproteins (VLDL) are effectively the carriers of triglycerides in plasma and therefore are measurably almost the same when fasting we have an appropriate guideline in seeking optimal healthy longevity. Since it is already known that plasma triglycerides are about 100 mg/dL or less when we are young and healthy and that omega-3 fish oils (EPA/DHA) in sufficient amount will lower triglyceride levels as well as reduce C-reactive protein levels it becomes almost axiomatic to gain protection against heart attack and stroke by making daily ingestion of EPA/DHA as additional atheroprotection. Erinpharm recommends EPA/DHA from the Life Extension Foundation (logo at the top of this page) since it is high quality, triple distilled, and obtained from sustainable fisheries.
This video editorial by Dr. Helmi Lutsep, Associate Professor of Neurology at Oregon Health and Science University, reminds us that there are significant differences between men and women when decisions are made concerning stroke treatment and prevention. These substantial gender differences should guide strategies in management in an office/hospital setting as well as in the design of future clinical trials.
For those people unfortunate enough to have reached the stage of needing management of acute coronary syndrome or percutaneous intervention should be fully informed that knowledge of, and treatment of, cardiovascular disease has advanced significantly over the last couple of years providing ever more options and strategies for the well educated physician and more decisions for the patient.
Although the American College of Preventive Medicine (ACPM) understandably has pointed out that Information is not adequate to recommend general screening of men in the population for prostate cancer with digital rectal examination (DRE) or measurement of prostate-specific antigen (PSA), according to a position statement published in the February issue of the American Journal of Preventive Medicine, a newer and more accurate urine test is under development. PSA tests have significantly increased the detection of prostate cancer, very important for early and easily treatable detection, and is considered to be the current gold standard, but it has many drawbacks of specificity and sensitivity and is often elevated in men with benign conditions. Now Dr. Arul Chinnaiyan and colleagues at the Michigan Center for Translational Pathology, University of Michigan, is introducing a 'first generation' panel of biomarkers from urine samples which promises much greater specificity. He points out this is a process in development and he expects more biomarkers will become included to give even greater accuracy. For those who have had the experience of a prostate biopsy this is a very welcome development.
Treatment for the prevention of osteoporosis and bone fracture for those age 50 and older routinely uses calcium ion plus vitamin D supplements. This has led to some controversy however a new meta-analysis reaffirms this treatment modality and further suggests an additional benefit of protection against overall mortality when the patients's blood plasma has a high level of vitamin D. This of course corresponds to other studies showing the protective benefit against various cancers with a high vitamin D3 plasma level. Collective data such as this can reveal interesting facts such as the finding that higher levels of vitamin D are particularly effective in preventing colorectal cancer among women at age 60 and older. The clinical implications of such a finding is under further investigation and other studies are needed to explore secondary findings from another study that calcium supplementation could increase cardiovascular risk.
There is a sense of awe among many working in cardiovascular intervention at the technology advances enabling surgeons to access arteries and parts of the heart that would have appeared science fiction as recently as ten years ago. This technology insight, by Dr. Steve Ramcharitar and colleagues, about magnetic navigation and precise control of the direction of a guide wire or device in a percutaneous intervention for chronic occluded arteries gives wonder at the development and future direction of such technology not only for targeting chronic plaque occlusions but also for stem-cell implantation. The cost of setting up teams to work with such high technology has been slow in even the most advanced centers but is starting to become more widely available and gives us a vision of what the near future could bring.
The termination of Pfizer's torcetrapib clinical trials aimed at raising HDL-cholesterol by substantial amounts was a devastating setback in the progress toward reversal of arterial plaque accumulation. This report, by Linda Brookes, from the American Heart Association (AHA) 2007 Scientific Sessions gives an excellent review of the post hoc findings that torcetrapib appears to have off-target activated increased production of serum aldosterone. So although there was clear evidence of reversal of plaque in those patients who achieved the largest increases in HDL-cholesterol the increased aldosterone levels revealed an off-target pharmacology unrelated to CETP inhibition. Thus the concept of raising HDL-cholesterol with a CETP inhibitor in order to cause plaque reversal is still very much viable. The focus now shifts to CETP inhibitors being developed by other pharmaceutical companies; in particular anacetrapib which is being developed by Merck and is reported not to have the deleterious molecule specific effects of torcetrapib. Linda Brookes, a freelance medical reporter based in New York and London, is to be complimented on pointing out clearly that reduction of CETP activity is still the main approach to reversal of arterial plaque.
Are you fully aware of certified primary stroke centers and the accredited primary stroke center nearest to where you live and work? Have you this information readily available for your family, friends and colleagues? The importance of being on a surgical table within the first few crucial hours makes the difference between almost complete recovery and severe disability or death. Be prepared.