ErinPharm Gazette January 2008
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As 2008 begins we find that progress is being made on Alzheimer's disease, a universal flu vaccine is on the horizen, the concept of recreating a heart from a matrix has been proven in an animal model, physicians have access to a simple ultrasound carotid plaque detector to add to an office ankle/brachial blood pressure monitor, statins continue to show multiple benefits, further insights into HDL-cholesterol levels and particle size are gained, the importance of Vitamin E to health is detailed, and the important benefits of fish oil supplements is again a topic. There is a call to establish a responsible informed TV Health Network and the CDC reports that death from heart attack and stroke continues to decline with a reduction of 25% since 1999. Those of us in the developed counties who are aware and proactive will benefit. Over one billion people on this planet are still suffering, now, and in the near future.
A review of January 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
Keep up to date with advances in the prevention, diagnosis, and treatment of colorectal cancer.
Know about the latest treatment guidelines for addiction.
Patients should know everything there is to know about Gastro-esophageal Reflux Disease (GERD)
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.
Alzheimer's disease is a focus of numerous clinical trials as the next medical frontier to be crossed. Now in a startling report published in the Journal of Neuroinflammation by Dr. Edward Tobinick and Dr. Hyman Gross the claim is made that a remarkably rapid and sustained, though limited, recovery was made for a single 81 year old man who received perispinal injections of Enbrel (Etanercept) into his neck. There is controversy about the theory of action of this biologic agent as well as about the principal investigator himself but we could dare to hope that this is a breakthrough start to resolving and reversing the devastation that Alzheimer's disease brings to the patient and the patient's family. Enbrel is an anti-inflammatory protein, a tumor necrosis factor (TNF) blocker, that has numerous side effects but is useful in the treatment of patients with rheumatoid arthritis, psoriasis, and related conditions and has been prescribed to almost a half million patients worldwide. The influenza viruses afflicting populations worldwide constantly mutate and cause an ongoing effort to produce new vaccines for each new sub-type detected. In an annual influenza epidemic it is estimated that 5-15% of the population will become infected with death in elderly and high risk groups. A World Health Organization (WHO) report estimates 250,000 to 500,000 deaths worldwide each year. Experts fear a pandemic is only a matter of time before it occurs, similar to influenza pandemics in the past. Now great promise is on the horizen with an announcement by Acambis, a leading vaccine development company, that they have succeeded in producing a vaccine targeted at an unchanging sequence in the influenza virus genetic code. This recombinant vaccine, ACAM-FLU-A™, has produced up to 90% seroconversion in those vaccinated in a Phase I trial and is well tolerated. This is proof in principle that a universal influenza vaccine for all types of influenza can be produced.
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An old folk remedy for heart health, hawthorn berries, has received a modern approval from the results of a review of the use of hawthorn extract in patients with chronic heart failure. The researchers pointed out that although there is abundant historical evidence for the use of hawthorn extracts from the flowers and leaves of the hawthorn plant, the range of bioactive potency in commercial preparations varies widely and so needs caution, and a physician's co-operation, to add a hawthorn extract to standard heart-failure medications. The researchers, led by Dr. Max Pittler of Peninsula Medical School, Universities of Exeter and Plymouth, UK, reported that hawthorn extract added to standard heart-failure medication increased exercise performance and cardiac oxygen consumption and may have improved heart-failure symptoms such as fatigue and dyspnea. Reported adverse events were infrequent, mild and transient.
The importance of statins in the search for optimal healthy longevity reaches a new stage with the establishment of a Medscape Resource Center with a focus on Landmark Statin Trials. Since the original studies have proved beyond doubt that treating raised cholesterol levels in patients reduces cardiovascular events and death, and current studies exploring the optimal lower level of LDL-cholesterol to aim at promoting regression of atherosclerotic plaque, there are now studies exploring the variety of beneficial effects and risks associated with statin use. Use this resource center as your direct link to ongoing research. The ultimate objective will be to promote a steady but ongoing depletion of arterial plaque; perhaps with the next generation of medications based on increasing HDL-cholesterol levels.
Keep up to date with advances in the use of statins.
In an extremely important and remarkable review led by Dr. Wim van der Steeg, at the Academic Medical Center, Amsterdam, The Netherlands, it is reported that a focus only on raising HDL-cholesterol levels could well be counterproductive and be associated with an increased risk of coronary artery disease. He and his colleagues have made it clear that not only is HDL particle size a significant factor but also the concentration levels of circulating apolipoproteins determine whether elevated HDL-cholesterol levels will be cardioprotective or cause harm. They suggest it is possible that as the HDL particle becomes too bulky it could become less functional or even dysfunctional. Given this insight, the suggestion arises that study focus should shift toward promoting the plasma levels of the protein carrying the cholesterol fraction, apolipoprotein A1 (ApoA-1). This should provide stimulus to research pharmaceutical companies to use their 'chemical libraries' to find a molecule that increases circulating ApoA-1 plasma levels. It should also give reason to measure ApoA-1 levels simultaneously with HDL-cholesterol levels in order to properly evaluate the clinical significance and antiatherogenic/atherogenic potential.
In this modern hectic world of advances in medical opinions and strategy there is a real need for a responsible informed TV Health Network. Some may remember the 1980s and 1990s when such programs began. They ended because of financial support. The public hunger for reliable and unbiased sources of health information can be seen throughout all media. Unfortunately it is often promotional, biased, one-sided,
sensational, or just plain wrong. A TV Health Network run by the NIH, the Institute of Medicine, Medscape, WebMD, the CDC, and other informed and responsible organizations is an idea for which the trime has come. This video editorial by Dr. Larry Grouse, Executive Director of the ARIA Initiative of the World Health Organization, makes a cogent point. Now the question is - who will take this dream and turn it into reality? When could this become part of our society?
It is intriguing that a double-blind, reandomized, parallel design supplementation study in which healthy subjects took either alpha tocopherol or placebo conducted by Dr. Helen Griffiths at Aston University, Birmingham, UK, showed that the subjects receiving alpha tocopherol experience a two fold increase in apolipoprotein A1 after 28 days which corresponds with known data that plasma alpha tocopherol levels are inversely related to cardiovascular (CV) disease risk despite intervention studies failing to show any consistent benefit against cardiovascular disease.
The inconsistent results of Vitamin E, the natural mix of tocopherols, on cardiovascular disease caused researchers at the Southwest Foundation for Biomedical Research to investigate Vitamin E's effect on HDL-cholesterol in 250 baboons. They concluded that HDL-particle size was influenced by treatment with Vitamin E and were not genetically determined but that genes do appear to play a role in the negative effect Vitamin E can have on HDL-particle size. So now the focus shifts to study of HDL-cholesterol size and what group of humans will benefit from tocopherol supplementation and which group will not. Note: Vitamin E, tocopherols, are fat soluble and can accumulate in the tissues; can also reduce a person's production of Vitamin D. Maybe a reason for those who take Vitamin E to also take Vitamin D3, adding further benefit.
However for those who lack prudence and self-dose in attempts to raise HDL-cholesterol levels a note of caution: As Dr. Alan Fogelman at the UCLA School of Medicine, Los Angeles, California, warns us: high HDL-cholesterol levels can be cardioprotective or atherogenic; it could well depend on also measuring paroxonase and platelet-activating acetylhydrolase levels since these levels may be determining factors whether the level of HDL-cholesterol is protective or proinflammatory. As yet in the future are the availability of tests for these two enzymes as well as the 7 LDL types and the 5 HDL types.
Despite the reduction of nicotine addiction in the United States in recent decades, and the results of the introduction of Chantix as yet unmeasurable, a video editorial by Dr. Harvey Finegold, President of the Institute of Medicine, makes it clear that further measures need to be taken, starting with strict regulatory authority, reduction of nicotine content in tobacco products, and support of tobacco cessation programs in all healthcare plans. The decline in smokers since the 1960s has been a great accomplishment but is no longer decreasing. At this point, one in five adults smokes, with continuance nearly half will die prematurely, nearly half a million deaths in the United States each year are attributed to tobacco use and exposure, and $89 billion a year is spent by healthcare for smoking-related conditions. It is a paradox that such a dangerously toxic and addictive substance has become part of global social fabric. Following Dr. Finegold's suggestions will move us further toward the objective of a smoke-free society.
It is very disappointing that a comprehensive and detailed article published in Am. Heart J. on the role of fibrates in the prevention of cardiovascular disease revealed that doing so does not reduce the incidence of fatal heart attack or stroke although it does reduce the incidence of non-fatal heart attack by some 22%. This was a pooled meta-analysis of long-term randomized placebo-controlled clinical trials covering 36,489 patients from ten published trials so is very valuable information.
An encouraging publication in Am. Heart J. by Dr. Rachael Wyman and colleagues describes the results of office-based carotid plaque imaging on 50 patients. It is encouraging in that now advances in technology have given us an office-based ultrasound detection of carotid plaque with a small, lightweight, handheld ultrasound device with high resolution imaging. The scanning measurement took about 5 minutes to perform. Although this small study found that discovery of carotid plaque in a patient did not motivate patients to make lifestyle changes that only means more education on subclinical atherosclerosis is needed. It also means that patients should be more pro-reactive in urging their physicians to add this ultrasound device to the ankle-brachial ultrasound scanner he/she should now have become comfortable with over the last couple of years. Ignorance, once abolished, cannot be re-established. Having solid real measurements to give to the patient about his/her degree of subclinical atherosclerosis will give the physician more treatment options and further substantial reason to urge lifestyle changes.
In a very nice video editorial by Dr. George Griffing titled 'Mother was right about 'cod liver oil' we are reminded that adding EPA/DHA supplements to a regular diet can be beneficial in several ways.
An intriguing association between bilirubin levels and peripheral artery disease has been found by Dr. Todd Perlstein at the Brigham and Women's Hospital, Harvard Medical School, Boston. According to a report issued in the January Arteriosclerosis, Thrombosis, and Vascular Biology, the prevalence of peripheral artery disease is significantly lower in subjects with a higher bilirubin level. The magnitude of this effect, also seen among patients with Gilbert's syndrome (a genetic disorder associated with elevated bilirubin levels) is sufficient to propose elevating bilirubin levels to observe the impact on cardiovascular disease. There has not yet been such a study to date.
Surely this year will go down in medical/scientific history as the year in which it was first reported that a beating rat heart in a laboratory was engineered from a functional scaffold seeded with cardiac cells. The implications are profound. The work, by Dr. Doris Taylor, at the University of Minnesota, and Dr. Harald Ott, at Harvard Medical School, has Dr. Taylor being quoted as saying that moving application of this approach to human therapy could be as close as 5 to 10 years. This is staggering, since the use of a patient's own adult stem cells would provide a totally compatible heart. We live in wondrous times.
Interest is growing from many in society seeking methods for brain enhacement. Brain fitness is becoming a 'hot' topic for conversation.
Death rates from coronary heart disease and stroke continue to decline. Since 1999 there has been a further 25% decline. The message is working: Lifestyle changes, lipid level modification, early detection and prevention, new procedures and therapies. There are new wonders ahead. Participate, take control of your life.