ErinPharm Gazette  September 2008
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Vitamins, supplements, blood tests
A review of September 2008. A selection of topics.
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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.

September 30, 2008        John L. Fahey           johnfahey@tds.net
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.
Read this article from Medscape

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Readers of ErinPharm Gazettes are among those aware, motivated, and seeking to take advantage of knowledge generated on the expanding frontiers of medical/scientific research. It is important to recognise that while we are privileged to be part of this future coming rapidly toward us we also live on a planet where the majority of our fellow human beings suffer under a burden of disease overwhelming and horrifying. One such disease is malaria. It threatens half the world's population, will strike up to half a billion people this year, at least a million will die, most of them under age 5, the vast majority living in Africa.
From National Geographic     
YOU can make a difference. YOU can take the time to care. YOU can reach out to our distant cousins in our common human lineage. YOU can click this link and become part of.....NothingButNets....YOU can join the fight against malaria.
From Nothing But Nets     
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LEF Retail Store 
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As of March 31, 2008, Abbott Laboratories has already submitted an NDA (New Drug Application) to the US FDA for TriLipix as monotherapy and in combination with a statin.
Abbott press release
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America's best hospitals
US News and World Report
Attention turning toward the antiproliferative effect of statins. Global cancer incidence needs increased education and strategies for treatment. Low LDL-cholesterol levels related to diagnosis of early cancer but not statin usage. Measles is making a comeback. Gastric bypass surgery can lead to resolution of diabetes even before weight loss. Perioperative statin treatment for vascular surgery gives dramatic reduction in cardiovascular events. Further benefits of omega-3 fatty acids. Evidence that optimal LDL-cholesterol levels are within a range.Recommended current Vitamin B12 healthy levels are probably too low. Health alert for more focus on possibilities of deep venous thrombosis and pulmonary embolism. Effective safe tPA thrombolysis for stroke extended from three to four and a half hours.
Arterial health can also be damaged by hypertension (high blood pressure). It is a condition often undiagnosed or ignored in and by the general population. It is a 'silent killer' since it can exist in an individual unaware of their high blood pressure for many years insidiously and incrementally damaging the blood circulation system prior to a catastrophic cardiovascular incident. The current impetus toward having households add a home blood pressure monitor to gauge the daily blood pressure status of those with hypertension could well raise the profile of the importance of regular blood pressure monitoring. ErinPharm recommends the Omron brand of blood pressure monitor as being inexpensive and easy to use. New data revealed May 2008 confirm that hypertension control in the general population appears to be better in the United States than in Europe though diabetics are ill served by the latest US guidelines and only about half of US patients achieve a blood pressure objective. This data comes from a comprehensive multi-country survey by investigators led by Dr. Y. Richard Wang, of Temple University and University of Pennysylvania, in which a total of 21,053 patients with a primary or secondary diagnosis of hypertension  in six countries were evaluated. These patients had visited 1,284 primary care physicians and 291 cardiologists. With a definition of control as a blood pressure less than 140/90 mm Hg it was found that 53% of US patients reached that objective compared to 27% to 40% of Europeans. In Canada new guidelines for hypertension management were released to the public in January 2007 and stressed the importance of recognizing "high normal" blood pressure, i.e. 130-139/85-89 mm Hg, and the warning that more than half of such individuals will develop hypertension within four years if they do not make lifestyle changes. The point is also made that for individuals who do not follow a healthy lifestyle more than 90% will develop hypertension. Since guidelines, medications, and lifestyle changes can and will bring blood pressure to a healthy level over a time period of up to six weeks there is a need to overcome this societal inertia on the part of health care professionals and the general population to not actively seek blood pressure normalization. Yes, it does take significant effort at times, needs ongoing attention, requires a personal commitment on the part of the patient BUT it will result in a healthier way of life with a much reduced risk of heart attack or stroke. The next few years will see the launch of a number of new antihypertensive drugs and combination 'polypills'. In India a 'polypill' with two antihypertensives, aspirin, and a statin is expected to gain acceptance. The years to come will see major advances in this combined approach to arterial health.
From Medscape   
As attention turns toward investigating the antiproliferative effects of statins a research report by Dr. Thalacker-Mercer and colleagues, from the University of Alabama at Birmingham, presented at the American Physiological Society conference In Hilton Head, South Carolina in late September gave preliminary data indicating that a dose of Simvastatin (Zocor) of 40 mg/day appeared to reduce the viability of proliferating muscle progenitor cells by half. The effect was found to be dose dependent. This is particularly important to older patients on a statin with an age-related decline in muscle progenitor cells who will need to realize that statin usage should be coupled to regular daily exercise, good nutrition, and coenzyme Q10 supplementation.
From Revolution Health    
A plan of action to tackle the growing cancer crisis in the developing world was announced at the close of the World Cancer Congress in Geneva, Switzerland, August 31. Survival rates from cancer are rising in more affluent countries but worsening in poorer countries where 72% of the 7.8 million global cancer deaths in 2007 occur. About one third of cancers can be prevented and one third can be cured if detected early and treated. Public education to dispel myths and misconceptions about cancer is proposed. It will be important to improve the use of opiod analgesics for relief of cancer pain. Currently about 90% of morphine use for cancer pain is in Europe and North America. This wide gap is intolerable since cancer pain is often agonizing. Details of the World Cancer Declaration, including the option of signing in to support the plan, is on the UICC (International Union Against Cancer) website.
From the UICC 
Adding to the controversy about a link between statin treatment and cancer risk is an analysis by Dr. Richard Karas and colleagues, Tufts University School of Medicine, Boston, Massachusetts, published online August 22 in an expedited paper in the Journal of the American College of Cardiology, that concludes there is a relationship between low LDL-cholesterol levels and incident cancer for control patients not treated with statins comparable to the incidence among patients treated with statins. Thus treatment with statins to a low LDL-cholesterol levels does not increase the incidence of cancer. That a low LDL-cholesterol level in non treated patients indicates a cancer risk needs investigation into whether this is a result of a natural low LDL-cholesterol level in a genetic subgroup of individuals or whether cancer causes a lowering of LDL-cholesterol levels. Thus monitoring of the lipid profiles of healthy people could reveal an early warning of an early cancer.
From Medscape   
Although measles was declared eradicated in the United States in 2000 it has made a comeback in recent years. Measles, a respiratory infection caused by a highly contagious virus, results in cough, runny nose, inflamed eyes, sore throat, fever and a red, blotchy skin rash. Also called rubeola, measles can be serious and even fatal for small children. Approximately 30 million to 40 million cases of measles occur worldwide each year, resulting in close to 1 million deaths. The measles vaccine is a highly effective way to prevent measles. However, vaccination programs are hindered by parents who appose vaccination for religious or philosophical reasons and is incomplete in much of the world. From January through July 2008 a total of 131 measles cases were identified in 13 states and the District of Columbia. No deaths have been reported but this highly contagious disease has the potential to lead to pneumonia, encephalitis, and death. Opinion that is ill-informed and fed by media scaremongering has been partly responsible for this insidious disease re-entering the population. Most children, except those with certain medical conditions, should receive measles vaccination at 12 to 15 months with a second between 4 and 6 years.
From the Baltimore Sun 
The remarkable and serendipitous discovery that gastric bypass in the obese can lead to rapid control of diabetes even before weight loss begins has been investigated by researchers at the Université de Lyon and as reported in the September 3rd issue of Cell Metabolism, study co-author Dr. Gilles Mithieux points out that the surgery results in the remaining lower portion of the intestine increasing production of glucose and enhanced glycemic control thus contributing to satiety and weight loss. This result is not seen with gastric banding.
From Reuters (Medscape)
From LfeScan      .
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In a very clear-cut study that will have an impact on vascular surgery in the future a new randomized placebo-controlled trial, the DECREASE III (Dutch Echographic Cardiac Risk Evaluation Applying Stress Echo II) was reported at a hotline session September 1 at the European Society of Cardiology Congress 2008 by Dr. Don Poldernas, of the Erasmus Medical Center, Rotterdam, in which it was revealed that perioperative treatment with a statin led to a nearly 50% reduction in myocardial ischemia as well as reductions in cardiovascular death and nonfatal heart attack. Almost a million vascular surgeries are performed each year with a 2% death rate. Dr. Poldermans stated that he believes coronary plaque rupture is responsible for at least half of these fatalities and thus stabilizing coronary plaque with a statin gives this potential benefit.
From Medscape Heartwire 
An evaluation of the respective benefits of omega-3 fatty acids versus 10mg Crestor in symptomatic heart-failure patients published online in The Lancet and presented at the European Society of Cardiology 2008 Congress is notable that the modest benefit of omega-3 fatty acids in reducing all-cause mortality and admission to hospital for cardiovascular reasons contrasted to no benefit for those taking the statin. Dr. Luigi Tavazzi, of the Fondazione IRCSS Policlinico San Matteo, Pavia, Italy, who presented the data to the media during a press conference, pointed out that omega-3 fatty acids are effective, safe, simple, and cheap. The two nested studies, the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico Heart Failure (GISSI-HF) trial, designed to test hypotheses relating to omega-3 fatty acids versus a statin, followed patients with chronic heart failure for almost four years. The result has been to conclude that patients with an underlying, symptomatic, and progressive heart failure condition do not benefit from LDL-cholesterol lowering with a statin, but do benefit from treatment with omega-3 fatty acids. It is a disappointing result for clinicians who currently advocate statins for such patients.
From Medscape        
In an intriguing study of data from Chinese patients with type-2 diabetes in the Hong Kong Diabetes Registry, including 6,107 patients age 35 and over with no history of cancer when enrolled between 1996 and 2005, showed that the lowest risk of cancer was found with patients having an LDL-cholesterol level between 2.8 and 3.8 mmol/L, ( ~ 109 to 148 mg/dL) and risk increased toward very low levels and very high levels of LDL-cholesterol. The data, analyzed by Dr. Juliana C. N. Chang and colleagues at the Chinese University of Hong Kong, suggest that LDL-levels could be used as risk markers for cancer. Dr. Eric L. Ding and Dr. Frank B. Hu, at the Harvard School of Public Health, suggest that since the association is not related to LDL-cholesterol lowering with a statin, the clinical utility for cancer risk stratification remains unclear. Many other factors could account for this association. So, as yet, this data is a start to evaluating the relationship between LDL-cholesterol levels and cancer.
From Medscape (Reuters)    
To activate Medscape hyperlinks register with Medscape. Get direct access to authors, reports, and medical information and research publications  through the links.
An alert arises from  a study published in the September 9 issue of Neurology that current 'normal' Vitamin B12 levels may be too low. The prospective study, by Dr. A. David Smith and Anna Vogiatzoglou, at the University of Oxford, U.K., studied 107 community dwelling volunteers aged 61 to 87 years of age without cognitive impairment at enrollment for a period of five years and found that those with the higher levels of Vitamin B12 were 6 times less likely to experience brain volume loss. Since no adverse effects have been observed with excess Vitamin B12 in healthy people it leads to the suggestion that fortification or supplementation, particularly in the elderly, should be viewed as an ameliorative for the public health problem of loss of cognitive ability in the elderly. This is a strong and well designed study. It needs follow-up on larger numbers of people.
From Medscape  
From Reuters     
The Acting Surgeon General, Dr. Steve Galson, announced a call to action September 12 from the Office of the Surgeon General. It is a call to action for a co-ordinated multifaceted plan to reduce the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the US population. There are approximately 100,000 deaths each year with DVT and PE causative factors. That DVT and PE are initially silent yet preventable and treatable indicates a major gap in public awareness and outreach from clinicians and health care workers to the population at risk. There is a need for educating the general population to the causes, symptoms and prevention of DVT. Clinicians and hospitals must remain constantly alert to the possibility of venous thromboembolism in all their patients.
From Medscape Heartwire 
From the Office of the Surgeon General    
In a very welcome finding the period of time for effective thrombolysis of a stroke clot has been extended from three hours to four and a half hours. This finding, of observational data from a large European registry, from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Registry (SITS-ISTR) and expected in the soon to be reported Cooperative Acute Stroke Study (ECASS 3), will extend the time window from stroke onset significantly, enabling many more patients with ischemic stroke to receive tPA thrombolysis within allowed safe guidelines. For any aware individual this means having a strategy to reach the operating table of the nearest hospital accredited Stroke Center within the window allowed for treatment. ErinPharm advises knowing and printing out the location of your nearest accredited Stroke Center, know that calling and waiting for an ambulance is the wisest strategy, alerting your local hospital so that if necessary helicopter transport to the Stroke Center can be arranged while your ambulance is on the way. The results of tPA thrombolysis of a stroke clot within the time window is dramatic with most patients being able to return to a normal life. Be aware. Help protect your family, friends, and co-workers. Be the person with a strategy when someone near you has a stroke.
From Medscape  
From Bio-Medicine        
Maintenance of telomeres, or reducing telomere shortening, in healthy cell division, is of intense scientific interest since it is believed that doing so will enhance immune health and slow the rate of aging. Currently Geron is exploring this with its investigation of an extract of the root of the herb astralagus. Now a firm foundation for the benefit of intensive lifestyle management emerges from a study establishing that comprehensive healthy lifestyle changes will substantially increase telomerase activity and thus telomere maintence capacity. The study found that a 3-month intervention among 30 patients with low-risk prostate cancer altered gene expression in healthy prostate tissue significantly increasing telomerase activity. Intervention consisted of improved nutrition, moderate exercise, stress management, and increased social support. The Dean Ornish team at the University of California and the Preventive Medicine Research Institute in Sausalito, California, are to be commended for this work, establishing a logical molecular reason for such lifestyle changes.
From Medscape  
From prostatecancerinfolink   
Confirmation of a number of earlier studies on the benefit of combining a statin with omega-3 fish oils comes from a report by Dr. Kevin Maki and colleagues, at Provident Clinical Research, Glen Ellyn, Illinois, published in the August 15 issue of the American Journal of Cardiology. They evaluated 20 mg/day of Simvastatin with 4 gm/day of omega-3 fish oil in 39 patients. The conclusion to be drawn from this preliminary study is that addition of omega-3 fish oils to  a statin regimen in patients with high LDL-cholesterol and high (>200 mg/dL) triglycerides is important and beneficial, enabling patients to reach lipid profile objectives. Dr. Maki commented to reuters health that the effect is similar to that observed with Simvastatin/fenofibrate and so therefore is another treatment option.
From Medscape  
From the American Journal of Managed Care 
One of the problems the healthy elderly face is the attitude by many physicinas that their high blood pressure is of little consequence and not worth treating. this detailed and comprehensive review of recent clinical studies should cause such physicians to reevaluate their opinion. For the patient intent on a healthy longevity the findings that show a reduced incidence of dementia for the very elderly given antihypertensive medications give a basis for treatment to maintain cognitive and mental ability and even the finding that antihypertensive treatment for the Alheimers patient can help reduce cognitive decline. It is time for a shift in thinking about this topic.
From Medscape   
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For younger patients this video editorial by Dr. Henry Black, President of the American Hypertension Society, about prehypertension is complelling in its emphasis that prehypertension is real and should be evaluated and adressed. Again this is a topic often neglected by many physicians. Their opinion should change.
From Medscape