ErinPharm Gazette April 2007
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The most significant article of note this month is the report of the American Heart Association/American Stroke Association on new guidelines for the early management of acute ischemic stroke. The report clearly emphasises the critical importance that a stroke patient reaches an operating table at a primary stroke center within the first few hours of the event. Only these centers have the 24/7 capability of determining if the stroke is ischemic (most strokes) and thus can be treated with intravenous and/or intra-arterial tPA immediately so that the recovery of the patient is optimal. This is a pivotal time in the medical management of stroke for the general population since only 29% of strokes activate emergency high-speed transit to a primary stroke center with an even smaller percentage actually reaching a stroke team within the critical first few hours. Think ahead, plan your strategy, know the location of your nearest certified primary stroke centers, every minute counts. For those living in cities make sure your 911 service will speed you or your loved one only to the nearest certified primary stroke center. For those in rural communities make sure your local medical center has procedures to helicopter you or your loved one to the nearest certified primary stroke center within the critical time period. These are changing times. Be alert, aware of stroke symptoms: (video)You are fortunate to know these facts and live at this time in medical history.
A review of April 2007
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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.
April 30, 2007 John L. Fahey johnfahey@tds.net
The Life Extension Foundation
Tremendous strides forward are being made in the treatment of breast cancer. Keep up to date on these advances. Medscape Breast Cancer Resource Center
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 Gastroesophageal Reflux Disease (GERD)
Advances in lung cancer therapies are moving ahead. Keep up to date.
Leading expert Dr. Mark Freedman presents new perspectives on multiple sclerosis
University of Kansas research scientist, Dr. Ann Manzardo, is exploring the link between thiamine deficiency and a genetic predisposition to alcoholism.
Treatment of chronic pain patients with opioids causes serious problems for primary care physicians.
The first comprehensive map of Genomic copy number variations has been developed. Such copy numbers influence genetic diversity and susceptibility to disease.
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.
The American Cancer Society is your main source of information in the ongoing battle against cancer.
Primary prevention of cardiovascular disease in those with diabetes is directly addressed in guidelines from the American Heart Association (AHA) and the American Diabetes Association (ADA). This excellent review and comparison of the guidelines gives a comprehensive discussion of each of these guidelines. The authors have presented a tabular and clear outline of lifestyle intervention targets for the patient to aim at. This is an important and significant review. 16 authors, a complete approach to prevention.
Imaging studies presented at the American College of Cardiology 2007 Scientific Sessions give the disappointing news that although torcetrapib dramatically raised HDL-cholesterol levels and significantly lowered LDL-cholesterol levels there was no evidence of a reduction in the progression of atherosclerotic plaque. This has raised questions about the conceptual basis of simulating the known antiatherogenic (high HDL) profile in those with a CETP (cholesteryl ester transfer protein) deficiency with a molecule in the torcetrapib class. There are other CETP inhibitors in the pipeline from Pfizer and other companies and this is now an open question as to if such an approach is the right one to reverse atherosclerosis. Some believe the torcetrapib results are unique to the torcetrapib molecule. Others do not.
Those at high risk for atherosclerosis due to low HDL, high triglycerides, and small dense LDL-cholesterol have a mixed abnormal lipid profile common in diabetics and requires a rational therapy of combination drug treatment. This publication, from Dr. Charles Reasner, Medical Director at the Texas Diabetes Institute, gives optional approaches to drug combination therapy with a statin as the first component..
An international multi-center clinical study: Efficacy and safety of co-administration of Ezetimibe/Simvastatin (Vytorin) with Fenofibrate in patients with mixed hyperlipidemia. Complete and detailed results.
In yet another warning to the American public that excessive consumption of carbonated (sugar) colas and similar full-calorie soft drinks has reached alarming proportions, leading to obesity, diabetes, and other sequelae has been published by the American Public Health Association.
In a strongly worded article it is emphasised that the majority of elderly people considered 'frail' can benefit just as much as younger people from chemotherapy for cancer. The consequences of advanced aging include the misperception of the public that frailty is concomitant with chronological age. This is despite evidence to the contrary that an active healthy life expectancy can be extended by utilizing adoption of a healthy lifestyle including management of chronic conditions such as diabetes and hypertension as well as early detection and treatment of cancer. The trajectory of aging for any individual is related to multiple factors and assessment based on chronological age is inappropriate when considering medical intervention.
Calcium, Vitamin D supplements, and dairy products are protective against colorectal cancer according to studies done by Dr. Song-Yi Park at the University of Hawaii in Honolulu. Data was collected from more than 191 thousand participants of a multi-ethnic cohort study.
The addition of EPA fish oil to statin therapy has been shown to significantly reduce the incidence of coronary events among patients in Japan, where coronary artery disease rates are low and fish consumption high. The investigators, led by Dr. Mitsuhiro Yokoyama of Kobe University Graduate School of Medicine, believe the beneficial effects of adding 1,800 mg eicosapentaenoic acid (EPA) to statin therapy, had multiple biological effects including reduction of triglycerides, and attenuation of inflammation, thrombosis, and arrhythmia.
In a suprising development researchers have reported that the universal donor blood type O can be produced from blood types A, B, and AB by easily removing blood group antigens using newly discovered enzymes.
The International Stroke Conference 2007 took place at the Moscone Convention Center in San Francisco February 7-9. This report summarizes current key data on stroke prevention, stroke epidemiology, transient ischemic attack, intracranial hemorrhage, treatment of stroke, neuroprotection, and intracranial stenosis. This is an excellent review of 'state of the art' in what can be done for the stroke patient. It was not within the purview of of this conference to address the very wide disparity of these options available to stroke patients across the United States. The sad fact is that medicine and treatment of stroke has vaulted ahead of the capacity of the medical system to apply current knowledge to the entire population. It is known that a patient with TIA or stroke symptoms should be on an operating table at a primary stroke center in less than three hours from appearance of the symptoms for maximum, and sometimes remarkable, recovery. The troubling fact is that only single digit percentages of patients are educated to this or even able to reach a primary stroke center within this crucial period of time. For the individual this means a plan, a strategy, to reach the nearest primary stroke center in the event of emergency.
In yet another interesting application of statin therapy Dr. Floyd J. Frost and colleagues of the Lovelace Respiratory Research Institute in Albuquerque, New Mexico have reported that use of low dose statin therapy of at least 4 mg/day cut the risk of death from influenza/pneumonia and chronic obstructive pulmonary disease (COPD) by 40% and 83% respectively. This remarkable survival benefit adds to reports of the antiinflammatory and inmmunomodulating effects for statins. This demands further studies to reach verification and application to such patients.
An excellent article from the Journal for Nurse Practioners by Nadine M. Zatsick, RN, and Paula Mayket, RN, reviews and adds considerable weight to the growing opinion that addition of substantial amounts of omega-3 fish oils (EPA/DHA) to the diet of the average individual has substantial health benefit and considerable cardioprotective effects.
The American Heart Association/American Stroke Association has released new guidelines for the early management of acute ischemic stroke. The guidelines were published in the early Stroke ASAP issue and will appear in the May print issue of Stroke. These guidelines emphasise the importance of the few hours after stroke onset which are so critical - 'time is brain' - and reports the horrifying fact that activation of emergency medical services among patients with acute stroke is as low as 29%. Given modern medical therapies of intravenous and intra-arterial tPA in use at primary stroke centers giving remarkable recovery incidence, there is need for a concerted national program to resolve this gap between what is available, what can be done, and what the average stroke patient experiences in his/her first few hours.
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