Cholesterol Levels and Heart Attack Risk: Treatment to Achieve Specific Numbers May Not Be Justified

According to a report in BusinessWeek,half of all heart attacks and newly-diagnosed cases of cardiovascular disease occur in people with normal or even low levels of LDL (the “bad” cholesterol).

Recent studies suggest that statins – drugs that are used to lower cholesterol – seem to benefit some people whose cholesterol levels are already low, but who exhibit signs of inflammation within their blood vessels. (1)

These findings imply that some other mechanism besides cholesterol – one that might be addressed through lifestyle changes or some other non-statin means – plays a significant role in the generation of coronary artery disease.

The National Cholesterol Education Program, the Framingham Heart Study, and Faulty Cholesterol Guidelines

For doctors who have tried to follow the recommendations of influential bodies like the National Cholesterol Education Program (NCEP) and whose practice protocols are based on data from the Framingham Heart Study (arguably the longest, most comprehensive, and most respected analysis of heart disease in the world) the news of cholesterol’s demotion must be sobering.

It is understandable that the Framingham Study is the yardstick for measuring a given individual’s risk for developing cardiovascular disease; after all, this longitudinal trial has been generating valuable information since 1948.

Unfortunately, despite the statistical power of the Framingham Study, it remains, in fact, a conglomeration of numbers – susceptible to mathematical manipulation and open to disparate interpretation.

For example, Framingham’s outcomes form the basis for the “treat-to-target” rationale used by most physicians to prevent heart disease in their patients. This concept, which is practically the standard of care in the United States, mandates the reduction of LDL cholesterol levels (almost always through the aggressive use of statin drugs) to below 70 mg/dL for people who are at high risk for coronary artery disease, and to less than 130 mg/dL for people who are not at high risk.

Such a reduction in LDL cholesterol usually parallels a reduction in total cholesterol, often to less than 160 mg/dL. Oddly enough, many medical experts, including John Abramson, MD, a Robert Woods Johnson Fellow, medical statistician, faculty member at Harvard Medical School, and author of Overdosed America, the Broken Promise of American Medicine, believe that lowering total cholesterol to such levels actually increases the risk of death from causes other than heart disease for both men and women after they reach the age of 50. (2)

Allan Spreen, MD, a panelist for the Health Sciences Institute, contends that Framingham data show that when total cholesterol levels fall below 160 mg/dL, the incidence of heart disease once again increases, indicating that the benefits from cholesterol reduction bottom out around that point.

Furthermore (and somewhat chillingly), the recommendations of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults – whose guidelines are incorporated into the NCEP – were promulgated by a group of individuals whose decisions may have been influenced by their relationships with statin-manufacturing pharmaceutical firms: Five of the 14 panel members who wrote the guidelines – including the panel chair – disclosed financial ties to these companies. (2)

Thus, it is possible that cholesterol guidelines disseminated to American physicians and their patients have been more intent on promoting greater statin use than on presenting a balanced interpretation of the science that surrounds heart disease.

Finally, to further reinforce the notion that doctors must rethink the cholesterol issue, a new study from Annals of Internal Medicine supports what some experts now believe is the best approach to preventing coronary artery disease.

In this trial, Dr. Rodney Hayward and his associates demonstrated that a “tailored” approach, where fixed doses of statin medications are administered based on an estimate of a patient’s net benefit, is far superior to simply increasing a patient’s statin doses to achieve a targeted cholesterol level. In fact, the research team could find no circumstances under which “treat-to-target” therapy was preferable to a tailored approach. (3)

Alas, it seems that addressing the modifiable risk factors for heart disease (smoking, obesity, sedentary lifestyles, poor diet, etc.) may once more become vogue; the days of simply pouring statins into a patient to reach an arbitrary and hitherto magical cholesterol level may be numbered.

Lung Diseases – Restrictive vs Obstructive Types: How are COPD and IPF Different from Each Other?

COPD is Chronic Obstructive Pulmonary Disease. IPF is Idiopathic Pulmonary Fibrosis. Nearly 30 million Americans suffer from one of these major lung diseases.

Respiratory diseases count for about one in seven deaths every year. Interstitial lung disease affects five million people in the world annually; other major lung diseases include cystic fibrosis, tuberculosis, mesothelioma, sarcoidosis, and pulmonary hypertension.

What is a Lung Disease?

Any disorder that affects one’s ability to breathe, including lung cancer, which results in a nagging cough, shortness of breath, pain in the chest and a decrease in one’s ability to perform any significant exertion, is a lung disease.

Definitions of Restrictive and Obstructive Lung Disorders

When the airways of the lungs become narrow or are blocked so that one cannot exhale completely, the disorder is defined as “obstructive.” Chronic Obstructive Pulmonary Disease (COPD), which includes chronic bronchitis and emphysema, and asthma are considered obstructive lung diseases. Generally these are caused by inflammation in the airways.

When the lungs have lost tissue or the cells stiffen due to invasive environmental factors, the lungs lose their ability to expand on inhalation. They are restricted, and the term “restrictive” is applied to the disease. Lung cancer is a restrictive lung disease as are pulmonary fibrosis (PF) and pneumonia. This eventually impairs the body’s ability to transfer oxygen into the bloodstream.

“Interstitial” refers to any restrictive disease of the air sacs around the lung cells. Interstitial Lung Disease (ILD) was a synonym for IPF but now is used as an umbrella term which includes IPF.

Thus, an obstructive lung disease prevents proper exhalation, and a restrictive lung disease prohibits proper inhalation. Someone with obstructive lung disease can take a full deep breath, but cannot exhale it completely (risking the retention of carbon dioxide in the bloodstream and further inflammation of the airways). A person with restrictive lung disease cannot take a deep breath but has no difficulty exhaling all that he does inhale. As his disease progresses, the lung tissue stiffens in greater amounts and the capacity to hold oxygen in the lungs diminishes steadily. Less and less oxygen is supplied to the body’s organs.

Differences Between Two Types of Lung Disease

COPD is characterized by heavy mucus production and a constant loose cough. Effective treatments include prescribed inhalants using handheld inhalers, nebulizers or other forced-air equipment. As the disease progresses, supplemental oxygen may be used to assist the active patient. There is no cure for these diseases; current treatments can enable the patient to continue a fairly active lifestyle for a number of years.

Pulmonary Fibrosis (referred to as IPF if it is “idiopathic,” or has no known cause) does not produce mucus, nor is it helped by inhalants to clear obstructed airways. Many patients experience a dry cough which becomes extremely debilitating. Other symptoms include increasing demands for supplemental oxygen and a decline in ability to perform daily living tasks. Lung capacity diminishes to as little as 11% of normal, and oxygen requirements can exceed 12 liters per minute (unlike COPD oxygen requirements which seldom exceed 2 liters per minute in most patients.)

A standard of treatment used to be giving the patient high doses of prednisone (a steroid) to halt further progression of scarring thought to be caused by an inflammation. However, prednisone treatment is successful in a smaller percentage of patients than previously thought, and its side effects are so damaging to the body that many health professionals feel prednisone is no longer the preferred choice of treatment. Drug trials have been conducted for many years to find a more successful treatment for IPF, including pirfenidone, which is currently awaiting FDA approval following a series of favorable trials. At present, however, there are no known drugs that successfully treat IPF and the only “cure” available is lung transplant. Progression of the disease is usually more rapid than with COPD.

Differencesmay be Confusing

Since the greater number of lung disease cases tend to be obstructive, such as asthma and COPD, many healthcare professionals are ill-prepared to treat restrictive diseases such as IPF. There is a tendency, unfortunately, to assume that those treatments that succeed with COPD will also work for IPF. Consequently, IPF patients are often taught “pursed-lip exhalation” in which one forces the exhaled breath out between tightly pursed lips. This is a useless strategy for anyone who has no difficulty exhaling but can’t inhale sufficiently.

Other misguided treatments include prohibiting IPF patients from having greater amounts of supplemental oxygen than 2 lpm, because “the patient might become dependent on it” or “it will damage the lungs.” COPD patients do have issues with high-flow supplemental oxygen, but patients with restrictive lung diseases need all the oxygen they can get. Loss of oxygen to the brain, to the extremities, and to other vital organs can seriously affect quality of life and will hasten death.

Preventing Lung Disease

The most obvious preventive strategy is never to smoke. Quitting is the number one health measure to prevent lung disease. Other measures include maintaining a healthy diet, keeping active with cardiopulmonary exercise, and avoiding exposure to such environmental triggers as asbestos, second-hand smoke, and air pollution. Some lung disorders are inherited, so be aware of family history and prepare accordingly to keep one’s lungs as healthy as possible.

If anyone begins to experience symptoms such as unexplained fatigue, shortness of breath on exertion, or a persistent nagging cough, he or she should see his physician as soon as possible. Treatment at the earliest stages of lung disease will prolong life and extend one’s quality of life immeasurably.

Treatment and Symptoms of Gestational Diabetes: Managing and Controlling Diabetes During Pregnancy

Symptoms, complications and risk factors associated with gestational diabetes. Treatment involves a carefully controlled diet and regular exercise.

Gestational diabetes is a type of diabetes that occurs in pregnant women. Unlike type I and type II diabetes, gestational diabetes goes away once the baby is born. However, in some women, blood glucose levels remains high even after giving birth and they develop type II diabetes.

Insulin Resistance and Gestational Diabetes

The digestive system in the human bodies breaks down food into glucose. The cells in turn consume glucose to produce energy. A hormone called insulin helps in moving the glucose from the intestine into the cells through blood.

In pregnant women, hormones from the placenta interfere with the action of insulin. This is called insulin resistance. In most women, the pancreas produces enough insulin to overcome the insulin resistance. In some pregnant women, the production of insulin is not adequate to overcome insulin resistance and this leads to gestational diabetes.

Symptoms of Gestational Diabetes

According to the American Diabetes Association, about 4% of all pregnant women are affected with GD. Though most women do not show any symptoms, some women may show excessive weight gain or may experience excessive hunger or thirst or excessive urination.

Risk Factors

Some women are more at risk for developing diabetes during pregnancy. Some of the risk factors are:

  • obesity or overweight
  • diabetes during a previous pregnancy
  • family history of diabetes
  • age over 30
  • race- African Americans, Asians, Latinos and Native Americans are more likely to develop gestational diabetes than Caucasians.
  • having previously given birth to a large child
  • having given birth to a baby who died at birth or shortly after birth

Treatment of Gestational Diabetes

Since the diabetes goes away once the baby is born, treatment for gestational diabetes aims to keep the blood glucose levels at normal levels. This is achieved by following a diet plan (provided by a doctor or registered dietitian), regular exercise, careful monitoring of blood glucose levels and in some cases through medication.

Complications of Gestational Diabetes

When the diabetes is poorly controlled, the high blood sugar levels in the mother’s blood can pass through the placenta into the baby and this causes the baby to grow very large. A very large baby can cause problems at birth and some women may need a C-section.

During pregnancy, the baby’s body makes more insulin to control the high glucose levels. If the pregnant woman has high glucose levels in the blood just before giving birth, the baby’s body compensates by making extra insulin. After birth, this extra insulin can cause the baby’s glucose levels to drop too low, causing hypoglycemia.

Babies of diabetic mothers are slightly more at risk for stillbirth. Jaundice and respiratory difficulties are some other problems found in babies of women affected with gestational diabetes.

The Four Phases of Alzheimer’s Disease: Read More about this Disease

Alzheimer’s disease most often occurs after the age of 65 and progresses through four phases of thought and physical deterioration.

Research is ongoing and weekly headlines outline new theories and discoveries but the cause for Alzheimer’s disease has not been defined. There is no permanent cure and very little besides the standard rule to eat well, exercise, and strive to stay mentally active are given as preventative measures.

What has been established however, is the pattern of decline in cognitive and physical abilities. Although the progression is different for each individual, seven years is the average life expectancy after diagnosis. Alzheimer’s disease has four defined stages.

More about the Four Phases of Alzheimer’s

Predementia is the first definable stage. The difficulty to remember recently learned information is probably the most noticeable display of failing brain function. A variety of small struggles with planning, abstract ideas and attentiveness can be witnessed in the course of daily living during this early stage of the disease.

The inability to remember the meaning of words and understanding the relationship between concepts are also symptoms of predementia. It is in this stage that apathy is first seen in patients.

Early dementia is when the patient’s impairment meets the clinical definitions and measurements of Alzheimer’s disease. Individuals can still take care of most tasks by themselves, but do need help with activities involving decision making. Memory issues and difficulty executing a series of movements become more apparent in this stage.

Language skills begin to suffer as the patient’s vocabulary gets smaller but can still communicate basic thoughts. It is not understood when and what memory areas the disease will effect, since Alzheimer’s disease does not impact all areas of the brain equally in a predictable manner.

More on the Phases of Alzheimer’s

The name “moderate dementia” is misleading as it is in this phase that an individual’s independence is lost. Speech, reading, writing and gross motor skills deteriorate progressively. The patient may no longer recognize family or friends and long term memory begins to fade.

Behavioral and mental disorders that must be dealt with include: uncontrolled laughing or crying, sudden aggressive outbursts, wandering, and sundowners syndrome. Extensive caregiving is required.

Advanced dementia is the final and heartbreaking stage of Alzheimer’s disease. Bedridden, and eventually completely without speech, patients can sometimes only communicate through emotional signaling. Apathy and extreme fatigue usually replace the aggressive behaviors displayed previously.

Patients literally wither away and most often expire from some other medical condition. Alzheimer’s disease is very seldom the sole cause of death itself.