How to Prevent Stroke in Women?…Walking

Posted on April 25, 2010 by wngai
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If you are a woman and will like to reduce your risk of stroke, you might like to walk at least 2 hours a week, especially at a brisk pace.

According the long-term follow-up of the Women’s Health Study (WHS) that involved 39,315 healthy US women 45 years and older and followed up for 12 years, women who walked 2 hours or more per week had a 30% lower risk for any stroke than women who did not walk.  Furthermore, women who walked at a brisk pace (>4.8 km/hour) had a 37% lower risk for any stroke than women who did not walk.

At baseline, women were asked to estimate the average time spent on 8 groups of recreational activities during the past year: walking or hiking; jogging; running; bicycling; aerobic exercise; aerobic dance; use of exercise machines; tennis, squash, or racquetball; lap swimming; and lower-intensity exercise, including yoga.  They were also asked about their walking pace.

The patients were stratified into different groups: those who do not walk regularly and those who walk at a pace of less than 3.2 km/hour, 3.2 to 4.7 km/hour (considered to be an average pace), 4.8 to 6.3 km/hour (considered to be brisk pace), or 6.4 or more km/hour (a striding pace).

After a follow-up of 13 years, the investigators found an inverse relationship between the amount of time spent walking and decrease in stroke.

Table 1. Stroke Risk According to Time Spent Walking at Baseline and at 3 Years of Follow-Up

Time spent walking at baseline/at 3 years (hours per week) <2/<2 <2/≥2 ≥2/<2 ≥2/≥2
Total stroke, No. of cases 117 29 26 31
Ischemic stroke, No. of cases 98 28 19 26
Hemorrhagic stroke, No. of cases 19 1 7 5

The WHS was supported by grants from the National Institutes of Health.

Stroke. Published online April 6, 2010.

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Another Option in the Second Line Treatment of Patients with Advanced Non-Small-Cell Lung Cancer (NSCLC)

Posted on April 25, 2010 by wngai
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Docetaxel(Taxotere) has long been considered the standard of care for second-line treatment of advanced NSCLC.  However, the disadvantage of using this agent include the need to administer it with corticosteroid premedication and its toxicity profile

A new study published in the March 29 version of the Journal of Clinical Oncology indicated that vinflunine(Javlor) was as efficacious as docetaxel in treating patients with advanced non-small-cell lung cancer (NSCLC).  Even though vinflunine had higher rates of certain side effects, the drug’s overall toxicity profile was manageable.

The study randomized 551 patients with stage III/IV NSCLC who had progressive disease after first-line therapy with a platinum-containing regimen to receive either vinflunine or docetaxel until disease progression or toxicity.

Median progression-free survival was 2.3 months in both the vinflunine and docetaxel arms while the median overall survival rates were 6.7 and 7.2 months with vinflunine and docetaxel, respectively.

Quality-of-life scores which included the percentage of patients who used analgesics during treatment and treatment compliance were also similar in the two groups.

Adverse effects such as injection-site reactions, abdominal pain, neutropenia, leukopenia, constipation, vomiting or alopecia, however, were observed more frequently with the vinflunine group.

Nonetheless, the investigator suggested that vinflunine may be another option to docetaxel in the 2nd treatment of patients with advanced NSCLC since most of the adverse effects observed with vinflunine were manageable.

J Clin Oncol 2010.

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Dietary Pattern that Cuts the Risk of Alzheimer’s disease

Posted on April 25, 2010 by wngai
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According to a new study published in the April 12 issue of the Archives of Neurology, individuals who consume a diet rich in nuts, fish, poultry, vegetables, fruits, and olive oil–based salad dressings but low in high-fat dairy products, red meat, organ meats, and butter have a reduced risk for Alzheimer’s disease.

Dr. Gu and her colleagues studied a cohort of 2,148 elderly subjects 65 years and older who were freed of dementia at the study entry.  All subjects were asked about their dietary patterns via questionnaire, and were evaluated every 1.5 years for an average of 4 years on standardized neurologic and neuropsychological measures.

During the follow-up of 4 years, 253 individuals developed Alzheimer’s disease. The investigator, however, found that one dietary pattern — characterized by higher intakes of salad dressing, nuts, fish, tomatoes, poultry, cruciferous vegetables, fruits, and dark and green leafy vegetables and a lower intake of high-fat dairy products, red meat, organ meat, and butter — was significantly associated with a reduced risk for Alzheimer’s disease.

Compared with subjects who adhered to other dietary patterns, subjects who strictly adhered to this dietary pattern were 38% less likely to develop Alzheimer’s disease.

This dietary pattern is rich in ω-3 and ω-6 polyunsaturated fatty acids, vitamin E, and folate but poor in saturated fatty acids and vitamin B12,

Before this study, other studies have also shown that fruits and vegetables and unsaturated fatty acids are associated with a lower risk of Alzheimer’s disease.

The study was supported by federal National Institute on Aging grants.

Arch Neurol. Published online April 12, 2010.

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Pradaxa eliminates the need to monitor INR in Atrial Fibrillation patients

Posted on April 25, 2010 by wngai
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Good news for atrial fibrillation (AF) patients who require taking warfarin to prevent stroke.  It is well known that routine blood monitor and food interaction represent major hassles for patients taking warfrin.

However, a new drug, Pradaxa (dabigatran), might be able to provide the same protection as warfarin without the need of blood monitoring and food interaction in AF patients, according to research findings presented at the American Stroke Association’s International Stroke Conference.

The findings were based on an analysis of a subgroup of 3623 patients from the RE-LY trial, randomized patients to receive either warfarin, a low dose of Pradaxa twice a day, or a higher dose of Pradaxa twice a day, for a median of two years.

At the end of the study, there were not differences in the incidence of stroke or clot between any of the Pradaxa and warfarin group.  Stroke or clot in other blood vessels occurred in 55 patients on low-dose Pradaxa, 51 patients on high-dose Pradaxa and 64 patients on warfarin.  However, patients who were treated with the lower dose of Pradaxa were 32-percent less likely to experience a major bleeding event than those treated with wafarin.

Besides being an effective and safer anticoagulant, Pradaxa does not interact with other foods and does not require routine blood monitoring.  In other words, patients who take Pradaxa are free to take any food they like and they do not require to visit their physicians on a regularly basis for blood test.

Pradaxa is currently approved in some countries for the primary prevention of blood clots in patients who have undergone elective total hip or total knee replacement surgery. It use, however, has not been approved in the US.

American Stroke Association’s International Stroke Conference 2010

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Chinese Scientists Uncover How Arsenic Treats Blood Cancer

Posted on April 25, 2010 by wngai
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In China, arsenic has long served the dual role of intentional poison as well as traditional Chinese medicine. 

In 1992, a group of Chinese doctors reported they have successfully used arsenic to treat acute promyelocytic leukemia (APL), with cure rates as high as 90%. 

In a paper published in the April 9th issue of Science, Dr. Zhang and his team reported for the first time how arsenic attacked specific proteins that keep cancer cells alive and well in APL patients

According to the published paper, arsenic promotes degradation of an oncogenic protein that drives the growth of APL cells.

The researchers are now investigating whether arsenic can also be used to treat other cancers.  They believed arsenic is a better drug than chemotherapy due to its moderate its side-effects.  There is no hair loss or suppression of bone marrow function in patients treated with arsenic.

Although there are some countries currently using arsenic to treat APL, most countries are resistant to the idea due to its toxicity profile.  However, a commentary written by Dr. Scott Kogan at the University of California San Francisco indicated that proper case selection and combination therapy with arsenic may improve outcomes for treating not only promyelocytic leukemia, but other diseases as well.

Science 2010;328:240-243.

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Pancreatic cancer – Causes, Prevention, Prognosis, Diagnosis and Latest Treatment

Posted on April 17, 2010 by wngai
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Prevalence

Pancreatic cancer is the fourth most common cause of adult cancer death, accounting for an estimated 42,470 new cases and 35,240 deaths in USA for 2009.  The high mortality rate is due to the high incidence of metastatic disease at initial diagnosis, the aggressive clinical course and the failure of current therapies. 

Causes

It is not clear what causes pancreatic cancer, but some risk factors have been linked to the disease.  Modifiable risk factors that have been associated with pancreatic cancer include:

Smoking: Smokers have 2 to 3 times higher risk of getting pancreatic cancers.. About 2 to 3 out of 10 cases of pancreatic cancer are thought to be caused by smoking.

  • Obesity and lack of exercise: Overweight people and those who don’t get much exercise are more likely to develop pancreatic cancer.
  • Diabetes: Patients with type 2 diabetes have an increase risk of getting pancreatic cancer.
  • Chronic pancreatitis: Some patients with chronic pancreatitis develop pancreatic cancer
  • Cirrhosis of the liver: People with cirrhosis due to hepatitis and alcohol consumption seem to have an increased risk of pancreatic cancer.
  • Work exposure: Heavy exposure to certain pesticides, dyes, and chemicals may increase the risk of getting pancreatic cancer.
  • Stomach problems: Having too much stomach acid or having bacteria called H. pylori in the stomach may increase the risk of pancreatic cancer.

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Coffee may reduce the risk of becoming diabetes

Posted on April 16, 2010 by wngai
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Good news for coffee drinkers.  A study published in the March issue of the American Journal of Clinical Nutrition indicated that coffee consumption could reduce subclinical inflammation and oxidative stress, as well as increase in HDL-cholesterol levels. 

Since subclinical inflammation and oxidative stress have been linked to the development of type 2 diabetes, the results also suggested that long term coffee consumption can cut the risk of developing type 2 diabetes.

In this study, 47 habitual coffee drinkers were asked to stop drinking coffee for one month, then drank four cups of coffee per day, followed by eight cups of coffee daily in the second month. All subjects were younger than 65 years of age, but with an increased risk of developing diabetes based on a diabetes risk score.

After the two months of drinking coffee, the researchers found that all subjects experienced a significant decrease in markers of subclinical inflammation, including interleukin-18 (a known risk factor for type2 diabetes) and adiponectin, but no increases in C-reactive protein (CRP) levels. Markers of oxidative stress, on the other hand, were significantly reduced.

The researchers also found an increase of total-cholesterol levels by 12% after 2 months of drinking coffee.  However, apolipoprotein A1 land HDL-cholesterol levels were also increased (by 7%).

Kempf K.  Am J Clin Nutr 2010-04-10

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High-Protein, Low-Carbohydrate Diet – a viable option for Obese Teens to lose weight

Posted on April 15, 2010 by wngai
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Fear that a high-protein, low-carbohydrate diet could adversely affect the growth and cholesterol level; parents have few option to help their kids to lose weight. 

A study published in the March issue of the Journal of Pediatrics, however, shed light that a high-protein, low-carbohydrate diet can be a safe and effective option to lose weight.

The researchers randomized 46 severely obese teenagers to eat either a high-protein, low-carbohydrate diet or a low-fat diet for 13 weeks. The teenagers were 14 years old and were at least 175% above ideal weight.

At the end of the study, those who took high-protein, low-carb diet lost 29 pounds while those on the low-fat diet lost only 16 pounds. Most importantly, both groups were able to maintain the weight loss 9 months later.  

The high-protein, low-carbohydrate diet appeared to be safe, with no serious harmful effects on growth, bone mineral density and cholesterol levels. In fact, LDL cholesterol declined but HDL cholesterol increased.

The study was funded by the National Institutes of Health and the National Cattlemen’s Beef Association.

Source: J Pediatr 2010.

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Vitamin K Intake Cut Cancer Risks

Posted on April 14, 2010 by wngai
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A study published in the March 24th issue of the American Journal of Clinical Nutrition suggested that higher dietary intake of vitamin K may reduce the incidence of cancer and cancer-related mortality, particularly lung or prostate cancers.

Vitamin K exists in two natural forms: vitamin K1, or phylloquinone, found in green leafy vegetables and vegetable oils, such as canola and soybean oils; and vitamin K2, or menaquinone, found mostly in meat and cheese.

The researchers collected the dietary data on 24,340 German adults and followed them for 10 years on the incidence cancers.

The results of the study indicated that vitamin K2 was linked to a reduce risk of developing or dying from cancer, whereas vitamin K1 was not.  In particular, subjects in the highest quartile of vitamin K2 intake were 28% less likely to have died of any one of the cancers, especially lung and prostate cancers, than those in the lowest quartile.

Since this was an observational study, the investigator could not fully confirm that the observed reduction in cancer risk is entirely due to vitamin K2 and not to the other components inside the food that contained vitamin K2.

Future studies are required to evaluate the relationship between people’s blood levels of vitamin K and levels of cancer risks.

In the U.S., the recommended daily intake for vitamin K, in all forms, is 120 ug for men and 90 ug for women. In the current study, men in the highest quartile got 92 ug/day or more; their female counterparts got at least 84 ug/day.

Am J Clin Nutr 2010.

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Omega-3 PUFAs prevent arrhythmia after cardioversion

Posted on April 13, 2010 by wngai
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Patients who are at high risk of atrial fibrillation (AF) recurrence after electrical cardioversion are more likely to stay in sinus rhythm if they take an omega-3 polyunsaturated fatty-acid (PUFA) supplement on top of standard antiarrhythmic therapy, according to a randomized, placebo-controlled trial presented at the American College of Cardiology 2010 Scientific Sessions.

The study randomized 200 patients who had AF persisted for at least one month despite therapy with amiodarone and either ACE inhibitors or angiotensin receptor blockers (ARBs) to receive either placebo or 1 g/day omega-3 PUFA in addition to the other drugs after electrical cardioversion.

The omega-3 PUFA supplement contained eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) ethyl esters in an average ratio of 0.9 to 1.5.

Patients were also monitored on their warfarin levels to achieve an international normalized ratio (INR) between 2 and 3.

At the end of the year, patients who took omega-3 PUFA on top of anitarryhtmic agents required fewer shocks (144 vs. 169, p<0.001) and lower shock energies (1.21 vs. 1.76, p<0.001) for successful cardioversion.  Also, more of them were in sinus rhythm after cardioversion (59% vs. 34.3% in 12 months, p<0.0002).

Table 1.  Cardioversion requirements by treatment group

Parameter Placebo, n=99 Omega-3 PUFA, n=100 p
Mean energy for cardioversion (J) 169 144 <0.001
Mean number of shocks required 1.76 1.21 <0.001

Table 2.  Time to first AF recurrence (primary end point) and rate of maintained sinus rhythm (secondary end points) in omega-3 PUFA and placebo groups, by intention to treat

End point Placebo, n=99 Omega-3 PUFA, n=100 p
Time first recurrence (d)      
Mean 139 168 <0.001
Median 112 156 <0.001
Rate of maintained sinus rhythm (%)      
1 mo 88 94 0.082
3 mo 70 84 0.031
6 mo 49.5 73.0 0.004
12 mo 34.3 59 0.0002

In multivariate analyses, patients who took omega-3 PUFA therapy were associated with a 57% reduced risk of AF recurrence after cardioversion. The benefit was independent of age, AF duration, and whether the patient had diabetes.

American College of Cardiology 2010 Scientific Sessions.

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