j’s blog

April 10, 2005

Poor Blood Pressure Control Ups Stroke Risk

Category: Hypertension

MedlinePlus: Poor Blood Pressure Control Ups Stroke Risk

NEW YORK (Reuters Health) - About half of all first-time strokes in patients being treated for high blood pressure result from the pressure not being adequately controlled, Swedish researchers report. Older age, diabetes, and smoking also raise the risk of stroke in these patients.

The study, published in the medical journal Stroke, included nearly 28,000 men and women aged 45 to 73 living in Malmo.

Sixty percent of patients had high blood pressure, but only 23 percent of them were being treated. Moreover, among those receiving treatment, nearly 90 percent had pressures above recommended limits, according to Dr. Cairu Li of Malmo University Hospital and colleagues.

Two-thirds of patients with inadequately controlled blood pressure were on single-drug regimens, the researchers note, with beta-blocker type drugs being the most commonly used overall.

During follow-up, which averaged six years, 137 strokes occurred among the patients with high blood pressure. The researchers found that 45 percent of the stroke risk could be attributed to inadequately controlled blood pressure.

While there were only minor initial differences in survival between patients with controlled or poorly controlled blood pressure, these differences increased over time.

“Adequate (blood pressure) control may prevent a substantial proportion of first-ever stroke among” patients treated for high blood pressure, the researchers conclude.

SOURCE: Stroke, April 1, 2005.

NT-proBNP: Testing Elders’ Blood for Heart Disease

Category: Heart Health

Testing Elders’ Blood for Heart Disease
High Levels of a Protein Could Predict Death, Heart Trouble

By Miranda Hitti
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Tuesday, April 05, 2005

April 5, 2005 — A blood test could help predict heart disease in older adults even after taking into account more traditional risk factors.

The key blood chemical may change with age, according to a new study in The Journal of the American Medical Association.

Could the findings lead to a new heart disease blood test for senior citizens? Perhaps, but more work is needed first, write the researchers, who included Caroline Kistorp, MD, of Denmark’s Frederiksburg University Hospital.

Heart disease is a leading cause of death for U.S. men and women. It hits older adults especially hard.

About 84% of heart disease deaths occur in people aged 65 and older, according to the American Heart Association (AHA). Similarly, about 88% of stroke deaths strike people aged 65 or older, says the AHA.

Probing the Blood to Predict Heart Trouble

In middle-aged people, high blood levels of the inflammatory marker known as C-reactive protein have been linked to heart problems. But a few decades from now, another blood marker may be more important, say Kistorp and colleagues.

For adults aged 50-89, another protein was a better predictor of heart disease than C-reactive protein, says Kistorp’s study.

The protein studied was called NT-proBNP. Besides beating C-reactive protein as a heart disease predictor, it also surpassed another marker of heart disease — urine protein levels.

Tracking Heart Disease

Results came from 626 people in Copenhagen. Virtually all were white, which is one reason why Kistorp’s team says further, more diverse tests are needed.

At the study’s start, none had heart or kidney failure, and 537 had no history of heart disease. The participants gave blood and urine samples for screening and were followed for five years.

During the study, 94 people died of any cause and 65 had a first major cardiovascular “event.” Those included a nonfatal heart attack, stroke, heart failure, chest pain (unstable angina), coronary heart disease, and transient ischemic attacks (ministroke).

Participants with the highest blood levels of NT-proBNP were at higher risk of heart disease deaths and heart problems, including heart attack and stroke, than those with the lowest levels.

The increased risk of heart disease continued to exist even after the researchers took into account traditional risk factors for heart disease, such as smoking and being overweight.

Earlier Findings

In 2003, other researchers reported that another inflammatory marker, interleukin-6, was a better predictor of heart disease, stroke, and heart failure in a three-year study of 2,225 people in their 70s.

That study didn’t cover the type of protein studied here, but the researchers said they thought C-reactive protein might not be as closely tied to cardiovascular events in older people. That study appeared in the November 2003 edition of the journal Circulation.

SOURCES: Kistorp, C. The Journal of the American Medical Association, April 2, 2005; vol 293: pp 1609-1616. News release, JAMA/Archives. American Heart Association. WebMD Medical Reference from Healthwise: “Transient Ischemic Attack (TIA) — Topic Overview.” Cesari, M. Circulation, Nov. 2003; vol 108: pp 2317-2322. News release, American Heart Association (2003).

Vigorous Activity Cuts Arthritis Disabilities

Category: Arthritis, Exercise

Vigorous Activity Cuts Arthritis Disabilities

Inactivity Nearly Doubles Loss of Physical Function Among Seniors With Arthritis

By Miranda Hitti
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Thursday, April 07, 2005

April 7, 2005 — Older adults with arthritis who do their best to get regular, vigorous physical activityarthritis who do their best to get regular, vigorous physical activity have an advantage over those who are sedentary.

“Lack of regular, vigorous physical activity … almost doubled the odds of functional decline after controlling for all risk factors,” says a study in April’s issue of Arthritis & Rheumatism.

If everyone in the study had gotten enough activity, decline in physical function could have been as much as 32% lower, the researchers estimate.

“Older persons with chronic conditions need to be encouraged to participate in physical activities, regardless of their current capabilities,” they write.

Arthritis and other rheumatic conditions are the leading causes of disability in the U.S., says the study. Nearly 60% of U.S. adults aged 65 and older have arthritis, and 10% of them say their daily activities are limited, the researchers note.

Trouble With Daily Life

Arthritis can be painful, and that may understandably make some patients want to avoid physical activity.patients want to avoid physical activity. But the new study says that’s not always a great idea.

More than 5,700 people with arthritis participated. All were at least 65 years old.

At the study’s start, nearly one in five said their physical function was limited, and some 13% had trouble with activities of daily life. Almost 6% said they had trouble with two or more activities, while twice as many reported problems with three or more daily tasks.

Men, Whites More Active

Many participants said they weren’t very active, but women and minorities were more likely to fall into that category.

Women were more likely than men to say they had a hard time with daily activities.

About 68% of women said they didn’t get regular, vigorous activity, compared to 57% of men. Among minorities of either sex, the rates were 73% for blacks, 70% for Hispanics, and 63% for whites or people of other races.

After two years, 14% of at-risk participants reported declines in physical function. That included 15% of all women in the study, 18% of Hispanics, and nearly 19% of black participants.

After evaluating various potentially unhealthy behaviors, the researchers found that lack of regular, vigorous physical activity nearly doubled the risk of functional decline. Almost two-thirds of the participants did not get regular physical activity.

More Problems 2 Years Later

The biggest predictor of limitations in daily activities was lack of regular vigorous physical activity. A decline in mental skills also predicted physical limitations in daily activity.

“Function declined less frequently in persons who engaged in regular, vigorous physical activity, regardless of their baseline ability,” write the researchers, who included Dorothy Dunlop, PhD, of Northwestern University’s medical school.

In other words, being as active as possible was beneficial. Health care providers can help design a plan to do that safely.

Lack of regular physical activity is a potentially modifiable risk factor which could substantially reduce functional decline and health care cost, they conclude.

SOURCES: Dunlop, D. Arthritis & Rheumatism, April 2005; vol 52: pp 1274-1282. News release, John Wiley & Sons, Inc.

Mediterranean Diet Linked to Longer Life

Category: Nutrition, Exercise

Mediterranean Diet Linked to Longer Life

Researchers Recommend Diet Low in Meat and Dairy, High in Fruits and Veggies

By Salynn Boyles
WebMD Medical News Reviewed By Michael Smith, MD
on Thursday, April 07, 2005

April 7, 2005 — There is more evidence that eating like a villager on the Isle of Crete can help you live longer.

A study examining eating patterns in nine European countries found that people who ate a traditional Mediterranean diet lived longerpeople who ate a traditional Mediterranean diet lived longer than those who didn’t.

Researchers say a healthy man of 60 who follows the diet, which is rich in fruits and vegetables and low in meat and dairy, can expect to live a year longer than a man of the same age who doesn’t follow the diet.

“A year may not sound like much to some people,” study researcher Dimitrios Trichopoulos, MD, PhD, tells WebMD. “But I’m in my mid 60s, and it sounds pretty good to me.”

Living to 100

Physiologist Ancel Keys was both the world’s best-known champion of the Mediterranean diet and its best advertisement.

Keys was the first to notice, more than half a century ago, that heart disease was rare in Mediterranean areas like Greece and southern Italy, where olive oilolive oil and red winered wine were dietary staples and people ate plenty of fruits and vegetables.

Keys died late last year at the age of 100, still active and doing nutrition research until the last few years of his life.

In an interview with WebMD in 2000, he lamented the fact that the typical meat, cheese, and pasta-heavy dishes Americans encounter in Italian restaurants have little in common with traditional Mediterranean fare.

“The Mediterranean diet was nearly vegetarian, with fish and very little meat, and was rich in green vegetables,” he said, adding that something got lost in the translation from Italy to the U.S. “They may call it Italian, but it’s very different from the food we studied.”

Eating Mediterranean

The newly published study involved more than 74,000 healthy men and women aged 60 and older living in Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, and the United Kingdom.

Study participants were asked about their diets, medical and smoking histories, exercise patterns, and other relevant health information. Researchers measured how closely they stuck to a Mediterranean-style diet using a special scale developed by the researchers. The findings are reported in the April 8 issue of the British Medical Journal.

Eating a Mediterranean diet was linked to a longer life. The largest association was seen in Greece and southern Italy, where people stuck more closely to the diet.

Mediterranean Diet: More Than Olive Oil

Trichopoulos says there is no single component of the Mediterranean diet that holds the key to longer life. Though the mantra of Mediterranean eating could be “olive oil good, saturated fats bad,” there is more to it than that.there is more to it than that.

“In this case, the total is better than the sum of the parts,” he says. “You can’t point to one thing and say that is what does it.”

People who follow traditional Mediterranean diets:

* Eat mostly plant foods, including fruits, vegetables, beans, whole grains, and nuts.
* Eat fish often but eat other animal-based foods such as red meat, poultry, and dairy sparingly.
* Drink alcohol in moderation — no more than one drink a day for women and no more than two drinks a day for men. While many believe that red wine offers health advantages over other forms of alcohol, Trichopoulos says that is still not clear. One drink equals 1.5 ounces of liquor (whiskey, gin, vodka, etc.), 5 ounces of wine, or 12 ounces of beer.
* Don’t limit fat consumption, as long as fats are derived from plants, not animals, and are not overly refined. Trichopoulos says olive oil is the best fat, but canola and soybean oils are also good.

Going to Extremes

Trichopoulos says the current mania for low-carbohydrate eating in the U.S. incorporates some elements of Mediterranean eating but not others.

“Americans tend to go to extremes when it comes to eating, and right now they hate carbohydrates and love protein,” he says. “Lowering carbohydrates is probably a good thing, but too much meat-based protein is not.”

Nutrition researcher Alice Lichtenstein, DSc, is a strong proponent of Mediterranean eating. But she worries that people will lose sight of the fact that there is more to good health than what you eat.

“Two-thirds of Americans are overweight or obese,” she says. “If everyone adopted this diet but did not change anything else, it is unlikely that they would reap the benefits.”

In other words, getting regular exercise and limiting calories, no matter what form they come in, is just as important as following a particular diet.

“There is no simple fix,” she says. “You really have to think about the whole package. Not just what you are eating, but how much you are eating and whether you are moving. There are no shortcuts to good health.”

SOURCES: Trichopoulos, A. British Medical Journal, April 8, 2005; online edition. Dimitrios Trichopoulos, department of epidemiology, Harvard School of Public Health, Boston. Alice Lichtenstein, DSc, senior scientist and director, Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center of Aging, Tufts University, Boston. WebMD Feature: “Setting the Recipe Straight: Forget Pasta if You Want Real Mediterranean Food.”

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