Reducing your stroke risk…because I care

stroke-1-in-6-graphics_170x304With all the upcoming excitement about Halloween, you may have overlooked the fact that yesterday was World Stroke Day.

This year, the global campaign to tackle stroke was highlighted with the slogan “Because I care…”.

The phrase showcases the role of caregivers in supporting people who have suffered a stroke and aims to correct misinformation about the disease, such as the misconception that stroke only happens later in life.

Every other second, stroke attacks a person, regardless of age or gender. Of the 15 million people who experience a stroke each year, six million do not survive. Worldwide about 30 million people have had a stroke and most have residual disabilities.

Overall approximately 55 000 more women have strokes than men each year, mainly because stroke occurs more frequently at older ages and women generally live longer than men. Of note, women are twice as likely to die from a stroke than breast cancer each year.

And recent data published in the Lancet, shows a striking 25% worldwide increase in the number of stroke cases in people aged between 20 and 64. This younger age group now accounts for a shocking 31% of strokes.

But, with greater awareness, these figures don’t have to continue their alarming trend.  Stroke can be prevented, treated and managed in the long term. The campaign theme “Because I care” emphasizes these areas.

The slogan was chosen as it can easily be adapted to all cultures and in any setting. It attempts to address prevailing misinformation about the disease, e.g., stroke only happens later in life. The campaign also celebrates the important contributions of caregivers and the role they play as conduits between the stroke community and the general public in correcting misinformation.

Because I care…

    • Stroke 02.11.13I want you to know the facts about stroke
    • I will work to break down the myths surrounding stroke
    • I want you to learn how to minimize your risk of stroke
    • I want you to have access to the best possible treatment
    • I will ensure that you receive quality treatment, care and support
    • I will be with you every step of the way towards your full recovery

Research presented at the recent European Society of Cardiology [ESC] Congress  showed that there are plenty of steps young obese women can take to reduce their risk of stroke. In young women without metabolic disorders such as high blood pressure, high cholesterol and high blood sugar  or abnormal glucose metabolism being overweight did not increase the chance of having a stroke compared to normal weight women without metabolic disorders. However, the risk of stroke increased by 3.5 times in women who were overweight and had metabolic disorders.

Study author, Dr Michelle Schmiegelow said: “Obesity puts young women at a major risk of developing high blood pressure, diabetes or high cholesterol, which dramatically increases their likelihood of having a stroke. Young women who are overweight or obese probably have a window of opportunity to lose weight and keep a healthy lifestyle so that they reduce their risk of getting high blood pressure, diabetes and high cholesterol. In this way they can protect themselves from having a stroke or heart attack.”

Awareness of important risk factors, such as atrial fibrillation  and hypertension, is crucial.

OBESE-BLACK-WOMENProfessor Joep Perk, MD, a Swedish Cardiologist and spokesperson for the ESC says: “Women are at the same risk of stroke as men, and the level of risk is completely steered by the underlying risk factor pattern they have. The majority of people who have a stroke are disabled for the rest of their lives and may be paralyzed or lose their ability to speak. The devastating consequences of this disease for patients and their loved ones make prevention even more important.”

He adds: “Prevention for all cardiovascular disease follows the same pattern, be it stroke, heart attack, or peripheral arterial disease. Step one for women is absolutely to stop smoking – that beats everything. The second most important thing is to know your blood pressure to see if you are at risk. And finally, adopt healthy behaviors like eating heart healthy food and keeping the amount of salt you eat under control.”

stroke FASTThe global campaign against stroke asks people to commit to six stroke challenges:
•    Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol
•    Be physically active and exercise regularly
•    Maintain a healthy diet high in fruit and vegetable and low in salt and keep blood pressure low
•    Limit alcohol consumption
•    Avoid cigarette smoke. If you smoke, seek help to stop now
•    Learn to recognize the warning signs of a stroke and how to take action.

Check, check, check, check, check and check!  I’m feeling up to the stroke challenge.  Are you?

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Don’t Ignore the Snore

snoringThink for a moment about the factors that influence health.  Chances are you thought about: smoking, obesity, high blood pressure, high cholesterol and insufficient exercise. Maybe you added in family history of disease, and stress. How about snoring?

What!?!  Well, according to researchers at Henry Ford Hospital in Detroit, snoring may put your health at a greater risk than any of the above.

Their study revealed that isolated snoring may not be as benign as first suspected.  The trauma and subsequent inflammation caused by the vibrations of snoring can lead to changes in the carotid arteries – the pair of blood vessels that deliver blood to your brain and head. Snoring can cause a build-up of plaque which can eventually block the blood supply to the brain and increases the risk of stroke.

Snoring is more than a bedtime annoyance and it shouldn’t be ignored. Patients need to seek treatment in the same way they would if they had sleep apnea, high blood pressure or other risk factors for cardiovascular disease,” says lead author Robert Deeb, M.D., with the Department of Otolaryngology-Head & Neck Surgery at Henry Ford.

Obstructive sleep apnea– a sleep disorder that occurs due to the collapse of the airway in the throat during sleep and causes loud snoring and periodic pauses in breathing – has long been linked to cardiovascular disease, along with a host of other serious health issues.

But the risk for cardiovascular disease may actually begin with snoring, long before it develops into obstructive sleep apnea.

carotid arteryInvestigators reviewed data for 913 patients aged 18-50, who had participated in a diagnostic sleep study, none of whom had sleep apnea.  54 patients completed a survey regarding their snoring habits, and underwent a carotid artery ultrasound to measure the thickness of the innermost two layers of the carotid arteries. This test is able to pick up the first signs of carotid artery disease.

What they found was that snorers were had significantly greater thickening of the carotid arteries, compared to non-snorers.  Interestingly, no statistically significant differences in carotid artery thickening could be found for patients with or without some of the traditional risk factors for cardiovascular disease – smoking, diabetes, hypertension or hypercholesterolemia.

Snoring is generally regarded as a cosmetic issue by health insurance, requiring significant out-of-pocket expenses by patients. We’re hoping to change that thinking so patients can get the early treatment they need, before more serious health issues arise.”

The Henry Ford research team plans to conduct another long-term study on this topic, particularly to determine if there’s an increased incidence of cardiovascular events snoring2in patients who snore.

In the meantime, instead of kicking your snoring bed partner out of bed, seek out medical treatment for him…or her.

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Ho Ho Ho: health hazards for Santa

santa_claus obesityAfter weeks of harried holiday shopping, when the stores finally close on the evening of December 24, it will be a welcome reprieve from the madness. Families and friends gather together and enjoy a relaxing day or two of rest.

But for one man, the real work is just beginning. That’s right – Santa Claus is coming to town!

And while he spends most of the year enjoying a flexible work schedule, monitoring naughty-and-nice behaviors around the world and occasionally checking in on his elves and reindeer, things are about to get frantic for Old Nick.

And to be honest, this year we’re a little concerned about his health.  That belly fat!  The all-nighter he’s about to pull!  All those cookies!

He may know when you are sleeping, but the only way for Santa to get the job done is to stay up all night on December – and that can lead to some serious health concerns.
Studies have suggested that drowsy driving is as dangerous as drunk driving.  Even if he manages to get Rudolf and his friends safely parked on the rooftops, sleep deprivation could cause his judgment to become fuzzier, leading to the wrong presents traveling down the wrong chimneys.
What’s worse is that sleep loss has a cumulative effect. So while people in the Southern hemisphere might do OK, those of us in Northern climes, and especially those on the West Coast aren’t so lucky. Chronic sleep deprivation could mean he could fly over some houses altogether.

santa + sackBut even if we manage to keep him awake with coffee and Red Bull rather than the usual glass of milk, we’ve got to change Santa’s sack. By carrying something that weighs more than 10% of his body weight, one shoulder is going to end up taking on most of the burden, which could lead to back strains, sprains and spasms.
If you’re thinking of getting Santa a gift this season maybe you could consider a backpack, or better still, a rolling suitcase.

That’s not to say Santa doesn’t need the exercise of his Christmas Eve jaunt. Like 70% of adult men in the US, he is severely overweight. The health risks linked to obesity include Type 2 diabetes, coronary heart disease, stroke, hypertension, certain types of cancer and osteoarthritis.

With his giant waist comes the risk of belly fat associated problems such as insulin resistance, high triglycerides, heart disease and metabolic syndrome.

Santa beardThen there’s that beard to worry about. After a month or so of letting thousands upon thousands of kids sit on your lap at the mall, we wouldn’t be surprised if he’s harboring some germs in his whiskers.  So if Santa touches his beard followed by his eyes, ears or mouth, he’s pretty much bound to catch something, especially in the midst of this cold and flu season.

We suggest leaving some hand sanitizer next to the milk and cookies this year to give him a fighting chance.

And finally we’re worried about that thin Red Suit. While we’ll give Santa props for covering his head with a hat, traveling outside all night in December in a red velvet suit and a touch of faux fur seems ill advised. In addition to the hat, he should probably throw on a scarf or knit mask, mittens, thermals and a water-resistant coat to ward off hypothermia.

So whether you’ve been naughty or nice, there’s still time to give some thought to Santa’s Health, as well as your own this Christmas season.

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Sleeping Your Way to Success

As the fall semester winds down at colleges and universities, countless students will doubtless be pulling all-night study sessions to prepare for upcoming exams. Fueled by Red Bull, Monster energy drinks, or sheer fear of failure, last minute cramming will be going on in dorm rooms, libraries around the world.

Ironically, as it turns out, the loss of sleep during these all-nighters could actually work against students performing well.

Dr. Philip Alapat, medical director of the Harris Health Sleep Disorders Center, and assistant professor at Baylor College of Medicine, recommends that students study throughout the semester instead, and get at least 8 hours of sleep the night before exams.

Memory recall and ability to maintain concentration are much improved when an individual is rested,” he says. “By preparing early and being able to better recall what you have studied, your ability to perform well on exams is increased.”

College-aged students ideally should get 8-9 hours of sleep a night. Truth is, most students get much less.

Any prolonged sleep deprivation will affect your mood, energy level and ability to focus, concentrate and learn, which directly affects your academic performance,” Alapat adds.

All-nighters, especially when coupled with caffeinated beverages lead to a risk for developing insomnia and sleep disorders, including apnea, restless legs syndrome, narcolepsy and chronic fatigue syndrome.

Alapat’s recommendations:

  • Get 8-9 hours of sleep nightly (especially before final exams)
  • Try to study during periods of optimal brain function (usually around 6-8 p.m.)
  • Avoid studying in early afternoons, usually the time of least alertness
  •  Don’t overuse caffeinated drinks
  • Recognize that chronic sleep deprivation may contribute to development of long-term diseases like diabetes, high blood pressure and heart disease

Good advice!  Excuse me while I go to bed – I have an Advanced Cardiac Life Support (ACLS) exam in the morning!

Apples, Pears & Risk of Death

Are you an apple or a pear? Could your big belly shorten your life?

Conventional wisdom tells us that the shape of our body and where we store fat can drastically alter our health outlook. For example, apple shapes – people who carry their weight around their middles – have long been thought to have a higher risk for heart disease and type 2 diabetes, when compared to the general population. But recent research suggests that this risk might be overstated and that excess fat anywhere on the body raises disease risk equally.

Body mass index (BMI), the most commonly accepted measure of obesity, has long been criticized because it doesn’t take into account body composition. Because it only uses height and weight, it can classify muscular people as overweight or obese.

So a father-son team of researchers from New York have come up a new tool – the A Body Shape Index (ABSI).

This formula takes into account waist circumference (WC), BMI, and height.

In a study of  more than 14,000 adults, above average ABSIs correlated with a higher risk of premature death — even when adjusted for risk factors like smoking, diabetes, hypertension, and cholesterol. Regardless of age, gender, BMI, and ethnicity, elevated death rates were found for both high and low BMIs and WCs.  This led the researchers to conclude that both measures are inaccurate for predicting premature death risk.

Measuring body dimensions is straightforward compared to other most medical tests, but it’s been challenging to link these with health,” says researcher Nir Krakauer, assistant professor in the department of civil engineering at the City College of New York.

The bottom line of all this?  It’s not just belly fat that can kill you, excess pounds anywhere can have an adverse effect on health.

However, before you throw in the towel or start ordering your coffin, other studies suggest you shouldn’t worry if have a bit of junk in the trunk!  According to new research from Oxford University, fat in the thighs and buttocks might actually help protect you from metabolic disease and a Danish study even found that people with thin thighs have a greater risk of premature death.

What’s your body shape, and how do you feel about it? We look forward to hearing from you.

FDA Ad Study: Clarifying the Confusion

As a public health agency, the FDA encourages the communication of accurate health messages about medical conditions and treatment.  One way the pharma industry does this is through non-branded disease awareness communications. These are aimed at either the general public or health care practitioners and discuss a particular disease or health condition, without making mention of any specific drug.  Usually, they encourage consumers to seek, and health care practitioners to provide, appropriate treatment for the particular disease state.

This is helpful for under-diagnosed and under-treated diseases such as depression, hyperlipidemia, hypertension, osteoporosis, and diabetes. Some research has shown that consumers prefer disease awareness advertising. It’s considered more informative and less persuasive than full product advertising.

The pharma industry likes it too.  Disease awareness communications are not subject to the regulations and restrictions mandated by the FDA for prescription drug advertising.

But now, the FDA is concerned that disease awareness ads might confuse consumers. According to a Federal Register notice issued on June 20, the agency wants to know whether the public can distinguish between product claims and disease information, and how different types of information impact comprehension.

So worried in fact,  the Agency has planned a study entitled, “Experimental Study: Disease Information in Branded Promotional Material” to look into those questions.

The study will examine print ads for three conditions – COPD, lymphoma and anemia.

4,650 American adults will be divided into three groups and asked to review the ads electronically.

  • One group will see information about the disease that avoids discussion of disease outcomes the drug has not been shown to address i.e.  “Diabetes is a disease in which blood sugar can vary uncontrollably, leading to uncomfortable episodes of high or low blood sugar.”
  • Other participants will see disease information that mentions consequences of the disease that go beyond the indication of the advertised product, such as, “Untreated diabetes can lead to blindness, amputation, and, in some cases, death.”
  • A third group will see drug product information only.

Disease information will be presented in different ways. For example, on alternating paragraphs, on separate pages or in different fonts and colors from product claims.

Specifically the study will address whether or not consumers are able to distinguish between claims made for a medication and general disease information when they see an advertisement for a drug.  For example, if an ad for a drug that lowers blood glucose, mentions diabetic retinopathy do consumers  think the drug will prevent the affliction, even if no direct claim is made?

The Agency says: “If consumers are able to distinguish between disease information and product claims in an ad, then they will not be misled by the inclusion of disease information in a branded ad. If consumers are unable to distinguish these two, however, then consumers may be misled into believing that a particular drug is effective against long-term consequences.”

SRxA’s Word on Health looks forward to seeing the results. Given that warning letters have been issued in the past over ads that contain mixed messages, this is an opportunity for the FDA to revisit its stance toward such advertising, reduce consumer confusion and, most importantly, learn how best to disseminate useful health information.

Simple, Fast, and Beautiful

Take a good look at the image to the left.  Could it be the latest high tech cardio machine from a swanky new-age gym, a computerized gold club that provides instant feedback on your swing or perhaps a revolutionary whole-house Bluetooth speaker system?

No, no and no!

What you are looking at, ladies and gentlemen, is a revolutionary new device for the treatment of high blood pressure.  Yes, that’s right. Not monitoring, but treatment.

The Vessix Vascular V2 Renal Denervation System™  is the result of a collaboration between two California based companies –  Vessix Vascular, Inc., a pre-revenue stage medical technology company, and product innovation consultancy Karten Design.

This new technology has the potential to help the 68 million (one in three) adults in the United States who suffer from hypertension — a condition that is more common than cancer, diabetes, and coronary artery disease combined.

Hypertension is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease and was listed as a primary or contributing cause of death for more than 347,000 Americans in 2008.

In 2010, high blood pressure cost the United States $93.5 billion in health care services, medications, and missed days of work

Today, anti-hypertensive drugs are the primary treatment for hypertension. But despite the widespread use of drugs, only about half of hypertensive patients around the world are well controlled, even when multiple medications are taken at optimal dosages.

This new device could potentially change all that.

In as little as 30 seconds per artery, the Vessix V2 System performs a one-time minimally invasive catheter-based percutaneous procedure that has been shown to significantly reduce blood pressure.
Using a short blast of radiofrequency (RF) energy to disable the sympathetic nerves surrounding the arteries leading to the kidneys, in a procedure called renal denervation.

TV’s  Dr. Mehmet Oz has called  this treatment “a profound game changer.”

Hyperactivity of the renal nerves leads to uncontrolled high blood pressure, also called resistant hypertension. According to the American Heart Association, a 5 mm Hg reduction in systolic blood pressure results in a 14% decrease in stroke, a 9% decrease in heart disease, and a 7% decrease in overall mortality. In clinical studies, renal denervation has shown to reduce systolic blood pressure by as much as 20%.

Vessix’s patented V2 Catheter delivers precise temperature-controlled energy to both renal arteries in 60 seconds, while the only other competitively marketed Renal Denervation system takes 50-60 minutes. The rapidity of the V2’s treatment promises to reduce patient discomfort as well as exposure to radiation for both the patient and the interventional cardiologist performing the procedure.

I wanted a design that immediately communicates that there’s something new and exciting going on — even before I explain how the product works,” said Vessix CEO Raymond Cohen. “The goal was to have the product look faster, sexier, and more advanced than any other piece of equipment found in the hospital.”

To ensure the system’s design supports the physician’s natural workflow in the catherization lab, Karten Design worked with Vessix during the early phases of product definition, visiting hospital cath labs and interviewing doctors to determine the system’s ideal usage. Karten Design researchers and designers learned about the human factors surrounding a catheter-based procedure, including visibility, access, and sterility.

Vessix began a 64-patient human clinical in February in Europe. The first patient treated was 39 years old with pre-treatment blood pressure readings of 174/114 despite taking four anti-hypertensive medications. The second patient was 44 years old with a blood pressure of 168/106 despite taking six anti-hypertensive medications. The 10 center study will follow patients for 24 months following their renal denervation procedure.

Although the system has already received a CE Mark approval for the treatment of hypertension, it is not yet available in the US.

Assuming all goes well with the clinical studies, we look forward to the day it is.

Pills That Pack On Pounds

If you are one of those people who are overweight  and would love to blame something other than too much food or lack of exercise, this blog is for you.

According to the Harris County Hospital District’s Drug Information Center, weight gain or loss may not always be attributed to lifestyle. For some, it’s due to the medicines they’re taking.

Certain meds can cause significant weight changes. For example, weight-related side-effects are common in medicines taken by patients with diabetes, high-blood pressure and mental health conditions.

Those likely to experience weight increase include people taking steroids and women on birth control, while those taking antidepressants such as Prozac® and Wellbutrin® are likely to lose weight.

However, this does not mean you should immediately start making changes to your medication regimen. Drugs are weird. They do different things to different people and it’s often impossible to predict which people will have which side effects from which drugs.

Because of the stigma of weight gain, patients may tend to stop taking their medicines or decrease their dosage without talking to their physician,” says Ryan Roux, PharmD, chief pharmacy officer, Harris County Hospital District. “Doing this is a bad thing. It can affect your health in a number of negative ways.”

Instead, it’s important that you tell your physician about any weight changes and then reassess the drugs or dosages taken. The more you can become actively involved in your treatment and be informed about long-term medication use, the better.

Not sure if the meds you’re taking could be to blame?

SRxA’s Word on Health brings you a list of some common medications and their weight side effects listed both by brand and generic name:

Diabetes

Weight promoting

  • Actos® (pioglitazone)
  • Amaryl® (glimepiride)
  • Insulins

Weight loss or weight neutral

  • Byetta® (exenatide)
  • Januvia® (sitagliptin)
  • Symlin® (pramlintide)
  • Metformin
  • Precose® (acarbose)

Hypertension

Weight promoting

  • Lopressor ® (metoprolol)
  • Tenormin® (atenolol)
  • Inderal® (propranolol)
  • Norvasc® (amlodipine)
  • Clonidine

Antidepressants

Weight promoting

  • Paxil® (paroxetine)
  • Zoloft® (sertraline)
  • Amitripyline
  • Remeron® (mirtazapine)

Weight loss or weight neutral

  • Wellbutrin® (bupropion)
  • Prozac® (fluoxetine)

Antipsychotic

Weight promoting

  • Clozaril® (clozapine)
  • Zyprexa® (olanzapine)
  • Risperdal® (risperidone
  • Seroquel® (quetiapine)
  • Lithium
  • Valproic Acid
  • Carbamazepine

Antiepileptic Drugs

Weight promoting

  • Carbamazapine
  • Neurontin® (gabapentin)

Weight loss or weight neutral

  • Lamictal® (lamotrigine)
  • Topamax® (topiramate)
  • Zonegran® (zonisamide)

As always, we advise – for more information about the effects of medicines, consult your physician or pharmacist.

The Spare Tire of Business Travel

Uh oh!  More bad news for busy pharma executives, physicians and Word on Health bloggers.  A new study published in the April Journal of Occupational and Environmental Medicine has found that people who travel frequently for business increase the rate of poor health and health risk factors, including obesity and high blood pressure.

Travel is a prominent feature of business life in the United States, with an estimated 405 million long-distance business trips taken in 2009. While there is a large body of literature on health risks associated with business travel, this is almost exclusively focused on infectious diseases and the risks of deep vein thrombosis and pulmonary embolism associated with long-distance air travel.

In this latest study Catherine A. Richards, MPH, and Andrew G. Rundle, DrPH, of the Mailman School of Public Health at Columbia University compared health risks for employees at different levels of business travel. They used data on more than 13,000 employees from a corporate wellness program. Close to 80% of the employees travelled at least one night per month. Nearly 1% were “extensive travellers” which they defined as those who are on the road more than 20 nights per month.Employees who did not travel at all were actually a less-healthy group. Compared to light travellers (1-6 nights per month), non-travellers were about 60% more likely to rate their health as fair to poor.   However, this may reflect a “healthy worker effect”, with employees who have health problems being less likely to travel, suggest the authors.

Otherwise, rates of less-than-good health increased along with nights of travel. Extensive travellers were a staggering 260% more likely to rate their health as fair to poor, compared to light travellers.

Other health risk factors showed similar patterns: obesity was 33% more likely for non-travellers and 92% more likely for extensive travellers.
The same two groups were also more likely to have high blood pressure and elevated cholesterol levels.

Although business travel is often equated with long airline flights, relatively short business trips in personal cars are much more common.   Several factors could contribute to health risks in frequent business travellers, such poor sleep, fattening foods, increased alcohol consumption and long periods of inactivity.

The authors of the study suggest a number of interesting solutions to the problem such as employee education programs on the association between business travel and health and strategies to improve diet and activity while traveling.  They also recommend that companies who reimburses employees for meals while traveling, tie reimbursement rates to dietary quality. A “stick” approach might be to reimburse high–energy density food meals at a below cost rate, while a “carrot” approach might be to reimburse healthy meals at an above cost rate.

Additionally, companies that have arrangements with particular hotel chains could make having a gym part of the criteria for selecting a hotel chain and employees should be given time and perhaps financial incentives to exercise while traveling.

How do you cope with life on the road?  Please share your travel tips with us.

Is prescription drug spending sky-rocketing out of control?

Are prescription costs raising your blood pressure?

According to the latest news and numbers from the Agency for Healthcare Research and Quality (AHRQ) they may well be.  Figures, just released, show that insurers and consumers spent $52.2 billion on prescription drugs for outpatient treatment of metabolic conditions such as diabeteshypertensionhigh-cholesterolobesity and thyroid disease.

The four remaining top therapeutic classes of outpatient prescription drugs were:

In 2008, purchases of metabolic drugs by adults age 18 and older accounted for 22% of the total $233 billion spent to buy prescription drugs.

To put this number in perspective, $223 billion would buy you either 1,000 brand new 747 jumbo jets; 137 new space shuttles or 495 space shuttle missions!