Reducing your stroke risk…because I care

With 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…

• I 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.

Professor 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.”

The 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?

NSAID’s in the News (again)

Let me start by saying, that despite spending the last 20-something years in or around the pharmaceutical industry, I don’t like taking pills. That said, I’m not particularly partial to pain either. So when my knees or back hurts or I’m doubled over with dysmenorrhea, like many other people, I’ll reach for the ibuprofen.

But that may be about to change. Results from a new, large international study of non-steroidal anti-inflammatory drugs (NSAIDs), showed that high doses of them increase the risk of a major vascular event such as heart attack, stroke or death from cardiovascular disease by around a third.

In other words, for every 1,000 people with an average risk of heart disease who take high-dose ibuprofen for a year, about three extra would have an avoidable heart attack, of which one would be fatal, the researchers said.

This puts the heart risks of generic NSAIDs on a par with Vioxx – the painkiller that U.S. drugmaker Merck famously pulled from sale in 2004 because of links to heart risks.

The study team from Oxford University in the UK, gathered data, including on admissions to hospital, for cardiovascular or gastrointestinal disease, from all randomized trials that have previously tested NSAIDs.

This allowed them to pool results from 639 trials involving more than 300,000 people and re-analyze the data to establish the risks of NSAIDs in certain types of patients.

In contrast to the findings on ibuprofen and diclofenac, the study found that high doses of naproxen, another NSAID, did not appear to increase the risk of heart attacks. The researchers said this may be because naproxen also has protective effects that balance out any extra heart risks.

Researcher, Colin Baigent stressed that the risks are mainly relevant to people who suffer chronic pain, such as patients with arthritis who need to take high doses of for long periods. “A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous,” he said.

He also warns patients not to make hasty decisions or change their treatment without consulting a doctor.

“For many arthritis patients, NSAIDs reduce joint pain and swelling effectively and help them to enjoy a reasonable quality of life,” he said. “We really must be careful about the way we present the risks of these drugs. They do have risks, but they also have benefits, and patients should be presented with all those bits of information and allowed to make choices for themselves.”

Donald Singer, a professor of clinical pharmacology and therapeutics at Warwick University, who was not involved in the study, said its findings “underscore a key point for patients and prescribers: powerful drugs may have serious harmful effects.”

In the meantime, I for one, will be revising my pain versus pill-popping habit, or switching to naproxen.

Testing, Testing… $, $$, $$$

If doctors knew the exact price of expensive medical tests would they order fewer of them?

That’s exactly what Johns Hopkins researchers wanted to know.

The answer has just been published in the Journal of the American College of Radiology, and it’s a resounding: No!.  According to the investigators, revealing the costs of MRIs and other imaging tests up front had no impact on the number of tests doctors ordered for their hospitalized patients.

“Cost alone does not seem to be the determining factor in deciding to go ahead with an expensive radiographic test,” says the study’s senior author, Daniel J. Brotman, M.D., director of the hospitalist program at The Johns Hopkins Hospital. “There is definitely an over-ordering of tests in this country, and we can make better decisions about whether our patients truly need each test we order for them. But when it comes to big-ticket tests like MRI, it appears the doctors have already decided they need to know the information, regardless of the cost of the test.”

Some earlier studies have suggested that much of the expense of laboratory tests, medical imaging and prescription drugs is unknown or hidden from providers and patients at the time of ordering, leaving financial considerations largely out of the health care decision-making process and likely driving up costs. Other studies have shown that doctors ordered fewer laboratory tests in some cases when they were given the price up front.

But, imaging tests appear to be “a different animal.”

Although there are certain inherent disincentives, aside from cost, to ordering some major tests, such as the potential danger of radiation used, physicians also need to learn how to explain to patients why they may not need them.

For the six months of the study, Brotman and his colleagues identified the 10 imaging tests most frequently ordered for patients at The Johns Hopkins Hospital. Five of these were randomly assigned to the active cost display group and 5 to the control group. During a 6-month baseline period from November 10, 2008, to May 9, 2009, no costs were displayed. During a seasonally matched period from November 2009, to May  2010, costs were displayed only for tests in the active group. At the conclusion of the study, the radiology information system was queried to determine the number of orders executed for all tests during both periods.

And, when they compared the ordering rates to the rates from a six-month period a year earlier, when no costs were displayed at all, they found no significant difference in ordering patterns.

Is this a good or a bad thing?

Certainly there are many instances when expensive tests are justified. When a key diagnosis is needed there are limited options for comparison shopping.  For example, when a patient appears to have had a sub-acute stroke, an MRI is needed regardless of cost.

That is not to say there aren’t times when physicians need to look more closely at whether too many imaging tests are being ordered. Do ventilated intensive care unit patients really need a daily chest X-ray to look for potential lung problems?  Especially when there is good medical evidence that outcomes aren’t compromised if X-rays are ordered only when the patient’s condition appears to be worsening.

“For too long, there has not been enough attention paid to the bottom line in health care,” Brotman says. This isn’t about rationing care to hold down costs, he says, but about choosing tests a little more wisely.

Even though price transparency didn’t influence the way physicians ordered imaging tests in this study, financial considerations may play a role in other circumstances if tied to clinical evidence.

If you show a provider that he or she is ordering four times as many CT scans as a colleague whose patients have similar outcomes, it could change the decision-making calculus for the better.

“Cost transparency must be part of the solution to solving fiscal challenges in medicine,” Brotman says. “Providers have no idea how much they’re spending. Patients don’t know either. Having everyone understand more of the economics of health care is a great place to start cutting costs in medicine.”

Seems logical to us.

Ho Ho Ho: health hazards for Santa

After 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.

But 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.

Then 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.

Fend off a 2nd Heart Attack with Fruit and Fiber

Each year, at least 20 million people worldwide survive a heart attack or stroke. Most of them, will then be prescribed a veritable cocktail of drugs including lipid-lowering agents, beta blockers, aspirin, anti-platelet medications, and angiotensin modulators.

In the misguided belief that this polypharmacy will guard against future catastrophic cardiovascular events, many patients think they don’t need to follow a healthy diet.

However a new, 5-year study of almost 32,000 patients in 40 countries showed those who ate a heart-healthy diet rich in fruits, vegetables and fish had an average:

• 35% reduction in risk for cardiovascular death
• 14% reduction in risk for new heart attacks
• 28% reduction in risk for congestive heart failure
• 19% reduction in risk for stroke

Researchers from McMaster University were able to demonstrate, for the first time, that while drug treatments, substantially lower the risk of another heart attack, a high quality diet also significantly lowers the risk.

Mahshid Dehghan, the study’s lead author and nutritionist at McMaster University’s Population Health Research Institute (PHRI) and his team assessed the association between diet quality and the risk of cardiovascular disease using information collected from men and women who participated in two major McMaster-led global studies: ONTARGET, and TRANSCEND.

Participants with cardiovascular disease were asked how often they consumed milk, vegetables, fruits, grains, fish, nuts, meat and poultry over the past 12 months. They were also asked about lifestyle choices such as alcohol consumption, smoking and exercise. A healthy diet was indicated by a high intake of fruits, vegetables, whole grains and nuts as well as a high intake of fish compared to meat, poultry and eggs.

The results showed that a heart-healthy diet offered a “consistent benefit” over and above the benefits of taking medications to reduce the risk of heart attack and stroke.

Globally, healthy eating was associated with a lower risk of cardiovascular disease by more than 20% in all regions of the world and across all income groups.

“Physicians should advise their high-risk patients to improve their diet and eat more vegetables, fruits, grains and fish,” Dehghan said. “This could substantially reduce cardiovascular recurrence beyond drug therapy alone and save lives globally.”

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.

Feeling Fruity?

I’m sure all of our readers are familiar with the old saying, “An apple a day keeps the doctor away.”

Which, of course, got us musing, what about other fruit?  Well, it turns out that “An orange a day may keep strokes away!”  At least, it seems, for women.

According to a study just published in Stroke eating high amounts of citrus fruit, such as oranges and grapefruit, reduces the risk of ischemic stroke by 19%.

Researchers say the key to the reduced risk is a certain flavinoid found in citrus – flavonones. Citrus fruits and juices are the main dietary source of flavanones.

The findings were part of the Nurses’ Health Study, which included nearly 70,000 women who were followed for 14 years and reported on their dietary intake every four years.

While the risk of stroke was lower in those who ate citrus fruit, not all of the women’s flavonoid consumption came from citrus fruit. Flavonoids are also found in other types of fruit, vegetables, tea, and best news of all…dark chocolate and red wine.

This study confirms a previous findings that vitamin C and potassium, both of which are found in citrus fruits can protect against  heart disease, ischemic stroke and intracerebral hemorrhage.

Although some experts say that further prospective studies are needed to confirm these associations, we know what we’ll be putting in our shopping carts this week.

Heart Health Hits Home

As I child, I didn’t understand the concept of death, as an adolescent I thought  I was invincible, as a young adult, death was something that happened to grandparents, parents and their friends. But now I’ve come to the point in my life, maybe it’s the final step in growing up, when I suddenly realize it could happen to me.

Why the sudden comprehension of mortality?

Last week, two of my closest friends almost died.  One was sitting in my kitchen, drinking wine and catching up on the latest neighborhood gossip, when he remarked he didn’t feel well. A few questions and a blood pressure reading later, we were testing the limits of my car’s performance on route to the local Emergency Department. A few hours and a few tests later, he was in a Medevac helicopter and on his way to emergency cardiac surgery. Thankfully, he’s home now, doing well and embellishing the story of his MASSIVE heart attack, brush with death, and quadruple bypass surgery with each passing day. (Actually it was just a stent, placed under local anesthetic – but let that be our secret, I wouldn’t want to ruin his 15 minutes of fame!)

The other , a fabulous, funny, vibrant woman, suffered a thrombotic stroke and also ended up being hospitalized and having surgery.

Prior to these events, both friends had been generally healthy. They both exercised, they both watched their weight and neither saw these life-changing events coming. Their brush with mortality was the wake-up call they needed, and further lifestyle changes are being implemented as we speak.

It was also the wake-up call I needed. Yesterday I rejoined the gym and resolved to exercise more, eat and drink less and visit my doctor more often.  Nearly losing my friends was the inspiration I needed.

Cardiovascular disease is the leading cause of death in the United States; one in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day.

“Heart disease takes the lives of far too many people in this country, depriving their families and communities of someone they love and care for—a father, a mother, a wife, a friend, a neighbor, a spouse. With more than 2 million heart attacks and strokes a year, and 800,000 deaths, just about all of us have been touched by someone who has had heart disease, heart attack, or a stroke.”  says Department of Health and Human Services Secretary, Kathleen Sebelius.

Recently, the American Heart Association/American Stroke Association  joined forces with Million Hearts™ to build healthier lives free of cardiovascular disease and stroke. As part of this they have developed a heart attack risk calculator and a life check calculator to help you understand your cardiovascular health and move you closer to your life goals.

For those, still looking for a motive, I highly recommend viewing a “Living Proof” video, created by physicians, nurses and patients at MetroSouth Medical Center.

In it, heart disease survivors and those who have lost loved ones to heart conditions used cardboard signs to deliver an urgent call to action. Their main messages?  Get screened for heart disease and early intervention and prevention pays off.

February is National Heart Month and I for one am taking notice.  Are you?

A New Reality for Stroke Patients?

Traditional post-stroke rehabilitation programs are designed to improve motor and sensory abilities. With the help of specially trained nurses, physical, and occupational therapists survivors relearn the skills needed for activities such as personal grooming, preparing meals, and housecleaning.  This may all be about to change.

A new study has shown that virtual reality games may be the key to recovery. The results show that the patients were more likely to improve their arm strength if they played virtual reality games than if they received standard physical therapy.  The study will be published in the May issue of Stroke.

Stroke survivors suffer mobility problems when parts of the brain controlling leg or arm muscles are impaired. Rehabilitation exercises can help the brain create new connections between nerve cells. Yet, according to study researcher Dr. Gustavo Saposnik, Director of the Stroke Outcomes Research Unit at St. Michael’s Hospital at the University of Toronto, standard therapies provide only modest benefits in terms of improving mobility.

Virtual reality games have been adapted to aid in stroke rehabilitation. In these games, patients interact with a virtual world. They can be immersed in this world by placing a display screen over their eyes, or they can interact with a computer or TV screen, just as they would with a standard video game. The virtual reality games vary in the tasks they ask subjects to perform. Some games require patients to manipulate virtual objects. Other games, including those played on the Nintendo Wii, may require patients to flex their arms and wrists.

Saposnik and his colleagues analyzed 12 studies that tested the effects of virtual reality and electronic games on stroke recovery.

Five of the studies were trials in which patients were randomly assigned to receive standard therapy or play virtual reality games. Taken together, these studies showed patients who played virtual reality games were about 5 times more likely to improve their upper body strength than those who received the standard therapy.

The other seven studies looked at patient improvement before and after playing the games. These studies found on average, a 14.7% improvement in patients’ grip strength and a 20% improvement in their ability to perform standard tasks.

Virtual reality games activate different parts of the brain than standard therapies, which may explain the greater improvement seen in patients who played the games.  The games also activate mirror neurons which are a special type of nerve cell that fire when a person observes someone else performing a particular movement. “Engaging the mirror neuron system probably facilitates the formation of new brain connections and aids in recovery,” Saposnik said.  In addition, virtual reality games can provide auditory and sensory feedback that is important for rehabilitation.

Larger trials are now planned to determine the true benefit of the games.

Have virtual reality games helped you or anyone you know recover from illness?  SRxA’s Word on Health would love to hear from you.

Sweet Protection Against Parkinson’s Disease

New research shows men and women who regularly eat berries may have a lower risk of developing Parkinson’s disease.  Men may further lower their risk by regularly eating apples, oranges and other sources rich in dietary flavonoids.

The study which was supported by the National Institutes of Health involved 49,281 men and 80,336 women. Researchers gave participants questionnaires and used a database to calculate intake amount of flavonoids. They then analyzed the association between flavonoid intakes and risk of developing Parkinson’s disease. They also analyzed consumption of five major sources of foods rich in flavonoids: tea, berries, apples, red wine and oranges or orange juice. The participants were followed for 20 to 22 years.

During that time, 805 people developed Parkinson’s disease. In men, the top 20% who consumed the most flavonoids were about 40% less likely to develop Parkinson’s disease than the bottom 20% of male participants who consumed the least amount of flavonoids.

In women, there was no relationship between overall flavonoid consumption and developing Parkinson’s disease. However, when sub-classes of flavonoids were examined, regular consumption of anthocyanins, which are mainly obtained from berries, were found to be associated with a lower risk of Parkinson’s disease in both men and women.

“This is the first study in humans to examine the association between flavonoids and risk of developing Parkinson’s disease,” said study author Xiang Gao, MD, PhD, with the Harvard School of Public Health in Boston.

Fruit consumption has also been related to health benefits in a whole range of conditions including cancer, stroke, heart disease, diverticulosis, hypertension, cataracts, diabetes, asthma, and bronchitis.

Do you have any fruity stories to share?  SRxA’s Word on Health would love to hear from you.