“Death in old age is, of course, inevitable, but death in middle age is not”, so rightly said by Dr. Kerr.
Professor Peter Elwood, who is at the School of Public Health at the University of Wales in Cardiff, has done a remarkable piece of work observing a large cohort of Welsh men for over 30 years. By carefully monitoring patterns of behavior — smoking, alcohol consumption, and so on — he has mapped these behaviors onto the risk of developing cardiovascular disease, diabetes, dementia, and, of course, cancer. He showed that if we live well, if we choose to live well, then we can have remarkable reductions in the risk of developing all those types of diseases.
The 5 Longevity “Virtues”
There are 5 basic types of good behavior: regular exercise, not smoking, alcohol consumption within guidelines, maintaining a low BMI (body mass index), and eating a predominantly plant-based diet.
Thus, if one practices 4 or 5 of those “virtues,” compared with men who practice none, the reduction in the risk for cardiovascular disease is around 67%; the reduction in the incidence of diabetes is 73%; the reduction in developing cancer is 20%-25%; remarkably, the reduction in dementia is 65%; and the reduction in all-cause mortality is 32%. Most of the reduction in cancer risk was related to smoking, and frankly the other forms of behavior in this cohort did not affect the development of cancer very remarkably.
Very similar outcomes have been found in large studies in the United States and elsewhere in Western Europe.
Many deaths in middle age are preventable. Let us live well. and Live Long!
An environmental scan report published last year in the Journal of American College of Cardiology revealed staggering global CVD statistics. CVD currently accounts for 17.3 million deaths per year and that number is expected to grow to more than 23.6 million by 2030. Additionally, elevated blood pressure was found to cause 51 percent of stroke deaths and 45 percent of coronary heart disease deaths. The report also noted that stroke mortality exceeds ischemic heart disease mortality in 74 World Health Organization member countries, with China, Africa and South America having an excessively higher rate of stroke than the other countries. The study revealed that despite the projection that heart disease and stroke will be the leading cause of death through the year 2030, only 150 new cardiovascular drugs are in development, contrasted with the more than 700 underway for the treatment of cancer.
Atrial Fibrillation (AF) is a common condition affecting the elderly. The prevalence of AF increases with age. It is estimated that 1% of individuals above the age of 60 and 8% of individuals above the age of 80 years must be suffering from AF
AF means fast beating of the upper chambers (atria) of the heart. The atrial rate is expected around 400-600 beats per minute. At this rate there is no effective contraction of the upper chambers and this causes blood to stagnate. This can cause small clots which can then migrate to the brain causing stroke. The other symptoms of this condition may be palpitations and breathlessness. A fast heart rate for a long time may also cause the heart pumping to go down and cause a condition called heart failure.
AF increases stroke risk!
The most devastating consequence of this heart beat disorder is stroke. The elderly (aged > 65 years) are at high risk of stroke. The other risk factors for stroke are blood pressure, heart failure, diabetes and patients who have had strokes in the past.
Treatment of AF:
Treatment of AF is two-fold.
1. The primary goal is to prevent strokes.
Patients with the highest risk should receive blood thinners. Warfarin and Dabigatran are the commonest drugs used. Individuals at lower risk can be treated with Aspirin.
2. The second goal of treatment is to control or prevent AF.
Patients who have had AF for a long duration are on drugs which slow down the heart rate and thereby reduce palpitations. In the initial stages of the disease, the recurrence of the condition (AF) can be prevented by medications. There are multiple drugs available and should be taken in consultation with physicians.
The main goal of treatment still remains Stroke Prevention.
Do you think twice before popping in a painkiller analgesic in your mouth. If no, read this!
A recent meta-analysis was done to study the effects of analgesics like ibuprofen, diclofenac and coxibs on heart risks, stroke risk, and gastric bleeding risks.
The meta-analysis included 280 randomized trials of analgesics (non-steroidal, NSAID) versus placebo with 124 513 participants, 68 342 person-years. It also included 474 trials of one NSAID versus another NSAID 229 296 participants, 165 456 person-years. It was published recently in the Lancet.
The main outcomes were major vascular events like heart attacks, stroke, or vascular death and gastrointestinal complications like perforation, obstruction, or bleed.
Major vascular events like heart attacks and strokes were increased by about a third by all the analgesics like coxib, diclofenac. Ibuprofen also significantly increased major coronary events. Compared with placebo, of 1000 patients allocated to a coxib or diclofenac for a year, three more had major vascular events, one of which was fatal.
Naproxen did not significantly increase major vascular events.
Heart failure risk was roughly doubled by all NSAIDs.
All NSAID regimens increased upper gastrointestinal complications like bleeding and perforation.
The vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs.
Although NSAIDs increase vascular and gastrointestinal risks, the size of these risks can be predicted, which could help guide clinical decision making
In view of the above findings it would be advisable not to pop in a pain killer for mild aches and pains. Patients who need pain killers for chronic pain should take them strictly under medical supervision.
Eating more fiber may lower the risk of stroke, according to the first meta-analysis of relevant research on fiber intake and stroke.
“We found that across the normal range intakes, with each additional 7 grams per day consumed, risk of stroke was reduced by about 7%,” Dr Victoria J Burley (University of Leeds, UK) said in an interview.
“This sounds like quite a small reduction in risk, but because stroke affects so many people, lowering risk by 7% could potentially impact many thousands of individuals,” Burley noted.
The results, published online March 28, 2013 in Stroke and partly supported by the cereal industry, buttress dietary recommendations to increase intake of total dietary fiber, the researchers say.
Previous studies have shown that dietary fiber may help reduce stroke risk factors, including high blood pressure and elevated LDL-cholesterol levels.
Burley and colleagues analyzed eight relevant cohort studies from the US, Europe, Australia, and Japan published between 1990 and 2012, comprising more than 200 000 individuals. Follow-up ranged from eight to 19 years, and case numbers ranged from 95 fatal strokes to 2781 incident events.
Total dietary fiber intake was inversely associated with risk for stroke (hemorrhagic plus ischemic).
“The relationship between dietary fiber and stroke risk seems to be linear, so this means that even small increases in intake may have an effect on long-term stroke risk,” Burley said.
“Most populations in high-income countries, such as the US, don’t eat enough fiber-rich foods, and clinicians should encourage patients to improve their intake of fruits and vegetables, whole grains, legumes, and nuts and seeds to achieve fiber goals. Meeting the guideline for dietary fiber intake is likely to have other health benefits, such as good digestive health, lowering blood cholesterol, and stabilizing blood glucose. In the long term, our data suggest that risk of stroke may be reduced as well,” she added.
Best type of fiber uncertain
Dr Gustavo Saposnik (St Michael’s Hospital, University of Toronto, ON) comments that the most important finding was the 7% reduction in the incident risk of stroke for every 7 g of daily fiber consumption.
“The authors explained this is achievable by eating a small portion of whole-meal pasta (70 g), a piece of fruit (apple/pear/orange), plus a serving of tomatoes each day,” he noted.
So, grab that bowl of cereal today!
Learn to recognize a stroke, because time lost is brain lost.
Call 9-1-1 IMMEDIATELY if one or more of the following symptoms suddenly occur:
Numbness or Weakness
Of the face, arm or leg, especially on one side of the body
Or trouble speaking or understanding
Or trouble seeing in one or both eyes
Loss of Balance or Coordination
Dizziness or trouble walking
With no known cause
A stroke is a medical emergency!
If given within three hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator (tPA) can reduce long-term disability for the most common type of stroke.
There are 2 treatment options for patients suffering from acute stroke. One is a clot buster called t-PA which is given intravenously. The second is a procedure called Angioplasty wherein the blocked artery is opened mechanically by a clot aspirating device or giving the drug directly into the artery with the help of small tubes. In some cases, a stent (spring like device) is placed across the artery.
There has been a long standing debate to know which one is a superior treatment option. Physicians consider the Angioplasty option as superior as the doctor is directly opening the artery by a mechanical device. The drug option is considered inferior as the effect of the drug can be limited in some patients.
So for the first time, both these treatment options were compared directly with each other. They found that the Clot buster was more effective when compared to the angioplasty approach. The study got published in the NEJM, a premier medical journal in the Feb 6, 2013 issue.
362 patients with acute ischemic stroke underwent randomization (181 to endovascular treatment and 181 to drug-tPA). Primary outcome of death and disability was studied at the end of 90 days.
A total of 55 of the 181 patients (30.4%) in the endovascular-treatment group survived without disability as compared with 63 of the 181 patients (34.8%) in the intravenous t-PA, drug group (absolute difference, −4.4 percentage points).
At 90 days, 26 patients in the endovascular-treatment group (14.4%) and 18 in the intravenous t-PA group (9.9%) had died.
This trial failed to show that the Angioplasty approach was superior to the drug option: intravenous t-PA. It also challenged the Physicians common notion that Angioplasty is superior to the drug.
It is a victory of a Drug over a mechanical procedure called Angioplasty. Again, reminding us that with the advent of better drugs, equally good and sometimes more effective treatment can be delivered safely!