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Tuesday, October 26, 2010

Another reason to stop smoking (as if you really needed one)

Heavy Smoking Linked to Alzheimer's in Study

MONDAY, Oct. 25 (HealthDay News) -- Heavy smoking in middle age seems to increase the risk for developing Alzheimer's disease or another dementia, a large new study suggests.

"We found that people who reported heavy smoking in midlife had more than a 100 percent increase in risk of Alzheimer's disease and vascular dementia," said lead researcher Rachel A. Whitmer, a research scientist in Kaiser Permanente's Division of Research in Oakland, Calif.

"We have known that smoking is a risk factor for cancer, stroke and cardiovascular disease," she said. "This adds to the evidence that what is bad for the heart is bad for the brain."

The report is published in the Oct. 25 online edition of the Archives of Internal Medicine.

For the study, Whitmer's group collected data on 21,123 ethnically diverse people in the Kaiser Permanente health care system who were surveyed between 1978 and 1985, when they were 50 to 60 years old.

During an average follow-up of 23 years, the researchers found that 25.4 percent were diagnosed with dementia, including Alzheimer's (1,136 people) or vascular dementia (416 people), which is the second most common form of dementia after Alzheimer's disease. Vascular dementia is caused by damage to the arteries in the brain.

Compared with non-smokers, those who smoked more than two packs of cigarettes a day in midlife had a "dramatic increase" in the incidence of dementia -- more than a 157 percent increased risk of developing Alzheimer's disease and a 172 percent increased risk of developing vascular dementia, Whitmer's team found.

Former smokers and people who smoked less than half a pack a day did not appear to be at increased risk of Alzheimer's or vascular dementia, the researchers note.

The associations between smoking and dementia did not change even after adjusting for race or gender, high blood pressure, high cholesterol or heart attack, stroke or weight, they add.

A link between Alzheimer's and smoking has been shown before, but this new study pinpoints the specific risk for middle-age smokers for developing both Alzheimer's and vascular dementia, the researchers say.

Smoking, an established risk factor for stroke, may contribute to the likelihood of vascular dementia by causing small clots in the brain. Smoking also contributes to oxidative stress and inflammation, which may be linked to the risk of developing Alzheimer's disease, the researchers say.

"The brain is not immune to long-term damage from smoking," Whitmer said.

Two smaller studies of predominantly white participants also suggested that mid-life smoking raised the risk of developing Alzheimer's, researchers noted.

Commenting on the new study, William Thies, chief medical and scientific officer at the Alzheimer's Association, said "this is a sound confirmation of something that's been known for a while."

Another expert, Dr. Samuel E. Gandy, the Mount Sinai Professor of Alzheimer's Disease Research at Mount Sinai School of Medicine in New York City, said the findings are promising.

"Environmental factors in Alzheimer's disease have been long sought, and, until now, only head injury has emerged," Gandy said. "Unlike head injury, a tobacco smoking association is especially important because that is a risk that can be modified."

Wednesday, October 20, 2010

The "Original" Dr Portnay

I'm not the only Dr Portnay. The "original" Dr Portnay is an Internist/Endocrinologist working in the Boston area. He's one of the smartest clinicians I know. He has been my teacher for the past 39 years.
Here is a copy of his letter to the editor that was recently published in The Boston Globe.
YOUR ARTICLE "Mass. recasting health payments: Officials draft plans for new system to compensate doctors, hospitals'' (Metro, Sept. 27) is correct in that we need new ways to pay for health care. The proposed system of global payments sounds and appears attractive, but it reminds me of the managed care (HMO capitation) that we had in the 1990s.

Under that system, physicians were criticized for being so-called gatekeepers, and were blamed for limited care probably because it cost physician capitation dollars. Patients became angry at their primary care physicians for limiting access to care that patients thought they needed or wanted. This system failed miserably in spite of the cost savings.

My question to those advocating global payments for care is: How will this be different?

Dr. Gary I. Portnay





Thursday, October 7, 2010

Another reason to observe Meatless Mondays --- $$$$$


Noisy Workplace Contributes to Heart Disease

October 6, 2010 (Vancouver, British Columbia) — Analysis of data from the National Health and Nutrition Examination Survey (NHANES) shows that chronic exposure to occupational noise may contribute to coronary heart disease, especially among young men who smoke [1].

Some small studies suggest that noise may increase the risk of coronary disease and hypertension, but the findings have not been consistent, so Dr Wenqi Gan (University of British Columbia, Vancouver) and colleagues examined a cross-section of NHANES participants, because the survey is representative of the whole US. The results of their study are published online October 5, 2010 in Occupational and Environmental Medicine.

The study includes 6307 participants from NHANES from 1999 to 2004, age 20 and older and employed at the time of the interview. Most of the 1236 participants who reported they are chronically exposed to loud noise at work (21.2%) are male (83.3%). The average age of the noise-exposed participants is 40, and they are more likely than the nonexposed participants to be white, have a lower level of education, smoke, and be exposed to secondhand smoke. They also have a higher average body-mass index and are more likely to be regular drinkers.

Compared with participants who are never exposed to loud noise at work, those chronically exposed to occupational noise have a two- to threefold increased prevalence of angina pectoris, MI, CHD, and isolated diastolic hypertension, the study shows. After adjustment for various covariates, the odds ratios for angina pectoris, coronary disease, and isolated diastolic hypertension are 2.91, 2.04, and 2.23, respectively.

The association of noise exposure with angina pectoris, MI, and coronary disease is particularly strong for participants who are over 50 years old, male, and current smokers. However, the study did not find a significant correlation between noise exposure and increased levels of cardiovascular biomarkers, including blood lipids and circulating inflammatory mediators.

"This study suggests that excess noise exposure in the workplace is an important occupational health issue and deserves special attention," the authors conclude. They suggest that noise may contribute to the risk of myocardial ischemia or infarction because it is a "potent external stressor," like sudden emotional stress or physical exertion, and thereby activates the sympathetic nervous system and endocrine system, leading to coronary vasoconstriction and subsequent partial or complete coronary occlusion in people with or without preexisting coronary atherosclerotic plaque. The stress of noise could also lead to disruption of a vulnerable coronary plaque, the authors suggest.

The researchers acknowledge that their study did not include participants who had been exposed to workplace noise in the past but no longer work in that environment, and "the temporal relationship between noise exposure and the development of coronary heart disease is uncertain. . . . Future prospective cohort studies are necessary to clarify the relationship between previous noise exposure and the risk of CHD."

Heartwire © 2010 Medscape, LLC

Wednesday, October 6, 2010

Healing Hearts lecture series

If you are in the Stamford area tomorrow with nothing to do in the afternoon, come here me talk about "How to Outlive Heart Disease".

Stamford hospital
Tully Center

Please come and introduce yourself after the lecture, I would love to meet you.

Mouth-To-Mouth In CPR Might Be Overrated

For some time now, we have been waiting for the American Heart Association to change it's guidelines regarding CPR. 

It is clear that Hands-Only CPR is at least as effective and now maybe better than standard CPR. In fact, we've been teaching this technique in the Stamford, CT area for over a year now.  

Hopefully, we will see an official adoption of this technique in the AHA guidelines soon. 

 Mouth-To-Mouth In CPR Might Be Overrated

by Whitney Blair Wyckoff

- October 5, 2010

If the prospect of locking lips seems like an unsavory requirement for performing CPR, don't worry. A new study says you don't have to use your mouth to save a life.

A study out of Arizona found that adult cardiac arrest patients who received hands-only CPR had a higher rate of survival than patients who received conventional CPR -- which consists of both chest compressions and rescue breaths -- and those who didn't get CPR. According to the American Heart Association, 300,000 people experience out-of-hospital cardiac arrest each year in the U.S.

"Anyone who can put one hand over the other, lock their elbows and push hard and fast can save a life," said lead author Bentley J. Bobrow, a medical director for the bureau of emergency medical services and trauma system at the Arizona Department of Health Services.

The paper, which is slated to be published in the Oct. 6 issue of the Journal of the American Medical Association, evaluated the results of a public education program in Arizona that promoted compression-only CPR. The authors cite previous research showing that removing the mouth-to-mouth part of CPR makes it easier to perform.

The research looked at 4,415 adults in Arizona who went into cardiac arrest outside a hospital during a five-year period. Of those, 2,900 didn't get CPR, 666 received traditional CPR and 849 received hands-only CPR. Researchers excluded cases from the study population for several reasons, including if CPR was performed by a medical professional, if it was performed in a medical facility or there was missing data.

Those who received hands-only CPR had a 13.3 percent rate of survival to hospital discharge. Patients who didn't receive CPR had a 5.2 percent survival rate, and those who got conventional CPR were only slightly better at 7.8 percent.  Researchers also found that the rate of people providing CPR went up over the five years of the study as did the rate that the hands-only method was used.

This research follows two studies in the New England Journal of Medicine that found chest compression-only CPR is at least as effective as the traditional method.

But Bobrow told Shots that the American Heart Association guidelines make the final call on whether compression-only CPR will be universally considered on-par with conventional CPR.

Bobrow says that it's important to note that this only applies to adults -- children, he says, need the rescue breaths.  That's because in children, a respiratory emergency frequently precedes the cardiac arrest, he says.

He says that if other communities implemented a similar public health education strategy, they could save thousands a year.

"We really believe that other communities can and will implement a similar effort," Bobrow says. "Really, there is a huge potential." [Copyright 2010 National Public Radio]

Tuesday, October 5, 2010

Metabolic syndrome

What is the metabolic syndrome?

Metabolic syndrome affects one out of every four Americans (2/5 people over age 60).

Individuals who have at least three of the following criteria are considered to have this condition:

1. abdominal obesity
2. elevated triglyceride levels
3. low HDL cholesterol
4. high blood pressure
5. Resting blood glucose levels greater than 100 mg/dL

Those with metabolic syndrome are at increased risk for heart attack, stroke and even death.

Monday, October 4, 2010

NYTimes: Behavior: Losing Fat, as Easily as Closing Your Eyes

From The New York Times:

VITAL SIGNS: Behavior: Losing Fat, as Easily as Closing Your Eyes

A study finds sleep-deprived participants felt hungrier than others, and had higher levels of ghrelin, a hormone that drives appetite.