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Should Statins be Available for Everyone?

They lower cholesterol and heart attack risk and may hold promise against other diseases, including cancer. Doctors consider broadening their use.
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Should statin drugs be put in the water, or what? ¶ More than 13 million Americans are taking these medications to lower their cholesterol and hopefully stave off heart disease — a job the drugs appear to excel at. Statins can lower “bad” LDL cholesterol by 20% to 60%. Over time, this can lower the risk of having a heart attack by about the same amount. ¶ For many years, it was believed that statins worked solely by reducing blood cholesterol, which can build up in sticky plaques in the arteries that supply blood to the heart, potentially blocking blood flow and causing heart attacks. But evidence is mounting that the drugs reduce heart disease risk through more than just their cholesterol-lowering effects. New research suggests they may be beneficial even for people with cholesterol in the normal range. ¶ This has doctors and medical researchers debating whether many more people should be on statins than currently fall under treatment guidelines. Some drug companies and doctors have even argued that low doses of the drugs should be available over the counter, as they are in the United Kingdom.

At the same time, other studies are reporting that statins might help prevent or treat a number of noncardiovascular conditions — including multiple sclerosis, cancer and Alzheimer’s disease. With all this news, many may be wondering, “Should I take a statin, just in case?”

Experts, for the most part, will say only, “Maybe.”

Most of the people at high risk of cardiovascular disease “are going to be safer and live longer if they’re on a statin than if they’re not,” says Nathan Wong, director of the UC Irvine Heart Disease Prevention Program. But that doesn’t hold for people whose risk for heart attacks is very low to begin with, he adds. “I’m not saying that everyone is going to be better on a statin. They need to be used with discretion.”

All six statins available today — atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol) and fluvastatin (Lescol) — work by blocking an enzyme called HMG-CoA reductase.

In the liver, blocking this enzyme shuts down cholesterol production and increases the amount of cholesterol the liver takes out of the bloodstream.

But statins also block HMG-CoA reductase in the cells lining blood vessels, where, among other things, they can reduce inflammation.

Dramatic results
The anti-inflammatory effect of statins has been on many heart experts’ minds since the Nov. 9 announcement of the results of a clinical trial called JUPITER. The trial showed that statin treatment can reduce the risk of heart disease in people with normal cholesterol levels but high levels of inflammation as measured by blood levels of a marker called C-reactive protein (CRP).

A team led by Dr. Paul Ridker of Brigham and Women’s Hospital in Boston and Harvard Medical School found that in 8,901 people with high blood CRP levels, rosuvastatin (Crestor) reduced the risk of a heart attack by 54% and the need for bypass surgery or angioplasty by 46% compared with an equal number of people taking a placebo.

There were 68 heart attacks and 131 bypass surgeries/angioplasties in the placebo group, but only 31 and 71, respectively, in the group taking the statin. There were 48% fewer strokes — 64 versus 33. These effects were so dramatic that regulators stopped the trial, slated to go for four years, after less than two. AstraZeneca, the company that makes Crestor, funded the JUPITER trial.

The results raise an obvious question: Are the cholesterol-lowering effects or the inflammation-reducing effects of statins more important?

Dr. Christopher Cannon, a cardiologist at Brigham and Women’s, says they both play a part: “You have to have some cholesterol get into the arteries [and cause damage]. And if you have inflammation that damages the lining of the arteries, the cholesterol gets in more easily.”

Inflammation can also encourage plaques to rupture, causing clots that block blood flow. “Both [cholesterol buildup and inflammation] are happening simultaneously, and both are inhibited simultaneously with statins,” Cannon says.

Currently, more than 13 million people take statin drugs for elevated LDL cholesterol, and at least 47 million more have cholesterol levels high enough to make them eligible by current National Heart, Lung, and Blood Institute cholesterol guidelines.

Ridker estimates an additional 4 million to 6 million people would be added to the mix if everyone who would have qualified for the JUPITER trial (men over 50, women over 60, LDL cholesterol below 130 mg/dL and CRP above 2 mg/L) started taking a statin.

Anti-inflammatory:

Statins may be good for more than just fighting heart disease.

Very preliminary studies suggest that the anti-inflammatory effects of statins could help treat autoimmune diseases. A small, nine-month study of 36 patients with multiple sclerosis published in April in the journal PLoS One showed that statin treatment, either alone or combined with standard MS treatment, reduced the number of brain lesions characteristic of the disease by 24% and reduced their size by about 12%.

Another pilot study of just seven people, published in September 2007 in the Journal of the American Academy of Dermatology, showed that a statin reduced the severity of the skin disease psoriasis

A combined analysis of 19 studies, published in August in the International Journal of Cancer, found that statin use reduced the risk of advanced prostate cancer by 23%.

And a study published in November in the Journal of the National Cancer Institute showed that men prescribed statins had a 4.1% decline in their blood levels of prostate-specific antigen (PSA), a marker of prostate cancer.

There is some evidence that statins can lower the risk of developing Alzheimer’s disease. An October study of almost 7,000 people in Rotterdam, Netherlands, found that people taking a statin had about a 50% lower risk of Alzheimer’s compared with those who had never used cholesterol-lowering medication. Other studies, however, have failed to find an effect of statins on the risk for dementia or Alzheimer’s disease.

As the benefits of these drugs are experienced by more people, the risks will be too. Though statins are generally considered safe, they do have side effects.

Drugs’ side effects:-
The most commonly reported adverse event associated with statins is muscle pain. A 2006 analysis of seven clinical trials published in Medscape General Medicine found that 2.5% to 6% of patients taking statins reported aches and pains related to their drugs.

Rhabdomyolysis, a breakdown of skeletal muscle that can lead to kidney failure and sometimes death, has also been linked to statins. According to the 2006 Medscape report, less than 0.1% of patients taking statins reported rhabdomyolysis. There was only 0.15 death from rhabdomyolysis per 1 million prescriptions.

Liver effects are also seen in some patients taking statins. In less than 1% of patients taking moderate doses of statins, and in about 2% to 3% of those taking high doses, liver enzyme levels are abnormally high. But the enzyme changes usually subside after discontinuing statin use or switching to a different statin, says Dr. Antonio Gotto, dean of Weill Cornell Medical College in New York.

In 2007, the Food and Drug Administration conducted an investigation into whether statins increase the risk of the fatal neurodegenerative disease amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, when the agency received a higher than expected number of reports of the disease in people taking statins. Although an analysis of 41 long-term controlled clinical trials reported in September detected no such link, the FDA has said it plans to continue studying the issue.

Dr. Scott Grundy, a professor of internal medicine and director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas, says he thinks the drugs, on balance, are safe. But he adds that caution is still warranted, especially when it comes to considering a broad expansion of their use or prescribing them earlier in people’s lives.

Statins have been in use only since the late 1980s, he notes, and so there hasn’t been enough time yet to learn what might happen if someone were to be on the drugs for 30 or 40 years. “It is possible that some of these rare side effects might turn out to be quite important if [statins are] started early in life and continued for years and years,” he says.

Whether statin use is substantially expanded may depend on how the results of the JUPITER trial and other recent research are incorporated into new cholesterol guidelines slated to be released next year by the National Heart, Lung and Blood Institute.

If CRP testing becomes part of the standard battery of tests that guide risk assessment and statin treatment decisions, millions more Americans could find themselves filling a prescription.

Currently, most doctors use CRP testing as a sort of tie-breaker when they are on the fence as to whether a patient is at high enough risk of heart disease to warrant statin therapy. Patients might, for example, have intermediate cholesterol levels but a family history of heart attacks or some other risk factor.

Dr. Mary Malloy, co-director of the adult lipid clinic and director of the pediatric lipid clinic at the UCSF Medical Center, does not think this should change, even though she characterizes the JUPITER results as “very impressive.”

“I am personally not ready to corral everyone over 35 and do CRP testing,” she says.

Wong says it’s important that people take into account a person’s absolute risk when judging whether or not a patient needs a statin.

Of the JUPITER trial, he says, “There was a 44% reduction in cardiovascular events. This sounds very dramatic, and it is.” But the risk of heart attack in those patients was pretty tiny to begin with — 2.8%. The 44% drop took it down to 1.6%.

The bottom line is that monetary cost as well as potential side effects of statins must be weighed against the potential benefits.

Wong’s biggest concern is that people will get the idea that statins are a cure-all — and they’ll stop bothering about habits that could affect their heart health just as much.

“People think statins are magic pills,” he says. “You can’t forget about other risk factors like smoking, diabetes and blood pressure. . . . you have to make sure all these things are adequately controlled.”

Sources: Los Angles Times

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Natural Cures for Allergies

4 Drug-free options for seasonal allergies:-….CLICK & SEE

Drug-free antidotes are nothing to sneeze at, especially if you’re susceptible to side effects such as drowsiness and dry mouth from popular OTC allergy pills. Below, some promising alternatives that can help get you through the remaining weeks of hay-fever season symptom free.

Butterbur (Petasites hybridus)
Like many OTC meds, this perennial shrub is believed to block histamines. Studies show it can work as well as Zyrtec or Allegra at relieving allergy symptoms—with less drowsiness. A common brand is Petadolex; take as directed. Make sure the label specifies that pyrrolizidine alkaloids have been removed; they’ve been linked to side effects.

Nasal irrigation
The sinus cavities are rinsed with lukewarm saline water. Decades’ worth of clinical tests have found that washing allergens out of the nose is safe, effective, inexpensive, and free of side effects. Ceramic Neti pots, a plastic squeeze bottle such as SinuCleanse ($11), or sprays like ENTsol ($18) all work well. Use warm, distilled water and ¼ teaspoon of kosher salt per 1 cup for the Neti pot.

Spirulina….CLICK & SEE
A type of blue-green algae supplement, it’s rich in beta-carotene, protein, and chlorophyll. A University of California, Davis, study found that 2 g of spirulina daily for 12 weeks eased allergies better than did a placebo. Earthrise Farms (earthrise.com) grows much of the spirulina in the United States; recommended daily doses cost less than $1.

Stinging Nettle (Urtica dioica)
This flowering plant isn’t soft to the touch, but the powdered form has been helpful for centuries. A handful of promising studies since 1990 show it eases allergies, though results vary. Try up to 9 g of pills daily, suggests Roberta Lee, M.D., medical director at the Continuum Center for Health and Healing in New York City.

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Sources:msn.health & fitness

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All Is Not Lost

Snap out of it,  say friends and relatives if you are feeling down or  having the blues. However, the person soon starts to feel better, with or without such ineffectual advice, as negative thoughts and feelings usually last for about two weeks.
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Several bouts of depression may occur during the course of a lifetime. These may be precipitated by chronic illness, the loss of a loved one, financial difficulties or failures. If the precipitating situation changes for the better, recovery is faster.

Depression becomes a disease when it lasts longer than two weeks. It may occur as repeated attacks with short symptom-free intervals, or it may be present constantly. Sometimes a precipitating factor may not exist. It is a difficult diagnosis for the person and his or her relatives to accept as there are no outward physical signs of illness. There is only an all-pervading sense of gloom and inability to get things done. Everything becomes too much of an effort. The person may also become increasingly isolated as he or she fails to keep social obligations or maintain relationships. Constant talk about death, pacing, agitation and withdrawal are danger signals. It means the depression is severe enough for the sufferer to even attempt suicide. Getting over it  is no longer an option and medical treatment is required.

The changes during a bout of depression are not due to a weak personality. The altered behaviour results from an imbalance in the ratios of three chemical messengers in the brain: serotonin, adrenaline and dopamine. This may be genetic, with the condition running in families. Or it may be a response to a life event, precipitated by medication or hormonal changes.

Women become depressed four times more often than men. This is because the female hormone, estrogen, affects the brain chemicals. Menarche, menstruation, pregnancy and menopause produce sudden marked alterations in a woman’s hormone levels. Sometimes  post delivery” blues may be severe enough to incapacitate the mother and even drive her to suicide.

People of all age groups and communities are prone to depression. Children react differently in such a situation than do adults. They perform poorly in class or may refuse to go school. They may develop vague abdominal symptoms and vomit. Adolescents, who generally have confused and uncontrolled emotions, may respond to an underlying depression with unreasonable anger or substance abuse.

Monsoon days are dull and grey with little or no sunlight. The darkness and enforced physical inactivity may aggravate an underlying depression.

National public health does not consider depression a priority as it is a nebulous condition which is not contagious. But depression does seriously affect the national economy as many patients remain undiagnosed and untreated. Their productivity is affected as they are frequently absent from work, apparently uninterested, inefficient and have poor interpersonal relationships.

Sleep disturbances   excessive sleep or insomnia   may be the first sign of depression. There may be early wakening with an inability to fall asleep again. The weight may increase or decrease as the person experiences appetite swings, eating too much or too little. Alcohol or drugs may be used as an escape mechanism to elevate the mood. After the initial euphoria passes, there is a rebound and this worsens the condition. In older people, depression may manifest itself as vague physical symptoms, aches and pains which defy diagnosis, requiring repeated unsatisfactory visits to the doctor.

Depression may alternate with elation in people with a “bipolar disorder”. Such people may be withdrawn and non-functional or productive and creative depending on their mood swings. They either talk too much or not at all.

Once depression is diagnosed, it needs to be tackled. Taking sleeping tablets (sedatives) purchased without a prescription OTC (over the counter) to correct the sleep disturbances alone is not the answer. A combination of anti-depressant medication and psychotherapy probably works best. The medication corrects the imbalances in the chemicals in the brain. The drugs belong to various groups and subtypes. The response of each person varies; a drug that works for one may not work for another. The medications take around six weeks to start acting. Once the mood becomes stable, the person is able to function normally.

Children and young adults respond paradoxically to some anti-depressants. Drugs like paroxetine may increase the suicidal tendency in persons between 18 and 24 years of age. Treatment in adolescents and young adults thus has to be carefully monitored.

Patients need to be supported by family, friends and psychotherapy during treatment. Otherwise, they may prematurely discontinue the treatment thinking that the drug   does not work.  Also, once the symptoms have disappeared, treatment needs to be continued for 9 to 12 months for complete recovery. This, too, may not be followed as patients may not see the need to continue medication once they start feeling better.

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Source: The Telegraph (Kolkata, India)

‘Good’ Bacteria Help Kids with Diarrhea

Supplements containing two different strains of lactobacillus, a bacteria commonly found in yogurt, can help ease bouts of severe diarrhea in children and reduce their hospital stays.

Such treatments, with so-called good bacteria,” are commonly referred to as probiotics. They are thought to work by altering the microbial ecology in the gut of the person who ingests them.

The probiotic treatment cut the amount of time children with diarrhea spent in the hospital. Probiotic-treated children spent 1.6 days in the hospital, on average, versus 2.6 days for the patients given placebo.

And children who received treatment within 60 hours of when their diarrhea began spent an average of 1.7 days in the hospital, versus 3.5 days for kids who received placebo within this time.

The research team also found that children given lactobacillus were less likely to show signs of infection with rotavirus, the leading cause of diarrhea in infants, than youngsters who did not receive the bacteria treatment.

From:The Pediatric Infectious Disease Journal.

Dr. Mercola‘s Comment:

Although one less hospital day may not seem very significant, there clearly was a difference between the two groups. These are the types of studies that traditional doctors require before they adopt these simple measures more broadly.

It is likely that even more impressive results would have been achieved had the babies been put on the eating plan and eliminated wheat and dairy during their infection.

I have seen these probiotics work in many intractable diarrheas in a matter of hours. The trick is to use HIGH doses (which were not used in this study), which likely explains the small difference between the two groups.

Probiotics are the only supplement I advise nearly every patient to start. Once their food choices are cleaned up they can stop taking it. While it is not necessary to take them forever, I do believe it is wise to use one bottle of a good probiotic a year, as most of us are less than perfect with our food choices.

There are probably many other good brands in your local health food store. However, be careful because some brands do not contain what the label claims. A good probiotic will work very well most types of acute diarrhea. I recommend one capsule, or ¼ tsp of the powders, every 30-60 minutes until the diarrhea is gone. It usually resolves in about four hours. These products are quite impressive.

Source:www.mercola.com