The New York Times reports here that a study in The Journal of The American Medical Association tosses a bit of cold water on the notion that a biomarker known as C-reactive protein (CRP) is a factor in causing heart disease.
To back for a moment, a very well-publicized study called JUPITER showed a strong connection between elevation of CRP and the development of heart disease in men over the age of 50 and women over 60. This was true regardless of the patients cholesterol level. (Moreover, the study showed demonstrably that taking rosuvastatin, a cholesterol-lowering medication) reduced the risk of heart attack. Some folks took this to mean that high CRP caused heart disease, and that lowering CRP would reduce the risk. Others, including me, thought that this more about inflammation - inflammation in the body serves as a trigger for heart attacks, and inflammation causes the CRP to be elevated.
Combined with the new study, it does seem more likely that the latter view is more likely correct. To sum it up, it now appears that elevated CRP is a good biomarker for heart disease, but lowering the CRP level offers no benefit. As an analogy in the article puts it, inflammation is like a fire in the house: silencing the alarm (lowering CRP) does not mean all is safe. You have to put out the fire, and the alarm will then go silent.
The late Dr. Ralph Feigen, a legendary pediatrician who had served as physician-in-chief of Texas Children’s Hospital in Houston and as president of Baylor College of Medicine, was accomplished in the halls of medicine in many ways. Interestingly, he was also accomplished in the staircases of medicine. You see, Dr. Feigen simply did not use elevators until very late in life. I never asked him the exact reasons for this, but I have been up and down a fair number of stairs with him and it was hard to keep up - in spite of a 30-year age difference.
I thought of him as I read two articles dealing with the benefits of using the stairs. The first is an ask-the-doctor piece about the relative merits of going up versus going down stairs (short answer: up is better for the heart, but both are worth doing). The second piece wonders whether people would use the stairs more often if they were given their rightful attention in buildings: more accessible, better lighting, carpeted, perhaps some music or something hanging on the walls.
Folic acid, or more correctly: folate) has been widely recognized as essential to the prevention of neurological disorders in infants when taken by pregnant moms. This, combined with the knowledge that the body does not store much of it, has led to its common inclusion in the prenatal vitamins taken by women.
It later appeared that folate consumption during pregnancy could lessen the risk of preterm delivery. Finally, a study ofbirth statistics in Canada shows that there seems to have been a drop in the incidence of heart defects since that country began requiring more folate in certain foods.
The possible downside may be that too much folate in older folks may promote some cancers.
You can see more of the story from the Associated Press here.
It seems as if the guidelines for weight gain during pregnancy are somewhat of a mystery, and it seems that different obstetricians look at the subject differently. There is a recent study, as reported in Medscape, suggesting that obesity in pregnancy may lead to metabolically compromised infants.
Actemra, an investiational biologic drug (investigational in the U.S., but on the market in Japan) shows some promise as a second-line drug in the fight against rheumatoid arthritis. The term “second-line” means it is effective when added to another drug, presumably because the two medicines act in different ways toward a common outcome. In this instance, Actemra was tested when added to methotrexate, and progress was shown using X-ray analysis of joint disease.
You can see a story on this here, courtesy of MedPage Today.
IL-6 has been recognized as a biomarker for inflammation.
Throughout my legislative career, I noticed that businesses and doctors rarely agree on healthcare policy. The reason is pretty straightforward: policy usually is about money.
In the current scenario of unprecedented intrusion of the federal government into healthcare, it seems the docs and the chambers of commerce have found common ground - opposition to at least one version of the governments plans.
Read more on the Wall Street Journal’s Health Blog. This is not trivial stuff, as these two groups will have a massive say in anything the congress and the White House propose. Watch for attempts by lawmakers to buy off one side or the other.
This one will generate some discussion, courtesy of our friends at MedPage Today. Researchers are suggesting in the British Medical Journal that older folks should be put on an antihypertensive drug - even if they have normal blood pressure. By looking at dozens of clinical trials and comparing incidents of heart attacks and strokes, they have come to the conclusion that any of the 5 major classes of antihypertensive medications will be equally effective in reducing events in older patients, and that this holds whether the patient is hypertensive or not.
Researchers at the LSU Health Science Center in New Orleans have been using markers for diabetes and have found that fat in the liver and skeletal muscle cells can predict poor insulin sensitivity, meaning the body may produce insulin but the cells do not respond to it in allowing glucose into the cells. The finding of skeletal and liver fat was important only if the child was also obese. This poor sensitivity to insulin is closely associated with the development of overt diabetes.
The findings were in kids 7-9 years old.
Strokes originate in two forms. One is hemorrhagic stroke, wherein blood vessels rupture inside the brain. The other is known as ischemic stroke, caused when a blood vessel is blocked by plaque or a clot.
In an earlier blog, I discussed the JUPITER study, which showed benefits of rosuvastatin in patients with elevated C-reactive protein (CRP) in preventing heart attack and ischemic stroke regardless of the LDL cholesterol levels. Now a follow-up of those patients, reported by the folks at MedPage Today, shows no increase in hemorrhagic stroke rates - a concern since patients taking another statin, Lipitor, had shown such an increase.
This is more good news for the maker of rosuvastatin (brand name: Crestor) and for those taking it.
A study comparing various diet techniques - low-carb, etc. - indicates that what really matters most is to reduce total calorie consumption. As reported in the L.A. Times health section, as well as many other outlets, this finding augments the longevity value of caloric-restriction discussed in previous blogs.