Medical Articles by Dr. Ray

Dec

2002

What Goes Around Comes Around With Blood Pressure Medications

By Ray Schilling | Heart Disease, High Blood Pressure, Prevention, Stroke

A large clinical study with 42,418 men and women 55 years and older has been published in the American Medical Association Journal recently(JAMA 2002:288:2981-2997,3039). The thiazide type water pill chlorthalidone(12.5 mg to 25 mg/day) is the clear winner in this trial, called the ALLHAT trial. It stands for “Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial” and is the largest hypertension trial that was ever performed going over a period of 5 years.

In this trial a calcium channel blocker(amlodipine) and an ACE (=angiotensin converting enzyme)inhibitor(lisinopril) were tested as the initial medication and compared to chlorthalidone.There was a 15% higher risk to develop a stroke with lisinopril and a
38% increased risk with amlodipine to develop congestive heart failure when compared to the chlorthalidone group. The interesting conclusion from this study is that the least expensive therapy for high blood pressure turns out to be the safest. Another ineresting finding was that black patients responded much better to water pills than to ACE inhibitors, which had been noted before by other authors. When more than one medication is required to control high blood pressure, the dosage of the second medication can often be kept lower with a combined therapy thus reducing the likelihood of side-effects and complications.

What Goes Around Comes Around With Blood Pressure Medications

Comments: Several decades ago the teaching was that the doctor would start a new high blood pressure patient with a water pill first, and combine this with a second or even third pill of a different medication class, if the water pill would not be effective enough on its own (it was called the “step care therapy”). For decades the side effects of the water pill consisting of low potassium blood levels brought the water pill treatment in disrepute. The original trials,however, were done with chlorthalidone doses of 50 and 100 mg per day, much higher than would now be recommended. It appears that with this study medicine has gone a full circle back to the old stand-by water pill, but at a much safer, lower dosage.

Here is a useful link (regarding hypertension): http://www.nethealthbook.com/articles/cardiovasculardisease_hypertension.php

Last edited December 10, 2012

Dec

2002

Bone Growth Can Be Stimulated Even In Desperate Cases

By Ray Schilling | fractures

In the past bone fractures that did not heal (called “non-union of a fracture” in medical terms) could not be treated other than with an electrical device, called bone stimulator. But now a large international team of 66 researchers from the US and South Africa have published a well controlled randomized study in the American Journal of Bone and Joint Surgery (84:2123-2134;2002). Dr.S.Govender et al. used a newly developed protein substance (rhBMP-2, from the Wyeth Laboratories) to treat 450 comparable open shin bone fractures.

The patients were either treated conventionally or with the additional help of this bone growth substance and data on wound healing, infection rates and delayed unions were collected. At 6 weeks 83% of the experimental group showed complete wound healing of the soft tissue compared to 65% of the control group. There were also significantly lower hardware failures, wound infections and need for postoperative visits by the doctor.

At the 12 month follow-up point there were 44% less non-unions when the two groups were compared with a lot less invasive secondary surgeries being needed.The authors of the two scientific collaborative teams concluded that this new bone producing protein will raise the standard of treating complex fractures that are difficult to heal.

See this news of the FDA approval

Bone Growth Can Be Stimulated Even In Desperate Cases

Last edited October 14, 2014

Dec

2002

Folic Acid In Cereal Reduces Abnormalities Of The Brain and Spine In The Unborn Child

By Ray Schilling | Nutrition, Other neurological conditions, Prevention, Women’s Diseases

In 1998 the Canadian government approved the mandatory addition of folic acid in cereal products as studies in the past had shown that pregnant women did not always take their prenatal folic acid supplements to prevent neural tube defects (abnormalities in brain and spine formation).

A total of 336,963 children of women who were either pregnant before or after the 1998 folic acid fortification program was institued, were screened for open neural tube defects. The result was that prior to the legislation there were 113 cases per 100,000 pregnancies. After 1998 there were only 58 per 100,000 pregnancies found.

Dr. Joel G. Ray from the Sunnybrook and Women’s College Health Sciences Center in Toronto who was the lead researcher stated that a food fortification program with folic acid in addition to the regular prenatal folic acid tablet supplementation is essential. To a large extent this will prevent these devastating congenital malformations that cause disabilities or death.

Folic Acid In Cereal Reduces Abnormalities Of The Brain In The Unborn Child

Based on: Lancet 2002;360:2047-2048.

Comments: It is also important for women to know that folic acid tablets need to be taken already before, around and after conception to be most effective with regard to preventing brain and spinal malformations. The nervous tissue is one of the fastest growing tissues in the first few weeks of pregnancy. Any deficiency of cell differentiation, for which folic acid is an essential ingredient, has devastating longterm consequences for the child.

Last edited December 10, 2012

Dec

2002

Study Shows Echinacea Not Effective For The Common Cold

By Ray Schilling | Infectious Disease, Lung Disease, Prevention

A study shows echinacea not effective for the common cold. 148 college students participated in this experiment at the University of Wisconsin. The researchers wanted to see whether Echinacea was more effective than placebo (“fake pills” with no herb in it). The Annals of Internal Medicine (Ann Intern Med 2002;
137:939-946,1001-1002) published this study recently.

How they did the experiment

The students were given 1 Gram capsules of a mixture of Echinacea herbs that can he bought in health food stores. With the onset of the common cold the students were given 1 capsule 6 times daily for the first day and three times daily from the second to the 10th day. The researchers examined all the students in the placebo group and the Echinacea group for symptoms, duration of the cold and the severity of the cold. The mean duration for both groups was 6 days. None of the criteria in measuring the severity of the cold symptoms were different in both groups. Dr. Barrett, the lead investigator concluded that there was no measurable difference between the two groups, but added that the findings of this trial should not be “the last word” on Echinacea. More studies need to investigate this matter.

Study Shows Echinacea Not Effective For The Common Cold

Conclusion

Here is the problems with the study. The investigators assumed that a placebo pill would not have an effect. However, countless other studies have shown that a placebo often has a 15% to 20% effect. On the other hand it is difficult to have another control for this by not taking any pill. It would be obvious to the subject in the trial that they are the negative control. A negative placebo effect would kick in. So, don’t stop taking Echinacea yet, if you have been taking this normally to treat a common cold. But those of you never took it in the past, you may want to wait first. See what other studies will say in future regarding Echinacea.

Last edited September 16, 2018

Nov

2002

WAVE Trial Failed To Show Benefits Of Estrogen (Premarine) And Vitamins

By Ray Schilling | Health, Heart Disease, Hormones, Prevention, Women’s Diseases

Dr. David D. Waters of the University of California at San Francisco reported in Chicago at the American Heart Association’s Scientific Session 2002 about the WAVE trial. This stands for “Women’s Angiographic Vitamin and Estrogen” trial.

The results of this study were simultaneously published in the Journal of the American Medical Association(JAMA 2002;288:2432-2440). It was a “carefully designed randomized study” where 423 women with established blood vessel damage to their hearts (established by angiography) were put on a therapy and then followed for an average of 2.8 years. Essentially the question was whether or not estrogen (Premarine) and vitamins (Vit.E and C) would have a protective effect on the blood vessels. Surprisingly the worst outcome was in the group with estrogen replacement and vitamins. The placebo group (=no estrogen, only vitamins) had the lowest death rate. The authors felt that the beneficial effect of estrogen (speak “Premarine”) on heart vessels could not been verified in this study. The take home message to the physicians at the conference was that they should concentrate on lowering the known risk factors: weight reduction, blood pressure control, cholesterol lowering and increasing exercise. Estrogen should be given in low doses (Premarine 0.625mg per day) only to those women who are symptomatic with hot flashes, but not to every postmenopausal woman.

WAVE Trial Failed To Show Benefits Of Estrogen (Premarine) And Vitamins

NOTE : This group of postmenopausal women is a selection of women more likely suffering from hyperinsulinism with a higher rate of cardiovascular disease (and also arthritis and possibly a higher risk for cancer as well). The most logical therapy for these women is to work on weight loss, to increase exercise and to change their diet to a zone diet as this is known to lower cholesterol. Hoping to cure these women with estrogen or vitamin manipulation alone does not make “medical common sense” to me. Also, those women who had not had a hysterectomy were not dealt with as a separate group, although they were put on medroxyprogesterone acetate (Prempro). This is called a “confounding bias” and should have been openly discussed, which it was not. This means the WAVE trial made waves, but it was not a properly designed randomized study.

You may want to read these useful related links to chapters of my free Internet based Nethealthbook: For links to arteriosclerosis, heart attacks and strokes see this link: http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/
For a link to hyperinsulinism follow this link:
http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Last edited October 25, 2014

Nov

2002

Heart Attack And Stroke Risk Measured With C-Reactive Protein

By Ray Schilling | Heart Disease, Infectious Disease, Prevention, Stroke

An old blood test that has been popular in assessing how aggressive rheumatic illnesses such as rheumatoid arthritis or lupus are, is now considered as the newest test to assess the risk of heart attacks. Up to now subfractions of cholesterol, in particular the LDL cholesterol level, has been used to assess the risk for a heart attack, but this according to a new study in the New England Journal of Medicine (Nov. 14, 2002) by Dr. Paul Ridker should be supplemented by a blood test checking for the C-reactive protein. What is interesting about the C-reactive protein is that it originates from certain lining cells in blood vessels of liver tissue when inflammatory substances circulate in the body. Other research has shown in the past that arteriosclerosis is in part due to an inflammatory process in the lining of the blood vessels that leads to the production of the C-reactive protein. Unfortunately other chronic illnesses and infections also lead to an elevation of the C-reactive protein as does the common cold or the flu. However, when 28,000 women of the Brigham and Women’s Hospital study were followed for 8 years it turned out that the C-reactive protein was a more reliable predictor for who would eventually suffer from a stroke or a heart attack than the traditional LDL cholesterol. The investigators felt that the LDL cholesterol is predictive for who is more likely to develop fatty deposits (atheromatous plaques). On the other hand the C-reactive protein appears to be more predictive for who is at a high risk for rupture of these atheromatous plaques. The bottom line is prevention by eating a diet with less fatty meats, by eating more fruit and vegetables and by engaging in an exercise program.

Heart Attack And Stroke Risk Measured With C-Reactive Protein

Some patients need their cholesterol reduced with medication such as the statins. You may want to browse through these useful related links to chapters of my free Internet based Nethealthbook: For more details regarding the use of the C-reative protein test in rheumatoid arthritis see this link: http://www.nethealthbook.com/articles/rheumatologicaldisease_rheumatoidarthritis.php Regarding arteriosclerosis, heart attacks and strokes follow this link: http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Last edited December 10, 2012

Nov

2002

New Blood Test To Predict Breast Cancer Survival Rate

By Ray Schilling | Cancer

Dr. Keyomarsi, a researcher and radiation oncologist from the M.D. Anderson Cancer Institute in Houston/Texas, has published a very important piece of research in the New England Journal of Medicine (N Engl J Med 2002;347:1546-1547,1566-1575). A group of 394 breast cancer patients were followed for 6.4 years and cyclin E was measured with a special blood test. Cyclin E is a key substance involved in cell division in general and also in breast cancer cells. Dr. Kyomarsi’s research showed that cyclin E, and in particular high levels of its socalled “truncated isoforms”, correlated very well with poor survival. On the other hand low cyclin E levels (truncated isoforms) were a powerful predictor for excellent survival. In the above mentioned breast cancer study 12 patients out of a group of stage 1 patients (= localized breast cancer) died after an average of 4.1 years from the point of diagnosis. All of these patients had high cyclin E levels. In contrast, none of the other stage 1 patients had died within 5 years from the diagnosis and all of their cyclin E levels were low. Other known risk factors for poor survival are lymph gland metastases, negative estrogen receptors on the surface of the cancer cells and late-stage disease. Each of those factors has a risk of about 1.7-fold. A high (truncated isoform) cyclin E level is associated with a 2.1-fold risk when compared to the low risk group with a low cyclin E level. There is a subgroup of breast cancer patients with high total cyclin E levels who have a risk of 13.3-fold of dying from breast cancer.

New Blood Test To Predict Breast Cancer Survival Rate

You may want to read these useful related links to chapters of my free Internet based Nethealthbook: A general overview regarding cancer: http://www.nethealthbook.com/articles/cancer_canceroverview.php#cancer This chapter deals specifically with breast cancer: http://www.nethealthbook.com/articles/cancer_breastcancer.php

Last edited December 10, 2012

Nov

2002

Nuts Cut Heart Attacks And Strokes In Half

By Ray Schilling | Health, Heart Disease, Nutrition, Stroke

According to Dr. Elliot M. Berry of Hebrew University Hadassah Medical School in Jerusalem and Dr. Ram B. Singh of the Medical Hospital and Research Centre, Moradabad/India, the word is out that a Mediterranean diet with walnuts and almonds, fruits and vegetables can safe lives and prevent heart attacks.

In a paper, published in the medical journal Lancet 2002;360:1455-1461, 1000 Asian patients with a high risk for heart disease and strokes were put on two diets: a “control” heart smart diet and the experimental diet,which consisted of the Mediterranean diet.

Surprisingly,not only did the high risk patients benefit from the Mediterranean diet, but also the control group that had already been on a healthy heart smart diet. Over 2 years the heart attack
rates, death rates and heart disease event rates were all roughly cut into half on the Mediterranean diet. Cholesterol levels were significantly reduced,as much as would have been achieved with expensive cholesterol lowering medications. According to Dr.Berry the key to the understanding of this is found in the alpha-linoleic acid found in nuts and almonds. It is a precursor of the omega-3-fatty acids also found in fish oil, which in turn lower cholesterol, prevent blood clotting and are a natural remedy to prevent inflammation in the body.

Nuts Cut Heart Attacks And Strokes In Half

Further investigations will be done by the research team to understand the mechanism of action of the healthy Mediterranean diet. In the meantime Dr. Berry stressed that other lifestyle changes must accompany the Mediterranean diet, namely an active exercise program and regular relaxation exercises such as yoga.

You may want to read these useful related links to chapters of
my free Internet based Nethealthbook:

Hardening of the arteries:
http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

Last edited October 25, 2014

Nov

2002

New Research Shows That Coffee Drinking Is Healthy

By Ray Schilling | Diabetes, Health, Heart Disease, Prevention

Forget what somebody may have whispered into your ear in the past,namely that coffee drinking would be bad for you. Dr. Rob M. van Dam and Dr.Edith J. M. Feskens from the National Institute for Public Health and the Environment in Bilthoven, theNetherlands, have recently completed a prospective study with a large number of participants.

The results were published in the Lancet 2002;360:1477-1478. The goal of the study was to see whether coffee consumption would have a positive or negative effect on the development of diabetes (type 2 or mature onset diabetes). Approximately 17,000 men and women were followed along over a period of time and 306 new cases of diabetes were detected. The average consumption of coffee was 5 cups per day. There was a striking difference between those who drank 7 cups of coffee per day and those who drank 2 cups or less per day: With 7 cups per day there was a 50 % LESSER risk of developing diabetes. The authors pointed out that it is known that some of the active ingredients in coffee are: the bioflavonoids, chlorogenic acid, the minerals magnesium and potassium, and vitamin B3.

New Research Shows That Coffee Drinking Is Healthy

Chlorogenic acid and magnesium have been known in the past to have a stabilizing effect on glucose metabolism thus preventing diabetes.The authors were surprised though about the magnitude of the diabetes protective effect. They suggested that
other authors should do further studies to confirm their findings and to attempt to pinpoint the mechanism of action. In the meantime they cautioned that it would be premature to recommend to increase coffee consumption for everybody.

Useful related link to a chapter of my free Internet based Nethealthbook: http://nethealthbook.com/health-nutrition-and-fitness/

Last edited October 25, 2014

Oct

2002

Work Stress Is A Killer…More Than 2-Fold Over A Period Of 25 Years

By Ray Schilling | Diabetes, Heart Disease, Obesity, Stroke

In mid October 2002 the British Medical Journal(BMJ 2002;325:p.857-860) published a paper by Dr. Mika Kivimäki from the University of Helsinki where 812 healthy factory workers were followed for about 25 years. The issue was whether stress from work would have negative consequences, which could be measured in terms of cardiovascular disease. Various risk groups were defined from low stress to high stress.

Low stress jobs were classified as people who often had more training, more responsibilities, better salaries, physically less strenuous jobs with more job security. High stress jobs involved the opposite(high demand/low job control/low salary/no job security). Depending on which subgroups of high versus low risks were compared, the investigators found a 2.2 to 2.4-fold increase of strokes and heart attacks due to cardiovascular disease.The team measured other cardiovascular risk factors. They found a significant increase of cholesterol in the high stress job group after 5 years. After 10 years there was a marked weight gain in the stressed group with obesity becoming much more frequent. The authors noted that this likely led to a change of metabolism in the sense of hyperinsulinism, which is known to cause high cholesterol levels and leads to hardening of the arteries with heart attacks and strokes.

Work Stress Is A Killer…More Than 2-Fold Over A Period Of 25 Years

Visit these useful related links to chapters of my free Internet based Nethealthbook:
Hyperinsulinism or syndrome of insulin resistance:
http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Heart disease:
http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Stroke:
http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/hemorrhagic-stroke/

Last edited October 25, 2014

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