Aspirin Gives Strokes

NSAID Use Associated With Future Stroke in Healthy Population

 

September 8, 2010 (Stockholm, Sweden) — Short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with an increased risk of stroke in a Danish population study including only healthy individuals.
Presenting the study at last week's European Society of Cardiology (ESC) 2010 Congress, Dr Gunnar Gislason (Gentofte University Hospital, Hellerup, Denmark) said the results could have "massive public-health implications."

"First we found an increased risk of MI with NSAIDs. Now we are finding the same thing for stroke. This is very serious, as these drugs are very widely used, with many available over the counter," Gislason told heartwire . "We need to get the message out to healthcare authorities that these drugs need to be regulated more carefully."

Cochair of the session at which the study was presented, Dr Robert Califf (Duke Clinical Research Institute, Durham, NC), agreed that the results raised a major public-health issue, especially in the US, where many NSAIDs were available without a prescription.

For the current study, Gislason and colleagues examined the risk of stroke and NSAID use in healthy individuals living in Denmark. He explained to heartwire that information on each individual in the Danish population is kept in various national registries. His team started with the whole population of Denmark aged over 10 years. To select just the healthy individuals, they excluded anyone admitted to the hospital within the past five years or those prescribed chronic medications for more than two years. This left a population of around half a million, who were included in the study. By linking to prescribing registries, the researchers found that 45% of these healthy individuals had received at least one prescription for an NSAID between 1997 and 2005. They then used stroke data from further hospitalization and death registries and estimated the risk of fatal and nonfatal stroke associated with the use of NSAIDs by Cox proportional-hazard models and case-crossover analyses.

Results showed that NSAID use was associated with an increased risk of stroke. This increased risk ranged from about 30% with ibuprofen and naproxen to 86% with diclofenac.

Risk of Stroke With Various Nsaids

NSAID	HR (95% CI) for risk of stroke
Ibuprofen	1.28 (1.14–1.44)
Diclofenac	1.86 (1.58–2.19)
Rofecoxib	1.61 (1.14–2.29)
Celecoxib	1.69 (1.11–2.26)
Naproxen	1.35 (1.01–1.79)

Gislason noted that there was also a dose-relationship found, with the increased risk of stroke reaching 90% (HR 1.90) with doses of ibuprofen over 200 mg and 100% (HR 2.0) with diclofenac doses over 100 mg. He pointed out that the results were particularly striking, given that this study was conducted in healthy individuals.
He conceded that his results could have some confounding but noted that the data were controlled for age, gender, and socioeconomic status and the patient population did not include those with chronic diseases. "We also have to think about the degree of confounding needed to nullify risk. It would have to increase risk four- to fivefold, which is very unlikely," he commented.

He said he did not find the results that surprising in view of the accumulating evidence of increased MI risk with these drugs, adding that the mechanism was probably the same. There have been several hypotheses about the mechanism linking NSAIDs with cardiovascular events, including increased thrombotic effect on platelets, the endothelium, and/or atherosclerotic plaques; increasing blood pressure; and effect on the kidneys and salt retention.

Gislason told heartwire that there is reluctance among the medical profession to limit the prescribing of these drugs. "The problem is that we don't have randomized trials, and it is very hard to change the habits of doctors. They have been using these drugs for decades without thinking about cardiovascular side effects."
He also stressed that the public needs to be protected by not allowing NSAIDs to be bought without a prescription. He has had some success in this regard in Denmark at least, where diclofenac became available over the counter recently, but after some of the MI data came out, Gislason's group campaigned the health authorities, and it has now become a prescription-only drug again. But he noted that many more NSAIDs are available over the counter in the US.

He believes the harmful effects of these agents are relevant to huge numbers of people. "If half the population takes these drugs, even on an occasional basis, then this could be responsible for a 50% to 100% increase in stroke risk. It is an enormous effect."

These results have been partly published in Circulation: Cardiovascular Quality and Outcomes earlier this year [1]. Gislason told heart wire that the novelty of the results presented at the ESC meeting was that "we had further analyzed our data regarding specific stroke and looked at the risk of ischemic stroke, and we confirmed that the risk of ischemic stroke was substantially elevated." He added: "We are in the process of analyzing these data related to time to risk and the effect of duration of treatment on stroke risk."

 

Vitamin D Deficiency May Contribute to Musculoskeletal Pain

Musculoskeletal pain, or pain that affects the bones and muscles in the body, is a common complaint among all segments of the population. Still, despite the high incidence and potential consequences of such pain, precise diagnosis and effective treatment are not always easily attained.

What's more, extremely low levels of vitamin D (known as hypovitaminosis D) may be partly responsible for causing some musculoskeletal pain that goes undetected, which can often lead to more severe consequences, including softening of the bones.

In order to determine the prevalence of hypovitaminosis D in patients suffering from musculoskeletal pain, researchers examined 150 patients (ages 10-65) with musculoskeletal pain who had no known health conditions that would decrease the production or absorption of vitamin D, or otherwise account for their pain.

The study found that 55 percent of individuals younger than age 55 had exceptionally high rates of vitamin D deficiency, while 28 percent of patients had severely deficient vitamin D levels. The deficiencies were similar for both men and women.

The moral of the story? Don't underestimate the role that vitamins and nutrition play in maintaining health and well being.

For more information on the benefits of vitamins, visit www.chiroweb.com/find/archives/nutrition/vitamins.

Reference:
Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clinic Proceedings 2003;78, pp1463-70.

Scottish warning over vitamin D levels

Sunlight on the skin helps generate vitamin D

 

New leaflets are to be handed out urging people to make sure they get enough vitamin D.

Doctors are concerned people in Scotland are not getting enough of the vitamin from sunlight and are not topping up their levels with a healthy diet.

There is increasing evidence that a lack of vitamin D could be linked to cancer and multiple sclerosis.
Doctors are also concerned about a rise in the bone disease rickets.
Rickets is a rare condition which causes the softening and weakening of bones in children.

Pregnant and breastfeeding women are particularly at risk of vitamin D deficiency, along with children under five, the elderly, the housebound and people with darker skin.
About 10 to 15 minutes a day of sunshine is considered safe.

But in Scotland the sun is only strong enough to provide vitamin D between April and September.

If the body's reserves of vitamin D run out during the winter, they need to be topped up from oily fish, eggs, meat or a supplement.


Health Secretary Nicola Sturgeon said: "We know that in Scotland the winter sun is not strong enough to provide the minimum vitamin D needed for health - especially for those with darker skin.

"A significant proportion of the UK population has low vitamin D levels. This leaflet aims to ensure that those at risk are aware of the implications of vitamin D deficiency and know what they can do to prevent it."
She added: "Vitamin D is key to maintaining healthy bones. Young children have a high risk of deficiency and we are seeing an increase in reported cases of rickets in Scotland.
"These conditions are easily prevented by improving diet and taking a supplement if you are at risk.
"Recent research suggests that vitamin D deficiency may also contribute to a range of other medical conditions. The Scottish government are keen to continue to monitor this evidence."

The health secretary is due to speak at the Shine on Scotland conference on Tuesday, which will bring together academics from across the world to consider the possible links between vitamin D deficiency and various health problems.
The event is taking place after schoolboy Ryan McLaughlin took a petition to the Scottish Parliament which called on ministers to produce new guidelines on vitamin D supplements for children and pregnant women, along with an awareness campaign about the issue.

Ryan took up the cause after watching his mother Kirsten suffering from MS.

He said: "It's amazing that I only launched Shine on Scotland early last year and so much has happened since.
"The petition lodged at the Scottish Parliament got great support and I'm really grateful to the Scottish government for being prepared to look at this issue.
"I hope the summit is a great success and that something positive can be done for people with MS and to prevent future generations from developing it."

Dr. Green says:  For people eating plenty of good, healthy red meat, this isn't a problem.  Saturated Fats and Protein are what fed our ancestors for thousands of years and it's just as good for us today.  It's only nonsense of the food pyramid and vegetarianism that causes this and many other problems.  Meat is full of vitamins and nutrients.  It is what we were designed to eat. 

Drinking beer could help prevent weak bones

Drinking certain types of beer can help prevent osteoporosis, claims a new study. Photograph: David Sillitoe

Beer is a rich source of a nutrient that can help prevent weak bones – but it depends what type you drink, claim researchers at University of California, Davis, today.

As one of the nation's favourite tipples, beer is a rich source of dietary silicon, which can help cut the chance of developing diseases like osteoporosis, they conclude.
However, not all beers are the same, with those containing malted barley and hops having higher silicon content than beers made from wheat.

Some light lagers made from grains like corn have the lowest levels of silicon while beers made from hops seem to come out on top, according to the study. The research, published in the Journal of the Science of Food and Agriculture, examined 100 commercial beers and their production methods.
The experts said beer was a major source of dietary silicon – roughly half of the silicon in beer can be readily absorbed by the body.

Charles Bamforth, lead author of the study, said: "Beers containing high levels of malted barley and hops are richest in silicon.
"Wheat contains less silicon than barley because it is the husk of the barley that is rich in this element.
"While most of the silicon remains in the husk during brewing, significant quantities of silicon nonetheless are extracted into wort and much of this survives into beer."

Dr Claire Bowring, from the National Osteoporosis Society, said: "These findings mirror results from previous studies which concluded that moderate alcohol consumption could be beneficial to bones.
"However, while the National Osteoporosis Society welcomes measures to improve bone health we do not recommend anyone increases their alcohol consumption on the basis of these studies.
"While low quantities of alcohol may appear to have bone density benefits, higher intakes have been show to decrease bone strength, with an alcohol intake of more than two units per day actually increasing the risk of breaking a bone.

"There are also many other health concerns linked with alcohol which cannot be ignored."
Catherine Collins, a dietician at St George's Healthcare NHS Trust in London, said there was no recommended daily amount of silicon people should be consuming.
She said it was hard to prove deficiency in silicon because so little was needed.
"Sources of silicon do include beer – either alcohol-containing or alcohol-free – and it's also added as an anti-caking agent to powders such as baking powder.
"It is found in different amounts in water, so contributes to beer's total silica content.
"Silica may well contribute to bone health but in a minor way.
"It is not really significant compared with nutrients that we know are essential for bone health and are potentially deficient in the UK diet – such as calcium and vitamin D.

High-Risk Moments for Your Low Back

How to Avoid Injury and Pain

By Marc Heller, DC

What are the high-risk times and events for your lower back? Why can you get into more trouble doing something as simple as picking up a loaf of bread from the trunk of the car, rather than doing something more challenging? What simple steps can you take to avoid injury and pain? Let's get the answers to these questions and more.

Two Critical Moments
When it comes to your lower back and injury risk, there are two critical times when you need to be especially careful. One is first thing in the morning. Your back is actually swollen at that time. You are substantially taller, and the discs have extra fluid in them. A careless forward bend or twist first thing in the morning can do substantial damage to your discs or other back structures. It doesn't seem fair that such a simple thing, bending and twisting, something you have done thousands of times before, can suddenly cause big problems.

The other critical time is after you have been sitting. Long car drives or airplane trips are especially challenging. In this case, the culprit is something called "creep." This means that your ligaments and tendons lengthen into the position that you have been in. Think of sitting as a bent-forward position, as your legs are forward. The ligaments and tendons do not provide protection properly when they have been lengthened by creep. When you first get up from sitting, you are at risk. The longer you have been sitting, the higher the risk. If you sit more upright, with good lumbar support, you will have somewhat less risk.
 
Here are some common events that can contribute to lower back pain. Keep in mind that in all of these scenarios, your back was already vulnerable.

Scenario #1: You didn't sleep well last night, perhaps from sleeping in an unfamiliar bed after travel, after sitting too long. You get up, feel stiff, but ignore it. You sit down in a soft chair to enjoy your morning hot drink. You get up and get a sudden sharp stab in the back.

Scenario #2: You get up from sleeping, and sit at your laptop, and get entranced by a video or article. You end up sitting far longer than you planned. You get up, and can't completely straighten up.

Scenario #3: You get up from sleeping, drink your morning coffee, which wakes up your gut, and you go to bathroom to empty your bowel. You are a bit constipated, and have to strain. When you get up from the toilet, your back spasms.

Overnight sleeping, even a good sleep on your favorite bed, leaves your back somewhat swollen. Swollen may be an exaggeration, but the reality is that there is extra fluid in all of your joints.

If you have a good back, none of this matters. If you have a vulnerable back, it all matters. Ideally, when you get up, you should do some kind of activity that warms up and "wrings out" the excessive fluids. A short walk, some simple movements, can make a real difference. Sitting down at the computer, sitting on the toilet, etc., can get you in trouble.

So, who has a good back versus a bad back? Unfortunately, most of us have bad backs, at least in the sense that they can be subject to injury and pain at any time. In fact, studies suggest that as many as eight in 10 people experience low back pain during their lifetime. That's a lot of back pain already happening or waiting to happen. And as you can tell from the above discussion, some of the scenarios whereby people experience back pain are all too common.

How to Avoid Injury and Pain
Don't bend over immediately after sitting. Sitting, even in good posture, puts you at risk. The longer you sit and the worse the seat, the more at risk you are. Airlines are very risky; it's hard to get up and move around because of the tight quarters, and the minute the plane stops, you bend over and get stuff from under the seat, or reach up, and twist and lift to get your bag from the overhead compartment. After a long sit, give yourself at least a few seconds of backward bending and/or moving around to reset your spine. Then you can carefully, using your hips rather than your back, bend over to pick up something.

When you sit, don't slump. Slumping reinforces the risks, makes it more likely for something bad to happen to your discs or joints or muscles. So, sit up straight, and keep your back in neutral. Neutral means that you keep a bit of a lordosis in your lower back, keep the lumbar spine from slumping forward, stay more upright. This simple action can make a huge difference. Like any habit, this will require you to "Just Do It" for a few weeks.

Talk to your doctor about these and other high-risk moments for your lower back and what you can do to relieve low back pain or avoid the pain altogether. And make sure to review "Self-Care for Back Pain", which provides information on exercises your doctor may prescribe if you are experiencing back pain.

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Marc Heller, DC, maintains a chiropractic practice in Ashland, Ore. He is a nationally recognized expert in treating tailbone, sacroiliac and lower back pain.

Supplements for osteoarthritis 'do not work'

Two popular supplements taken to combat joint pain do not work, a study says.

The review of 10 previous trials by Bern University in Switzerland found glucosamine and chondroitin did not have any beneficial effect on osteoarthritis of the hip or knee.

But the researchers said they did no harm so if people wanted to continue taking them they could.
This is because of the so-called placebo effect, where symptoms improve because a patients feels better psychologically for taking a substance.

Researchers analyzed the results of tests on 3,800 patients, assessing changes in levels of pain after patients took glucosamine, chondroitin or both together.  They then compared the effects with patients who took a placebo, the British Medical Journal reported.

Lead researcher Professor Peter Juni said: "Compared with placebo, glucosamine, chondroitin and their combination do not reduce joint pain or have an impact on narrowing of joint space.
"Health authorities and health insurers should be discouraged from funding glucosamine and chondroitin treatment."

But the researchers argued that given these supplements were not dangerous there was no reason for patients not to keep taking them if "they perceive a benefit and cover the cost of treatment themselves".
Global sales of glucosamine supplements reached nearly £1.3bn in 2008, although very few are funded by the NHS as they are not recommended by NICE, the official advisory body for the health service.

New cartilage Glucosamine and chondroitin are natural body chemicals which go to make up cartilage, the natural shock absorber in our joints which prevents bones rubbing together.  Some glucosamine and chondroitin is made by the body, but taking them as supplements is thought to boost the production of new cartilage.


However, Dr James Kennedy, of the Royal College of GPs, said he had never prescribed them to a patient.
"If a patient is eating a balanced diet then do they really need supplements?" he asks.
Jane Tadman, from Arthritis Research UK, said they were two of the most popular health supplements for osteoarthritis - and two of the most commonly investigated.
"NICE makes it clear in their guidelines on osteoarthritis that while they don't feel there's enough evidence to warrant the NHS paying for the supplements, some people may want to consider an over-the-counter trial as part of a wider self-management plan which includes exercise and keeping to an ideal weight, and we would support that view," she said.

The researchers' conclusion also supports the view taken by the Scottish Medicines Consortium

Eating nuts can lower cholesterol, say experts

Eating nuts may help lower cholesterol levels, US research suggests.

The review of 25 studies, involving nearly 600 people, showed eating on average 67g of nuts - a small bag - a day reduced cholesterol levels by 7.4%.

The US Loma Linda University team believes nuts may help prevent the absorption of cholesterol.

UK experts said the research showed nuts were an important part of a healthy diet, but warned against eating nuts covered in sugar or salt.

Previous work has indicated eating nuts regularly is beneficial, but the Archives of Internal Medicine study set out to put an accurate figure on the effect.

The effects of nut consumption were dose related, and different types of nuts had similar effects  Lead researcher Joan Sabate

The people involved ate 67g of nuts a day on average, over a period of three to eight weeks.

As well as improving cholesterol levels, it also reduced the amount of triglyceride, a type of blood fat that has been linked to heart disease.

However, the impact was least pronounced among the overweight.

It is not yet clear why nuts have this effect, although one suggestion is that it is down to the plant sterols they contain, which are thought to interfere with cholesterol absorption.

Lead researcher Joan Sabate said increasing nut consumption as part of a healthy diet should be recommended.

He added: "The effects of nut consumption were dose related, and different types of nuts had similar effects."

Ellen Mason, senior cardiac nurse at the British Heart Foundation, agreed, but she urged people to go for unsalted nuts.

"Apart from salted peanuts at the pub, nuts in sugary cereals or the traditional Christmas selection, nuts have been largely lacking in our diets in the UK," she added.

The study was carried out by independent researchers, although it was partly funded by the International Tree Nut Council Nutrition Research and Education Foundation

High GI' carbohydrates increase women's heart risk

Women who eat diets heavy in certain carbohydrates may be at greater risk of coronary heart disease, according to researchers.

A study of over 47,000 Italian adults found that women alone whose diets contained a lot of bread, pizza and rice doubled their heart disease risk.

These foods have a high glycaemic index (GI), meaning they release energy and raise blood sugar quickly.

The findings are published in Archives of Internal Medicine.

The experts say much more research is needed to understand why these high GI foods, rather than carbohydrates per se, appear to pose a risk - and why the risk applies to women and not men.

Low GI carbohydrates, such as pasta, which release energy and raise blood sugar far slower, showed no such link with heart disease.

Glycaemic index

The doctors who produced the report studied 15,171 men and 32,578 women who completed dietary questionnaires over many years.

This allowed the researchers to calculate overall carbohydrate intakes as well as the average glycaemic index of the foods eaten and the glycaemic loads of the diets.

They could try broadening the types of bread and cereals they eat to include granary, rye or oat; including more beans, pulses; and accompanying meals with a good helping of fruit and vegetables  Victoria Taylor of the British Heart Foundation

The glycaemic index (GI) is a measure of how much a food raises blood glucose levels compared with the same amount of glucose or white bread.

The glycaemic load is calculated based on the glycaemic index of a given food and also on the total amount of carbohydrates it contains.

After seven years, 463 participants had developed coronary heart disease.

The researchers found that the women whose diet had the highest glycaemic load had more than double the risk of heart disease compared with those women with the lowest glycaemic load.

The authors concluded: "Thus, a high consumption of carbohydrates from high-glycaemic index foods, rather than the overall quantity of carbohydrates consumed, appears to influence the risk of developing coronary heart disease."

The researchers believe that a high-glycaemic diet may dampen 'good' cholesterol levels in women more than in men.

But further research is needed to verify the absence of a link between high-glucose foods and cardiovascular disease in men, says the study.

Victoria Taylor, senior heart health dietician at the The British Heart Foundation, said that for women, choosing lower GI foods could be useful in helping them to reduce their risk of coronary heart disease.

She said: "They could try broadening the types of bread and cereals they eat to include granary, rye or oat; including more beans, pulses; and accompanying meals with a good helping of fruit and vegetables."

Five-a-day has little impact on cancer, study finds

Eating more fruit and vegetables has only a modest effect on protecting against cancer, a study into the link between diet and disease has found.

The study of 500,000 Europeans joins a growing body of evidence undermining the high hopes that pushing "five-a-day" might slash Western cancer rates.

The international team of researchers estimates only around 2.5% of cancers could be averted by increasing intake.

But experts stress eating fruit and vegetables is still key to good health.

In 1990, the World Health Organization recommended that everyone consume at least five portions of fruit and vegetables a day to prevent cancer and other chronic diseases.

The advice has formed a central plank of public health campaigns in many developed countries. It has been promoted in the UK since 2003 and in the US for nearly two decades.

But research has failed to substantiate the suggestion that as many as 50% of cancers could be prevented by boosting the public's consumption of fruit and vegetables.

It's still a good idea to eat your five-a-day but remember that fruits and vegetables are pieces in a much larger lifestyle jigsaw  Yinka Ebo Cancer Research UK

This latest study, which analysed recruits from 10 countries to the highly-regarded European Prospective Investigation into Cancer and Nutrition, confirms that the association between fruit and vegetable intake and reduced cancer risk is indeed weak.

The team, led by researchers from the Mount Sinai School of Medicine, in New York, took into account lifestyle factors such as smoking and exercise when drawing their conclusions.

But writing in the Journal of the National Cancer Institute, they said they could not rule out that even the small reduction in cancer risk seen was down to the fact that the kind of people who ate more fruit and vegetables lived healthier lives in many other respects too.

Broccoli not biscuits

In the best case scenario, an extra two portions of fruit and vegetables each day could prevent 2.6% of cancers in men and 2.3% of cases in women, the study concluded.

Research should focus more sharply on specific fruits and vegetables and their constitutents  Walter Willett Harvard School of Public Health

Vegetables, which tend to be richer in nutrients, appeared to be more beneficial than fruits, while heavy drinkers seemed to gain the most from a higher intake of both when it came to protection from cancers caused by alcohol and smoking.

In an accompanying editorial, Professor Walter Willet of Harvard University said the research strongly confirmed the findings of other studies, showing "that any association of intake and fruits and vegetables with risk of cancer is weak at best".

But he stressed specific substances contained in certain fruit and vegetables, if harnessed, could still have an important, protective effect.

Substantial evidence suggests lycopene from tomatoes, for instance, may reduce the risk of prostate cancer, while chemicals in broccoli are thought to stimulate a gene which protects against bowel cancer.

And data still suggests fruit and vegetables may provide protection against cardiovascular disease, one of the major killers in the developed world - although this too has yet to be proven categorically.

Keeping lean

But while the links between diet and cancer remain unclear, obesity is now seen as an established risk factor.

Eating five-a-day still has health benefits

Fruit and vegetables could therefore be beneficial just by virtue of taking the place of more calorific fare, health experts say.

In any event, a reduced risk of 2.5% should not be dismissed out of hand, the World Cancer Research Fund argues.

"For the UK, this works out as about 7,000 cases a year, which is a significant number," says Dr Rachel Thompson from the charity, which in a major 1997 report said there was "convincing evidence" of the protective effect of fruit and vegetables.

Yinka Ebo of Cancer Research UK said: "It's still a good idea to eat your five-a-day but remember that fruits and vegetables are pieces in a much larger lifestyle jigsaw.

"There are many things we can do to lower our chances of developing cancer such as not smoking, keeping a healthy weight, cutting down on alcohol, eating a healthy balanced diet, being physically active and staying safe in the sun."

Canada's doctors told to stop using swine flu vaccine

GlaxoSmithKline has advised doctors in Canada to stop using a batch of its swine flu vaccine, amid reports of severe side-effects in some patients.

The batch of some 170,000 doses was put on hold because of the reported higher than usual number of patients having anaphylactic reactions.

This may include breathing problems, raised heart rate and skin rashes.

The pharmaceutical company said it was investigating the reports, which could lead to the withdrawal of the batch.

The reports say one in 20,000 people suffered adverse reactions to the batch of GlaxoSmithKline's Aperanix vaccine.