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No Extra Benefits Are Seen in Stents for Coronary Artery Disease

2012-03-07T14:50:00.001-07:00

No Extra Benefits Are Seen in Stents for Coronary Artery Disease

By NICHOLAS BAKALAR

Published: February 27, 2012

The common practice of inserting a stent to repair a narrowed artery has no benefit over standard medical care in treating stable coronary artery disease, according to a new review of randomized controlled trials published on Monday.

Stable coronary artery disease is the type of heart ailment that causes angina, or chest pain, after physical exercise or emotional stress but generally not at other times. The review did not include studies of the emergency use of stents for heart attacks.

Stent implantation involves a procedure called percutaneous coronary intervention, or P.C.I., in which a surgeon inserts a mesh tube made of metal into an artery that has become narrowed by accumulated plaque. The tube, threaded through an artery in the leg or arm, expands to hold the artery open at the point where blood flow is restricted.

Some of these devices, called drug-eluting stents, are coated with medicine that helps to keep the artery open. The cost of the procedure varies from about $30,000 to $50,000, and more than one million are performed every year in the United States.

The procedure has certain risks. According to Dr. David L. Brown, an author of the analysis, the risk for death is about one in a thousand, and complications can include stroke, heart attack, bleeding, kidney damage and serious allergic reactions. But those events are rare, and the review did not detect any increased risk in P.C.I. compared with medical treatment.

Despite the widespread popularity of the procedure, previous studies have reached mixed conclusions as to whether stents are effective for treatment of stable coronary artery disease.

The researchers reviewed eight randomized trials comparing P.C.I. with standard medical care. Combining data from all the studies, the researchers found that prescribing beta blockers, ACE inhibitors, statins and daily aspirin — now standard for treatment of stable coronary artery disease — was just as effective as stent implantation for prevention of chest pain, heart attack, the need for a future P.C.I. and death.

More than half of patients with stable coronary artery disease are now implanted with stents without even trying drug treatment, Dr. Brown said. The reason, he believes, is financial.

“In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there’s incredible pressure to do more procedures,” he said.

“When you put in a stent, everyone is happy — the hospital is making more money, the doctor is making more money — everybody is happier except the health care system as a whole, which is paying more money for no better results.”

Dr. Allan Schwartz, chief of cardiology at Columbia, who was not involved in the study, said that the analysis reinforced what was already known — that treatment with medicine first is usually the best approach.

“I agree with the conclusions,” he said, “but they shouldn’t be oversimplified. Cardiac disease is complicated, and there are lot of factors that go into assessing who should and shouldn’t be treated with stenting.” Sometimes a stent is indicated even in patients with stable coronary artery disease, he said — for example, when the medicine doesn’t work or has intolerable side effects.

Two recent meta-analyses showed an advantage for P.C.I. But those reviews considered patients enrolled in the 1980s and 1990s when balloon angioplasty without stents was the predominant form of surgical intervention, and when medical therapy generally did not include statins, ACE inhibitors and other drugs that are now standard in medical treatment.

This review, published in The Archives of Internal Medicine, included only prospective randomized trials that compared P.C.I. and medical therapy with medical therapy alone. There were 7,229 patients in all, half randomized to P.C.I. and half to medicine alone. More than 70 percent of the surgical patients received stents, and the studies followed patients for an average of more than four years
.Death rates were 8.9 percent with P.C.I. and 9.1 percent with medical treatment. Rates for nonfatal heart attacks were 8.9 percent for those who got stents and 8.1 percent for those on medicine alone.

P.C.I. was eventually performed on 30.7 percent of patients who got only medicine, but a second P.C.I. was required for 21.4 percent of those who got stents. None of these differences was statistically significant.

Dr. Harlan Krumholz, a cardiologist and professor of medicine at Yale who was not involved in the study, said that the findings hold a lesson for doctors treating heart patients. “When people are making decisions, it’s important to disclose to them that this procedure — outside of an emergency — is not known to be lifesaving or to prevent heart attacks,” he said. “The vast majority of people who have this procedure have the expectation that it will help them live longer. That belief is out of alignment with the evidence.”

Some theories suggest that stenting reduces mortality by improving blood flow or stabilizing plaques that can break away and cause blood clots, but the researchers found nothing to support those ideas.

Angina is often the symptom that convinces doctors and patients that medical therapy is not enough and that a stent is required. But in this analysis, 29 percent of people who had P.C.I. still had angina, compared with 33 percent of those on medicine, an insignificant difference.

These results support the current concept of coronary artery disease, the authors wrote — that it is a systemic inflammatory disease of the arteries that cannot be successfully treated by surgical intervention at a particular site on one artery.

According to Dr. Brown, a professor of medicine at Stony Brook University, many doctors cannot accept this. Instead, he said, “interventional cardiologists use the analogy of a pipe blocked in a house — it’s a terrible analogy, but patients accept it. It’s simplistic and erroneous.”

Vytorin Side Effects May Result In Clogged Arteries Lawsuits

2012-03-07T14:44:00.000-07:00

Vytorin Side Effects May Result In Clogged Arteries Lawsuits

Vytorin | Lawyers, Lawsuits | Side Effects: Clogged Arteries, Heart Attack, Stroke

On January 14, 2008, the results of a long-awaited study on the effectiveness of Vytorin to reduce artery clogging plaque in patients with high cholesterol were released. The ENHANCE study found that Vytorin, a combination of cholesterol lowering Zetia and the statin Zocor, worked no better to reduce clogged arteries than a high dose of a less-expensive, generically available statin alone. Our Vytorin Side Effects Lawyer Have Many Experienced Years Handling Defective Drug Lawsuits.

Vytorin

Vytorin, developed and marketed jointly by Merck and Schering-Plough, is a combination of cholesterol-lowering Zetia and the statin Zocor.Vytorin was approved by the Food & Drug Administration in 2004 to treat both sources of cholesterol - absorption in the intestine of both biliary and dietary cholesterol, and production in the liver and peripheral tissues. It was believed that the treatment of cholesterol from both sources would likely to result in lower cholesterol levels. It was likewise theorized that this reduction in cholesterol would in turn reduce the amount of plaque buildup in the arteries, thus reducing the risk of heart attack and stroke. However, the results of the ENHANCE study showed that Vytorin brought about no measurable reduction in the amount of artery plaque buildup.

The ENHANCE Study

The ENHANCE study, which was funded by Merck and Schering-Plough, focused on a group of 720 patients with a rare condition predisposing them to high cholesterol. The patients were given either Vytorin or a high dose of simvastatin, the generic form of Zocor. While both Vytorin and Zetia were found to have significantly reduced cholesterol in these patients, neither drug provided any significant benefit versus the statin drug Zocor in slowing down clogging of the arteries. Overall, the study failed to meet its primary goal, which was to show whether Vytorin was more effective than Zocor alone in preventing progression of atherosclerosis in the carotid artery, which is in the neck.

Such plaque buildup is a major risk factor for heart attacks and stroke. Many doctors had been prescribing Vytorin or Zetia on the theory that the drugs would reduce this risk in people with high cholesterol. The ENHANCE study was a serious blow to this theory.

There is some evidence that Merck and Schering-Plough tried to suppress the ENHANCE studies findings. The data from the ENHANCE trial was supposed to be released by March 2007, but that didn’t happen. In November 2007, the doctor who supervised the ENHANCE trial told the New York Times that the drug’s’ makers, who controlled the study’s raw data, blocked its release. In December, a congressional committee requested more information on the ENHA NCE study. Merck and Schering-Plough maintained that the ENHANCE results were delayed because of the complexity of the data.

According to the New York Times, Merck and Schering-Plough also tried at one point to change the ENHANCE study’s endpoint. The endpoint is the main medical result the study was meant to measure, and it is generally accepted among scientists that for a clinical trial to be valid, the endpoint must never change. Following a great deal of outcry, Merck and Schering-Plough backed off changing the ENHANCE endpoint in December.

It is understandable that Merck and Schering-Plough would have wanted to delay the disappointing results of the ENHANCE study. Combined Vytorin and Zetia sales were about $3.7 billion for the nine months ended Sept. 30, up 33% from the year-earlier period. The disappointing results of ENHANCE put those sales at risk, as many doctors may opt to prescribe the generic version of the Zocor alone, rather than the combo pill Vytorin. Generic versions of Zocor cost roughly $1 per pill, compared with about $3 per Vytorin tablet.

Statin - increased risk of confusion, memory loss, and new-onset diabetes

2012-03-07T14:32:00.000-07:00

Statin Cholesterol Drug Muscle Toxicity

Dr. Michael Greger
March 7, 2012

Last week, the Food and Drug Administration announced newly-mandated safety labeling for cholesterol-lowering statin drugs such as Lipitor, Mevacor, Crestor, Zocor, and Vytorin. The FDA issued new side-effect warnings regarding the increased risk of confusion, memory loss, and new-onset diabetes associated with taking this class of drugs.

In their press release, to reassure consumers, the FDA stressed the importance of lowering cholesterol: “We want health care professionals and patients to have the most current information on the risks of statins, but also to assure them that these medications continue to provide an important health benefit of lowering cholesterol.” They fail to mention the intervention that can lower cholesterol as much as statins and comes associated with a list of beneficial side-effects including lower dementia and diabetes risk: a plant-based diet.

The FDA also included a new warning about muscle damage. Even people who don’t experience pain or weakness on statin drugs may be suffering muscle injury, the subject of my NutritionFacts.org video pick today:

Lowering one’s cholesterol through diet involves more than just avoiding the bad (dietary cholesterol, saturated and trans fats). It also means piling on the good, by choosing plant foods packed with soluble fiber (such as oatmeal) and phytosterols (such as nuts). My 3-minute video New Cholesterol Fighters details eight products put to the cholesterol-lowering challenge. Red yeast rice is not recommended—more on that in my videoPower Plants.

According to the editor-in-chief of the American Journal of Cardiology (as detailed in my one-minute video Heart Attacks and Cholesterol: Purely a Question of Diet), to achieve the cholesterol level necessary to prevent heart attacks, most of us must either take cholesterol-lowering drugs for the rest of our lives, or embrace a plant-based diet.

It’s our choice.

In health,
Michael Greger, M.D.

2012-03-07T12:47:00.000-07:00

Women less likely to get immediate heart attack treatment

By Liz Szabo, USA TODAY

Updated 2/21/2012 5:12 PM

Reprints & Permissions

Women having heart attacks are less likely than men to get immediate treatment and more likely to die in the hospital, says a groundbreaking new study that tracked more than 1.1 million patients.

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Forty-two percent of women never experience the classic heart attack symptom of chest pain or pressure, compared with 31% of men, the study says.

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Forty-two percent of women never experience the classic heart attack symptom of chest pain or pressure, compared with 31% of men, the study says.

Women are less likely to get immediate treatment to stop the heart attack in its tracks: clot-busting drugs, balloon procedures to open the arteries or bypass surgery, the study says. Partly because of such delays, 15% of female heart attack patients die in the hospital, compared with 10% of men. Delaying care can be fatal. "Time is muscle," says study author John Canto of the Watson Clinic and Lakeland Regional Medical Center in Florida. "And muscle is life."

The study actually may underestimate the gender gap, because many female heart attacks never make it to the hospital, says Cam Patterson, chief of cardiology at theUniversity of North Carolina-Chapel Hill, who was not involved in the study.

Women are less likely to be properly treated, even when they have similar symptoms to men, according to the analysis in today's Journal of the American Medical Association, which included patients from 1994 to 2006.

In many cases, however, both doctors and patients may fail to realize the seriousness of the situation.

Forty-two percent of women never experience the classic heart attack symptom of chest pain or pressure, compared with 31% of men, the study says. That's especially true for women younger than 55, Canto says. In the short-term, heart attack patients without chest pain or discomfort are almost twice as likely to die as those who have that classic symptom, the study says.

Women without chest pain may develop shortness of breath, nausea, vomiting, light-headedness and pain in the back or jaw, according to the American Heart Association. Women who develop sudden, crippling fatigue — such as the feeling that they can't tidy the kitchen without a rest — may face imminent danger of a heart attack, says cardiologist Nieca Goldberg, medical director of NYU Langone Medical Center's Tisch Center for Women's Health.

Groups such as the American Heart Association have tried for years to educate women about these symptoms. The study suggests that, in spite of such campaigns, many women and their doctors fail to recognize these symptoms — or the need for immediate treatment, Goldberg says.

It's possible, Canto says, that there are genetic or biological reasons that make heart attacks in young women more lethal than attacks in older men. "If a young woman is premenopausal and she is experiencing a heart attack, something is seriously wrong," he says.

Canto says it's too early to change medical guidelines based on his study alone. He hopes other researchers will try to replicate his study, to see if his findings hold up. But several heart experts say the findings should be taken seriously.

"It's been sinking in to cardiologists for a while that women having heart attacks are more likely to have symptoms other than the classic chest pain syndrome that we see in the movies," Patterson says. "I was shocked, though, at how closely this was associated with worse outcomes and more cardiac death in women with heart attacks. This study makes me worried that we still don't get it."

Doctors or emergency responders may not take women's symptoms seriously, says Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York and an American Heart Association spokeswoman.

"Women are coming in saying they're nauseous, they're fatigued, they're sweating, and doctors say, 'You're fine,' " she says. "Doctors will say it's anxiety and it's all in your head."

Yet women also may not take their heart symptoms seriously enough, she says.

"We have a tendency to downplay what we're feeling," Steinbaum says. "If you say to your doctors, 'It's probably in my head,' then the person who is listening starts dismissing it. If you think you're having a heart attack, say it. And if you're wrong, then you're wrong."

Fewer than 20% of people who seek medical help for a heart attack are actually having one, Canto says.

Goldberg says both men and women should know their cholesterol levels, blood pressure and blood sugar . "We should use this study as an eye-opening bit of news to these women," she says. Because many young women never see a cardiologist, she says obstetrician-gynecologists could screen patients for heart disease by running simple tests and measuring patients' weights. That's especially important in light of new research, released last week, suggesting that pregnant women who develop gestational diabietes or a complication called pre-eclampsia have a much higher risk of later developing heart disease, Goldberg says.

"We are doing a miserable job of educating women about their risk of heart disease," Patterson says. "When I ask my wife what is she most afraid of, she says breast cancer. And yet she is six times more likely to die of a heart attack. We have a desperate message to share about the risk of heart disease in women of all ages."

Pills as good as stents for stable heart patients

2012-03-07T12:45:00.000-07:00

Pills as good as stents for stable heart patients: analysis

CHICAGO | Mon Feb 27, 2012 7:21pm EST

(Reuters) - Treating stable heart patients with a handful of pills works just as well as propping open blocked heart arteries with a stent, U.S. researchers said on Monday, adding to evidence that less-invasive, less-costly drug treatment works as well as implanting a medical device in such patients.

Stents, made by companies such as Boston Scientific Corp, Abbott Laboratories and Medtronic Inc, are still the preferred treatment for opening up blocked heart arteries in patients rushed to the hospital with an acute heart attack.

But several studies have shown the heart devices are no better than drugs in patients with stable heart disease, in which heart arteries have narrowed and may be causing chest pain.

The latest analysis by Dr. Kathleen Stergiopoulous and Dr. David Brown of Stony Brook University Medical Center in New York, published in the Archives of Internal Medicine, attempts to knock down lingering arguments that earlier results were based on outdated technology.

Older analyses had included data from trials comparing drug treatments with balloon angioplasty, in which a balloon-tipped catheter is inserted and the balloon is inflated to open the narrowed passage.

For the latest so-called meta-analysis, the team pooled data only from newer studies that compared drug treatments with stents - a wire-mesh tube used to prop open the artery and prevent it from reclosing.

"The question was is there any benefit to stenting the blockages in these patients as an initial therapy procedure over treating them with optimal medical therapy and referring them to get a stent if necessary," Brown said in a telephone interview.

The analysis included results on more than 7,200 patients enrolled in eight studies between 1997 and 2005 comparing stents with medical therapy in stable heart patients with narrowed sections in their heart arteries.

"The result showed quite clearly there was no benefit of stenting as far as reducing death, heart attack, repeat procedures and even reducing symptomatic angina (chest pain)," Brown said.

He added that his analysis was the first to include only studies that used stents, and the results offered the most up-to-date comparison of the benefits of stenting procedures with modern medical therapy, which includes aspirin, a variety of blood pressure medicines such as beta-blockers, ACE-inhibitors or angiotensin receptor blockers and cholesterol-lowering statins.

'MISSES THE MARK'

Still, some doctors were not satisfied.

"The meta-analysis published in Archives of Internal Medicine uses old data, from 1995 to 2005, which offer little, if any, new information to guide clinical care," Dr. Theodore Bass, vice president of the Society for Cardiovascular Angiography and Interventions, a group of heart doctors that specialize in stenting procedures.

Bass said in an email that the study "misses the mark" on the quality-of-life concerns for patients and that stenting procedures helped relieve chest pain, or angina, in stable patients.

Dr. William Boden of the Samuel S. Stratton VA Medical Center in Albany, New York, who wrote a commentary in the journal, said relieving angina appeared to be the "last remaining sacred cow" for doctors who argue in favor of stents over drugs.

Boden is the lead author of a large study called COURAGE published in 2007 in the New England Journal of Medicine that was one of the first to challenge the value of stents and angioplasty over drug treatment.

In that study, patients with chest pain did get slightly more pain relief with stenting, but those benefits only lasted one to three years. "They are not durable," he said.

More recent studies could not show stents were any better than drugs at relieving angina, he contended.

Boden and Brown attribute the changes to improvements in medications, and given that most of them are generic, getting more doctors to choose drugs first could save a lot in health costs.

"In the context of controlling rising health care costs in the United States, this study suggests that up to 76 percent of patients with stable coronary artery disease could avoid percutaneous coronary intervention (such as stenting) altogether if treated with optimal medical therapy," Brown and Stergiopoulous wrote.

But fewer than half of Americans with stable coronary artery disease who get a stent have been treated with drugs first, Dr. Rita Redberg, editor of the Archives of Internal Medicine, said in an editorial.

She said more than 1 million stents were implanted each year to treat coronary artery disease in the hopes that stents would work better than drugs, despite ample evidence to the contrary.

Brown said part of the reason doctors ignored those studies was that there was a big financial incentive to use stents versus drugs.

"If I put a stent in you, I submit a bill for my fee, which could be $1,000 to $2,000. The hospital submits another bill for using the hospital, the stent, the equipment and nursing time," he said. The whole thing could add up to $20,000 or $30,000.

Brown therefore doubts the study will sway too many doctors, but said it may influence insurance companies.

"A few practitioners might change their behavior, but third-party payers will be influenced by it and they will start by making stricter criteria for reimbursing these procedures," he said.

(Reporting By Julie Steenhuysen; Editing by Peter Cooney)

How Statins effect memory.

2012-03-07T12:08:00.000-07:00

March 5, 2012, 4:54 PM

A Heart Helper May Come at a Price for the Brain

By TARA PARKER-POPE

Stuart Bradford

Well

Tara Parker-Pope writes about consumer health.

After a heart attack and quadruple bypass surgery in 2010, Steve Colburn of Portland, Ore., began taking a cholesterol-lowering statin at the maximum dose. Soon, he began experiencing memory problems.

“Thinking and remembering became so laborious that I could not even recall my three-digit telephone extension or computer password at work,” said Mr. Colburn, 62, a sales representative and product developer. “All day, every day, I felt like my brain was mush.”

His doctor suggested a “drug vacation,” and when Mr. Colburn stopped taking the statin for six weeks, the problems disappeared. Then he tried a different statin at a high dose, but the cognitive difficulties returned. His doctor has since lowered his dose by more than half, and while the memory lapses have not disappeared, he has learned to cope.

“I felt like I didn’t have a choice to give up the drug,” Mr. Colburn said. “But I wanted to work with a dose that kept my numbers in an acceptable range and at the same time hopefully provided enough clarity of thinking that I could live with it.”

Statins are the most prescribed drugs in the world, and there is no doubt that for people at high risk of cardiovascular problems, the drugs lower not only cholesterol but also the risk of heart attack and stroke. But for years doctors have been fielding reports from patients that the drugs leave them feeling “fuzzy,” and unable to remember small and big things, like where they left the car, a favorite poem or a recently memorized presentation. Last week, the Food and Drug Administration finally acknowledged what many patients and doctors have believed for a long time: Statin drugs carry a risk of cognitive side effects. The agency also warned users about diabetes risk and muscle pain.

Nearly 21 million patients in the United States were prescribed statins last year, but nobody knows how many of them have experienced cognitive side effects. Dr. Beatrice Golomb, associate professor of medicine at the University of California, San Diego, has collected more than 3,000 reports of side effects related to statin use. She said doctors have too often dismissed the complaints, writing off the memory lapses and muscle pain, in particular, as a normal sign of getting older.

Many patients on statins also take medications for other health problems, which has made it difficult to discern whether statins are always to blame. For six years, Bill Moseley of Towson, Md., tried taking statins to lower his cholesterol; he also began taking medications for hypertension and high blood sugar. He found the drugs to be mind-numbing.

“I felt like a zombie in the afternoons,” he said.

While taking the cocktail of drugs, he began making driving errors. “I’d feel spacey and wouldn’t be in the right lane in enough time to make a turn,” he said. “Or I wouldn’t see someone I should be seeing. It was a feeling of detached, suppressed mental capability that should be there.”

Against his doctor’s advice, Mr. Moseley in 2006 stopped all of the drugs and began focusing on healthful eating and exercise, meeting regularly with a personal trainer and lifting weights. Four months later, the cognitive problems disappeared. Today, he is 69, his cholesterol has dropped from 225 to about 125, and his blood pressure and blood sugar are under control.

“I’m back to normal, and the more I work out over time, the better and better I get,” he said.

To be sure, millions of patients taking statins never experience cognitive side effects. John Hannon, 60, of Oceanside, N.Y., began taking a statin 20 years ago to lower his total cholesterol, which was about 270. Now his total cholesterol is in the 135 to 150 range.

“I’ve had no side effects that I’m aware of,” he said. “For me, it has been a wonder drug.”

Dr. Steven Nissen of the Cleveland Clinic noted that cognitive side effects have not been detected in randomized controlled trials of statin therapy. And even the warnings about muscle aches and diabetes need to be weighed against the fact that the drugs are proven to lower risk for heart attack and stroke, he said.

“For most physicians, and certainly for me, these warnings haven’t changed the decision-making process about who gets a statin and who doesn’t,” Dr. Nissen said.

Robert F. Hickey of Eagle, Colo., started taking statins in 2008 to lower his cholesterol, which was above 300. He also takes a myriad of other medications as a result of a kidney transplant. Last September, he began noticing memory problems and would sometimes go blank in the middle of memorized presentations.

“I began to notice, for a split second, difficulty with word recall,” said Mr. Hickey, a clinical psychologist and lecturer. “It was vocabulary that I use every day and had used for decades.”

His doctor put him through a battery of tests for early-onset dementia but found no signs of it. Instead, he suggested cutting the statin dose in half. Mr. Hickey said he hasn’t noticed any meaningful improvement yet, but the real test will come this week during a lecture in Las Vegas.

“I’ll have my hard copy with me, just in case,” he said.

What your cholesterol number really says

2011-08-19T13:50:00.000-06:00

What your cholesterol number really says

See show times »

By David S. Martin, CNN

August 17, 2011 3:57 p.m. EDT

Editor's note: Dr. Sanjay Gupta explores the signs, tests and lifestyle changes that could make cardiac problems a thing of the past on "The Last Heart Attack" at 8 p.m. ET Sunday on CNN.

(CNN) -- Learning your cholesterol numbers -- the good, the bad and the total -- is a well-established part of the annual physical exam.

A high cholesterol number results in angst and possible treatment. A low number brings relief. But are we putting too much stock in cholesterol as a sign of our heart attack risk?

"The cholesterol number is essentially worthless," says Dr. Arthur Agatston. The Miami cardiologist and South Beach diet books author says the cholesterol of people who have heart attacks and those who don't are almost identical.

"The overlap is troubling," Dr. Kwame Akosah at the University of Virginia agrees. "As an isolated predictor, it falls short."

As a sign of the weakness in cholesterol numbers alone, one large study found the average LDL cholesterol of people hospitalized for heart disease was 105, which is considered "near optimal."

The study, published in the American Heart Journal in 2009, found almost half of the hospital admissions had LDL cholesterol levels below 100, traditionally considered "low risk."

What causes a heart attack?

Ways to keep your cholesterol healthy

RELATED TOPICS

Another study found that only half of heart attacks occurred in people with high cholesterol (at or above 240), while a fifth of the heart attacks struck people whose cholesterol levels (below 200) deemed them safe based on long-held guidelines.

Agatston says the cholesterol numbers fall short because they measure cholesterol in your blood. They don't tell you the amount of LDL, or bad cholesterol, building up as plaque in the blood vessel walls. Plaque is what causes heart attacks.

As a result, studies show some people who think they're high risk based on cholesterol numbers are not, while others who think they are in the clear are developing dangerous plaques.

Your body needs cholesterol. The waxy substance is in the lining of every cell in your body. You also use cholesterol to make hormones, vitamin D and other substances.

Cholesterol circulates in the blood stream with the help of lipoproteins. The low-density lipoprotein, or LDL, carries cholesterol away from the liver. The high-density lipoprotein, or HDL, scavenges excess cholesterol and brings it back to the liver.

Your body produces cholesterol in the liver. You can also get cholesterol in fatty foods. When the LDL in the blood outstrips the HDL's ability to scavenge it, plaque can accumulate. The buildup of plaque is a lifelong process, beginning in childhood, but everyone is different.

Your genes play a role in whether you are prone to accumulating LDL as plaque. High blood pressure also makes you more prone to plaque buildup. If you are obese or diabetic or a smoker or suffer from a chronic inflammatory condition like lupus, you are also more likely to accumulate plaque than someone with the same LDL cholesterol number.

Akosah says he uses all these factors to determine a patient's "global risk" and tailors the treatment accordingly.

Also, there are different LDL particle sizes. Smaller particles tend to penetrate the vessel wall more easily than larger LDL particles.

Most heart attacks are not caused by the slow narrowing of blood vessels but by a rupture of a blister or bubble of plaque in an artery that is less than 50 percent blocked. Half of all heart attacks come with no warning at all, making diagnostic tests all the more important.

Younger women may be particularly jeopardized by a heavy reliance on cholesterol numbers. One study that looked at heart attacks in women under 65 found none had been deemed "high risk" for a heart attack using the traditional Framingham Risk Score, which looked at age, smoking, blood pressure, total cholesterol and HDL.

A class of drugs called statins lowers LDL cholesterol. Exercise and a low-fat diet rich in fruits, vegetables, whole grains and legumes can also lower LDL and raise HDL. Smokers who quit also improve their cholesterol numbers.

But the numbers themselves may be only the first step in learning your heart health.

"High cholesterol is not a diagnosis. It's a symptom. It's like a fever. The first step is to figure out what's going on," says Dr. James A. Underberg, a professor at New York University School of Medicine who specializes in preventive cardiovascular medicine.

2011-07-07T15:18:00.000-06:00

What It Is:Vitamin D is a fat-soluble vitamin. There are two major forms of vitamin D D₂ (ergocalciferol) and D₃ (cholecalciferol). Both vitamin D₂ and D₃ and appear to be absorbed with equal efficiency and, at moderate doses, are equally able to raise levels of 25-hydroxyvitamin D the hormonally active form of vitamin D and a clinical measure of vitamin D status. However, at very high doses, D₃, may be more efficient at raising 25-hydroxyvitamin D levels.

Vitamin D₂ (ergocalciferol) is made by the conversion of a sterol found in plants and yeast. Vitamin D₂ is used in some dietary supplements.

Vitamin D₃ is produced naturally in human skin exposed to ultraviolet B light and occurs in some animal products, such as cod liver oil, and, in smaller amounts, in other fatty fish such as herrings, mackerel, sardines, and tuna. Vitamin D₃ is the most common form used in dietary supplements and is the form generally used to fortify foods such as milk (which naturally contains a small amount of vitamin D₃). Vitamin D₃ is made by the conversion of cholesterol compounds, such as 7-dehydroxycholesterol from lanolin found in sheep's wool.

What It Does:

Bone

Vitamin D regulates the amount of calcium and phosphorus in the body, partly by controlling their levels of absorption. Vitamin D treats and prevents rickets in children and osteomalacia (bone softening) in adults. Given to breast-fed infants, vitamin D may help increase bone density.

Taken with calcium, vitamin D can help decrease post-menopausal bone loss and prevent osteoporosis (loss of bone density), as well as improve tooth retention in the elderly. In girls ages 9 to 13, regular supplementation with calcium and vitamin D has been shown to significantly increase bone density and bone strength (measured in arms and legs) compared to placebo (Greene, Osteoporosis Int 2011).Other effects:

A study found that older women (69 years and older) whose vitamin D levels were not between 20 and 29.9 ng/mL had a greater risk of being frail.¹⁸ Frail individuals were those experiencing at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. The risk of frailty was increased by 47% among those with vitamin D levels below 15 ng/mL, 24% among those with levels below 20 ng/mL, and 32% among those with levels above 29.9 ng/mL. An average of 4.5 years after these measurements were made, those originally not frail but whose blood levels had been below 20 ng/mL were 21% more likely to have become frail or died. These findings correspond with the 2010 report from the Institute of Medicine (IOM) indicating that 20 ng/mL is a sufficient level for vitamin D and that levels above 30 ng/mL may be associated with certain risks.¹⁷

Research has found that men with low levels of vitamin D in the blood (15 ng/mL and lower) were at increased risk for heart attack compared to those with sufficient levels (30 ng/mL and higher) even after adjusting for other risk factors and physical activity. This may contribute to the higher rate of cardiovascular mortality among black Americans compared to white Americans, as blacks tend to have lower vitamin D levels.¹More recently, an analysis of two large studies showed that men who consumed 600 IU or more per day of vitamin D from foods and supplements were 16% less likely to have cardiovascular disease and stroke over a period of approximately 20 years compared to men consuming less than 100 IU per day. The same association was not seen among women; the reason for this is unclear but one possible explanation given is that women may need higher intake of vitamin D because they tend to have a higher percentage of body fat than men and vitamin D is fat soluble. In addition, vitamin D intake during the study period, which ended in 2006, may have been too low to produce meaningful differences.²¹ A large trial giving 2,000 IU per day as a supplement is underway and may yield additional insights (principal investigator is J.E. Manson).
Lower levels are also associated with a higher risk and severity of depression. A study in Italy, for example, showed that older women with low vitamin D levels (below 20 ng/mL) were twice as likely to develop depressive mood as those with higher levels. Older men with low levels were 60% more likely to develop depressive mood.⁹ Data from the same study showed that those who were severely vitamin D deficient (below 10 ng/mL) were approximately 60% more likely than those who were vitamin D sufficient (above 30 ng/mL) to experience substantial cognitive decline, although there was no such association attention level.¹³

A study from Finland suggested that high vitamin D status provides protection against Parkinson's disease. People with the highest vitamin D levels (above 20 ng/mL) had a 65% lower risk of developing Parkinson disease than those with the lowest vitamin D levels (below 10 ng/mL). A limitation of the study was that none of the groups had sufficient vitamin D levels (due to limited sun exposure in Finland).¹⁴ It is possible that greater risk reduction would have been observed in people with sufficient vitamin D levels.

Low levels of vitamin D are also associated with a higher risk in women of developing rheumatoid arthritis. There is conflicting evidence about whether vitamin D helps reduce the overall risk of dying from cancer, although studies have consistently shown that higher vitamin D serum levels were associated with decreased risk of death from gastrointestinal cancers.

Studies suggest that vitamin D may also improve balance and reduce the risk of falls in older adults, for reasons that aren't clear. However, a recent study in women aged 70 and older who were at-risk for bone fracture showed an increase in falls and fractures among those given an extremely high, single, annual dose (500,000 IU) of vitamin D_3.¹⁰This unexpected finding may have resulted from unusual effects of the extreme dose.¹¹ Much weaker evidence hints that giving vitamin D supplements to infants might decrease the risk of type 1 diabetes later in life, and that if women avoid vitamin D deficiency it might reduce their risk of multiple sclerosis.

A study in post-menopausal women showed 400 IU of vitamin D₃ and 1,000 mg of calcium daily were less likely to gain small to moderate amounts of weight compared to women taking placebo.

Researchers in Japan studied the effect of vitamin D₃ supplements (1,200 IU per day from December through March) on the incidence of seasonal influenza A in school children. Influenza A infection occurred in 18.6% of children in a placebo group versus 10.8% of children who received the supplement a 42% reduction in risk among those taking the supplement. The reduction was more prominent among children who had not been taking other vitamin D supplements. Influenza infection was not reduced among a subgroup of asthmatic children but those who became infected were significantly less likely to have an asthmatic attack if they received vitamin D than if they had not. Supplementation did not affect the incidence of influenza B (which is less common than influenza A and is not seasonal).¹⁴

A review of medical studies published from 1950 to 2009 that looked at, among other variables, vitamin D intake and asthma, suggested that vitamin D deficiency may be linked to airway inflammation, decreased lung function and poor asthma control. The researchers conducting the review hypothesized that vitamin D supplementation may lead to improved asthma control, although this cannot be established as many of the studies were not specifically designed to test the effects of vitamin D supplementation on patients with asthma.¹⁵
Higher serum vitamin D levels are associated with a reduced risk of allergy in children and adolescents. A review of data from a nationwide study of over 6,000 individuals showed that allergic sensitization was more common in those with serum vitamin D of less than 15 ng/mL compared to those with 30 ng/mL or greater for 11 out of 17 allergens. Results were adjusted for potentially confounding factors like time spent on indoor activities. The strongest associations were for allergy to oak (5 times the risk), peanut (2.4 times the risk), and ragweed (1.8 times the risk). There was also increased risk of allergy to dog, cockroach, mite, shrimp, ryegrass, Bermuda grass, birch and thistle. In adults, there was no consistent association between allergy and vitamin D levels.¹⁹

Vitamin D Protects Against Age-Related Vision Loss

2011-04-11T18:02:00.000-06:00

Vitamin D Protects Against Age-Related Vision Loss
For Women Under 75, Extra Vitamin D Could Ward Off Macular Degeneration

1 COMMENT
BY COURTNEY HUTCHISON, ABC NEWS MEDICAL UNIT
April 11, 2011

Many women must resort to using reading glasses as they age, but for Dorrette White, 47, the blurriness at the center of her vision was something more. After a routine visit to her eye doctor, this Brooklyn mother of four was told she was in the early stages of age-related macular degeneration (AMD), a leading cause of vision loss and blindness among older Americans that strikes 8 and half million Americans.

Fortunately for White, her condition is unlikely to lead to blindness any time soon, and for now her only "prescription" is a healthy lifestyle complete with lots of vitamin D-rich foods, said her ophthalmologist, Dr. Shantan Reddy. Reddy has prescribed her a healthy dose of vitamin D-rich dairy and leafy greens.When she first heard the news, she worried "that it's like months down the lineyou'll go blind or something like that," White said.

"She's got very early signs…and most of these patients don't progress to more advanced types. But to decrease risk further, I recommend her adding vitamin D rich foods," said Reddy, who is an assistant professor of Ophthalmology at NYU Langone Medical Center.

In Monday's study, women who consumed the most vitamin D cut their risk of developing early AMD by more than half when compared to women with vitamin D-poor diets. Researchers found that risk was lowest when patients consumed 720 international units of Vitamin D per day through foods such as cold water fish, leafy greens, and dairy.

A little over three ounces of blue fin tuna would meet the daily dose, for example.

Vitamin D as Medicine

Reddy said the findings are "wonderful" because currently there are "limited treatment in preventing the progression of macular degeneration and…no established means to prevent its occurrence. With this study we know there are vitamins that you can take through your diet that can decrease the odds of developing [it]."

"We can hit the problem before it even begins," he said.

Though vitamin D can be obtained from foods, supplements, or by exposure to the sun, researchers found that vitamin D levels among patients in the study were most affected by the amount of vitamin D they consumed, not by the amount of outdoor exposure they had.

Considering many Americans are actually deficient in vitamin D, this study may offer one more reason for women to include vitamin D-rich foods in the diet, especially because women with vitamin D levels well above the recommended minimum saw the most benefit, said the lead author on the study, Amy Millen of the University of Buffalo.

White Male Life Expectancy 75.7 years, Black Male 70.9 years

2011-03-17T10:02:00.000-06:00

Death rate down, life expectancy up in U.S.

By Nanci Hellmich, USA TODAY

Updated 9h 26m ago

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Children born today can expect to live longer than ever in U.S. history, according to preliminary government data released Wednesday.

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For white males, life expectancy is 75.7 years; for white females, 80.6.

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For white males, life expectancy is 75.7 years; for white females, 80.6.

Life expectancy at birth increased to 78.2 years in 2009, up from 78 years in 2008.

"What this means is that somebody born in 2009 can expect to live to an average of 78.2 years. This is a new record high for life expectancy," says Kenneth Kochanek, a statistician with the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention.

Death rates for 10 of the 15 leading causes of death decreased significantly between 2008 and 2009, including for heart disease, cancer and stroke.

"Basically, this is nothing but good news," Kochanek says.

The reasons for the decline will be examined when the final data is released later this year, he says.

Other findings from the National Vital Statistics System, which is data from death certificates from all 50 states and Washington, D.C.:

•For white males, life expectancy is 75.7 years; for white females, 80.6. For black American males, life expectancy is 70.9 years; for females, 77.4 years.

•Infant mortality in the U.S. hit a record low in 2009 at 6.42 infant deaths for every 1,000 live births. This is a 2.6% decline from 6.59 deaths per 1,000 births in 2008.

•Age-adjusted death rate for the U.S. population fell for the 10th year in a row to an all-time low of 741 deaths per 100,000 in 2009. This is down from 758.7 deaths in 2008.

•There were 2,436,682 deaths in the U.S. in 2009, down from 2,473,018 in 2008.

•Death rates declined for heart disease (down 3.7%), cancer (1.1%), chronic lower respiratory diseases (4.1%), stroke (4.2%), accidents (4.1%), Alzheimer's disease (4.1%), diabetes (4.1%), influenza and pneumonia (4.7%), septicemia (1.8%) and homicide (6.8%).

The increase in life expectancy and decline in death rates for major diseases are encouraging, says Ralph Sacco, a neurologist and president of the American Heart Association, and show "that our treatments and prevention programs are working."

But "death is not always the best measure of the burden of disease, since disability and quality of life are also important measures," he says.

"The continuing differences between blacks and whites also highlight the need to more effectively prevent cardiovascular diseases and stroke among African Americans."

Somethings really wrong with our water.

2011-03-15T12:20:00.000-06:00

This Study conducted in CT points to Birth Control pills and BPA as just two of many compounds that are effecting humans.

21 FEB 2011: INTERVIEW

Unraveling the Mystery Of
The Bizarre Deformed Frogs

Yale ecologist David Skelly wanted to know why a sizable percentage of frogs in the northeastern United States suffered from deformities. His ongoing research has implicated human activity — but not in the way many researchers had thought.

by carl zimmer

For the last two decades, strange things have been happening to frogs. Some frog populations have high rates of limb deformities, while others have high incidences of what is known as “intersex” — traits associated with both males and females, such as male frogs whose testes contain eggs.

David K. Skelly, professor of ecology at the Yale School of Forestry & Environmental Studies, set out to discover what was causing these deformities, which some researchers were attributing to the use of an agricultural pesticide called atrazine. Skelly launched an experiment in ponds throughout Connecticut, studying frogs in four landscapes: forests, agricultural areas, suburbs, and cities. And what he found was surprising — the highest rates of deformities were not occurring in and around farmlands, but in cities and suburbs.

Yale University

David K. Skelly

In an interview with Yale Environment 360 contributing writer Carl Zimmer, Skelly described what chemicals may be causing these abnormalities in frog populations, and explained why this phenomena may have troubling implications not only for amphibians, but for other vertebrates, including humans. One thing seems clear: The deformities showing up in frogs are almost certainly not caused by a single chemical, but rather by a whole suite of substances — including medicines excreted by humans into the environment — that act in concert to mimic hormones like estrogen or cause other ill effects.

“The fact that these kinds of estrogens out in the environment can have this kind of effect on a vertebrate — many people would say that that alone is a basis for us to be concerned,” says Skelly.

Yale Environment 360: You came to the question of pollution not as a medical researcher but as a wildlife biologist — you studied frogs. Tell us how that happened.

David Skelly: Well, as an ecologist, I start with the animals. When I started on this project I really didn’t know whether I was going to be studying pollution or what. I started off trying to understand where sexual deformities in amphibians came from in the environment. There had been some laboratory work that did in fact use pollutants and figure out whether exposure through pollutants like pesticides might cause these kinds of deformities. But to me, the cart was before the horse because we really didn’t understand the natural history of reproductive deformities in many groups.

e360: When did people first notice that there was something weird going on with these frogs?

Skelly: Really the laboratory work in this case came first. About ten years ago people started doing laboratory experiments with amphibians, and some work on atrazine, a pesticide, was important because it was showing that extremely low concentrations of the pesticide might lead to these kinds of deformities.

e360: And what deformities are you talking about?

Skelly: The deformities in particular are traits that are associated with animals that have characteristics of both males and females. And there are lots of different possibilities. The ones that we’ve been concentrating on and the ones that are most clear are, say, a frog that looks like a male and has testes, but when you look inside the testes there are eggs growing in there. That’s an attribute that you can say suggests intersex, a condition in between male and female.

David Skelly/Yale University

Skelly found deformities in almost all ponds sampled in suburban and urban landscapes.

So then after these lab results came out people started going out into the field and, lo and behold, they found these deformities sometimes to be quite common in natural populations. That was interesting because certainly in the past we’ve known about these deformities for a hundred years. And in fact, a lot of what we know about sexual development in animals, and invertebrates in particular, was worked out in amphibians as a model system. And people have looked for them in natural populations before, but until this recent spate of work starting about ten years ago they hadn’t been found to be common in too many places. What we found more recently is that in a variety of studies people are finding them to be quite common. What worried me about the work that had been done so far is that because the laboratory work had been focusing on agricultural pesticides, people went out and basically looked at gradients of agricultural intensity, or just worked in agricultural landscapes.

e360: So they think because atrazine in the lab can cause intersex deformities, let’s go look at places where these pesticides are used, like on farms?

Skelly: Yeah. On one level that makes a lot of sense. But on another level it can be misleading. You can tend to reach a conclusion that isn’t warranted because if you say I’m just going to go look in agricultural landscapes and I find these deformities there and I’ve done the laboratory work to show that exposure to the pesticide can lead to these deformities, you might just wipe your hands and say we’re done here. But what we didn’t know is what about all these other landscape types? Are deformities showing up in those landscapes as well? And that was really our goal — to ask very broadly, how often is this happening? Where is it happening? What does the landscape of amphibian intersex look like? And what we found was pretty surprising.

e360: Where did you go and what did you do to do the study?

Skelly: The prior work on amphibian intersex had primarily been done in the West and the Midwest. There was a study down in Florida. Nobody had looked at all in the northeastern United States and that’s where I’m based. So we worked in Connecticut, specifically in the Connecticut River Valley, and one of the nice things about Connecticut is that it’s got a pretty

We find intersex frogs in agricultural landscapes, but in suburban and urban landscapes at three times the rate.”

compact size but there is pretty high diversity of land-cover types. So there is an active agricultural landscape in Connecticut, there are certainly a lot of suburbs. There are urban areas and there are still a lot of forests in Connecticut. Connecticut ranks third or fourth in the nation for population density, and it ranks third or fourth in the nation for the proportion forested. We can take advantage of that. So we worked in a set of land cover types: agricultural; undeveloped, which in Connecticut means forested; suburban, people with lawns and houses and schools and that sort of stuff; and urban, mostly around Hartford.

So essentially we took the entire state and categorized areas around small ponds as fitting into one of those categories and then sub-sampled them randomly. And what we found is that we can find intersex frogs in a variety of landscapes. We find them in agricultural landscapes, but we find them in suburban and urban landscapes at three times the rate. So if they’re concentrated anywhere, they’re concentrated in these more densely settled places — places where people live and work. We didn’t find them in wooded landscapes, these undeveloped landscapes.

e360: So whatever is happening has something to do with human activity, since you’re not seeing it in the wooded landscapes.

Skelly: Right. So we feel very confident at this point that whatever is going on seems to be associated with some kind of human activities and we are finding it in agricultural landscapes so it’s not that whatever goes on in agricultural landscapes is inconsistent with it happening... [But] I think the fact that we found that in those kinds of landscapes where corn is being grown, the great majority of the ponds we sampled didn’t have any deformities at all. It suggests to me that whatever is going on in those landscapes compared with the suburban and urban ones, we’re not getting a signal that strongly points towards agricultural pesticides. Not at this point — we’ve got more work to do. But one of the striking things is that almost all the ponds in the suburbs and urban landscapes have deformities in them. So this is something that is practically ubiquitous in those places and yet is showing up in a much more spotty manner in agricultural landscapes.

e360: So if atrazine is not the only factor, what are your suspicions about what else might be going on?

Skelly: Well it’s pretty well known that amphibians, fish, and frankly vertebrates in general can be influenced by hormones that are just out there in the environment. There are actually whole biological systems that depend on that happening naturally. But it’s also clear that we put a lot of hormones into the environment. And in particular we know that estrogen exposure can lead to the kinds of deformities we are seeing. So we would be irresponsible if we didn’t at least explore that avenue. It seems like a pretty reasonable set of hypotheses at this point just to imagine that there’s a bunch of estrogens out there in the environment and perhaps atrazine is one of them.

There are dozens of chemicals that humans create to actually act as estrogen. Birth control pills are a perfect example. The estrodial people take as birth control or as prostate medicine, it goes through our bodies, it may get complexed with something, and then we excrete it and it can become active again in the environment. I mean that’s not hype, that’s

It is widely accepted that the way that toxins work in the environment is often in concert.”

absolutely been shown to happen as a matter of course. So that’s a very potent estrogen. And those molecules are reasonably durable. But there are many other chemicals that were not created to be estrogens and yet can act like estrogens once they’re out there. So one that many people may have heard of is Bisphenol A. That’s the chemical BPA and there was federal legislation to remove it from baby bottles. It’s a plasticizer. So it’s an industrial chemical that’s supposed to help us create something and then as a totally unintentional byproduct it can have this other kind of biological activity.

And it turns out there’s a variety of chemicals with molecules shaped such that they can bind to receptors on our cells, or in cells of frogs that are intended to receive estrogen molecules. And when these receptors bind with these other chemicals they turn that into a signal that says, okay, some estrogen just arrived. And if that happens often enough there are physiological responses in our bodies that in a frog’s testes could lead it to start creating eggs.

So the biology of all that is pretty well worked out. It doesn’t mean there aren’t other possibilities for what might be going on, but we know that these estrogens are out in the environment. We know that a species like frogs can respond to them. What we need to do is see whether the dots connect and whether the exposure happens in these ponds. And then as a follow-up to that, if all that comes together, then another step we need to take is do experiments — not in the laboratory, but out in the natural environment, and see whether we can actually create this kind of a cycle where there’s exposure going on and we can see inside of a natural pond.

So the way that you would nail this down is by experimentally exposing some animals in the field to this kind of cocktail of chemicals that we can first demonstrate are out there in the field, and then see what kind of biological responses we get. That’s the way we can with great certainty figure this out. And it’s important to be pretty certain about it because we’re talking about a variety of chemicals that are in the environment because they’re useful. You know these are people’s medications, they are industrial chemicals, they’re not out there for no reason. And we’re not going to be able to change people’s minds about them unless we have very good evidence suggesting that these effects are happening. And then the question is, what do you do about it?

e360: When you hear that frogs are having these sexual deformities, it sounds creepy. But does it have an actual ecological impact? I mean does the fact that we may be changing the nature of these frogs actually mean something to the wildlife itself?

David Skelly/Yale University

A deformed leopard frog metamorph found near Lake Champlain in Vermont.

Skelly: I think these results are important in two very different ways. Beyond being creepy, the fact that these kinds of estrogens out in the environment can have this kind of effect on a vertebrate — many people would say that that alone is a basis for us to be concerned. Because there are many other species that share some of the same biological pathways that frogs have. And that includes people, where we don’t want the possibility of this going on. So you can get precautionary about it and just say this isn’t about frog population viability. This is about not wanting to have chemicals that have that kind of biological activity out there.

e360: So back when Rachel Carson was writing Silent Spring, she was focusing on DDT and there was a certain clarity there where she could focus on one pollutant. And here we have a situation today where you have to think about atrazine and all these other chemicals that each individually might have an impact on these frogs and on people, or maybe together cumulatively have an impact. It makes the problem more complicated. How do you deal with that?

Skelly: It is complicated. And I think we’re still grappling, maybe struggling is a better word. The EPA [Environmental Protection Agency] and ecotoxicologists in general have been trying to figure out how to deal with mixtures for some time. So it is widely accepted that the way that toxins work in the environment is often in concert. But the paradigm that you described where beginning with Rachel Carson we were thinking about one chemical at a time — people like the clarity that comes from that. It’s clean and if you do this in the lab you get beautiful results. This standard of pure clear repeatable results has kind of gotten in the way of thinking about how bad things happen out in nature.

One thing that I can see on the horizon is that people are thinking about looking at biological pathways. So we’ve been talking about pathways where estrogens get turned into physiological responses. And instead of thinking about one chemical at a time, what are the chemicals out there that could cause that, and shouldn’t we be managing those as a group? Because we’re talking about medications, we’re talking about industrial chemicals, we’re talking about pesticides.

I think first what we need to do is come up with clear field-based cases where you can show very clearly that it is mixtures causing this and that managing chemicals one at a time isn’t going to work... It’s ironic you mentioned Rachel Carson because she started with a natural history phenomenon and then followed her nose to figure out what was going on, and traced it to a single chemical. It could have easily been traced to a group of chemicals and perhaps the history of environmental regulation would have rolled out differently.

e360: And so we would conceivably be regulating these chemicals in groups? I mean, wouldn’t somebody who makes the birth control pill say, well, we only contribute a tiny amount to this problem so why are you picking on us?

MORE FROM YALE e360

A Warning by Key Researcher
On Risks of BPA in Our Lives

The synthetic chemical, BPA — found in everything from plastic bottles to cash register receipts — is a potent, estrogen-mimicking compound. In an interview, biologist Frederick vom Saal harshly criticizes U.S. corporations and government regulators for covering up — or ignoring — the many health risks of BPA.
READ MORE

Skelly: I think that if we do get into thinking about and regulating mixtures of chemicals based on their action, as opposed to their intended use and their origin, it’s going to be an incredibly hairy regulatory problem. And I don’t pretend to understand how to deal with that except to say that there are a couple of bright hopes in this particular example. The first is that we can deal with a lot of chemicals regardless of their origin and regardless of their intent by changing how we manage waste. Right now a state-of-the-art sewage treatment plant has three stages. And what comes out the back end of that includes a lot of organic molecules, including estrogens, that really don’t get molested by the sewage treatment activities very much. If we could add a fourth stage – charcoal, sand bed, or something like that – that could remove a whole suite of things without thinking about what they are. The other way that we can deal with this is to build it into the front end. To build it into research and development of these chemicals so that we’re trying to think about could you create a plasticizer that works like BPA, but doesn’t act like a steroid?

POSTED ON 21 FEB 2011 IN BIODIVERSITY SCIENCE & TECHNOLOGY

A Great Readers Digest Article on Vitamin D3

2010-08-03T11:09:00.000-06:00

From Reader's Digest - April 2010
This article goes over several Vitamin Myths and ends with this paragraph.

Truth: A pill that's worth taking
As studies have eroded the hopes placed in most vitamin supplements, one pill is looking better and better. Research suggests that vitamin D protects against a long list of ills: Men with adequate levels of D have about half the risk of heart attack as men who are deficient. And getting enough D appears to lower the risk of at least half a dozen cancers; indeed, epidemiologist Cedric Garland, MD, at the University of California, San Diego, believes that if Americans got sufficient amounts of vitamin D, 50,000 cases of colorectal cancer could be prevented each year.

But many—perhaps most—Americans fall short, according to research by epidemiologist Adit Ginde, MD, at the University of Colorado, Denver. Vitamin D is the sunshine vitamin: You make it when sunlight hits your skin. Yet thanks to sunscreen and workaholic (or TV-aholic) habits, most people don't make enough.

How much do you need? The Institute of Medicine is reassessing that right now; most experts expect a big boost from the current levels (200 to 600 IU daily). It's safe to take 1,000 IU per day, says Ginde. "We think most people need at least that much."

So here's the Reader's Digest Version of the truth about vitamins: Eat right, and supplement with vitamin D. That's a no-brainer coupled with a great bet—and that's no lie.

Here's the full Readers Digest article

Once upon a time, you believed in the tooth fairy. You counted on the stability of housing prices and depended on bankers to be, well, dependable. And you figured that taking vitamins was good for you. Oh, it's painful when another myth gets shattered. Recent research suggests that a daily multi is a waste of money for most people—and there's growing evidence that some other old standbys may even hurt your health. Here's what you need to know.

Myth: A multivitamin can make up for a bad diet

An insurance policy in a pill? If only it were so.

Last year, researchers published new findings from the Women's Health Initiative, a long-term study of more than 160,000 midlife women. The data showed that multivitamin-takers are no healthier than those who don't pop the pills, at least when it comes to the big diseases—cancer, heart disease, stroke. "Even women with poor diets weren't helped by taking a multivitamin," says study author Marian Neuhouser, PhD, in the cancer prevention program at the Fred Hutchinson Cancer Research Center, in Seattle.

Vitamin supplements came into vogue in the early 1900s, when it was difficult or impossible for most people to get a wide variety of fresh fruits and vegetables year-round. Back then, vitamin-deficiency diseases weren't unheard-of: the bowed legs and deformed ribs of rickets (caused by a severe shortage of vitamin D) or the skin problems and mental confusion of pellagra (caused by a lack of the B vitamin niacin). But these days, you're extremely unlikely to be seriously deficient if you eat an average American diet, if only because many packaged foods are vitamin-enriched. Sure, most of us could do with a couple more daily servings of produce, but a multi doesn't do a good job at substituting for those. "Multivitamins have maybe two dozen ingredients—but plants have hundreds of other useful compounds," Neuhouser says. "If you just take a multivitamin, you're missing lots of compounds that may be providing benefits."

That said, there is one group that probably ought to keep taking a multi-vitamin: women of reproductive age. The supplement is insurance in case of pregnancy. A woman who gets adequate amounts of the B vitamin folate is much less likely to have a baby with a birth defect affecting the spinal cord. Since the spinal cord starts to develop extremely early—before a woman may know she's pregnant—the safest course is for her to take 400 micrograms of folic acid (the synthetic form of folate) daily. And a multi is an easy way to get it.

Myth: Vitamin C is a cold fighter

In the 1970s, Nobel laureate Linus Pauling popularized the idea that vitamin C could prevent colds. Today, drugstores are full of vitamin C–based remedies. Studies say: Buyer, beware.

In 2007, researchers analyzed a raft of studies going back several decades and involving more than 11,000 subjects to arrive at a disappointing conclusion: Vitamin C didn't ward off colds, except among marathoners, skiers, and soldiers on subarctic exercises.

Of course, prevention isn't the only game in town. Can the vitamin cut the length of colds? Yes and no. Taking the vitamin daily does seem to reduce the time you'll spend sniffling—but not enough to notice. Adults typically have cold symptoms for 12 days a year; a daily pill could cut that to 11 days. Kids might go from 28 days of runny noses to 24 per year. The researchers conclude that minor reductions like these don't justify the expense and bother of year-round pill-popping (taking C only after symptoms crop up doesn't help).

Myth: Vitamin pills can prevent heart disease

Talk about exciting ideas—the notion that vitamin supplements might help lower the toll of some of our most damaging chronic diseases turned a sleepy area of research into a sizzling-hot one. These high hopes came in part from the observation that vitamin-takers were less likely to develop heart disease. Even at the time, researchers knew the finding might just reflect what's called the healthy user effect—meaning that vitamin devotees are more likely to exercise, eat right, and resist the temptations of tobacco and other bad habits. But it was also possible that antioxidant vitamins like C, E, and beta-carotene could prevent heart disease by reducing the buildup of artery-clogging plaque. B vitamins were promising, too, because folate, B6, and B12 help break down the amino acid homocysteine—and high levels of homocysteine have been linked to heart disease.

Unfortunately, none of those hopes have panned out.

An analysis of seven vitamin E trials concluded that it didn't cut the risk of stroke or of death from heart disease. The study also scrutinized eight beta-carotene studies and determined that, rather than prevent heart disease, those supplements produced a slight increase in the risk of death. Other big studies have shown vitamin C failing to deliver. As for B vitamins, research shows that yes, these do cut homocysteine levels …but no, that doesn't make a dent in heart danger.

Don't take these pills, the American Heart Association says. Instead, the AHA offers some familiar advice: Eat a varied diet rich in fruits, vegetables, and whole grains.

Myth: Taking vitamins can protect against cancer

Researchers know that unstable molecules called free radicals can damage your cells' DNA, upping the risk of cancer. They also know that antioxidants can stabilize free radicals, theoretically making them much less dangerous. So why not take some extra antioxidants to protect yourself against cancer? Because research so far has shown no good comes from popping such pills.

A number of studies have tried and failed to find a benefit, like a recent one that randomly assigned 5,442 women to take either a placebo or a B-vitamin combo. Over the course of more than seven years, all the women experienced similar rates of cancers and cancer deaths. In Neuhouser's enormous multivitamin study, that pill didn't offer any protection against cancer either. Nor did C, E, or beta-carotene in research done at Harvard Medical School.

Myth: Hey, it can't hurt

The old thinking went something like this—sure, vitamin pills might not help you, but they can't hurt either. However, a series of large-scale studies has turned this thinking on its head, says Demetrius Albanes, MD, a nutritional epidemiologist at the National Cancer Institute.

The shift started with a big study of beta-carotene pills. It was meant to test whether the antioxidant could prevent lung cancer, but researchers instead detected surprising increases in lung cancer and deaths among male smokers who took the supplement. No one knew what to make of the result at first, but further studies have shown it wasn't a fluke—there's a real possibility that in some circumstances, antioxidant pills could actually promote cancer (in women as well as in men). Other studies have raised concerns that taking high doses of folic acid could raise the risk of colon cancer. Still others suggest a connection between high doses of some vitamins and heart disease.

Vitamins are safe when you get them in food, but in pill form, they can act more like a drug, Albanes says—with the potential for unexpected and sometimes dangerous effects.

Truth: A pill that's worth taking

As studies have eroded the hopes placed in most vitamin supplements, one pill is looking better and better. Research suggests that vitamin D protects against a long list of ills: Men with adequate levels of D have about half the risk of heart attack as men who are deficient. And getting enough D appears to lower the risk of at least half a dozen cancers; indeed, epidemiologist Cedric Garland, MD, at the University of California, San Diego, believes that if Americans got sufficient amounts of vitamin D, 50,000 cases of colorectal cancer could be prevented each year.

But many—perhaps most—Americans fall short, according to research by epidemiologist Adit Ginde, MD, at the University of Colorado, Denver. Vitamin D is the sunshine vitamin: You make it when sunlight hits your skin. Yet thanks to sunscreen and workaholic (or TV-aholic) habits, most people don't make enough.

How much do you need? The Institute of Medicine is reassessing that right now; most experts expect a big boost from the current levels (200 to 600 IU daily). It's safe to take 1,000 IU per day, says Ginde. "We think most people need at least that much."

So here's the Reader's Digest Version of the truth about vitamins: Eat right, and supplement with vitamin D. That's a no-brainer coupled with a great bet—and that's no lie.

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From Reader's Digest - April 2010This article goes over several Vitamin Myths and ends with this paragraph.

From Reader's Digest - April 2010

Vitamin D Protects Against Age-Related Vision Loss
For Women Under 75, Extra Vitamin D Could Ward Off Macular Degeneration

1 COMMENT
BY COURTNEY HUTCHISON, ABC NEWS MEDICAL UNIT
April 11, 2011

Unraveling the Mystery Of
The Bizarre Deformed Frogs

From Reader's Digest - April 2010
This article goes over several Vitamin Myths and ends with this paragraph.