Monthly Archives: August 2016

Alcohol Does to Your Heart

Having a drink or two a day can be a good thing, at least as far as the heart is concerned. There are nearly 100 studies of large populations that support this — they show consistently that people who drink moderately tend to have fewer heart events and are less likely to die of heart disease.

The key is moderation. Alcohol can be both tonic and toxin, since excessive drinking can lead to liver problems and other psychological and behavioral issues that impair health. In the latest study presented at the American Heart Association meeting in New Orleans, researchers pinpoint one way that alcohol can benefit the heart — by keeping good cholesterol levels high.

The study involved more than 80,000 healthy Chinese adults, who answered questions about their drinking habits and who gave blood for analysis four times during the six year study so researchers could measure their HDL as well as liver function and inflammatory markers. Those who reported drinking moderate amounts of alcohol — about one serving a day for women and two for men — had the lowest drop in HDL levels. With age, good cholesterol levels tend to decline, but these people seemed to slow that decline with their drinking. Those who abstained or drank more heavily didn’t show the same benefit.

Dr. Eric Rimm, director of cardiovascular epidemiology at the T. H. Chan Harvard School of Public Health, says the findings support other studies that have found that at any age, people who drink moderately tend to have higher HDL levels than those who don’t. HDL is important for heart health since it can mop up excess LDL, which can build up within blood vessel walls and contribute to plaques that can trigger heart attacks.

In fact, research suggests that having one or two drinks a day can lower risk of heart events about the same as losing around 30 pounds through diet and exercise. However, he says, “I’m hesitant to make that comparison, since weight loss is much more beneficial for other health reasons, such as reducing risk of cancer, diabetes and other chronic diseases.” Drinking and driving is also a leading cause of health problems and death.

The author, Shue Huang at Pennsylvania State University, reports that the Chinese population mostly drank beer or spirits, so the study doesn’t shed light on the effects of wine, although previous work shows that the ethanol in different alcoholic beverages generally has the same health effects. “Almost without exception if you look at fatal and non fatal heart disease, people who drink in moderation have substantially lower rates than people who abstain,” he says. All the more reason to raise a glass — but probably not more than that.

Let’s Safe As You Think

Over-the-counter and prescription drugs that control inflammation, like Advil, Aleve and Motrin, are among the most popular drugs people take. Without a prescription, they can relieve short-term pain from backaches and headaches, and at higher doses can reduce the inflammation behind chronic conditions like osteoarthritis or rheumatoid arthritis. But recent studies have questioned their safety, enough so that in 2015, the Food and Drug Administration (FDA) strengthened warnings on the drugs’ labels about their risk of heart attack and stroke.

But most concerning were the heart risks linked to a new class of these so-called nonsteroidal anti-inflammatory drugs (NSAIDs), the COX-2 inhibitors. These drugs were supposed to be kinder to the stomach and intestines, since NSAIDS typically activated chemicals that compromised the protective lining of these organs, leading to bleeding and pain. It turned out that the benefit for the intestines, however, came at a price to the heart. Two of the COX-2 inhibitors were removed from the market because studies showed they were linked to higher risk of heart attack and stroke.

That left one—celecoxib, or Celebrex—on the market, but the heart concerns led the FDA to require its maker, Pfizer, to pay for additional studies to ensure that celecoxib did not put people at increased risk of heart trouble. Now the results of the study show that contrary to what doctors and regulators expected, celecoxib does not lead to any higher rates of heart events than ibuprofen or naproxen. In fact, celecoxib may even cause fewer kidney problems than the other two NSAIDs.

“I would never have guessed these results,” says the study’s lead author, Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic. “The whole world has been saying for a decade now that if you must take an NSAID, you probably ought take naproxen because it’s the safest. We just don’t see that in these results. In almost every measure, ibuprofen looks worse, naproxen is intermediate and celecoxib is the best.”

The study, which is published in the New England Journal of Medicineand which Nissen will present at the American Heart Association annual meeting in New Orleans, involved more than 24,000 people with heart problems who needed to take an NSAID to treat conditions like arthritis and rheumatoid arthritis. They were randomly assigned to take one of the three drugs for nearly two years and followed for another three years for heart attacks, stroke or death. The people assigned to celecoxib did not show any higher rates of these events than those taking ibuprofen or naproxen. When Nissen and his team looked at kidney problems, they found lower risk among those taking celecoxib than among people taking ibuprofen.

“These results negate the preconceived notion—the present thinking—that COX-2 inhibitors are associated with increased heart risk,” says Dr. Nitin Damle, president of the American College of Physicians. “I think people may be more willing to start COX-2 inhibitors a little earlier because they see that heart risk is not increased.”

The previous concerns about COX-2 inhibitors and heart problems led many internists to prescribe NSAIDs like ibuprofen and naproxen as their first-choice therapies for people with osteoarthritis and rheumatoid arthritis, he says. They would only turn to celecoxib if people had stomach issues. Now that may change.

For people who take NSAIDs only occasionally, however, and for short periods of time, the findings shouldn’t make them worry that they’re putting their heart at risk. The study did not include healthy people who didn’t have a history of heart problems, and short-term use is not likely to have the same effect as longer term use typical of patients in chronic pain.

Nissen also notes that nearly 70% of the participants in the study stopped taking their assigned medication; that’s typical in a study of chronic pain in which people get frustrated when their symptoms aren’t relieved and switch from treatment to treatment. But the proportion who stopped their treatment in each group was about the same, meaning that the results were unlikely to have been drastically different if they had continued.

High Fives from Health Advocates

unduhan-50“My guess would be that there will be an explosion of cities…across the county that will pursue a soda tax,” said Howard Wolfson, Senior Adviser to Michael Bloomberg, during a press conference on Friday. “This is an issue whose time has come. We couldn’t be more excited to support local efforts.”

Still, the soda industry did not go down without a fight, mounting ad campaigns in cities like San Francisco to oppose the tax. All told the the American Beverage Association (ABA) spent $20 million to fight the issue. “It was unprecedented in terms of how the soda industry kicked it off in terms of spending,” said Dan Newman of the consulting firm SCN Strategies during the press conference. “They were absolutely flooding mailboxes and TV. We really risked drowning in soda propaganda.”

Ads funded by the ABA urged people to vote “no” on a grocery tax, even though the tax was solely targeting soda.

Soda-tax supporters also kicked in a fair amount of cash to fund the fight. Former New York City Mayor Michael Bloomberg, for instance, donated over $18 million to support the measures in Oakland and San Francisco, an billionaires John and Laura Arnold also reportedly donated $3.3 million in support of the soda taxes.

“Americans are saying to the beverage industry: ‘Enough is enough,’” says Dr. Dean Schillinger, a professor of medicine at the University of California, San Francisco. “These election results show that there is a new and real grassroots movement in America to put an end to the misleading messages about ‘drinking happiness.’”

Schillinger recently published a study in the journal Annals of Internal Medicine showing that when studies are funded by the beverage industry, they much less likely to report a link between sugary drinks and obesity and type 2 diabetes. “I believe that with the recent outcomes, we are finally seeing the war against diabetes as something we might actually win,” says Schillinger.

It’s still too early to determine the effect soda taxes have on chronic diseases like obesity and type 2 diabetes, but research has shown that since Berkeley, California, passed a soda tax in 2014, sugary drink consumption dropped 20%. A year after Mexico passed a soda tax in 2014, early researchreported an average 6% decline in purchases of sugar-sweetened beverages and a 4% average increase in untaxed beverages. Yet, some evidence suggests soda sales are back on the rise after the drop.