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Jewish World Review March 10, 2004 / 17 Adar, 5764
By Robert A. Wascher, M.D., F.A.C.S.
http://www.NewsAndOpinion.com |
The class of drugs referred to as "statins" has revolutionized the treatment
of patients with adverse blood cholesterol levels. These drugs appear to
exert their beneficial effects not only by lowering elevated levels of LDL
(the "bad cholesterol") and raising levels of HDL (the "good cholesterol"),
but also by reducing inflammation within the heart's arteries. However, the
optimal utilization of these powerful drugs has not been clear to date.
There are several statin drugs currently approved by the FDA for the
treatment of elevated blood cholesterol, and different doses of each drug
have been recommended by different experts. A new double-blind,
prospective, randomized study in this week's Journal of the American Medical
Association compared moderate versus intensive treatment with statins, and
the results of this study are very interesting, indeed.
The study was conducted at 34 different medical centers, and compared the
effects of "moderate-dose" pravastatin (40 mg per day) and "high-dose"
atorvastatin (80 mg per day) on the progression of known coronary artery
disease. The 654 patients in this study took either pravastatin or
atorvastatin for 18 months. A tiny ultrasound probe was threaded up into
the coronary arteries of 502 of these study participants initially upon
entering the study, and again following 18 months of statin therapy.
Although both groups of patients experienced a significant improvement in
their blood cholesterol values (as well as a significant reduction in the
inflammatory marker protein, c-reactive protein), the patients who took the
high-dose atorvastatin experienced a significantly greater improvement in
LDL, HDL and c-reactive protein levels when compared to the patients taking
pravastatin. More importantly, the high-dose statin group experienced no
significant progression of their coronary artery plaques over the 18-month
duration of the study, while the moderate-dose statin patients continued to
experience progression of their artery-clogging plaques. The precise
mechanism whereby the high-dose statin stopped progression of coronary
artery plaques was not directly assessed by this study. However, the
markedly greater improvements seen in the HDL, LDL and c-reactive protein
levels in patients receiving the high-dose statin regimen imply, at least,
that these favorable changes in known markers of coronary artery disease
risk are probably directly involved in halting the progression of already
established cardiovascular disease.
ANTIBACTERIAL HOME PRODUCTS & THE RISK OF INFECTION
This randomized, double-blinded study
encompassed 238 primarily Hispanic households in Manhattan. Participating
households were given unlabeled cleaning products for household cleaning,
laundry and hand-washing. Each household was randomly assigned to either
antibacterial products or non-antibacterial products. Hygiene practices and
symptoms of infectious diseases were then monitored by weekly phone surveys,
monthly home visits, and quarterly interviews, for a total of 48 weeks.
The study determined that there was no significant difference in the
incidence of infectious diseases between the households that used the
antibacterial cleaning products and the households that used the
non-antibacterial products. Specifically, there was no significant
difference in the incidences of respiratory infections, vomiting, diarrhea
or skin infections between the two groups. The study concluded that the
antibacterial cleaning products did not appear to reduce the incidence of
common household infectious diseases when compared to non-antibacterial
products. As the majority of the observed infectious diseases were likely
viral in origin, the authors did point out that even if the antibacterial
products did indeed kill bacteria, they did not appear to have any effect on
the viruses that cause the overwhelming majority of infectious diseases
among healthy people at home. In view of the continuing emergence of
disease-causing bacteria that are resistant to multiple antibiotics, it is
difficult to justify the addition of antibacterial agents to home and
personal cleaning products. The results of this study add further support
to this conclusion.
"CAMERA-INSIDE-A-PILL" IDENTIFIES ABNORMALITIES INSIDE YOUR INTESTINES
Radiologists can provide some details about the
interior of the small intestines by performing an "upper GI series," but
such radiographic studies do not provide the level of detail available with
endoscopes. CE utilizes a miniaturized digital camera and wireless
transmitter within a capsule that can be swallowed by the patient. As the
capsule passes through the GI tract, it repeatedly captures images of the
lining of the intestines and transmits them to a recording device worn by
the patient. Although seen as a promising new GI imaging technology, very
little scientific study of the merits of this amazing new technology has
been performed to date.
A study in the current issue of the journal Gastroenterology looked at the
sensitivity of CE in detecting the causes of blood loss from this
endoscopically silent area of the GI tract. A total of 100 patients with a
history of GI tract bleeding were enrolled in the study. All patients first
underwent upper and lower GI tract endoscopy without identifying a cause for
the patients' GI bleeding. Twenty-six of the patients presented with
ongoing active GI bleeding (Group A), while 31 presented with a prior
history of active bleeding that had since stopped (Group B). A third group,
consisting of 43 patients, presented without direct active bleeding, but
with positive occult blood stool tests and iron deficiency anemia (Group C).
All three groups of patients underwent CE. Among Group A patients, CE
revealed the cause of their active bleeding in 92% of cases, while CE
identified the cause of recent GI bleeding in only 13% of cases among Group
B patients. Among the Group C patients, CE identified the cause for occult
GI blood loss in 44% of cases. Overall, CE proved to be extremely sensitive
in detecting intestinal pathology resulting in GI bleeding, picking up the
actual abnormalities in about 90% of cases. In 87% of cases, CE picked up
abnormalities that resulted in specific treatments directed at the causes of
GI bleeding in Group A patients (i.e., patients who were actively bleeding
at the time of CE). The capsule had to be surgically removed in 5 patients,
but in 4 of those 5 cases, the capsule became stuck as a result of
abnormalities that required surgery anyway. The authors concluded that CE
is a highly sensitive and accurate method of identifying the causes of
active small intestinal bleeding in patients with normal upper and lower GI
endoscopy, and in patients with chronic occult GI bleeding and normal upper
and lower GI endoscopy. While there is a small risk of the capsule getting
hung-up within the GI tract, thus necessitating surgical removal, almost all
of these cases occurred due to intestinal abnormalities that require
surgical treatment anyway. CE represents an important new advance in our
ability to photographically image the longest segment of the GI tract, and
an area of our bodies that has, until now, been largely invisible except for
the limited and largely unimproved radiographic imaging that radiologists
have been performing for decades.
DIETARY FOLATE & OVARIAN CANCER INCIDENCE
All study volunteers completed dietary surveys, allowing researchers to
tease-out dietary risk factors for specific cancers. Overall, a low dietary
folate intake was only weakly associated with an increase in the risk of
ovarian cancer (these results were not statistically significant). However,
among women who consumed two or more alcoholic drinks per week, there was a
strong and statistically significant increase in the incidence of ovarian
cancer among women with low levels of folate in their diets. The women with
the lowest dietary folate intake experienced a 74% increase in the relative
risk of developing ovarian cancer during this more than decade-long study.
At the same time, there was no difference in the incidence of ovarian cancer
among women who consumed 2 or fewer alcoholic drinks per week, irrespective
of their folate intake. Thus, the authors conclude, high levels of dietary
folate may reduce the risk of ovarian cancer in women, and particularly
among women who consume two or more alcoholic drinks per week.
In addition to a possible role in the prevention of cancer, adequate folate
intake also appears to offer some protection against heart disease (by
lowering levels of homocysteine in the blood), and against certain birth
defects (e.g., spina bifida, cleft palate, cleft lip, heart anomalies and
limb malformations). In view of the critical health benefits of dietary
folate, the FDA mandated, in 1996, that rice, pasta, cornmeal, and other
grain products be fortified with 140 micrograms of folate per 100 grams of
food product.
JWR contributor Dr. Robert Wascher is an oncologic surgeon, professor of surgery, oncology research scientist, and author. He lives in Honolulu with his wife and two daughters.
Comment by clicking here.
Intensive statin therapy halts coronary artery disease progression; dietary folate & ovarian cancer incidence; "camera-inside-a-pill" identifies abnormalities inside your intestines; antibacterial home products & the risk of infection
Virtually every manufacturer of personal and home cleaning products is
marketing one or more products with "antibacterial" properties. Despite
concerns within the medical world about the explosion of
antibiotic-resistant bacteria, these products are heavily hyped as effective
agents in destroying bacteria, viruses or, simply, "germs on contact." A
new study in the Annals of Internal Medicine looked at the impact of these
antibacterial cleaning products on the incidence of infectious diseases in
households that use such products.
Capsule endoscopy (CE) offers a new method of visualizing the interior of
the small intestine. The esophagus, stomach, and first part of the small
intestine (the duodenum) can be directly visualized by flexible fiberoptic
scopes (endoscopes). The rectum and colon can also be inspected and
biopsied using an endoscope during colonoscopy. However, the 20 to 25 feet
of small intestine between the duodenum and the colon cannot be easily
visualized by endoscopes.
Several previous studies have suggested that low dietary intake of the
B-vitamin folate in the diet is associated with an increased risk of
colorectal and breast cancer. This increased risk of cancer in people with
folate-deficient diets appears to be especially significant among alcohol
drinkers. (Heavy alcohol consumption is associated with reduced blood
levels of folate.) Folate, or folic acid, plays a crucial role in the
repair of damaged DNA within our cells, and a deficiency of this vital
nutrient may impair our cells' ability to recover from genetic damage that
may, in turn, predispose us to an increased risk of cancer. A new Swedish
study, reported in the current issue of the Journal of the National Cancer
Institute, examined the link between dietary folate, alcohol intake and the
incidence of ovarian cancer in 61,084 women, aged 38 to 76 years. These
women were part of a large prospective study of mammography, the Swedish
Mammography Cohort study.
