Showing posts with label Stroke. Show all posts
Showing posts with label Stroke. Show all posts
Mouth bacteria found in stroke patients' brains. What does it mean?
Bacteria commonly seen in the mouth has been found in the brains of people who have had a stroke, a new study shows.
The Finnish research group behind the new findings has been studying a possible association between bacterial infections and cardiovascular disease for more than 10 years. Their study, published Thursday in the Journal of the American Heart Association, looked for signs of bacteria in blood clots removed from 75 patients who were treated for an ischemic stroke at Tampere University Hospital in Finland between 2013 and 2017.
Ischemic stroke is caused by a blockage in a blood vessel in the brain. It accounts for about 87% of all strokes.
The study found that 84% of the participants, or 63 of them, had bacterial DNA in their blood clot. Among them, 59 had a strain of streptococci commonly found in the mouth that can cause infections if they get into the bloodstream.
The work is "the first to show common presence of (this) bacterial DNA in ischemic stroke patients," said Olli Patrakka, the study's lead author.
The bacteria involved, called viridans streptococci, are believed to cause endocarditis, an infection of the lining, valves or muscles of the heart.
Patrakka, a graduate student in the Department of Forensic Medicine at Tampere University, said his colleagues in 2013 found the same strain of streptococci in blood clots removed from patients who had a heart attack. Additional studies found the same bacteria in patients who had a ruptured brain aneurysm or a blood clot in their leg.
"Our results suggest that bacteria might have a role in the (development) of serious complications related to atherosclerosis" – the buildup of plaque in the arteries, Patrakka said.
Studies have identified high blood pressure, high cholesterol, physical inactivity, diabetes, smoking and obesity as risk factors for heart disease. In 2012, a committee of the American Heart Association convened an expert panel to review the evidence on oral health and cardiovascular disease and concluded there was not enough evidence to show gum disease caused by bacteria was a direct cause of heart disease or that treating the gum disease would prevent heart disease.
Dr. Peter B. Lockhart, research professor in the Department of Oral Medicine at Carolinas Medical Center in Charlotte, North Carolina, was lead author of the AHA scientific statement. Although the new study clearly found oral bacteria in the brain, he said the significance of the finding is open to question.
Bacteria is present in the mouth, and it's not uncommon for it to enter the bloodstream, Lockhart said, whether or not a person is healthy or has periodontal disease.
"We now know that bacteria exist throughout the body, including in the blood," which was previously thought to be sterile. "Finding evidence of bacteria in blood clots doesn't mean they have a role in the disease process," he said.
But Patrakka said his research suggests regular dental checkups might help reduce the risk of heart disease.
Bacterial plaque buildup on the teeth can cause periodontal disease, an inflammation of the tissues around the teeth. About 47% of adults ages 30 and older have some form of periodontal disease, according to the Centers for Disease Control and Prevention.
"We believe that future studies will strengthen the view that regular dental care has a more important role than previously thought in the health of people," Patrakka said.
But for now, Lockhart expects doctors will stick to the clear-cut risks.
"If you are a cardiologist," he said, "you are going to focus your time with patients talking about smoking, diet, exercise and other well-documented contributors to cardiovascular disease."
Poor Oral Health Effects : Dental Hygiene
Here is a list of diseases that might be caused due to poor oral health effects that is bound to make you take better care of your teeth:
- Diabetes
If you have some periodontal disease or have been experiencing loss of teeth, then it is highly likely that you might be suffering from Diabetes. High blood glucose level provides an ideal condition for bacteria to thrive in the mouth and grow on gums. Fortunately, if you are able to control one, you can manage the other. So to an extent the impact of it can be controlled.
- Infertility
Studies reveal that men with periodontal disease are 7 times more likely to experience erectile dysfunction than men who take care of their dental health. A Research done by the European society revealed that women, who do not maintain a good oral hygiene, take longer time to conceive. If suffering from gum related diseases, then it might take more than 7 months to conceive compared to the peers who don’t suffer from anything.
- Heart Disease
Gum and heart disease often go hand in hand. Individuals suffering from periodontal disease are twice as likely to suffer from a stroke or heart disease compared to a normal person due to the bacteria. These bacteria have the ability to clogs the arteries, thus building enough pressure to cause a severe heart attack.
- Respiratory problems
Gum disease may increase your risk of getting respiratory infections, such as chronic obstructive pulmonary disease (COPD) and pneumonia. Te periodontal bacteria can travel through the blood streams to the lungs and aggravate it thus causing a lot of breathing trouble.
- Osteoporosis
The common link between osteoporosis and periodontal disease is bone loss. Bone strength can easily be identified with an oral health check up and that can help indicate if you are suffering from early stage of osteoporosis. Treating Osteoporosis in such cases become crucial as it should be done before it can weaken the bones of the jaw of the person suffering with periodontal disease. Understanding the signs of this at an early stage is very helpful as the patient can start to receive treatment before suffering a painful and potentially debilitating fracture.
- Obesity
Obesity increases an individual’s susceptibility by modulating the immune and inflammatory systems in a manner that predisposes to inflammatory tissue destruction and leaves an individual at greater risk of periodontitis. More bleeding on probing, deeper periodontal pockets and more bone loss were noticed in individuals with higher indicators of obesity. Thus maintaining a normal body weight and eating healthy food ensures less threat to the body along with focusing on the poor oral health effects on our body.
- Arthritis
Periodontitis has common link with Rheumatoid Arthritis (RA) due to its common pathogenesis and clinical presentation. Patients with RA are eight times more likely to have periodontal disease compared to control patients. Both the conditions are characterized by chronic inflammation in the soft-tissue site adjacent to bone. Both the diseases together will require life time disease management. In an effort to best maintain oral health, RA patients are encouraged to brush and floss on a regular basis and visit a dentist twice a year.
Well, now that it is clear why good oral hygiene is important, educate self and family about these effects and spread the awareness. Practice good oral hygiene by brushing after every meal with fluoride toothpaste and floss your mouth regularly. Doing so will save your teeth from Poor Oral Health Effects , and life as well!
Detect Your Risk of Sudden Heart Attack and Stroke
The PLAC® test measures blood levels of an enzyme called lipoprotein phospholipase A2 (Lp-PLA2). The Lp-PLA2 enzyme unleashes a chain of harmful events culminating in endothelial dysfunction, which is a pathological abnormality in the blood vessel wall that sets the stage for atherosclerosis, plaque accumulation, and rupture.6
An elevated level of Lp-PLA2 may signal that an arterial plaque is susceptible to rupture, which could cause a clot to break loose, precipitating a heart attack or stroke.
Traditional markers of cardiovascular risk such as cholesterol levels tell physicians very little about acute risk of stroke or heart attack.7 However, there is an important biochemical relationship between low-density lipoprotein (LDL) and Lp-PLA2. LDL particles are oxidized by oxygen free radicals, and these oxidized LDL particles penetrate into the intima, the innermost layer of the blood vessel wall.8
The PLAC® test measures the activity of the Lp-PLA2 enzyme associated with LDL particles when they are oxidized. David G. Harrison, MD, FACC, FAHA of Emory University School of Medicine in Atlanta, GA, notes, “if one has an elevated PLAC® test, it indicates that the person has [inflamed] atherosclerotic plaques in which LDL oxidation is occurring.”
Lp-PLA2 is made in the plaque itself and acts as a specific marker of inflammation that appears to be directly involved in forming rupture-prone atherosclerotic plaque. Patients with coronary artery disease have markedly elevated Lp-PLA2 levels, reflecting build-up of vulnerable plaque in the blood vessel wall.7,8
An autopsy study of 25 patients with sudden coronary death used antibody to Lp-PLA2 to track its presence within diseased coronary arteries. Although early plaques had very light staining for Lp-PLA2, or none at all, ruptured plaques that had caused sudden death showed intense Lp-PLA2 staining deep within the plaque.9
Similarly, patients undergoing surgery related to atherosclerosis of the carotid artery, one of the main arteries supplying the brain, had intense staining for Lp-PLA2 within macrophages—a type of white blood cell involved in plaque inflammation. Those who had carotid artery disease without symptoms had much less intense staining for Lp-PLA2.10
PLAC® Test Predicts Acute Cardiovascular Events
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High levels of Lp-PLA2 predict increased rates of coronary heart disease and stroke in multiple population-based studies. Physicians from the prestigious Mayo Clinic and other experts recently reviewed more than 25 published studies of Lp-PLA2, including a compilation of 14 prospective epidemiologic studies of 20,000 patients. They concluded that Lp-PLA2 is consistently linked to higher risk of heart attack and stroke, and that this increased risk is not significantly changed when conventional risk factors for cardiovascular disease are also considered. They determined that Lp-PLA2 is unique in being highly specific for plaque inflammation, as well as being involved in causing that inflammation.11-13
The PLAC® test is as sensitive and more specific than other markers for the prediction of acute events, allowing for enhanced ability to identify people who are at increased risk for an acute ischemic event.
Lp-PLA2 has been shown to predict endothelial function in a number of studies.6,14 A striking example of this is a study showing that individuals in the highest third of Lp-PLA2 levels are more than three times as likely to have coronary endothelial dysfunction than those in the lowest third.14 In this study, Lp-PLA2 levels predicted endothelial dysfunction independently of their association with cholesterol and other cardiovascular risk factors. A review of available studies shows that individuals with high levels of Lp-PLA2 have about two to three times the risk for acute cardiovascular events, and that this risk is independent of traditional cardiovascular risk factors.2,12,13 The association of high Lp-PLA2 levels with acute cardiovascular risk holds true even in apparently healthy older adults.15
Although LDL and other lipids are not consistent predictors of stroke risk, elevated Lp-PLA2 approximately doubles stroke risk.7,16
How Dental Hygiene Affects Your Health
You are constantly hearing how significant it is and about hygiene. But did you know that it isn’t just important due to the effects it has on your gums and teeth? Dental hygiene is significant because of the consequences it has on your health.
First things first, what’s dental hygiene? By brushing your teeth at least twice to three times each day with fluoride toothpaste that has been approved by the American dental association your teeth is brushing every day. In addition, you need to floss your teeth at least once every day to make sure you are removing. Another part of dental hygiene is eating a balanced diet and visiting your dentist for routine examinations. All this is part of dental hygiene.
Dental hygiene impacts your health more than you might imagine. If you do not brush your teeth plaque can form. Plaque is a sort of bacteria that creates right above your gum. The plaque will turn to tartar if you don’t keep up by brushing and flossing daily. After plaque turns to tartar the only way to go off it is to go see your dentist. Your physician has a procedure called scaling to take the tartar off. If the tartar isn’t removed you can develop gum disease such as gingivitis. If you create gingivitis and don’t get it could become periodontitis.
Periodontitis is a serious kind of gingivitis that is a stage of the disease that is damaging. The damage includes weakness of bones, teeth becoming loose or perhaps loss of teeth. There have been recent studies which have shown that periodontitis can be associated with diabetes, strokes, and cardiovascular disease.
Periodontitis can lead to diabetes, strokes, and heart disease because of inflammation in the mouth. Inflammation in the mouth causes cells and white blood cells to improve production which helps to fight infections. A side effect is caused by the higher production of protein and white blood cells. The side effect is that inflammation not only causes your gums inflamed but the infection gets into the blood and is carried down the redness to the blood vessels. Inflammation in the arteries makes them more vulnerable to the deposition of cholesterol and fats. Having deposition of cholesterol and fats in your arteries is exactly what leads to heart attacks and strokes. Studies have shown people that have significantly more plaque and bacteria in their own mouths have a higher risk for cardiovascular disease and strokes.
Additionally, if you have an existing heart disease you will want to make certain that you keep up in your dental hygiene. Hygiene can influence your health. For example, if you start to bleed from the gums in your mouth and the germs get into your bloodstream and remain on the valve.
Another way that hygiene affects your health is when you get older. Now you may need to have dentures if you do not look after your teeth or you may have mouth infections. Having mouth diseases or dentures that do not fit can lead to weight loss or malnutrition.
All these examples are the way dental hygiene affects your health. If you want more detailed information or have questions you wish to be answered on dental hygiene impacts your health contact your dentist or doctor and tell them your questions. Your dentist or physician will have the ability to help you find out what you have to do in order to receive the best dental hygiene according to your age and what health problems you have.
Since we were children, we’ve heard a lot about the value of practicing”great dental hygiene”, however, it is frequently assumed that we already know what that means. Unfortunately, we assume that we understand what the results of a normal practice will be… .but we are mistaken.
Many people only go so far as to consider the status of our teeth, nevertheless, and our personal look. Sometimes, we may also give some thought that if we took care of our teeth, we’d have fewer visits to the dentist.
We know at some level we wouldn’t require such drastic dental procedures like fillings, extractions, and root canals. We realize, at least we feel and would possibly look much better… .not to say experience less pain… .were our dental hygiene habits a little better. We can even grasp that the expense of dental processes will be a lot greater than the price associated with keeping our teeth and gums healthy on an everyday basis.
But, most of us never set the whole package together and realize that the entire impact that neglecting basic dental hygiene can have on us. Not only can our wallets and jaws be impacted, but time is also taken from our activities because we do our daily required dental care, or as we see to correct the conditions which developed as a result of our negligence. Worse, we’ll likely experience unnecessary pain, ill-health, and possibly early death, or debilitating conditions, as a result of not performing the few easy and relatively inexpensive actions which would look after the problem before it has an opportunity to occur. Carbonear Dental
THE OBVIOUS RESULTS OF POOR DENTAL HYGIENE
Obviously, for most of us, poor dental hygiene contributes to cavities (dental caries). Cavities are holes in the teeth that will need to be filled by a dental practitioner. Filling a cavity can cost anywhere from $100 on up. Some particular conditions and alternatives can cost even more or as much as $ 1,000.
Some teeth will be in rather a bad shape but can be saved by means of a root canal. The expense of a root canal can be in the high hundreds, and in the thousands of dollars. Some teeth that can’t be saved will need to be extracted. A ballpark cost for tooth extraction is between $75 and $150, but special situations and complications could run that cost greater, of course.
Not only is there the money cost of these dental procedures to consider, but there’ll usually be pain related to the condition as well. Many of these scenarios could be prevented by regular, basic hygiene measures, thus saving both money and distress. These situations, or the procedure used to fix them, might impact someone’s appearance, thus affecting their own self-image and self-esteem. Additionally, if someone has been neglecting the maintenance of the teeth, teeth, and mouth several teeth might be creating expensive concerning pain, and lowered self-esteem.
MORE HEALTH ISSUES RELATED TO POOR DENTAL HYGIENE
For some time, dental health care providers have been aware that diseases and conditions of the teeth, mouth, and gums can bring about some other health problems. Recent studies have not only confirmed this understanding but have broadened it. Without going into detail here, suffice it to say that dental hygiene has now been linked to many diseases and painful conditions such as stroke, diabetes, heart disease, and even cancer. https://www.carboneardental.com/site/cosmetic-services-carbonear-dentist‘>https://www.carboneardental.com/site/cosmetic-services-carbonear-dentist
Stroke study finds mouth bacteria in brain clots
Ensuring good oral hygiene could help to prevent stroke. This was what scientists proposed after finding DNA traces of oral bacteria in samples of blood clots that had caused strokes
Researchers from Tampere University in Finland analyzed clot samples from 75 people who received emergency treatment for ischemic stroke when they attended Tampere University Hospital's Acute Stroke Unit.
The patients had undergone thrombectomies. These procedures remove blood clots by means of catheters conducted through arteries. The catheters can deploy stent retrievers and aspirators to reduce or remove the clot.
When they analyzed blood clots sampled in this way, the researchers found that 79% of them bore DNA from common oral bacteria. Most of the bacteria were of the Streptococcus mitis type, which belong to a group that scientists call viridans streptococci.
The levels of the oral bacteria were much higher in the blood clot samples than they were in other samples that surgeons took from the same patients.
In discussing the implication of the results, the authors note that streptococci bacteria from the mouth can cause serious infection, such as of the heart valves, when they enter the circulation.
There is also evidence that bacteria can activate blood platelets directly. Could this be a possible route to increasing stroke risk?
"Activated platelets" trigger cells that promote atherosclerosis and "speed up the development of atherothrombotic lesions," they write.
"Bacterial surface proteins of S. mitis," they add, "can directly bind to various platelet receptors."
In regard to the recent findings, the researchers note that while they show that oral bacteria are involved, it is still unclear whether they cause strokes or whether "their role is solely as bystander."
In the meantime, they suggest that: "Regular dental care should be emphasized in the primary prevention of [acute ischemic stroke]."
Oral Hygiene and Heart Health – Is There Any Link that Affects our Health?
Gum disease symptoms:
Speak to your dentist if you have any of the below mentioned symptoms. Proper teeth evaluation and medical review can provide you with the best dental treatment. This will help you to ease gum disease.
- Feeling pain while chewing
- Persistent bad breath
- Sensitive teeth
- Loose teeth
- Swollen red gums
- Receding gum
Heart disease symptoms:
If your doctor is doubtful about the severity and duration of your cardiac symptom, then he may suggest you for a thorough physical examination and check your previous medical history. Following are some of the common symptoms seen during heart disease:
- Irregular heartbeat or arrhythmia
- Dizziness
- Fatigue
- Heart attack
- Edema
- Shortness of breath
- Chest pain or angina
Can you prevent gum disease?
Yes, you can prevent gum disease with healthy lifestyle choices and good oral hygiene. This, in turn, helps you to reduce the risk of developing heart disease. Check out the tips below:
- Brush your teeth and tongue twice daily with fluoride toothpaste
- Drink plenty of water
- Floss between your teeth to avoid tooth decay and gum inflammation
- Avoid smoking or chewing tobacco products
- Follow a diet rich in vegetables, low sugars, and high fibre
- Go for dental check-up twice in a year or as suggested
- Use fluoride mouth wash and mouth rinse
It is surprising to know about the link between oral health and overall health. A good oral care regimen is important to properly maintain our health. It is good to educate patients about the importance of practising oral health as its negligence paves the way for various other diseases. If your doctor feels you have any gum disease or heart issue, he may prescribe you with medi-cines; you can buy medicine online through trusted pharma online and apps.
Infections may be a 'trigger' for heart attack, stroke
Diabetes, high blood pressure and elevated cholesterol are well-known risk factors for cardiovascular disease. But what about just getting sick? Could picking up some type of bug increase your chance of having a stroke or heart attack?
A new study suggests it could.
Researchers have linked infections such as pneumonia and urinary tract infections to an increased risk of having a coronary event, such as a heart attack, or stroke within the next three months.
In the study published recently in the Journal of the American Heart Association, academic researchers examined a registry of patients tracked over multiple years in four U.S. cities. They looked at 1,312 patients who had a heart attack or other type of coronary event, and 727 other patients who had an ischemic stroke, the kind caused by a blood clot.
Of the heart disease patients, about 37 percent had some type of infection within the previous three months. Among stroke patients, it was nearly 30 percent.
Infections substantially increased the odds of having a heart attack or stroke compared to a year or two earlier in the same group of patients, and those odds were highest in the first two weeks following the infection.
Infections generally trigger an inflammatory reaction in the body, said Dr. Kamakshi Lakshminarayan, a neurologist and the study's senior author.
The body triggers its white cell production to help ward off an infection, but that process also increases the stickiness of cells called platelets, she said. This encourages the formation of clots that could block the flow of blood to the heart or brain.
"The infection appears to be the trigger for changing the finely tuned balance in the blood and making us more prone to thrombosis, or clot formation," said Lakshminarayan, an associate professor of epidemiology at the University of Minnesota's medical school. "It's a trigger for the blood vessels to get blocked up and puts us at higher risk of serious events like heart attack and stroke."
The study raises questions about whether patients hospitalized for infections should also begin receiving treatment to protect them from heart disease and stroke. Additional research may provide those answers, Lakshminarayan said.
Urinary tract infection, or UTI, was the most common type of infection reported in the study, followed by pneumonia and other respiratory infections. Skin and blood infections also were reported.
The study included patients treated for infections while hospitalized and those who received outpatient care. Both groups were more likely to have a cardiovascular event within three months of the infection, but this association appeared to be stronger among the inpatient group.
That's because infections requiring hospitalizations are probably more severe to begin with, said Juan Badimon, a professor of medicine and director of the atherothrombosis research unit at Mount Sinai School of Medicine's Cardiovascular Institute in New York.
"And if the infection is that severe, we can assume a stronger inflammatory response will result in a higher cardiovascular risk," said Badimon, who was not involved in the research but co-authored an editorial that accompanied the study.
He described the study's association between cardiovascular events and all types of infections, not just respiratory ones, a "novel discovery." But, he said, he would like to have seen researchers dig deeper and note whether the infection source – viral or bacterial – played a role in the increased risk for heart attacks and strokes.
Badimon hopes the findings will encourage the public to make sure their vaccinations are up-to-date, especially during flu season.
Lakshminarayan agreed.
"One of the biggest takeaways is that we have to prevent these infections whenever possible," she said, "and that means flu shots and pneumonia vaccines, especially for older individuals."
If you have questions or comments about this story, please email editor@heart.org.https://www.heart.org/en/news/2018/11/28/infections-may-be-a-trigger-for-heart-attack-stroke
Destruction of the cholesterol hypothesis
A raised cholesterol level, or LDL level, is not a risk factor for stroke. Not even in familial hypercholesterolaemia (FH) is a raised cholesterol level a risk factor for stroke.
Here, I am quoting from a study published in the Lancet called ‘Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration.’
‘After standardization for age, there was no association between blood cholesterol and stroke except, perhaps, in those under 45 years of age when screened. This lack of association was not influenced by adjustment for sex, diastolic blood pressure, history of coronary disease, or ethnicity (Asian or non-Asian).’ 1
I think that this was a big enough study to demonstrate that, if there is any effect, it can only be tiny. Yes, the study is over twenty years old, but it was done before statins came along to distort the entire area. By which I mean after the mid-nineties, a large number of people with raised cholesterol were being put on statins, thus making any interpretation of the impact of different cholesterol levels, on stroke, almost impossible.
As for Familial Hypercholesterolaemia. The findings of the Simon Broome registry (set up in the UK to study the health impact of FH) were, as follows
'The data also confirm our earlier findings that FH patients are not at a higher risk of fatal stroke.’ 2
Thus, a raised cholesterol level is not a risk factor for stroke, even at very high levels found in FH – even in homozygous FH (where both the subject’s genes are faulty so leading to more severe FH). Yet, and yet, statins reduce the risk of stroke. Not by much, and not to the extent that I consider the benefits to outweigh the harms, but they do. Here, plucked from a million possible articles is something from the American Heart Association
‘Millions more people worldwide may benefit from cholesterol-lowering statins after a global study showed the drugs help reduce heart attacks and strokes in people at moderate risk. The risk fell slightly further when patients also took blood pressure drugs.’ 3
The absolute figures wobble about, depending of which of the myriad studies and meta-analyses you choose to look at, but the reduction in stroke risk is about the same as the reduction in the risk of heart attacks/myocardial infarctions.
When I see facts like this, I try to use logic. The logic, in this case, goes something like this:
- Factor A (raised LDL) is not a risk factor for disease B (stroke)
- However, if you lower factor A, the risk of disease B falls
Conclusion. Something other than the lowering of Factor A is causing the reduction in the risk of disease B. If you take this thought one step further, the beneficial effect of statins on the risk of stroke, flatly contradicts the cholesterol hypothesis.
Post from Malcom Kendrick
Statin Treatment in Patients With Intracerebral Hemorrhage
Ever since the publication of the SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) in 2006, neurologists became aware of the fact that statins may increase the risk for future intracerebral hemorrhage (ICH) in patients with previous ischemic stroke or ICH.1,2 At the same time, observational studies reported an increased risk for hemorrhagic transformation or even symptomatic bleeding in ischemic stroke patients undergoing thrombolysis who were pretreated with statins.3,4 As a consequence, many physicians were very careful to administer statins in patients with ICH and often stopped statin medication immediately after hospital admission in those who had been taking the medication before the event. In 2011, Westover et al5 provided a Markov decision model that came to the conclusion that statins should be avoided in patients with a history of ICH, particularly in those cases with a lobar location. In clinical practice, this often results in the somewhat counterintuitive situation that after an ICH, statins are often permanently discontinued, whereas platelet inhibitors or even oral anticoagulants are resumed depending on the underlying comorbidity.6
Statins exert many pleiotropic effects in addition to cholesterol lowering. These properties may contribute to both its protective effects and also some unwanted side effects, including an increased risk for bleeding.7,8 On the other hand, however, sudden discontinuation of statins may lead to rebound effects which may impair vascular function and induce adverse clinical effects in patients with acute vascular events.9–12 Some years ago, we formulated the recommendation that statins should not be paused and acutely discontinued in ischemic stroke patients undergoing thrombolysis and inferred—based on only sparse clinical data—that this probably also applies for patients after acute ICH.13
Strokes and Parkinsons
Dear colleagues, I am Christoph Diener from the University of Essen in Germany. For the month of November, I have identified four interesting studies in neurology.
The first one was published in the European Heart Journal, and it addresses the question of whether, if you treat atrial fibrillation with anticoagulation, you can prevent the development of dementia.[1] There are a number of studies which basically show that people with atrial fibrillation have an increased risk for dementia, and this is true for both Alzheimer disease and vascular dementia.
Investigators from Sweden looked at the national health registry and the drug prescription registry. They identified 444,106 patients who had atrial fibrillation. About half of them were anticoagulated and the other ones were not anticoagulated, for whatever reason. They found that in a period between 2006 and 2014, the risk of developing dementia was reduced by almost 30% in patients who were anticoagulated. This was true both for warfarin and for NOACs [novel oral anticoagulants]. This would indicate in a large sample of almost 450,000 patients with atrial fibrillation that anticoagulation can prevent the development of dementia.
The next study deals with secondary stroke prevention and smoking.[2] This was a study which investigated pioglitazone in patients who had a TIA [transient ischemic attack] or stroke over a period of 5 years. This was called the IRIS trial. The investigators looked at patients who at baseline had the event—stroke or TIA—and smoked; then they looked at patients who quit smoking in the next 5 years. This percentage at the beginning was about 30%, and 42% of these patients stopped smoking. What they observed was a risk reduction of 35% for a recurrent stroke, myocardial infarction, and vascular death if people stopped smoking. The benefit was very clear for stroke and death. It was not significant for myocardial infarction.
Now, I would like to move to Parkinson's disease. There are a number of epidemiologic studies which would indicate that the consumption of caffeine can reduce the risk for Parkinson's disease. A publication in Neurologyinvestigated whether caffeine given twice daily in a dose of 200 mg in a period of between 6 and 18 months has an impact on the symptoms of Parkinson's disease.[3]
They randomized 120 patients to either caffeine twice daily or to placebo. The study could not show a benefit on the neurologic symptoms of Parkinson's disease, and there were no cognitive testing results in patients on caffeine. What the study does not answer is whether caffeine has a preventive effect on the cause of Parkinson's disease.
The last study was published in Annals of Neurology and investigated whether traumatic brain injury is a predictor of Parkinson's disease.[4] The investigators identified almost 89,000 patients who had Parkinson's disease and 118,000 controls around the age of 65 years. They looked at the connection between traumatic brain injury in the past 5 years to the incidence of Parkinson's disease. They found that there was a 64% increase in the risk of developing Parkinson's disease if the traumatic brain injury was within the past 5 years. The risk increased with a shortening of the time interval between traumatic brain injury and Parkinson's disease.
Now, whether there is a causal relationship or whether the traumatic brain injury happened due to falls—because the patients already started having motor symptoms of Parkinson's disease—cannot be answered by this study. It also has no impact on patient handling because you cannot prevent traumatic brain injury or falls to prevent Parkinson's disease. At least it is an interesting study, indicating that head trauma and brain trauma might be risk factors for Parkinson's disease.
Ladies and gentlemen, here are two studies from the stroke field and two interesting studies from the Parkinson's disease field. I'm Christoph Diener, a neurologist from the Department of Neurology in Essen, Germany. Thank you for listening.
Medscape Neurology © 2017 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this article: Four New Updates in Stroke and Parkinson Disease - Medscape - Dec 06, 2017.
Do not eat after 7pm
Eating late at night is putting millions of people in danger of heart attacks and strokes, experts warn.
A late-night meal keeps the body on 'high alert' when it should be winding down, researchers found.
Heart experts last night advised that adults should never eat within two hours of bedtime – and ideally nothing after 7pm.
In a healthy person, blood pressure drops by at least 10 per cent when they go to sleep.
But the results of a study of more than 700 people with high blood pressure found that eating within two hours of bedtime meant their levels stayed high.
Experts think this is because eating releases a rush of stress hormones when the body should be starting to relax.
People who do not see their blood pressure fall at night are known as 'non-dippers' – and have a much higher rate of heart-related death.
Late eaters were nearly three times more likely to be non-dippers, the Turkish researchers found.
Researcher Dr Ebru Özpelit, presenting her results at the speaking at the European Society of Cardiology congress in Rome, said: 'If we eat late at night, the body essentially remains on high alert as during the day, rather than relaxing for sleep.
'Stress hormones are secreted, causing blood pressure not to decrease during sleep, which should normally happen.'
Dr Özpelit, from Dokuz Eylül University in Turkey, tracked 721 on people diagnosed with high blood pressure, with an average age of 53.
She found that those who ate within two hours of going to bed were 2.8 times more likely to retain high blood pressure overnight.
Some 9.4 million people in the UK are diagnosed with high blood pressure, which is also known as hypertension.
They are already at a higher risk of heart disease, but if their blood pressure does not fall at night, that risk increases to a far higher level.
Experts estimate that 40 per cent of patients with hypertension are non-dippers – potentially 3.76million people in Britain - putting them at serious risk of major heart problems
Dr Özpelit said: 'It is more dangerous. If blood pressure doesn't drop by more than 10 per cent this increases cardiovascular risk and these patients have more heart attacks, strokes and chronic disease.'
But even healthy people with normal blood pressure should take note of the findings, Dr Özpelit said.
'How we eat may be as important as what we eat,' she said.
She advised that people do not skip breakfast, eat lunch, and keep dinner to a small meal.
'Eating breakfast and lunch is important but dinner must not be later than seven o'clock in the evening,' she said.
The findings add to a growing body of evidence which suggests keeping all meals to within a fixed period of time – and fasting at night – can have a wide range of health benefits.
Previous research has found that an early dinner reduces the risk of breast cancer, lowers blood sugar levels, and helps burn off calories.
Experts think part of the reason is that the body evolved to expect meals much earlier in the day – because people went to sleep when it got dark.
Dr Özpelit said the invention of electricity changed that – introducing 'erratic' eating patterns.
'With the advent of affordable artificial lighting and industrialization, modern humans began to experience prolonged hours of illumination every day and resultant extended consumption of food,' she said.
'Late night eating and skipping breakfast is such an erratic eating pattern which is becoming more prevalent day by day.'
Professor Peter Weissberg, medical director of the British Heart Foundation, said: 'This research suggests that eating a meal late at night may contribute to the failure of their blood pressure to reduce.
'It is normal for blood pressure to reduce overnight, even in people with high blood pressure.
'However, in some their blood pressure remains elevated throughout the night putting them at potentially higher risk of future complications.'
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The key is blood pressure reduction:
The key is blood pressure reduction:
1. Increase your activity level and exercise more
Sedentary older adults who participated in aerobic exercise training lowered their blood pressure by an average by 3.9 percent systolic to 4.5 percent diastolic (4). This is as good as some blood pressure medications.
As you increase your heart and breathing rates, your heart gets stronger and pumps with less effort. This puts less pressure on your arteries, and lowers your blood pressure.
How much activity? A 2013 report by the American College of Cardiology and the American Heart Association advises moderate- to vigorous-intensity physical activity three to four sessions weekly, 40 minutes each (5).
The American College of Sports Medicine makes similar recommendations (6).
But you don’t have to run marathons. Increasing your activity level can be as simple as using the stairs, walking instead of driving, doing household chores, gardening, going for a bike ride, or playing a sport. Just do it regularly and work up to at least half an hour per day of moderate activity.
An example of moderate activity with big results is tai chi. One study found that 12 weeks of tai chi training for 40 minutes three times a week produced a 8.8-15.6 mmHg decrease in blood pressure (7).
A 2014 review of studies on exercise and lowering blood pressure found that there are many exercise combinations that lower blood pressure. Aerobic exercise, resistance training, high intensity interval training, short bouts of exercise over the day, or walking 10,000 steps a day all lowered blood pressure (3).
Another review found that low- to moderate-intensity exercise training is as effective as higher-intensity exercise training in lowering blood pressure (8).
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2. Lose weight if you’re overweight
If you’re overweight, losing even 5 to 10 pounds can reduce your blood pressure. Plus, you’ll lower your risk of other medical problems.
A 2016 review of several studies reported that weight loss diets reduced blood pressure by an average of 3.2-4.5 mmHg (9).
3. Cut back on sugar and refined carbohydrates
Many scientific studies show that restricting sugar and refined carbohydrates can help you lose weight and lower your blood pressure (10).
A 2010 study compared a low-carb diet to a low-fat diet. The low-fat diet included a diet drug. Both diets produced weight loss, but the low-carb diet did much better in lowering blood pressure. The low-carb diet lowered blood pressure by 4.5-5.9 mmHg. The diet of low fat plus the diet drug lowered blood pressure by only 0.4-1.5 mmHg (11).
A 2012 analysis of 17 studies of low-carb diets and heart disease risk found that these diets lowered blood pressure by an average of 3.10-4.81 mmHg (12).
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A side effect of a low-carb, low-sugar diet is that you’ll feel fuller, because you’re consuming more protein and fat. You’ll also lower your risk for other diseases, such as diabetes (10).
4. Eat less sodium, more potassium
Cutting back on salt and increasing your potassium intake can lower your blood pressure (13).
Potassium is a double winner: It lessens the effect of salt in your system, and also eases tension in your blood vessels.
It’s easy to increase your intake of potassium — so many foods are naturally high in potassium. Here are a few:
- dairy foods (milk, yogurt)
- fish
- fruits (bananas, apricots, oranges)
- vegetables (sweet potato, potato, tomato, greens, spinach)
Note that individuals respond to salt differently. Some people are salt-sensitive: A higher salt intake increases their blood pressure. Others are salt-insensitive. They can have a high salt intake, and excrete it in their urine without raising their blood pressure (14).
Reducing salt intake using the DASH diet (Dietary Approaches to Stop Hypertension) is recommended by the National Institutes of Health (15). The DASH diet emphasizes low sodium, fruits, vegetables, low-fat dairy, whole grains, fish, poultry, beans, and fewer sweets and red meats.
5. Eat less processed food
Most of the extra salt in our diet comes from processed foods and restaurant food, not your salt shaker at home (16). Popular high-salt items include deli meats, canned soup, pizza, chips, and other snacks.
Foods labeled “low fat” are usually high in salt and sugar to compensate for the loss of fat. Fat is what gives food taste and makes you feel full.
Cutting down on (or even better, cutting out) processed food will give you less salt, less sugar, and fewer refined carbohydrates. All of this results in lower blood pressure.
Make it a practice to check labels. Sodium that’s listed as 5 percent or less on the label of a food item is considered low. Twenty percent or more is considered high, according to the U.S. Food and Drug Administration (FDA) (16).
6. Stop smoking
Stopping smoking is good for your health all-around. Smoking causes an immediate but temporary increase in your blood pressure and an increase in your heart rate (17).
In the long term, the chemicals in tobacco can increase your blood pressure by damaging your blood vessel walls and narrowing your arteries. The hardened arteries cause higher blood pressure. The chemicals in tobacco can affect your blood vessels even if you’re around secondhand smoke. Children around secondhand smoke had higher blood pressure than a control group (18).
7. Reduce excess stress
We live in stressful times. Workplace and family demands, national and international politics — they all contribute to stress. Finding ways to reduce your own stress is important for your health and your blood pressure.
Relieving stress starts with recognizing your stress triggers and your relaxation inducers. Practice deep breathing, take a walk, watch a comedy, listen to relaxing music. These are some of the ways people successfully relieve stress.
Music has been successfully used as a therapy to reduce blood pressure (19). Regular sauna use is also proven to reduce stress and blood pressure (20). And acupuncture has been shown to reduce blood pressure (21).
8. Try meditation or yoga
Mindfulness and meditation, including transcendental meditation, have long been used (and studied) as a method to reduce stress. A 2012 study notes that one university program in Massachusetts has helped more than 19,000 people using a meditation and mindfulness program (22).
Yoga, which involves breathing control, posture, and meditation techniques, can also be effective in reducing stress and blood pressure. A 2013 review of 17 studies of yoga and blood pressure found an average blood pressure decrease of 3.62-4.17 mmHg. Some types of yoga were nearly twice as effective as the average (23).
9. Eat some dark chocolate
Yes, chocolate lovers: Dark chocolate has been shown to lower blood pressure.
But the dark chocolate should be 60 to 70 percent cacao. A Harvard Medical School study found that eating one square of dark chocolate helped lower blood pressure. The benefits are thought to come from the flavonoids present in unsweetened chocolate, which help dilate, or widen, your blood vessels (24).
A 2010 study of 14,310 people found that higher dark chocolate consumption led to a significant decrease in blood pressure (25).
10. Try these medicinal herbs
Herbal medicines have long been used in many cultures to treat a variety of ailments.
Some of these herbs have been shown to lower blood pressure. More research is needed to find out what components in the herbs are most useful (26).
Always check with your healthcare provider or pharmacist before taking herbal supplements. They may interfere with your prescription medications.
Here’s a partial list of herbs whose effects in lowering blood pressure have been studied in human beings:
- black bean (Castanospermum australe)
- cat’s claw (Uncaria rhynchophylla)
- celery juice (Apium graveolens)
- Chinese hawthorn (Crataegus pinnatifida)
- coffee weed (Cassia occidentalis)
- ginger root
- giant dodder (Cuscuta reflexa)
- Indian plantago (blond psyllium)
- maritime pine bark (Pinus pinaster)
- river lily (Crinum glaucum)
- roselle (Hibiscus sabdariffa)
- sesame oil (Sesamum indicum)
- tomato extract (Lycopersicon esculentum)
- tea (Camellia sinensis), especially green tea and oolong tea
- umbrella tree bark (Musanga cecropioides)
11. Make sure to get good, restful sleep
Your blood pressure dips down when you’re sleeping. If you don’t sleep well, it can affect your blood pressure. People whose sleep is disturbed, especially the middle-aged, have an increased risk of high blood pressure (27).
For some people getting a good sleep isn’t easy. There are many ways to help you get good sleep. Try setting a regular sleep schedule, relaxing, exercising during the day, avoiding daytime naps, and making your bedroom comfortable (28).
The national Sleep Heart Health Study found that sleeping below 7 hours a night and more than 8 hours a night was associated with an increased prevalence of hypertension. Sleeping less than six hours a night was linked to the highest risk of hypertension (29).
12. Eat garlic or take garlic extract supplements
According to one clinical study, a time-release garlic extract preparation may have a greater effect than regular garlic powder tablets (31).
One 2012 review noted a study of 89 people with high blood pressure that found a reduction of 6-12 mmHg, compared with a control group (32).
13. Eat healthy high-protein foods
A long-term study concluded in 2014 found that people who ate more protein had a lower risk of having high blood pressure. For those who ate an average of 100 grams per day of protein, there was a 40 percent lower risk of having high blood pressure (33).
It’s not hard to consume 100 grams of protein daily on most types of diet.
High protein foods include:
- fish (3 ounces of salmon = 22 grams; canned tuna in water, 1 cup = 39 grams)
- eggs (1 egg = 6 grams)
- poultry (3 ounces of chicken breast = 27 grams)
- beef (3 ounces of lean beef = 22 grams)
- beans (kidney beans, 1/2 cup cooked = 7.6 grams; lentils, 1/2 cup cooked = 9 grams)
- nuts (peanut butter, 2 tablespoons = 8 grams)
- chickpeas (1/2 cup cooked = 7.3 grams)
- cheese (1 ounce of cheddar = 6.5 grams)
14. Take these blood pressure lowering supplements
These supplements are readily available and have had a track record for lowering blood pressure:
- Omega-3 polyunsaturated fatty acid (fish oil): A meta-analysis of fish oil and blood pressure found a mean blood pressure reduction of 0.99-1.52 mmHg (34).
- Whey protein: This protein complex derived from milk has been found to have many health benefits, in addition to lowering blood pressure (35).
- Magnesium: Magnesium deficiency is related to higher blood pressure. A meta-analysis found a small reduction in blood pressure with magnesium supplementation (36).
- Coenzyme Q10: This antioxidant lowered blood pressure by up to 10-17 mmHg in several clinical studies (37).
- Citrulline: Oral L-citrulline is a precursor of L-arginine in the body. It’s shown to lower blood pressure (38).
15. Drink less alcohol
Alcohol can raise your blood pressure, even if you’re healthy.
Drink in moderation. Alcohol raises your blood pressure by 1 mmHg for each .35 ounces of alcoholconsumed (39). Yes, that’s only a little more than a third of an ounce.
Moderate drinking is up to one drink a day for women and two drinks per day for men (40).
What constitutes a drink? One 12-ounce beer, 5 ounces of wine, or 1.5 ounces of distilled spirits (41).
16. Consider cutting back on caffeine
Caffeine raises your blood pressure, but the effect is temporary and the reaction varies from individual to individual (42).
Some people may be more sensitive to caffeine. If you’re caffeine-sensitive, you may want to cut back on your coffee consumption, or try decaffeinated coffee.
Research on caffeine, including its health benefits, is in the news a lot. The choice of whether to cut back depends on many individual factors.
Indications from one study are that caffeine’s effect on raising blood pressure is greater if your blood pressure is already high. This same study, however, called for more research on the subject (42).
17. Take prescription medication
If your blood pressure is very high or doesn’t decrease when you make lifestyle changes, consider taking prescription drugs. They work and will improve your long-term outcome, especially if you have other risk factors (43).
Talk with your doctor about the medication possibilities and what might work best for you.
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