Higher triglyceride level increases stroke risk

A study by scientists in Denmark revealed that increasing levels of non-fasting triglycerides are linked to an increased risk of ischemic stroke in men and women. Higher cholesterol levels were linked to greater stroke risk in men only. Details of this novel, 33-year study are now available online in Annals of Neurology, a journal published by Wiley-Blackwell on behalf of the American Neurological Association.



As per the World Health Organization (WHO) cardiovascular diseases are the number one cause of death globally?responsible for an estimated 17.1 million deaths worldwide ( 2004), with 5.7 million due to stroke. The American Stroke Association states that stroke is the third leading cause of death in the U.S. and 87% of all cases are attributed to ischemic stroke, occurring when the supply of blood to the brain is obstructed. The obstruction or blockage is typically caused by the build-up of fatty deposits inside blood vessels (atherosclerosis).

Medical evidence suggests that elevated non-fasting triglycerides are markers of elevated levels of lipoprotein remnants, particles similar to low density lipoprotein (LDL), or bad cholesterol, both of which are thought to contribute to plaque build-up. "Interestingly, current guidelines on stroke prevention have recommendations on desirable cholesterol levels, but not on non-fasting triglycerides," said lead study author, Dr. Marianne Benn from Copenhagen University Hospital. "Our study was the first to examine how the risk of stroke for very high levels of non-fasting triglycerides compared with very high cholesterol levels in the general population."

The Danish team followed 7,579 women and 6,372 men who were enrolled in the Copenhagen City Heart Study, all of whom were white and of Danish decent. Participants had non-fasting triglycerides and cholesterol measurements taken at baseline (1976-1978) and were followed for up to 33 years. A diagnosis of ischemic stroke was made when focal neurological symptoms lasted more than 24 hours. During the follow-up period, completed by 100% of participants, 837 women and 837 men developed ischemic stroke.

Results confirmed in both women and men, stepwise increasing levels of non-fasting triglycerides linked to increased risk of ischemic stroke. In women, triglycerides levels of 1-2 mmol/L (89-177 mg/dL) carried a relative risk of 1.2 and levels of 5 mmol/L (443 mg/dL) or greater were linked to a 3.9-fold greater risk, compared with women whose triglycerides levels were less than 1 mmol/L (89 mg/dL). At similar triglyceride levels men had a relative risk that ranged from 1.2 to 2.3. Increasing cholesterol levels did not associate with greater risk of ischemic stroke, except in men whose cholesterol levels were equal to 9 mmol/L (348 mg/dL) or more (relative risk of 4.4).

"Our findings suggest that levels of non-fasting triglycerides should be included in stroke prevention guidelines which currently focus on total cholesterol and LDL cholesterol levels," concluded Dr. Benn.


Posted by: Daniel    Source


Did you know?
A study by scientists in Denmark revealed that increasing levels of non-fasting triglycerides are linked to an increased risk of ischemic stroke in men and women. Higher cholesterol levels were linked to greater stroke risk in men only. Details of this novel, 33-year study are now available online in Annals of Neurology, a journal published by Wiley-Blackwell on behalf of the American Neurological Association.

Read more >>

Take care of your brain

As the average life span becomes longer, dementia becomes more common. Swedish scientist Laura Fratiglioni has shown that everyone can minimize his or her risk of being affected. Factors from blood pressure and weight to the degree of physical and mental activity can influence cognitive functioning as one gets older.

The lengthening of the average life span in the population has caused an increase in the prevalence of aging related disorders, one of which is cognitive impairment and dementia. An expert panel estimates that worldwide more than 24 million people are affected by dementia, most suffering from Alzheimer's disease. In the more developed countries, 70 percent of the persons with dementia are 75 years or older.



Age is the greatest risk factor for developing dementia. But there is growing evidence that the strong association with increasing age can be, at least partially, explained by a life course cumulative exposure to different risk factors.

Laura Fratiglioni's research group at Karolinska Institutet is a leader in identifying the risk factors that lie behind developing dementia and using this knowledge to develop possible preventative strategies. The group's research has shown that the risk is partly determined by an individual genetic susceptibility, and that active involvement in mental, physical and social activities can delay the onset of dementia by preserving cognitive functions. Further education early in life has a protective effect, and the group's research has shown that it is never too late to get started.

"The brain, just as other parts of the body, requires stimulation and exercise in order to continue to function. Elderly people with an active life ? mentally, physically and socially ? run a lower risk of developing dementia, and it doesn't matter what the particular activities are", says Professor Laura Fratiglioni.

Laura Fratiglioni's research has shown that physical factors are also significant. Not only high and low blood pressure, but also diabetes and obesity when middle-aged increase the risk of developing dementia after the age of 70. "What is good for the heart is good for the brain", she says.

Knowledge about risk factors and how to protect the brain from dementia is based on findings based on observation in which researchers have discovered statistical correlations in the population. Researchers in other current studies that are carried out in Europe are investigating what happens when a large number of study participants are given special help to better control vascular risk factors and to stimulate social, physical and mental activities. which should, at least, lead to a delay of dementia onset.

"You could say that we are progressing from observation to experiment. This means that in a few years we will know more about which strategies are most effective in preventing neurodegenerative disorders", says Laura Fratiglioni.


Posted by: Daniel    Source


Did you know?
As the average life span becomes longer, dementia becomes more common. Swedish scientist Laura Fratiglioni has shown that everyone can minimize his or her risk of being affected. Factors from blood pressure and weight to the degree of physical and mental activity can influence cognitive functioning as one gets older.

Read more >>

Blood pressure measurement method to revolutionize

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In a major scientific breakthrough, a new blood pressure measurement device is set to revolutionise the way patients' blood pressure is measured.

The new approach, invented by researchers at the University of Leicester and in Singapore, has the potential to enable doctors to treat their patients more effectively because it gives a more accurate reading than the current method used. It does this by measuring the pressure close to the heart ? the central aortic systolic pressure or CASP.

Blood pressure is currently measured in the arm because it is convenient however this may not always accurately reflect what the pressure is in the larger arteries close to the heart.


CASPro blood pressure measurement device.

Credit: University of Leicester


The new technology uses a sensor on the wrist to record the pulse wave and then, using computerised mathematical modelling of the pulse wave, researchers are able to accurately read the pressure close to the heart. Patients who have tested the new device found it easier and more comfortable, as it can be worn like a watch.

Being able to measure blood pressure in the aorta which is closer to the heart and brain is important because this is where hypertension can cause damage. In addition, the pressure in the aorta can be quite different from that traditionally measured in the arm. The new technology will hopefully lead to better identification of those who will most likely benefit from therapy by identifying those who have a high central aortic systolic pressure value. This will be particularly important for younger people in whom the pressure measured in the arm can sometimes be quite exaggerated in comparison to the pressure in the aorta.

A key question is whether measurement of central aortic pressure will become routine in clinical practice. Professor Williams said: "it is not going to replace what we do overnight but it is a big advance. Further work will define whether such measurements are preferred for everybody or whether there is a more defined role in selective cases to better decide who needs therapy and who doesn't and whether the therapy is working optimally" .

The University's close collaboration with the Singapore-based medical device company HealthSTATS International ("HealthSTATS") has led to the development of this world-first technique for more accurate blood pressure measurement.

The research work carried out by the University of Leicester was funded by the Department of Health's National Institute for Health Research (NIHR). The NIHR has invested ?3.4million with a further ?2.2million Capital funding from the Department of Health to establish a Biomedical Research Unit at Glenfield Hospital, Leicester, dedicated to translational research in cardiovascular research. The work, led by Professor Bryan Williams, Professor of Medicine at the University of Leicester and consultant doctor at University Hospitals of Leicester NHS Trust, has the promise to change the way we measure blood pressure.

Professor Williams, who is based in the University of Leicester's Department of Cardiovascular Sciences at Glenfield Hospital, said: "I am under no illusion about the magnitude of the change this technique will bring about. It has been a fabulous scientific adventure to get to this point and it will change the way blood pressure has been monitored for more than a century. The beauty of all of this, is that it is difficult to argue against the proposition that the pressure near to your heart and brain is likely to be more relevant to your risk of stroke and heart disease than the pressure in your arm.

"Leicester is one of the UK's leading centres for cardiovascular research and is founded on the close working relationship between the University and the Hospitals which allows us to translate scientific research into patient care more efficiently. Key to our contribution to this work has been the support from the NIHR without which we would not have been able to contribute to this tremendous advance. The support of the NIHR has been invaluable in backing us to take this project from an idea to the bedside. Critical to the success of this project has been the synergies of combining clinical academic work here with HealthSTATS and their outstanding medical technology platform in Singapore. This has been the game-changer and I really do think this is going to change clinical practice".




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IMAGE: This is the CASPal blood pressure measurement device.


Click here for more information.


Dr. Choon Meng Ting the Chairman and CEO of HealthSTATS said: "This study has resulted in a very significant translational impact worldwide as it will empower doctors and their patients to monitor their central aortic systolic pressure easily, even in their homes and modify the course of therapy for BP-related ailments. Pharmaceutical companies can also use CASP devices for clinical trials and drug treatment. All these will ultimately bring about more cost savings for patients, reduce the incidences of stroke and heart attacks, and save more lives".

Health Secretary Andrew Lansley said:

"I saw this new technique in action in Leicester when I visited a few months ago. This is a great example of how research breakthroughs and innovation can make a real difference to patients' lives. We want the NHS to become one of the leading healthcare systems in the world and our financial commitment to the National Institute for Health Research reflects this.

"I believe patients deserve the best therapys available and science research like this helps us move closer to making that happen".

Professor Dame Sally Davies, Director General of Research and Development and Interim Chief Medical Officer at the Department of Health, said:

"This is fantastic work by Professor Williams and his team and I am delighted to welcome these findings. I am especially pleased that the clinical research took place at the NIHR Biomedical Research Unit in Leicester. NIHR funding for Biomedical Research Centres and Units across England supports precisely this type of translational research, aimed at pulling-through exciting scientific discoveries into benefits for patients and the NHS by contributing to improved diagnostics and therapys".


Posted by: Scott    Source

Did you know?
In a major scientific breakthrough, a new blood pressure measurement device is set to revolutionise the way patients' blood pressure is measured. The new approach, invented by researchers at the University of Leicester and in Singapore, has the potential to enable doctors to treat their patients more effectively because it gives a more accurate reading than the current method used. It does this by measuring the pressure close to the heart ? the central aortic systolic pressure or CASP.

Read more >>

Relatives of melanoma patients

It is well known that sunbathing increases the risk of skin cancer and that this risk is increased in people with a family history of melanoma. New research published in BioMed Central's open access journal BMC Public Health shows that young people in this 'at risk' group are still ignoring sun safety advice.

Professor Sharon Manne at the Centre Cancer Prevention and Control Program, New Jersey, asked over 500 people with a family history of melanoma, the most dangerous form of skin cancer, whether they regularly sunbathed and whether they used sunscreen. Eventhough most of these people were aware that sunscreen would protect them against cancer and premature aging, a number of of them still did not feel it necessary to use any form of sun protection.



Disturbingly she observed that, despite their increased risk of melanoma, the younger women in this survey still viewed a tan as being healthy and were the most unlikely to use sunscreen. Professor Manne said, "To reduce the occurence rate of melanoma we need to reduce the perceived benefits of sunbathing and to increase to use of sun protection".


Posted by: George    Source


Did you know?
It is well known that sunbathing increases the risk of skin cancer and that this risk is increased in people with a family history of melanoma. New research published in BioMed Central's open access journal BMC Public Health shows that young people in this 'at risk' group are still ignoring sun safety advice.

Read more >>

Vaccine made with synthetic gene

Scientists at Albert Einstein College of Medicine of Yeshiva University have developed an experimental vaccine that appears to protect against an increasingly common and especially deadly form of pneumococcal pneumonia. Details of the new vaccine, which was tested in an animal model, are reported in a paper published recently in the Journal of Infectious Diseases


Pneumococcal pneumonia can occur when the lungs are infected with the bacterial species Streptococcus pneumoniae (also known as pneumococcus). "Like a number of microbes that cause pneumonia, pneumococcus is spread from person to person through coughing or sneezing," said principal investigator Liise-anne Pirofski, M.D., professor of medicine and of microbiology & immunology and the Selma and Dr. Jacques Mitrani Chair in Biomedical Research. Symptoms include cough, fever, shortness of breath, and chest pain.

The National Foundation for Infectious Diseases estimates that 175,000 people are hospitalized with pneumococcal pneumonia in the United States each year. In addition to pneumonia, pneumococcus causes 34,500 bloodstream infections and 2,200 cases of meningitis annually. It is responsible for more deaths in the United States ? 4,800 a year ? than any other vaccine-preventable disease. It poses a particular problem in the developing world, where it is estimated to cause more than one million deaths in children each year, as per the World Health Organization.

A pediatric vaccine has dramatically reduced the occurence rate of pneumococcal disease in children and adults, both by protecting vaccinated children and by reducing person-to-person transmission of the bacterium to others ? a phenomenon known as herd immunity.

"The pediatric vaccine is a great victory for modern medicine, but it doesn't cover all strains of disease-causing pneumococcus ? some of which have recently emerged and are very virulent," said Dr. Pirofski. "This problem, coupled with the fact that herd immunity doesn't protect immunocompromised patients as effectively as people with normal immunity, led us to look for a better vaccine".

The scientists focused on developing a vaccine against serotype 3 ? a pneumococcal strain that was not included in the pediatric vaccine used for the past decade and that has emerged as a cause of serious pneumonia in adults and children. Serotype 3 can trigger inflammation so overwhelming that it can result in very severe disease or even death.

The goal of this study was to produce a vaccine consisting of a live, attenuated (weakened) version of serotype 3 S. pneumoniae. To create their vaccine, the scientists focused on the serotype 3 gene that codes for pneumolysin, a toxin produced by all pneumococcal strains. The scientists replaced this gene with a synthetic version that they hoped would reduce the amount of toxin produced.

"Our idea was to design a live vaccine that would stimulate the immune system sufficiently to ward off disease but wouldn't lead to the severely damaging inflammatory response that this strain can cause," said main author J. Robert Coleman, Ph.D., a postdoctoral fellow in microbiology & immunology at Einstein, who helped develop the gene-modification technique, known as synthetic gene customization, while a graduate student at Stony Brook University.

"The novelty of this approach lies in the fact that the gene's expression would be reduced, but not eliminated," Dr. Coleman added. "Prior approaches to genetic regulation of virulence relied on knocking out genes, which eliminates their expression completely." .

Altering the pneumolysin gene in the seroptype 3 bacteria resulted in less pneumolysin toxin produced in vitro. When mice were injected with either attenuated or unattenuated serotype 3 bacteria, mice receiving the attenuated strain developed an inflammatory response much weaker than was observed in mice receiving the unattenuated serotype 3 strain. Most important, of the five mice injected with the attenuated strain, four survived a subsequent challenge from the highly virulent unattenuated serotype 3 strain, which was lethal in five of five unvaccinated, control mice.

This method of reducing gene expression had been used for viral pathogens, but this is the first time that gene customization has successfully controlled virulence in bacteria. The study's findings could potentially lead to pneumococcal vaccines based on weakened strains, and the Einstein scientists are now investigating whether they can reduce the expression of other genes linked to pneumococcal virulence.


Posted by: Mark    Source


Did you know?
Scientists at Albert Einstein College of Medicine of Yeshiva University have developed an experimental vaccine that appears to protect against an increasingly common and especially deadly form of pneumococcal pneumonia. Details of the new vaccine, which was tested in an animal model, are reported in a paper published recently in the Journal of Infectious Diseases

Read more >>

How many mammograms radiologists must read?

Radiologists who interpret more mammograms and spend some time reading diagnostic mammograms do better at determining which suspicious breast lesions are cancer, as per a new report published online on February 22 and in print in the recent issue of Radiology
In direct response to a report from the Institute of Medicine that called for more research on the relationship between interpretive volume and performance in screening mammography, the multi-site team undertook the largest and most comprehensive study of U.S. radiologists. The Institute of Medicine is the health arm of the National Academies, advisors to the nation on science, engineering, and medicine.



Funded largely through a unique collaboration between the American Cancer Society and the National Cancer Institute, the study examined information from 120 radiologists who interpreted 783,965 screening mammograms at six mammography registries in the Breast Cancer Surveillance Consortium (BCSC) over five years. The scientists looked at how screening outcomes were correlation to four different measures of each radiologist's annual volume: the number of screening and diagnostic mammograms?separately and in combination?and the percentage of total mammograms that were for screening rather than diagnosis.

"We observed that radiologists who interpreted more mammograms a year had clinically and statistically significantly fewer false-positive findings?without missing more cancers," said study leader Diana S.M. Buist, PhD, MPH, a senior investigator at Group Health Research Institute. "That means radiologists with higher 'interpretive volumes' could identify the same number of cancers, while making fewer women come in for extra tests that showed they did not have cancer." On average, for every cancer detected, 22.3 women were called back for more testing.

False-positive findings?when a mammogram suggests a breast cancer is present, but it turns out not to be?cause women anxiety and spur extra testing, which amounts to at least $1.6 billion in health care costs each year. Often, there's a tradeoff between minimizing false positives and maximizing sensitivity, which is the ability to identify cancer when present. But in this study, despite their lower false-positive rates, the high-volume radiologists had sensitivities and cancer-detection rates that resembled those of their lower-volume colleagues.

"We also observed that radiologists were more accurate at interpreting mammograms if they also interpreted some diagnostic mammograms." Dr. Buist said. Diagnostic mammograms evaluate breast symptoms or abnormalities seen on a previous screening mammogram. The cancer-detection rate was highest when at least one in five of the mammograms that a radiologist read a diagnostic, not screening, mammogram?instead of their focusing more exclusively on reading screening mammograms.

This report's findings have policy implications. The U.S. Food and Drug Administration (FDA) requires radiologists who interpret mammograms to read only 960 mammograms in two years, with no requirement about the type of mammograms they read (screening or diagnostic). In Europe and Canada, where volume requirements are 5? times higher, screening mammography programs have lower false-positive rates?but similar cancer-detection rates?than the United States.

"In the United States, the goal of screening is to achieve high sensitivity while keeping the rates of false positives low," Dr. Buist said. "No single measure can be calculated to make policy decisions, because any policy needs to weigh the tradeoff between missed cancers and false positives: Both have important impacts on women and society."

Dr. Buist added: "Based on these data, it would be beneficial if U.S. volume requirements could be increased to 1,000 or 1,500 screening mammograms per year, while adding a minimal requirement for diagnostic interpretation, which would optimize sensitivity and false-positive rates." As per her team's simulations, raising annual requirements for screening volume could lower the number of American women with false-positive workups?by more than 71,000 for annual minimums of 1,000, or by more than 117,000 year for annual minimums of 1,500?without hindering the detection of breast cancer.

Conversely, raising the volume requirements could cause low-volume radiologists to stop reading mammograms. Concerns have been raised that the cadre of U.S. radiologists who read mammograms is aging and retiring. In this study, for instance, radiologists' median age was 54, and 38 percent of them interpreted fewer than 1,500 mammograms a year.

"Without more radiologists interpreting more mammograms, women may have less access to the only screening test that trials have shown can reduce deaths from breast cancer," Dr. Buist said. "Unlike the mammography debate about whether women in their 40s should be screened, which is based on the weight of harms of false positives, the tradeoff around volume policy will concern workforce issues and reporting requirements that would necessitate changes to how the FDA collects information on how a number of mammograms radiologists interpret." Her team has also been testing strategies for improving how well radiologists interpret mammograms.

In a unique partnership and combination of funding, the American Cancer Society through the Longaberger Company's Horizon of Hope Campaign?, the National Cancer Institute through Breast Cancer Stamp Fund, and the Agency for Healthcare Research and Quality supported this study using data from the Breast Cancer Surveillance Consortium. The Longaberger Company, which sells baskets and other products through home shows, has raised more than $14 million through its Horizon of Hope campaign. From the sale of every Horizon of Hope basket, $2 goes to the American Cancer Society to support breast cancer research and other initiatives.


Posted by: Janet    Source


Did you know?
Radiologists who interpret more mammograms and spend some time reading diagnostic mammograms do better at determining which suspicious breast lesions are cancer, as per a new report published online on February 22 and in print in the recent issue of Radiology In direct response to a report from the Institute of Medicine that called for more research on the relationship between interpretive volume and performance in screening mammography, the multi-site team undertook the largest and most comprehensive study of U.S. radiologists. The Institute of Medicine is the health arm of the National Academies, advisors to the nation on science, engineering, and medicine.

Read more >>

Callous-unemotional traits

Research presented this week at the annual meeting of the American Association for the Advancement of Science highlights the importance of callous-unemotional traits (CU) in identifying children at risk of antisocial behavior and other adjustment problems.

The research, presented by Indiana University Bloomington faculty member Nathalie M.G. Fontaine, finds that the emergence of CU traits in childhood is in most cases influenced by genetic factors, particularly in boys. However, environmental factors appear to be more significant for the small number of girls who exhibit high levels of CU traits.


Nathalie Fontaine is a researcher at Indiana University.

Credit: Indiana University


In this first longitudinal study employing a group-based analysis to examine the correlation between childhood trajectories of CU traits and conduct problems, scientists observed that high levels of both CU traits and conduct problems were linked to negative child and family factors at age 4 and with behavioral problems at age 12.

CU traits, such as a lack of emotion and a lack of empathy or guilt, are exhibited by a small number of children and are linked to persistent conduct problems, which are experienced by 5 percent to 10 percent of children.

"The children with high levels of both CU traits and conduct problems between ages 7 to 12 were likely to present negative predictors and outcomes, including hyperactivity problems and living in a chaotic home environment," said Fontaine, assistant professor of criminal justice in the College of Arts and Sciences at Indiana University Bloomington. "If we could identify those children early enough, we could help them as well as their families."

The AAAS presentation combines findings from two articles, one published in July 2010 in the Journal of the American Academy of Child & Adolescent Psychiatry and the other to be published online this week by the Journal of Abnormal Psychology Co-authors include Fr?hling Rijsdijk of King's College London; Eamon McCrory of University College London; Michel Boivin of Laval University; Terrie Moffitt of Duke University and King's College London; and Essi Viding of University College London and King's College London.

The scientists examined data for more than 9,000 twins from the Twins Early Development Study, a data set of twins born in England and Wales between 1994 and 1996. Evaluations of CU traits and conduct problems were based on teacher questionnaires when the children were 7, 9 and 12. Family-level predictors at age 4 were based on information from parents, and behavioral outcomes at age 12 were based on information from teachers.

Participants were grouped in four trajectories for CU traits: stable low, stable high, increasing and decreasing. While most exhibited stable and low levels of CU traits, about one-fourth had stable high, increasing or decreasing CU traits. Participants were grouped in two trajectories for conduct problems, high and low.

Because the data set included both identical and non-identical twins, the scientists were able to examine the extent to which each trajectory of CU traits was correlation to genetic and environmental factors. They observed that, for boys in all four trajectories, genetic factors had the strongest influence. But for girls with stable high or increasing levels of CU traits, a shared environment had the strongest influence.

The research found an asymmetrical relationship between CU traits and persistent conduct problems. Children with high levels of CU traits were likely to also display high levels of conduct problems. But children with high levels of conduct problems did not necessarily exhibit high levels of CU traits.

Children with a high trajectory of CU traits and conduct problems were more likely than others to have experienced negative predictors at age 4, such as hyperactivity, negative parental discipline and chaos in the home. They also were more likely to experience negative outcomes at age 12, including problems with peers, emotional problems and negative parental feelings.

Fontaine emphasized that the findings do not mean that some children are or necessarily will become delinquents or psychopathic individuals -- or that heritability of CU traits equals destiny. Rather, the research suggests that CU traits appears to be used to identify children who are at risk for persistent and severe antisocial behavior and to implement appropriate interventions to support and help these children and their families.

The research also could inform decisions about whether to include CU traits as a sub-typing index within the category of conduct disorder for the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).


Posted by: JoAnn    Source


Did you know?
Research presented this week at the annual meeting of the American Association for the Advancement of Science highlights the importance of callous-unemotional traits (CU) in identifying children at risk of antisocial behavior and other adjustment problems. The research, presented by Indiana University Bloomington faculty member Nathalie M.G. Fontaine, finds that the emergence of CU traits in childhood is in most cases influenced by genetic factors, particularly in boys. However, environmental factors appear to be more significant for the small number of girls who exhibit high levels of CU traits.

Read more >>