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Newsletters December 2011 - Jefferson Cardiology Happenings

What's in this Newsletter:

Lowering Cholesterol in the Elderly

Over the years there has been some controversy as to the wisdom of treating high cholesterol in the elderly. Some confusing findings have been noted. Many elderly lose weight and become frail. With weight loss, the cholesterol may drop and noncardiovascular death may increase. Yet there has never been evidence that statin drugs cause cancer, weight loss or debility in the elderly.

What is the evidence of statin benefit in the elderly? An analysis of multiple studies was published in the geriatric literature in 2007. There was a total of 51,351 persons of whom 31,633 were over age 60. Statins reduced death from all causes by 15% and coronary heart mortality by 37%. Major benefit was seen after one year of therapy.

The PROSPER study evaluated persons 70-82 with cardiovascular risk factors or documented disease. This study did not show a mortality reduction but did demonstrate a decrease in cardiovascular events. Another study involving patients with catheterization proven coronary artery disease included persons to 97 years of age. This study demonstrated a 50% risk reduction in person aged 80-97 compared with 30% risk reduction in persons under ager 65.

There is information that statin use in middle age may reduce dementia in later life. When started late in life, statins may not have any effect on dementia.

It has been shown that statins may cause more muscle pain in persons with low levels of vitamin D. This pain can be reversed using vitamin D supplementa-tion.

In conclusion, it appears that persons aged 70-80 with known coronary artery disease will benefit from statin therapy. Prior research suggests that the lack of need to reduce cholesterol levels as low as recommended in younger person. It has been observed that there has been no evidence of benefit giving statin therapy to persons over 80 with high cholesterol, but without proven coronary disease.

Fitness and Health

Several publications have recently reviewed data evaluating physical fitness and health. One study revealed that men who are physically fit in their 40’s and maintained their levels of fitness for the next decade, had a 30% reduction in all cause mortality compared with men who were flabby at age 40. Another study evaluated treadmill performance over 11 years. Men who maintained high levels of fitness judged by treadmill performance over 11 years were less likely to die of heart disease, stroke or other causes com-pared to men who became less fit over time. Another study suggested that fitness was more important than obesity in terms of survival.

Antioxidants and Stroke

A Swedish study evaluated the relationship between stroke and a high antioxidant diet. The study revealed that women who had the highest intake of such antioxidant foods as fruit, vegetables, tea, whole grains and chocolate had a 17% lower stroke risk compared with the lowest antioxidant intake.

Treatment of Hypertension in Teens

A recent report from the University of Michigan indicated that only 23% of Michigan teenagers in a Medicaid program were given treatment for high blood pressure. Of those treated, two-thirds received medication from adult primary care doctors. These physicians are comfortable treating hypertensive older patients and are more familiar with the available medications. Pediatricians were the lease likely to prescribe blood pressure medication.

Staff News

We would like to extend a very Happy Birthday to our clinical manager, Brian Cooper, aka, Coumadin King!

Happy Holidays

We at JCA would like to wish everyone and their families a happy and safe holiday season and a prosperous New Year!

Mocha Meringue Kisses

1/3 cup sifted powdered sugar
2 tablespoons unsweetened cocoa powder
1 tablespoon cornstarch
1 teaspoon instant espresso coffee powder
3 egg whites
½ teaspoon vanilla
¼ cup granulated sugar
1/3 cup semisweet chocolate pieces
1 teaspoon shortening

Line a cookie sheet with parchment paper or foil; set aside. In a small bowl stir together powdered sugar, cocoa powder, cornstarch, and espresso powder; set aside.

In a medium bowl beat egg whites and vanilla with an electric mixer on high speed until foamy. Gradually add the granulated sugar, 1 tablespoon at a time, beating until stiff peaks form (tips stand straight). Gradually fold in the cocoa mixture.

Transfer the mixture to a pastry bag. Pipe twenty-four 2-inch kisses onto the prepared cookie sheet. (Or drop mixture by rounded teaspoons onto the prepared cookie sheet.) Bake in a 250 degrees oven for 1 hour. Cool on the cookie sheet. Remove from parchment paper.

In a small saucepan combine chocolate and shortening. Cook and stir over low heat until chocolate is melted. Drizzle the melted chocolate over cookies.

A publication of Jefferson Cardiology Association
Alan D. Bramowitz, M.D. | Michael S. Nathanson, M.D. | Gennady Geskin, M.D.

Jefferson Hospital Medical Building
Suite 403, Coal Valley Road
P.O. Box 18285

Belle Vernon Office
1533 Broad Ave
Belle Vernon, Pa 15012