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Newsletters November 2011 - Jefferson Cardiology Happenings

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Best Treatment for Asymptomatic Carotid Disease

A North American study published in 1995 and a European trial published in 2004 compared carotid surgery with non-surgical treatment in asymptomatic dis-ease. In both studies the 5-year risk of stroke was lower with surgical therapy but the stroke risk was only 5% better. No benefit was seen in women. In the sur-gical group there was a 2%-3% risk of stroke or death after surgery.

With the improvement in medical therapy is surgery still superior to medical therapy? In one study of 435 patients with asymptomatic carotid narrowing over 70%, only 10 patients or 2% had strokes after 3 years. However, 4 of the strokes occurred with unique carotid ultrasound signals. Only 1.5% of patients without these signals had strokes.

Another study of 253 patients with asymptomatic carotid blockage over 60% demonstrated only a 2.4% incidence of stroke over 3 years. Again, over 50% of the strokes occurred in persons with spe-cial ultrasound findings. Strokes only oc-curred in 1.7% of those without these findings.

Based on these findings an editori-alist concluded in the September 15, 2011 issue of Journal Watch General Medicine that many asymptomatic patients referred for carotid surgery or stenting may be at greater risk than those treated with medi-cations. Furthermore it is argued that as-ymptomatic patients should be treated medically until techniques are available at the community level to identify high risk ultrasound tissue characteristics better treated with invasive procedures. It is also noted that current guidelines do not rec-ommend carotid screening without symp-toms.

Vitamins and Women’s Health

There was recently much attention given to the controversial results coming from a study evaluating dietary supplements and women’s health. Women enrolled in the Iowa Women’s Health Study were followed for 19 years and 66% of these women took at least one dietary supplement. The study was initiated in 1986 in 38,772 women between ages 55-69.

Through December 31, 2008, 15,594 or 40% of the initial participants died. The use of multivitamins was asso-ciated with a 2.4% increase absolute risk for death. Such products as vitamin B6, folic acid, iron, magnesium and zinc were associated with a 3-6% increased risk of death. Copper was associated with an 18% increased risk for total mortality. Other supplements were not associated with increased mortality.

In an accompanying editorial, there was comment that vitamin E, vitamin A and beta carotene could be harmful. It was concluded that the use of vitamins and mineral supplements cannot be recommended in a well-nourished population. The supplements do not replace or add to the benefits of eating fruits and vegetables and may cause health problems.

Testosterone and Cardiovascular Events

It has been noted that low testos-terone levels may contribute to cardiovas-cular disease. Low testosterone levels may be associated with elevated lipids, obesity, atherosclerosis and possibly dia-betes. A Swedish study demonstrated that elderly men with the top 25% levels of testosterone have a 30% lower risk of car-diovascular event over five years than those with lesser levels. In a study of 2416 men aged 69-81 participating in an osteoporosis study over the next 5 years, there were 485 cardiovascular events. Those with the top 25% of testosterone had the fewest events.

This raises the question as to the role of testosterone supplements. To date, there is no definite data that testosterone supplementation reduces cardiovascular events. In fact, one study showed an in-crease in cardiovascular events with tes-tosterone supplementation. An argument can be made for treating older men with low testosterone levels. However, testos-terone levels normally fall with aging. Perhaps it can only be said that those men with the lowest levels of testosterone should be considered for supplementation.

Happy Thanksgiving

We would like to wish everyone and their family a very happy and safe Thanksgiving.

Gingersnap Pumpkin Pie
10 gingersnap cookies 2 tbsp low fat margarine
1 (16 oz) can pumpkin puree 4 egg whites
¾ cup sugar 1 tbsp pumpkin pie spice
1 (12 oz.) can evaporated skim milk Non-stick spray

Preheat oven to 350 degrees. Spray 9” pie pan with non-stick spray. Combine gingersnap cookies and margarine in food processor and pulse until fine. Form crust by lining pan with crumbs. Combine the remaining ingredients in a large mixing bowl. Mix thoroughly and pour into crust. Bake 30-40 minutes at 350 degrees or until a toothpick inserted in center of pie comes out clean. Cool and serve.

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