This week the American Cancer Society published its annual review of cancer statistics and trends. This year the big picture was overwhelmingly positive.
The three most frequently diagnosed cancers in men are prostate cancer, lung cancer, and colorectal cancer (in that order). For women the top three are breast, lung and colorectal cancer. (See the link below to Figure 1 in the study for details.) The incidences (the numbers of new diagnoses every year) of all of these cancers have decrease...
More
Carotid Artery Stenting Almost Ready for Prime Time
Three months ago I wrote about carotid artery narrowing, which is one of a number of causes of stroke. There are currently two alternative treatments for severe carotid artery narrowing: surgery, called endarterectomy, to open the artery, and a newer procedure called carotid artery stenting. (Read my previous post, link below, for some background about these procedures and their role in stroke prevention.)
Thus far, carotid artery stenting has not been shown to be as safe as endarterectomy. ...
More
Normal Weight Obesity: Why Losing Weight Is Not Always the Answer
Weight loss is one of the most common recommendations that doctors make. How do we know if a patient should lose weight? We usually use the Body Mass Index (BMI) which is a way to compare a patient’s weight to her height. (For all you math geeks, it’s the weight in kilograms divided by the height in meters squared. For all you physicists, I know the units make no sense.) A BMI of 18.5 to 25 is considered normal. A BMI of 25 to 30 is considered overweight, and over 30 is considered obese. ...
More
To Clot or to Bleed?
Aspirin has long been known to prevent strokes and heart attacks in patients with a previous stroke or heart attack. But aspirin has potentially serious side-effects. Aspirin can cause stomach ulcers, and it inhibits blood clotting raising the risk of life-threatening bleeding.
If we knew in advance that a patient was going to be in a car accident or have a bleeding stomach ulcer, we would discontinue the aspirin a week before the event and minimize the bleeding risk. (This is exactly what w...
More
A New Blood Thinner May Outperform Coumadin
Atrial fibrillation is a very common abnormal heart rhythm affecting 3 million Americans. The most dangerous complication of atrial fibrillation is stoke, which can happen when a blood clot forms in the fibrillating heart chambers and travels to the brain.
Blood thinners have been the mainstay of treatment for atrial fibrillation. They reduce the risk of stroke by preventing blood clots. Warfarin (marketed under the brand name Coumadin) is the most effective available oral blood thinner, but...
More
The Facts on Red Yeast Rice
Many of my patients ask me whether they should take red yeast rice to lower their cholesterol. This week’s issue of The Medical Letter has a very handy review of red yeast rice which I summarize below.
Red yeast rice is a food that is produced by fermenting rice with a specific species of yeast. It has been used in Chinese cooking and medicine for centuries. It contains many molecules that are similar to statins, the family of medicines including Liptor, Zocor and Crestor. In fact one of it...
More
National Cholesterol Education Month
The CDC says that September is National Cholesterol Education Month, and who am I to argue? So here is a dollop of education about cholesterol.
More
- High cholesterol is a major risk factor for strokes and heart attacks. Other risk factors include
- smoking,
- age,
- high blood pressure,
- diabetes and
- having a first-degree relative who had a heart attack in middle age or younger.
- High cholesterol doesn’t feel like anything. ...
Crestor Prevents Heart Attacks and Strokes in Patients with Normal Cholesterol and High CRP
“If you think health care is expensive now, wait until you see what it costs when it’s free.” -- P.J. O’Rourke I’ve written several times about the proven benefits of a family of cholesterol-lowering medicines called statins. Statins include the medications Crestor, Zocor, Lipitor, Mevacor, Pravachol and others. The group has a solid base of evidence showing that they prevent strokes and heart attacks in patients with high cholesterol and in patients who have had...
The Aspirin Controversy, Part II
My post last week created much confusion and worry. I received many emails asking “What about me? Should I keep taking aspirin or not?”
Let me clarify the issue by explaining what we already knew before last week’s study in the British Medical Journal. We knew that aspirin is valuable in:
More
- patients who have had a stroke
- patients who have had a heart attack
- patients who have had bypass surgery or angioplasty
- patients with angina (chest pain or d...
Aspirin Doesn’t Prevent Heart Attacks in Patients with Diabetes
Aspirin has been a mainstay in the treatment and prevention of cardiovascular disease for decades.
We know that in patients who have had a heart attack in the past aspirin prevents a second heart attack, and during a heart attack aspirin is life-saving. We also know that in patients with a prior stroke aspirin prevents further strokes. And in patients with symptomatic narrowing of the arteries, that is chest pressure with exertion (angina) or calf pain with walking (claudication), aspirin pre...
More