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    Essure Female Sterilization Device Appears Safe: Study

    News Picture: Essure Female Sterilization Device Appears Safe: StudyBy Dennis Thompson
    HealthDay Reporter

    Latest Womens Health News

    TUESDAY, Jan. 23, 2018 (HealthDay News) — Essure implants used in female sterilization have come under fire in recent years, with women reporting a wide array of problems to the U.S. Food and Drug Administration.

    A new study from France shows the implants are relatively safe and do not raise the risk of side effects or health problems, however.

    The results show that Essure should remain on the market as a viable option for some women who want to avoid pregnancy, said Dr. Eve Espey, chair of obstetrics and gynecology at the University of New Mexico School of Medicine.

    “I do hope calmer minds will prevail and we don’t lose a very valuable technique that’s helped lots and lots of women,” said Espey, who wrote an editorial that accompanied the study. Both were published in the Jan. 23/30 issue of the Journal of the American Medical Association.

    Traditional female sterilization — “having your tubes tied” — involves laparoscopic surgery. Small tools are inserted through tiny incisions in the abdomen to cut or seal a woman’s fallopian tubes, preventing pregnancy immediately.

    Essure implants — small springlike coils — are inserted into the fallopian tubes through the vagina, eliminating the need for any incisions. The procedure can be performed in an office setting in less than 15 minutes.

    Once inserted, the coils promote the creation of scar tissue that eventually seals off the tubes. However, the natural process can take up to three months, and in the meantime a woman can still get pregnant through unprotected sex.

    Essure is a valuable option for women with health problems serious enough that they might die under general anesthesia, which is required for laparoscopic surgery, said Dr. Charles Ascher-Walsh, director of gynecology and urogynecology for Mount Sinai Hospital in New York City.

    It’s also a good option women with prior abdominal surgery and for women with so much excess weight that laparoscopic surgery would be difficult to perform, Espey explained.

    Safety concerns related to Essure first arose in 2015 in the United States, the study authors said in background notes. Women began reporting a wide variety of side effects to the FDA, including bleeding, abdominal pain, migraine, depression, allergic reactions, autoimmune diseases and thyroid problems.

    The matter has grown so heated that Espey said she saw people protesting Essure right next to anti-abortion protesters when she attended the last annual meeting of the American College of Obstetricians and Gynecologists.

    To weigh these safety concerns, researchers, led by Dr. Kim Bouillon of the French National Agency for Medicines and Health Products in Saint-Denis, analyzed data from more than 105,000 French women who received sterilization between 2010 and 2014.

    About a third of the women received the Essure implant, and the rest had traditional laparoscopic surgery.

    Women who got the Essure implant faced lower immediate risk for complications, about 0.13 percent compared against 0.78 percent for surgery — not surprising, given that the procedure requires no incisions or anesthesia.

    However, Essure patients also faced a higher risk that the sterilization wouldn’t take effect — about 4.8 percent compared with 0.69 percent for surgery.

    They also were more likely to require another gynecological procedure within a year, about 5.7 percent versus 1.7 percent.

    “What they found is what we already knew, that a larger percent of women needed a second sterilization procedure because the first one didn’t work,” Espey said.

    But the researchers found no difference in other medical complications and side effects between Essure and laparoscopic surgery.

    Espey and Ascher-Walsh doubt that the findings will end suspicion regarding Essure’s safety.

    “This will give a little bit more evidence to us when we’re trying to let a patient know it’s not as bad as it sounds, but it’s one chord in a long tune of negativity,” Ascher-Walsh said. “I honestly don’t think it’s going to change too much.”

    Espey said she’s most worried that Essure’s manufacturer, Bayer, will decide it’s not worth the trouble and pull the device from the market.

    “My concern is it won’t matter what women think or what the research says. If the product goes off the market, it’s gone,” Espey said. “Having a robust method mix is most likely to have the best impact to allow women to plan their families and reduce unplanned pregnancy.”

    In a statement, Bayer said it supports the study’s conclusions.

    “Bayer believes it is critically important that women and their health care providers are armed with factual, unbiased information regarding permanent birth control options, given there are misconceptions and blatant untruths spread when it comes to all types of birth control, but particularly hysteroscopic surgery,” the company said.

    MedicalNews
    Copyright © 2018 HealthDay. All rights reserved.

    SOURCES: Eve Espey, M.D., chair, obstetrics and gynecology, University of New Mexico School of Medicine, Albuquerque, N.M.; Charles Ascher-Walsh, M.D., director, gynecology and urogynecology, Mount Sinai Hospital, New York City; Jan. 23/30, 2018, Journal of the American Medical Association

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      Grind Your Teeth at Night? Botox Might Help

      News Picture: Grind Your Teeth at Night? Botox Might HelpBy Steven Reinberg
      HealthDay Reporter

      WEDNESDAY, Jan. 17, 2018 (HealthDay News) — If you’re one of the millions of people who grind and clench their teeth during sleep, an injection of Botox might be the answer, a small study suggests.

      The condition, called bruxism, can lead to pain, headaches, jaw problems and damaged teeth. However, the researchers reported that shots of Botox into the chewing muscles in the cheek can block the signals that tell these muscles to contract, relieving the grinding and clenching.

      “Nighttime and daytime bruxism is a very common condition that can cause headaches, temporomandibular joint (TMJ) syndrome and dental problems that can lead to disability and adversely impact quality of life,” said the study’s senior researcher, Dr. Joseph Jankovic. He’s a professor of neurology at the Baylor College of Medicine in Houston.

      Although the cause of bruxism is still not well understood, Jankovic said, it’s thought to be due to abnormal signals coming from the brain that cause involuntary and forceful contractions of the jaw muscles. Those contractions result in clenching of the jaw and grinding of teeth.

      Botox injections are a treatment that’s gained favor in treating the condition, but their real value hadn’t been tested, Jankovic noted.

      “Our study is the first placebo-controlled trial of Botox that demonstrates the benefits of this treatment in patients who suffer with severe grinding of the teeth while asleep,” he said. “We showed that this treatment is not only effective, but also safe.”

      Jankovic added that he believes it should be the treatment of choice.

      Funding for the study came from Allergan Pharmaceuticals, the maker of onabotulinum toxin-A, known as Botox. Jankovic is a consultant to Allergan.

      Botox first made headlines as a treatment for facial lines and wrinkles by paralyzing the sub-surface muscles. It’s also been used to treat migraines, excessive sweating and muscle disorders, among other conditions.

      For the bruxism study, 22 people first spent a night in a sleep lab so the researchers could measure their teeth grinding and clenching symptoms. Botox can be used to treat people with severe and moderately severe cases of bruxism, Jankovic said.

      Next, 13 of the participants were given Botox injections through their cheeks into their chewing muscles. The other nine were injected with an inactive placebo. After four to eight weeks, the participants were reassessed while spending another night in the sleep lab.

      Among those given the placebo, none showed improvement in their grinding or clenching, according to the report. But six of the 13 people injected with Botox had symptoms the researchers described as “much improved” or “very much improved.”

      The participants also rated their symptoms and pain on two scales of 0 to 100, where 50 meant no change. People who’d received Botox reported fewer symptoms and less pain, with average scores of 65 on both scales. Those who’d been given the placebo reported no improvement, with average scores of 47 and 42, respectively.

      Jankovic said the Botox treatments produced no serious side effects. Two participants given the drug experienced lopsided smiles, which evened out after a couple weeks, he said.

      Limits of the study included its small size and lack of an accepted way of assessing the severity of teeth grinding, Jankovic said.

      Other treatments for teeth grinding and clenching include mouth guards, which can help prevent tooth damage but may not stop the grinding and clenching. In addition, behavioral and drug treatments have been tried, but they either have not been tested in clinical trials or have had mixed results, Jankovic said.

      The cost of Botox treatment varies, he said, but it’s covered by most health insurance.

      Though small-scale, the study showed that Botox is better than a placebo in treating teeth grinding, he said. Larger trials aren’t planned, and Allergan has not decided whether to apply for FDA approval for using Botox for bruxism, according to Jankovic.

      The study was published online Jan. 17 in the journal Neurology.

      Karen Raphael, a professor of oral and maxillofacial pathology, radiology and medicine at New York University College of Dentistry in New York City, isn’t convinced that most teeth grinding needs to be treated.

      “At best, sleep bruxism is now considered a risk factor for potential oral health problems, but not an inherent disorder,” she said.

      The central question, Raphael said, is whether bruxism should be treated when it’s not typically associated with dental problems.

      The participants were chosen because they reported facial pain and bruxism, but it’s not clear whether they suffered from bruxism or were told they had it, Raphael said. People with facial pain are often told that they have sleep bruxism, she said.

      The real benefit of Botox may be in treating TMJ disorders, she said.

      MedicalNews
      Copyright © 2018 HealthDay. All rights reserved.

      SOURCES: Joseph Jankovic, M.D., professor, neurology, Baylor College of Medicine, Houston; Karen Raphael, Ph.D., professor, oral and maxillofacial pathology, radiology and medicine, New York University College of Dentistry, New York City; Jan. 17, 2018, Neurology, online

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        Hormone Therapy May Be OK for Women With Migraines

        News Picture: Hormone Therapy May Be OK for Women With MigrainesBy Amy Norton
        HealthDay Reporter

        WEDNESDAY, Oct. 11, 2017 (HealthDay News) — Women who suffer from migraines may be able to safely use hormone therapy to treat menopause symptoms, a new study suggests.

        The study of 85,000 U.S. women found no evidence that hormone therapy carried a particular risk of heart attack or stroke among those with a history of migraine headaches.

        That possibility has been a concern, mainly based on studies of younger women with migraines. Those studies linked hormonal birth control pills to a small risk of stroke, particularly among women whose migraines feature “aura” symptoms — most often, visual disturbances such as seeing zigzag lines or bright flashes.

        Less has been known about any risks of hormone replacement therapy, said Dr. Jelena Pavlovic, the lead researcher on the new study.

        “It appears safe for women with migraines to use hormone therapy, in terms of their cardiovascular risk,” said Pavlovic, an assistant professor of neurology at Albert Einstein College of Medicine in New York City.

        That said, she added, the general advice for women is to talk to their doctor about the benefits and risks of hormone therapy — and to start “low and slow.”

        That’s the advice of groups such as the American College of Obstetricians and Gynecologists. They recommend that women only use hormone therapy at the lowest dose and for the shortest length of time needed to ease menopause symptoms such as hot flashes and night sweats.

        Doctors have been cautious about menopausal hormone therapy ever since 2002, when results were reported from a large U.S. government study called the Women’s Health Initiative (WHI).

        It found that women who were given menopausal hormone therapy — with estrogen and progestin, or estrogen alone — faced health risks. They included heightened odds of breast cancer, blood clots and stroke.

        Since then, studies have suggested the situation is more nuanced. Hormone therapy seems safer, for example, for relatively younger women at the beginning of menopause. (Women in the WHI were, on average, in their early 60s.)

        It’s remained unclear, Pavlovic said, whether women with migraines can safely go on hormone therapy.

        It’s estimated that migraines affect 1 in every 4 women, she said.

        For the new study, Pavlovic and her colleagues combed through data from the WHI.

        They found that of more than 85,000 participants with no history of heart disease or stroke, 8,800 women had suffered from migraines. During the study period, just over 1,100 women overall developed heart disease, a stroke or blood clots in the legs or lungs.

        The researchers found no evidence that women with migraines were more likely than others to suffer those complications. And migraine sufferers who were given hormone therapy faced no greater risks than those given a placebo.

        Dr. Huma Sheikh is an assistant professor of neurology at Mount Sinai’s Icahn School of Medicine in New York City.

        She said the new findings are “encouraging.”

        At one time, Sheikh said, many doctors treating women with migraines would have considered hormones to be “off the table.”

        “But now they’re becoming more open to it,” she said. That’s partly because hormones are prescribed at lower doses today versus years ago, Sheikh noted.

        The current study has limitations, Pavlovic acknowledged. For one, it looked at women’s risk of cardiovascular problems overall, and not their risk of stroke specifically.

        The researchers were also unable to look separately at women who had migraines with aura.

        Sheikh said further studies are needed to validate these findings — and to sort out whether certain women with migraines might face risks from hormone therapy.

        For now, she suggested first trying nonhormonal ways to manage menopausal symptoms.

        If women do consider hormone therapy, Sheikh added, their overall health has to be taken into account — including whether they have risk factors for heart disease and stroke, such as high blood pressure and diabetes.

        The findings were scheduled for presentation this week at the annual meeting of the North American Menopause Society, in Philadelphia. Studies presented at meetings are usually considered preliminary until published in a peer-reviewed journal.

        MedicalNews
        Copyright © 2017 HealthDay. All rights reserved.

        SOURCES: Jelena Pavlovic, M.D., Ph.D., assistant professor, neurology, Albert Einstein College of Medicine, New York City; Huma Sheikh, M.D., assistant professor, neurology, Icahn School of Medicine at Mount Sinai, New York City; Oct. 11, 2017, presentation, North American Menopause Society, annual meeting, Philadelphia

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          Health Tip: Fight Seasonal Affective Disorder

          (HealthDay News) — Seasonal Affective Disorder (SAD), common in the winter months, is a type of depression triggered by decreased exposure to daylight.

          Symptoms of SAD include feeling down, irritable, lacking energy, sleeping a lot or having cravings FOR sweet or starchy foods.

          The National Sleep Foundation suggests how to help manage SAD:

          • Expose yourself to more daylight. Go for a walk outside during the day, or buy an artificial light source that mimics sunlight.
          • Eat a healthy diet.
          • Stay active throughout the winter months.
          • Seek professional counseling if you cannot manage the feelings of SAD.

          MedicalNews
          Copyright © 2017 HealthDay. All rights reserved.

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            Almost 21 Million Worldwide Now Have Access to HIV Meds

            News Picture: Almost 21 Million Worldwide Now Have Access to HIV Meds

            Latest Sexual Health News

            TUESDAY, Nov. 21, 2017 (HealthDay News) — The number of people with HIV who take life-saving antiretroviral medications has increased by tens of millions worldwide in recent decades, a United Nations report says.

            The number rose from 685,000 in 2000 to 20.9 million as of June 2017, according to UNAIDS, the Joint United Nations Program on HIV and AIDS.

            “Many people do not remember that in 2000 there were only 90 people in South Africa on treatment,” Michel Sidibe, executive director of UNAIDS, said in an agency news release.

            “Today, South Africa has the biggest life-saving treatment program in the world, with more than 4 million people on treatment,” Sidibe said. “This is the kind of acceleration we need to encourage, sustain and replicate.”

            The new report also said that because more people with HIV are receiving treatment, more of them are alive and well.

            Research also shows that people with HIV who adhere to antiretroviral treatment are up to 97 percent less likely to transmit the AIDS-causing virus to others. And as treatment has become more available to pregnant women, there has been a sharp drop in the number of children born with HIV.

            However, a number of challenges remain, the report said. One is to provide antiretroviral treatment to over 17 million people with HIV who currently aren’t receiving it, including 919,000 children.

            Another challenge is to make HIV prevention a public health priority again, particularly in nations with rising HIV infection rates. In eastern Europe and central Asia, for example, the rate of new infections has risen 60 percent since 2010 and AIDS-related deaths have increased 27 percent, according to the new report.

            — Robert Preidt

            MedicalNews
            Copyright © 2017 HealthDay. All rights reserved.

            SOURCE: UNAIDS, news release, Nov. 20, 2017

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              Protect Your Heart in Frigid Weather

              News Picture: Protect Your Heart in Frigid Weather

              TUESDAY, Jan. 2, 2018 (HealthDay News) — As an Arctic front envelops much of the United States, the American Heart Association wants folks to know that shoveling snow in sub-freezing temperatures can be hard on the heart, especially for those with heart disease.

              Here are some shoveling safety tips from the association:

              • When shoveling, take frequent breaks so you don’t put too much stress on your heart. Assess how you feel during those breaks.
              • Don’t drink alcohol before, during or immediately after shoveling. Alcohol can increase your sensation of warmth, and cause you to underestimate the amount of strain your body is feeling.
              • To prevent hypothermia (a dangerous drop in body temperature), wear layers of warm clothing that trap your body heat. Wear a hat to prevent the loss of body heat through your head.
              • If you have a medical concern or question, or have symptoms of a medical condition such as heart disease or diabetes, you should consult a doctor before shoveling or exercising in cold weather.
              • Know the warning signs of heart attack. But even if you’re not sure it’s a heart attack, have it checked out. Don’t wait to call 9-1-1. Minutes matter in a heart attack, and fast action can be a lifesaver.
              • Learn CPR. It can significantly improve a victim’s chances of survival. If an adult collapses, call 9-1-1 and begin pushing hard and fast in the middle of the victim’s chest until help arrives, the heart association said.

              — Robert Preidt

              MedicalNews
              Copyright © 2018 HealthDay. All rights reserved.

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                Hormone Therapy May Ease Depression Linked to Menopause

                News Picture: Hormone Therapy May Ease Depression Linked to MenopauseBy Serena Gordon
                HealthDay Reporter

                WEDNESDAY, Jan. 10, 2018 (HealthDay News) — A year of hormone therapy cut the risk of depression symptoms in women going through menopause and early postmenopause, new research shows.

                “Thirty-two percent of women randomized to treatment with a placebo experienced clinically significant depressive symptoms. But for women randomized to hormone therapy, the risk was cut nearly in half, to 17 percent,” said co-principal investigator Susan Girdler. She’s a professor of psychiatry at the University of North Carolina at Chapel Hill.

                Girdler added there were two main factors that predicted whether or not women would experience fewer depression symptoms while on hormone therapy. One factor was being in perimenopause (the transition to menopause) and the other was experiencing significant life stress, such as losing a loved one or divorce.

                Surprisingly, for women with a past history of major depression — which is a known risk factor for future depression — hormone therapy didn’t appear to lessen the risk of depressive symptoms.

                Girdler said normally women going through menopause have a twofold to fourfold higher risk of depression symptoms. There are a number of theories as to why that is, including recent life stress and the idea that some women may be more vulnerable to wildly fluctuating hormones, she explained.

                To see if hormone therapy might have an effect on the risk of depression, the researchers recruited 172 women between the ages of 45 and 60. All of the women were either perimenopausal or recently postmenopausal at the start of the study.

                Half of the women were aged 51 or older. Seventy-six percent of the women were white, and 19 percent were black. The mean household income was between $50,000 and $80,000.

                The women were randomly selected to one of two groups. One group was given an inactive placebo patch to wear. The other group received skin patches that delivered 0.1 milligrams per day of estrogen.

                Every three months, women in the estrogen patch group were also given 12 days of the hormone progesterone to ensure that women who still had a uterus shed their uterine lining (endometrium), which helped to offset a potential increase in the risk of endometrial cancer related to estrogen therapy. Hormone therapy was given for a year.

                The researchers also asked the women to complete a depression symptom questionnaire. However, they didn’t diagnose any of the women with depression, just “clinically significant depressive symptoms.”

                Girdler said that significant fluctuations in hormone variability, as well as stressful life events, can destabilize the cortisol stress axis.

                Cortisol is a stress hormone that “helps mobilize the body to respond to stress and to release energy stores so we can prepare for the ‘fight-or-flight’ response. This worked beautifully in cave people, but the problem is we still respond to stress as if there’s a tiger coming after us, but instead we’re just sitting at a computer,” she explained.

                Dr. Hadine Joffe, executive director of the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital in Boston, co-authored an editorial accompanying the new study. Joffe said factors such as hot flashes and sleep disturbances may also play a role in the increased risk of depressive symptoms.

                “Those factors can be intervened with nondrug therapies, such as cognitive behavioral therapy,” Joffe said. And, if you can improve sleep by reducing hot flashes and chronic insomnia, you may also reduce depressive symptoms.

                If you can use a nondrug therapy, that’s preferred if it helps, Joffe said.

                The average time for the menopausal transition is about four years, according to Joffe. Girdler said it’s not clear how long women would need to take hormone therapy, but she doesn’t envision it would be needed for the entire transition time, particularly because the study found that hormones were most beneficial in women early in the menopause transition.

                Joffe and obstetrician/gynecologist Dr. Jill Rabin, from Northwell Health in New Hyde Park, N.Y., said the advice for premenopausal women remains the same. Recently, the nation’s leading authority on preventive medicine, the U.S. Preventive Services Task Force, stood firm and said only postmenopausal women should avoid hormone replacement therapy.

                “When the benefits of hormone therapy outweigh the risks, women should be on the lowest dose for the shortest time,” Rabin said of women going through the early stages of menopause.

                Rabin noted that women in the study did have irregular bleeding, which was a bit concerning. Girdler added that one woman experienced a blood clot.

                Rabin said the study raises some very interesting questions, but that it needs to be replicated in a larger, more diverse group of people. “This was a small, pretty homogenous study,” she pointed out.

                Dr. Alan Manevitz, a clinical psychiatrist from Lenox Hill Hospital in New York City, agreed that the study finding raises questions and needs to be duplicated.

                None of the experts recommended asking your doctor for hormone therapy to prevent depression, but Manevitz urged women going through menopause who are experiencing depressive symptoms to get a depression assessment.

                The study was published online Jan. 10 in the journal JAMA Psychiatry.

                MedicalNews
                Copyright © 2018 HealthDay. All rights reserved.

                SOURCES: Susan Girdler, Ph.D., professor, psychiatry, University of North Carolina at Chapel Hill; Hadine Joffe, M.D., executive director, Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston; Jill Rabin, M.D., professor, obstetrics and gynecology, Hofstra Northwell School of Medicine, and co-chief, division of ambulatory care, Women’s Health Programs-PCAP Services, Northwell Health, New Hyde Park, N.Y.; Alan Manevitz, M.D., clinical psychiatrist, Lenox Hill Hospital, New York City; Jan. 10, 2018, JAMA Psychiatry, online

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                  What Is Cholesterol? HDL and LDL Ranges and Diet

                  What is cholesterol?

                  Cholesterol is a chemical compound that the body requires as a building block for cell membranes and for hormones like estrogen and testosterone. The liver produces about 80% of the body’s cholesterol and the rest comes from dietary sources like meat, poultry, eggs, fish, and dairy products. Foods derived from plants contain no cholesterol.

                  Cholesterol content in the bloodstream is regulated by the liver. After a meal, cholesterol in the diet is absorbed from the small intestine and metabolized and stored in the liver. As the body requires cholesterol, it may be secreted by the liver.

                  When too much cholesterol is present in the body, it can build up in deposits called plaque along the inside walls of arteries, causing them to narrow.

                  What are the different types of cholesterol?

                  Cholesterol does not travel freely through the bloodstream. Instead, it is attached or carried by lipoproteins (lipo = fat) in the blood. There are three types of lipoproteins that are categorized based upon how much protein there is in relation to the amount of cholesterol.

                  Low-density lipoproteins (LDL) contain a higher ratio of cholesterol to protein and are thought of as the “bad” cholesterol. Elevated levels of LDL lipoprotein increase the risk of heart disease, stroke, and peripheral artery disease, by helping form cholesterol plaque along the inside of artery walls. Over time, as plaque buildup (plaque deposits) increases, the artery narrows (atherosclerosis) and blood flow decreases. If the plaque ruptures, it can cause a blood clot to form that prevents any blood flow. This clot is the cause of a heart attack or myocardial infarction if the clot occurs in one of the coronary arteries in the heart.

                  High-density lipoproteins (HDL) are made up of a higher level of protein and a lower level of cholesterol. These tend to be thought of as “good” cholesterol. The higher the HDL to LDL ratio, the better it is for the individual because such ratios can potentially be protective against heart disease, stroke, and peripheral artery disease.

                  Very low-density lipoproteins (VLDL) contain even less protein than LDL. VLDL like LDL has been associated with plaque deposits.

                  Triglycerides (a type of fat) may increase cholesterol-containing plaques if levels of LDL are high and HDL are low.

                  Total cholesterol score is the sum of HDL cholesterol, LDL cholesterol and 20% of triglycerides as determined by a blood test. A high score indicates an increased risk for developing cardiovascular disease and/or strokes.

                  Chart courtesy of the National Institutes of Health.




                  Cholesterol Levels: What the Numbers Mean


                  Cholesterol chart and graph

                  Cholesterol Levels


                  What are LDL and HDL Cholesterol?

                  LDL cholesterol is called “bad” cholesterol, because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease, stroke, and peripheral artery disease. LDL lipoprotein deposits cholesterol along the inside of artery walls, causing the formation of a hard, thick substance called cholesterol plaque.

                  HDL cholesterol is called the “good cholesterol” because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high levels of HDL cholesterol (low LDL/HDL ratios) are desirable and protect against heart disease and stroke.

                  Why is high cholesterol dangerous?

                  Elevated cholesterol levels are one of the risk factors for heart disease, stroke, and peripheral artery disease. The mechanism involving cholesterol in all three diseases is the same; plaque buildup within arteries decreases blood flow affecting the function of the cells and organs that these blood vessels supply.

                  • Atherosclerotic heart disease or narrowed coronary arteries in the heart can cause the symptoms of angina, when the heart muscle is not provided with enough oxygen to function.
                  • Decreased blood supply to the brain may be due to narrowed small arteries in the brain or because the larger carotid arteries in the neck may become blocked. This can result in a transient ischemic attack (TIA) or stroke.
                  • Peripheral artery disease describes gradual narrowing of the arteries that supply the legs. During exercise, if the legs do not get enough blood supply, they can develop pain, called claudication.
                  • Other arteries in the body may also be affected by plaque buildup causing them to narrow, including the mesenteric arteries to the intestine and the renal arteries to the kidney.

                  Where does cholesterol come from?

                  The liver is responsible for managing the levels of LDL in the body. It manufactures and secretes LDL into the bloodstream. There are receptors on liver cells that can “monitor” and try to adjust the LDL levels. However, if there are fewer liver cells or if they do not function effectively, the LDL level may rise.

                  Diet and genetics both play a factor in a person’s cholesterol levels. There may be a genetic predisposition for familial hypercholesterolemia (hyper=more = cholesterol + emia=blood) where the number of liver receptor cells is low and LDL levels rise causing the potential for atherosclerotic heart disease at a younger age.

                  In the diet, cholesterol comes from saturated fats that are found in meats, eggs, and dairy products. Excess intake can cause LDL levels in the blood to rise. Some vegetable oils made from coconut, palm, and cocoa are also high in saturated fats.

                  What are normal cholesterol levels?

                  Blood tests are required to measure total cholesterol and lipoproteins. For a complete lipoprotein analysis, the patient should be fasting for at least 12 hours.

                  The National Cholesterol Education Program endorsed by the American Heart Association suggests the following risk guidelines for levels of total cholesterol, HDL, and LDL:

                  Cholesterol Risk Guidelines
                  Total Cholesterol (mg/dL)
                  < 200 Desirable
                  200 to 239 Borderline high
                  > 240 High
                  HDL (mg/dL)
                  < 40 Low
                  > 60 High
                  LDL (mg/dL)
                  < 100 Optimal
                  100 to 129 Near Optimal
                  130 to 159 Borderline high
                  160 to 189 Near high
                  > 190 High

                  The goal is to have patients modify lifestyle and diet to maintain cholesterol levels within the normal range. It is important to remember that HDL may protect a patient from heart disease and it may be a treatment goal to raise a too low level of HDL.

                  Which foods can help lower cholesterol?

                  The American Heart Association has developed diet guidelines to help lower cholesterol levels. It may be a challenge to read the nutritional contents on food packaging and on restaurant menus or to do the math, but the benefit will decrease the risk of heart attack and stroke.

                  • Limit total fat intake to less than 25% to 35% of your total calories each day.
                  • Limit saturated fat intake to less than 7% of total daily calories.
                  • Limit trans fat intake to less than 1% of total daily calories.
                  • The remaining fat should come from sources of monounsaturated and polyunsaturated fats that are found in unsalted nuts and seeds, fish (especially oily fish, such as salmon, trout, and herring, at least twice per week) and vegetable oils.
                  • Limit cholesterol intake to less than 300 mg per day, for most people. If you have coronary heart disease or your LDL cholesterol level is 100 mg/dL or greater, limit your cholesterol intake to less than 200 milligrams a day.

                  Some food groups may be beneficial in directly lowering cholesterol levels and include foods with plant sterol additives, high fiber foods like bran, oatmeal, and fruits like apples and pears, fish, nuts, and olive oil. Some of these foods like nuts and fruits are also high in calories, so moderation is always advisable.

                  What other lifestyle interventions help lower cholesterol?

                  Weight loss and exercise are shown to decrease total cholesterol while increasing levels of HDL, the good cholesterol. Smoking cessation decreases LDL levels plus smoking is a primary risk factor for heart disease and stroke. One drink of alcohol a day may help increase HDL levels, but too much alcohol can damage the liver and increase the risk of elevated LDL.

                  What medications are available to treat high cholesterol?

                  Four types of drug classes are used to lower cholesterol levels.

                  Statins is the only class of cholesterol lowering drugs that have been directly related to reducing the risk of heart attack or stroke.

                  Alirocumab (Praluent) and evolocumab (Repatha) are two new medications that are antibodies to a protein, PCSK9, a receptor for LDL. These drugs are indicated for treatment in patients who have had heart attack or stroke or have familial hypercholesterolemia and are taking maximum therapy, but continue to have high LDL cholesterol levels in their blood.

                  You and your doctor will discuss what cholesterol medications are right for you based on your current and past medical history, your current health, and any other medications you are taking. These medications often need to be adjusted and monitored for side effects.

                  While all four medication groups may have a role in controlling cholesterol levels in association with diet, exercise, and smoking cessation, only statins are shown to decrease the risk of heart attack.

                  The American Heart Association and the American College of Cardiology recommend that statin therapy may benefit patients with a history of heart attack, those with elevated blood LDL cholesterol levels or type two diabetes, and those with a 10-year risk of heart disease greater than 7.5%. When monitoring how well statin therapy works, the goal for some individuals is no longer to reach a specific blood cholesterol level. Instead, patients with a high risk of heart disease will aim to decrease their cholesterol levels by 50% and those with a lesser risk will aim to lower their cholesterol levels by 30% to 50%. You need to discuss what levels are best for you to reach with your doctor.


                  REFERENCES:

                  American Heart Association. “About Cholesterol.” Updated: Apr 2017.
                  <http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.Wb1CX7pFyM8f>>

                  Greenland, P., et al. “2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.” Journal of the American College of Cardiology 56.25 (2010): e50-e103.

                  Grundy, S. M., et al. “Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.” Circulation 110.2 (2004): 227-239.

                  Stone, N. J., et al. “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Journal of the American College of Cardiology 7 Nov. 2013.


                  Reviewed on 10/11/2017

                  References

                  REFERENCES:

                  American Heart Association. “About Cholesterol.” Updated: Apr 2017.
                  <http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.Wb1CX7pFyM8f>>

                  Greenland, P., et al. “2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.” Journal of the American College of Cardiology 56.25 (2010): e50-e103.

                  Grundy, S. M., et al. “Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.” Circulation 110.2 (2004): 227-239.

                  Stone, N. J., et al. “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Journal of the American College of Cardiology 7 Nov. 2013.


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                    One other Legacy of Terror Assaults: Migraines

                    News Picture: Another Legacy of Terror Attacks: MigrainesBy Amy Norton
                    HealthDay Reporter

                    WEDNESDAY, Dec. 13, 2017 (HealthDay Information) — Survivors of terror assaults could also be vulnerable to creating frequent migraines or tension-type complications, a brand new examine suggests.

                    Norwegian researchers examined the aftermath of a 2011 terrorist assault on a summer season camp in Norway that left 69 folks useless and 33 severely wounded. Many of the useless have been youngsters.

                    The investigators adopted greater than 200 of the younger survivors, taking a look at what number of have been struggling recurrent complications. They discovered that many have been — and at a fee a lot greater than could be anticipated within the normal inhabitants.

                    Particularly, the teenagers had a three-times greater fee of weekly or each day complications.

                    “We discovered that the survivors extra typically endure from complications as in comparison with controls, with extra frequent and extreme complaints resembling migraine,” mentioned the examine’s lead researcher, Dr. Synne Stensland, of the Norwegian Heart for Violence and Traumatic Stress Research in Oslo.

                    In accordance with Stensland, the findings might have far-reaching implications.

                    “We have to acknowledge that survivors of terror — and most probably different excessive violence — could also be fighting extreme headache complaints,” she mentioned.

                    When that is the case, Stensland added, the complications would seemingly “have an effect on their capacity to manage within the aftermath of occasions.”

                    Early therapy of migraines and stress complications might forestall them from changing into power, she famous.

                    For the examine, Stensland and her colleagues in contrast 213 assault survivors with greater than 1,700 youngsters who had not skilled a terror assault. They served as “controls.” Every survivor was matched with eight teenagers of the identical age and gender.

                    In interviews 4 to 5 months after the assault, the survivors have been requested about any complications they’d had prior to now three months. That, the researchers mentioned, is previous the standard time for “acute stress reactions” — that are often short-term and might be thought-about “regular.”

                    General, a 3rd of the ladies have been affected by migraines, in contrast with 12 p.c of ladies within the comparability group. Amongst boys, 13 p.c of survivors had migraines, versus four p.c within the comparability group.

                    Rigidity-type complications have been much more frequent, affecting half of feminine survivors and 28 p.c of male survivors.

                    General, terror assault survivors had a three- to four-times greater threat for each varieties of headache, the examine discovered. That was the case even when different components, resembling previous publicity to violence, have been thought-about.

                    In accordance with Stensland, the disparity primarily confirmed up in charges of frequent headache. About 12 p.c of feminine survivors and 5 p.c of male survivors had each day complications. Nevertheless, each day complications have been unusual within the comparability group — affecting 1 to 2 p.c.

                    The examine was revealed on-line Dec. 13 within the journal Neurology.

                    Dr. Matthew Robbins is director of inpatient companies at Montefiore Headache Heart in New York Metropolis. He mentioned, “We all know traumatic life occasion can result in a brand new headache dysfunction, or make an current one even worse.”

                    This examine, he mentioned, highlights the affect of publicity to excessive violence, at a susceptible time in life.

                    Even below regular circumstances, ladies are extra liable to migraines — and that begins to emerge within the teenage years, Robbins mentioned. The notably excessive fee of headache issues in feminine terror survivors appears to replicate an “excessive” model of that standard sample.

                    And whereas the examine targeted on the aftermath of a mass killing, many individuals expertise smaller-scale violence or abuse, Robbins identified.

                    He mentioned it is already really useful that docs display headache sufferers for any historical past of abuse. Sufferers “should not hesitate” to convey up these experiences, he added.

                    In any case, therapy of recurrent complications ought to ideally contain treatment and non-drug, behavioral approaches, in accordance with Robbins.

                    And in circumstances the place trauma is an element, he mentioned, there’s “little question” that must be addressed in therapy.

                    Why would trauma set off or worsen recurrent complications?

                    “If we’re uncovered to an especially violent occasion, the sensory info is transmitted neurologically to and processed within the mind,” Stensland mentioned. “The mind and physique are alarmed. Neurological sensitivity is mostly elevated, stress hormones are launched and our protection system [immune system] is modulated.”

                    All of that, she defined, might make the mind “hypersensitive,” rendering an individual extra susceptible to ache.

                    Different points, resembling sleep issues, might add on to the consequences, Stensland famous.

                    MedicalNews
                    Copyright © 2017 HealthDay. All rights reserved.

                    SOURCES: Synne Oien Stensland, M.D., Ph.D., Norwegian Heart for Violence and Traumatic Stress Research, Oslo College Hospital, Oslo, Norway; Matthew Robbins, M.D., director, inpatient companies, Montefiore Headache Heart, and affiliate professor, medical neurology, Albert Einstein Faculty of Medication, Montefiore Well being System, New York Metropolis; Dec. 13, 2017, Neurology, on-line

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