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Archive for the ‘Preventative Health’ Category

 

Training Programs to Prevent ACL Tears Could be the Answer to an Athlete’s Prayers

Tuesday, November 18th, 2014

By Kaysie Brittenham, PharmD Student

Are specialized training programs the solution to the alarming number of ACL (Anterior cruciate ligament) tears among young athletes? ACL tears continue to be a major issue among children and teens participating in competitive sports such as basketball, soccer, volleyball, and gymnastics. There are approximately 200,000 (1 in 1,750) ACL injuries every year, a majority of which occur in patients 15-45 years of age with young females at greatest risk.5 The ACL is one of four important ligaments in the knee. It runs through the center and provides stability when athletes are cutting, pivoting, stopping, or landing from a jump. Ligaments in the knee connect bone to bone at the joint and act like strong ropes to hold the bones together and maintain joint stability. They can tear from the force of a hit or from an awkward movement putting more force on the ligament than it can tolerate.2

ACL injuries have both immediate and long term debilitating effects. After an ACL tear, athletes are often less likely to return to athletics and tend to experience greater problems later on in life. Surgery, lengthy rehabilitation, early development of joint problems, chronic pain, and disability are all possible effects from ACL tears. Additionally, there are many financial, emotional, and psychological effects. Currently, ACL reconstruction surgery uses grafts to replace the ligament. These grafts come from tendons (strong tissues connecting muscle to bone) in the knee or in the back of the leg of either the patient or a deceased donor. The procedure typically lasts no more than a few hours. However, rehabilitation can be quite lengthy. Each person recovers differently, with some experiencing more difficulty than others. Complete recovery typically takes 9 months of rehabilitation. Muscles take a long time to regain strength and the affected knee often requires painful physical therapy to recover range of motion and stability. Sadly, some people are never the same after surgery and continue to experience problems such as a noticeable limp, joint pain, or fear of reinjuring themselves. Despite improvements in surgery and rehab, ACL injury prevention strategies are being stressed more and more. The hope is that these programs will combat the high occurrence of these detrimental injuries. Recent studies have suggested that specific training programs can lower the risk of ACL injury by as much as 70 percent.1 These training programs are believed to strengthen lower leg muscles, improve core stability, and help athletes avoid dangerous knee positions.1

Training programs are being stressed predominantly in young female athletes. “The largest numbers of ACL injuries occur in female athletes ages 15 to 20.”1 In fact, females are 4-6 times more likely than males to experience a torn ACL.3 The prevalence of ACL tears among young female athletes after puberty is thought to be a result of developmental changes. As body size increases, muscles in females do not generally develop and increase in strength as they do in males.1 Additionally, girls tend to jump and land differently than boys. Girls generally use their leg muscles unevenly, land with straight knees, and have legs that differ in strength. “These imbalances, which become more pronounced after puberty, put girls at greater risk of tearing their ACLs.”2 However, with the help of training programs, it is believed that these tendencies can be altered.

Physicians and athletic trainers are stressing the idea of ACL tear prevention. Many believe that specialized training programs, consisting of simple exercises that alter the way athletes run, jump, and land, can significantly reduce the risk of ACL injury. These programs have demonstrated numerous benefits and though they are not one hundred percent effective, initial research shows promise.2 Training programs may only take a few minutes a day to implement and could include a combination of drills such as jogging, skipping, lunging, or other bodyweight exercises.2 Consciously practicing a technique over and over causes muscle memory to kick in when the athlete cannot focus all of their attention on technique.3 One study conducted by Dr. Cynthia LaBella, showed that “a 20-minute program of specialized warm-ups, strengthening drills and plyometrics (explosive jumping exercises) cut down dramatically on ACL injuries compared to girls who did not perform the drills.”2 LaBella’s research has led to the development of KIPP (Knee Injury Prevention Program) which is now one of many ACL injury prevention programs.

Since KIPP’s development, many schools have adopted the program or others similar to it.2 Evidence has shown that multi-component programs are more successful than single-component programs in decreasing the occurrence of ACL injures. Exercises within these programs include plyometrics, balance and core control, strength training, agility training, spatial awareness, and muscle memory training.3 Many programs differ with respect to number and types of exercises and the frequency and duration of training.  A pooled analysis, however, looked at all current studies on these training programs and concluded that the most effective programs combined 3 key components. These included core and lower leg muscle strengthening, plyometrics, and repeated enforcement of proper technique.4 Additionally, the most effective programs trained athletes for a minimum of twice per week for 6 weeks and included preseason and in-season training.4 Though more research needs to be done, evidence suggests there are benefits in utilizing ACL injury prevention programs.

Talk with your doctor if you have questions or are interested in learning more. They can help athletes and parents locate a qualified instructor and provide you with more information.4 Athlete’s tend to have a mindset that they’re invincible, but all it takes is one wrong movement. Is it worth being proactive and possibly preventing such a common and destructive injury? As a future health care provider, I strongly suggest that young athletes, particularly females, consider these training programs. I’ve seen first-hand the negative effects of ACL injuries and greatly support efforts to reduce their occurrence. Additionally, I would recommend that pharmacists encourage patients with possible ACL tears to have it looked at by qualified athletic trainers or sports medicine physicians. Based on their assessment an MRI may then be necessary to confirm a tear. If MRI results demonstrate a torn ACL, it is important for athletes to see a specialized orthopedic surgeon with high success rates in ACL reconstruction.

References

  1. Preidt R. Training Programs Protect Young Athletes From ACL Tears: Report. HealthDay Consumer News Service[serial online]. April 28, 2014: Available from: Consumer Health Complete – EBSCOhost, Ipswich, MA. Accessed October 26, 2014.
  2. Torn ACLs continue to ravage high school athletes. Record, The (Kitchener/Cambridge/Waterloo, ON)[serial online]. September 9, 2014: Available from: Points of View Reference Center, Ipswich, MA. Accessed October 26, 2014.
  3. Laible C, Sherman O. Risk Factors and Prevention Strategies of Non-Contact Anterior Cruciate Ligament Injuries. Bulletin Of The Hospital For Joint Diseases[serial online]. January 2014;72(1):70-75. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed October 26, 2014.
  4. Dharamsi A, LaBella C. Prevention of ACL Injuries in Adolescent Female Athletes. (cover story). Contemporary Pediatrics[serial online]. July 2013;30(7):12. Available from: Publisher Provided Full Text Searching File, Ipswich, MA. Accessed October 30, 2014.
  5. Kim, Jennifer. Anterior Cruciate Ligament Injury. Sports Medicine. http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/knee/anterior-cruciate-ligament-injury-acl/. Last Updated January 2009. Accessed November 9, 2014.

 

An Aspirin a Day Keeps Breast Cancer Away?

Wednesday, November 5th, 2014

By Lauren Haines, Pharm.D. student

According to the American Cancer Society, one in eight U.S. women will develop breast cancer in their lifetime.1 Breast cancer involves cancer cells forming a tumor in the breast tissue. Risk factors include: women ages 65 and older, inherited genetic mutations, two or more close relatives diagnosed at an early age, postmenopausal obesity, use of combined estrogen and progestin menopausal hormones, cigarette smoking, alcohol consumption, and women who breastfed for a long time. Currently, breast cancer is treated with surgery, radiation therapy, systemic therapy, chemotherapy, hormone therapy, and targeted therapy. Treatment with surgery is the most common and involves removing cancer from the breast to determine the disease severity. However, other methods may also be used to kill the cancer cells such as chemotherapy and radiation. These methods have many side effects that women must choose to endure to treat their cancer, including increased risk of uterine cancer, pain, hair loss, nausea, vomiting, fatigue, increased risk of infections, and depression.1

A new method researchers are evaluating to help prevent death from breast cancer is the use of aspirin. In a recent article by Michelle Holmes and colleagues, researchers evaluated the relationship between aspirin use and breast cancer survival. Researchers identified women newly diagnosed with breast cancer and then assigned them one of three groups, which were either to not receive any daily dose (75mg to 160mg depending on where it was bought) of aspirin, receive less than one daily dose of aspirin, or receive one or more daily doses of aspirin. Patients were followed throughout the study, for up to five and a half years, to determine if they died from breast cancer. When the women taking at least one daily dose of aspirin were compared to those not taking any aspirin in the last six months of the study, there was about a 4% decreased risk of death from breast cancer in the women taking the aspirin. However, the women taking less than a daily dose compared to those not taking any aspirin had about a 3% increased risk of death from breast cancer. The limitations of this study included that aspirin could be bought over-the-counter, so anybody could buy it without pharmacy record; low dosages were only available through prescriptions; and researchers lacked additional clinical data on breast cancer characteristics and treatment.2

Although using aspirin is still being researched to determine its effect on breast cancer patients, it may be a good option for women aside from standard treatment options. Current methods involve aggressive strategies to destroy breast cancer and prevent future cases, which must be authorized by a doctor or surgeon.  Aspirin is available over-the-counter, which would provide easy access for patients who can’t receive other types of treatment. However, aspirin does have side effects of its own that patients should be aware of, including: nausea, vomiting, stomach pain, and heart burn. Aspirin can also cause decreased blood clotting, which may cause increased bleeding. Also, aspirin shouldn’t be used during pregnancy, and it has many drug interactions with blood pressure, water, and blood thinner medications.3

Although the previous article doesn’t provide clear evidence that aspirin decreases death from breast cancer, other articles support its conclusions. In another article, researchers tested the effect of aspirin used with tamoxifen, a prescription drug used to treat breast cancer, to determine if the combination of the medications helped with the treatment. Researchers found that aspirin helped balance blood protein levels when used with tamoxifen, which improved treatment. However, research showed an increased risk of bruising and upset stomach with aspirin and tamoxifen therapy.4 Other research evaluated the use of aspirin while also using beta-blockers and ACE inhibitors, common drugs used to promote breast cancer patient survival.5 Results showed the use of aspirin with these drugs helped promote the survival process versus the use of the drugs without aspirin by increasing survival rate by more than 50%.5 Evidence also showed the use of aspirin greatly reduced the risk of developing breast cancer in women.6 However, the use of ibuprofen (Advil) and acetaminophen (Tylenol) didn’t reduce breast cancer risk like aspirin did. Ibuprofen had a slight reduction in breast cancer risk, but acetaminophen had no relationship with it. Aspirin especially showed a reduction in postmenopausal women.6 Research on the frequency of aspirin use and potential breast cancer diagnosis concluded that women using aspirin more than six times a week had a 23% decreased risk of developing breast cancer and was not associated with altering hormones.7

Thus, aspirin may be an appropriate choice for women with a high risk of developing breast cancer and women who have been diagnosed with it previously. Aspirin doesn’t require a prescription, so patients can easily buy it usually at a lower cost than many prescription medications. However, patients should consult their primary care physicians before taking aspirin to ensure they are not taking other medications that would interact with it, and that aspirin has potential to help them. Patients should also receive additional advice from loved ones to ensure they support their decision to use aspirin.  With both a decreased risk in developing breast cancer and an increased promotion of breast cancer survival, aspirin may be a good option for women.

Would you recommend aspirin to a friend diagnosed with breast cancer or who may have a risk of developing breast cancer?

 

References

 

  1. American Cancer Society- Breast Cancer. http://www.cancer.org/breastcancer/index. Updated 2014. Accessed October 3, 2014.
  1. Holmes MD, Olsson H, Pawitan Y, et al. Aspirin intake and breast cancer survival – a nation-wide study using prospectively recorded data in sweden. BMC Cancer. 2014;14(1):1150-1165.
  1. Aspirin. Aspirin: MedlinePlus Drug Information Web site. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682878.html#side-effects. Updated 2014. Accessed October 3, 2014.
  1. Holmes CE, Jasielec J, Levis JE, Skelly J, Muss HB. Initiation of aspirin therapy modulates angiogenic protein levels in women with breast cancer receiving tamoxifen therapy. CTS: Clinical & Translational Science. 2013;6(5):386-390.
  1. Holmes MD, Hankinson SE, Feskanich D, Chen WY. Beta blockers and angiotensin-converting enzyme inhibitors’ purported benefit on breast cancer survival may be explained by aspirin use. Breast Cancer Res Treat. 2013;139(2):507-513.
  1. Chung CT. Association of frequency and duration of aspirin use and hormone receptor status with breast cancer risk. Women’s Oncology Review. 2004;4(4):279-281.
  1. Bardia A, Olson JE, Vachon CM, et al. Effect of aspirin and other NSAIDs on postmenopausal breast cancer incidence by hormone receptor status: Results from a prospective cohort study. Breast Cancer Res Treat. 2011;126(1):149-155.

Chew or Dip, Time to Quit

Wednesday, November 5th, 2014

By Tyler Michael, PharmD Student

Smokeless tobacco use is on the decline in adults and children.1 This is not necessarily a time to celebrate for healthcare providers though. As the focus has been shifted away from the dangers of smokeless tobacco, some professionals have wrongfully started encouraging smokeless tobacco as a safer alternative to smoking.1,2 Someone seeking to quit smoking or using any tobacco products should seek nicotine replacement therapy, Chantix, or a combination with education if they wish to quit smoking.3

An article recently published by the American Heart Association discusses the heart health effects of discontinuing smokeless tobacco use. The goal of the cohort study, which followed the patients for 4 years, was to track how cessation of smokeless tobacco affects heart health after a myocardial infarction (heart attack). According to the article the mortality rate per 1000 people is 9.7 for those who stopped using smokeless tobacco and 18.7 for those who continued using it.4 These numbers show that people who continue using smokeless tobacco after a heart attack are almost twice as likely to die within the next 4 years. Not only did stopping smokeless tobacco use lower cardiovascular disease risk, but also cancer mortality risk as well. This shows that quitting is very important to the health of those already at risk, and in no way could its use be a safer alternative to cigarette smoking.

Some limitations of this study are that it only followed those who already had a heart attack, so it cannot be applied to the risks of those who have not previously had a heart attack.4 There were no exclusion criteria for this study so a patient could have had a terminal illness or another reason for death that would influence this data. There was a selection bias that did not allow patients over the age of 75 into the study, meaning it cannot be applied to anyone over that age.4

This article agrees with the current standard that smokeless tobacco poses a health risk. Siddiqui et al. shows in there research that those who use smokeless tobacco have higher blood pressure and cholesterol than those who do not use smokeless tobacco.5 Smokeless tobacco may have lower mortality risk than those who smoke over 15 cigarettes a day, but still a much greater mortality rate than those who do not use tobacco at all.6

Based on this article and the other articles on the topic, it is evident that smokeless tobacco is not healthy, and should not be viewed as a healthy alternative to smoking cigarettes. This article shows that smokeless tobacco use increases mortality risk and this research shows that it nearly doubles mortality risk in those who have already had a heart attack. I believe stopping use of all tobacco products is the safest route and nicotine replacement therapy can be used to help patients’ quit.3 Further research is needed to determine the best nicotine replacement therapy or smoking cessation medication in this population of patients with previous heart attack.

Stopping tobacco use is one of the best health decisions someone can make for themselves.  What method would you use to quit? If you have successfully quit, what worked for you?

 

References List

 

  1. Nelson D, Mowery P, Tomar S, Marcus S, Giovino G, Zhao L. Trends in Smokeless Tobacco Use  Among Adults and Adolescents in the United States. American Journal Of Public    Health [serial online]. May 2006;96(5):897-905. Available from: SPORTDiscus with  Full Text, Ipswich, MA.             Accessed October 1, 2014.
  2. Digard H, Proctor C, Kulasekaran A, Malmqvist U, Richter A. Determination of Nicotine Absorption  from Multiple Tobacco Products and Nicotine Gum. Nicotine & Tobacco Research [serial online]. January 2013;15(1):255-261. Available from: Consumer Health Complete – EBSCOhost,       Ipswich, MA. Accessed October 1, 2014.
  3. Heydari G, Masjedi M, Fadaizadeh L, et al. A Comparative Study on Tobacco Cessation Methods: A  Quantitative Systematic Review. International Journal Of Preventive Medicine [serial online]. June 2014;5(6):673-678. Available from: Academic Search Complete, Ipswich, MA. Accessed    November 2, 2014.
  4. Arefalk G, Hambreaus K, Lind L, Michaëlsson K, Lindahl B, Sundström J. Discontinuation of  Smokeless Tobacco and Mortality Risk after Myocardial Infarction. Circulation AHA. May 2014.  doi: 10.1161/CIRCULATIONAHA.113.007252
  5. Siddiqui S, Rana A, Singal S, Pandey D, Khan S. Assessment of Cardiovascular Risks of  Tobacco Chewers by Comparing it with Normal Human Beings. National Journal Of Physiology, Pharmacy & Pharmacology [serial online]. January 2014;4(1):76-79.   Available from: Academic Search Complete, Ipswich, MA. Accessed October 2, 2014.
  6. Bolinder G, Alfredsson L, Englund A, De Faire U. Smokeless Tobacco Use and Increased Cardiovascular Mortality among Swedish Construction Workers. American Journal Of Public Health [serial online]. March 1994;84(3):399-404. Available from: Business Source Complete, Ipswich, MA. Accessed October 2, 2014.

Proactive Use of Probiotics

Tuesday, October 28th, 2014

by Sarah Winey, PharmD candidate

According to the World Health Organization (WHO), two leading causes of death in young children, under the age of 5, are respiratory infections and diarrhea.1 Both respiratory tract infections (RTIs) and severe diarrhea are often caused by a bacterial infection, so an effective prevention therapy could reduce the incidence of these infections.  Currently, strategies are rarely employed for the prevention of these disease states, except avoidance of foods and conditions that may have an impact, such as fatty foods and environmental irritants. Avoidance of environment irritants can include avoidance of individuals who may carry infection and appropriate hygienic measures, such as hand washing. However, medical treatment frequently occurs only when the patient becomes symptomatic. The standard treatment for diarrhea involves fluid and electrolyte replacement or zinc supplementation, while the standard treatment for bacterial respiratory tract infections often involves antibiotic therapy.1 Probiotic therapy has been suggested as a potential preventative strategy for combating bacterial infections, including those associated with diarrhea and RTI’s.

Probiotics are live, healthy bacteria that are ingested in the form of a dietary supplement or cultured dairy products.2 The human body holds a significant amount of natural healthy bacteria in various locations, including the gastrointestinal (GI) tract.  When harmful bacteria enters the body, it competes for limited space with the healthy bacteria.  In the case of infection, the harmful bacteria overwhelms the system. The goal of probiotic supplementation is to overwhelm at risk areas, such as the GI tract, with healthy bacteria; in fact, the labeled dose is in terms of number of live cells or colonies, usually upward of one million.  In clinical testing, most patients do not experience side effects or experience only minor GI effects such as gas.3 According to current guidelines, probiotics have not been determined to replace standard treatment; nevertheless, the 2007 National Health Interview Survey found that probiotic-type products were the fifth most used natural product for children.3

In March 2014, the Pediatrics journal published a trial with the goal of determining whether a probiotic, Lactobacillus reuteri, had a significant impact on incidence of diarrhea in preschool children. The study was a forward-looking, random-sample, placebo-controlled trial (placebo- an identical substance to probiotic but has no effect) occurring from April 2011-June 2012 in four different day care centers in southeast Mexico City. The study population was comprised of healthy children aged six months to three years, born full term, and of similar socioeconomic status. The primary outcome, or goal, of the study was to determine if the number of days children experienced diarrhea was impacted by probiotic intervention. In addition, the number of days children experienced RTI’s, days of absence caused by diarrhea or RTI, days of antibiotic use, days of medical visits and cost impact due to intervention were studied. The study’s limitations included the possible lack of generalizability based on study location and choice of probiotic species.4

This study provided additional support to the theory that probiotic therapy can impact the prevention of bacterial infections, specifically diarrhea and RTI’s. The results showed that the intervention significantly reduced the incidence of both diarrhea and RTI.4 Additionally, the days of absence, number of medical visits, and antibiotic use were also significantly reduced as a result of probiotic intervention.4 Several other studies have found similar results. For instance, according to a Cochrane research review, probiotics were found to be a beneficial prevention strategy for infection; specifically, this study found that upper respiratory tract infection rate was reduced with probiotic use.5 Another research review of Randomized Control Trials (RCT’s) showed a decrease in duration and stool frequency as a result of probiotic intervention for diarrhea.6

In conclusion, probiotic therapy is a safe and seemingly effective for the prevention of respiratory infections and diarrhea.  This form of therapy may prove especially useful to parents of young children in daycare centers who are constantly in a crowded environment, which could lead to increased infection.  An additional option is the use of yogurt or other cultured dairy products, which also have the capability to reestablish normal, healthy bacteria in the GI tract. Currently probiotics are not an officially approved recommendation for children, should they be?

References:

  1. World Health Organization.Children: Reducing mortality. Media centre: Fact Sheets Web site. http://www.who.int/mediacentre/factsheets/fs178/en/. Updated 2014. Accessed September 20, 2014.
  2. EBSCO CAM Review B. Probiotics. Salem Press Encyclopedia Of Health [serial online]. January 2014;Available from: Research Starters, Ipswich, MA. Accessed August 31, 2014.
  3. National Center for Complementary and Alternative Medicine. Oral probiotics: An introduction. 2012.
  4. Gutierrez-Castrellon P, Lopez-Velazquez G, Parra M, et al. Diarrhea in Preschool Children and Lactobacillus reuteri: A Randomized Controlled Trial. Pediatrics [serial online]. n.d.;133(4):E904-E909. Available from: Science Citation Index, Ipswich, MA. Accessed September 24, 2014.
  5. Hao Q. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Of Systematic Reviews [serial online]. July 26, 2011;(9)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed September 20, 2014.
  6. Applegate J, Fischer Walker C, Ambikapathi R, Black R. Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children. BMC Public Health [serial online]. October 2, 2013;13(Suppl 3):1-8. Available from: Academic Search Complete, Ipswich, MA. Accessed September 1, 2014.

How can you help your baby if you are smoking and pregnant?

Tuesday, October 28th, 2014

By Samantha Smolinski, PharmD Student

Approximately 50% of women who smoke before pregnancy continue to smoke after pregnancy. Smoking during pregnancy has been shown to cause some adverse effects on the baby. These adverse effects include lifelong decreases in lung function, an increased risk for asthma, low birth weight, shortened pregnancy terms, miscarriage, and infant mortality.1,2 The standard of care for pregnant women who smoke is to suggest that they quit.3

Many women have difficulty quitting smoking. Research has shown that when women join smoking cessation programs like Freedom From Smoking through the American Lung Association or FreshStart from the American Cancer Society to help them quit smoking, they are more likely to quit due to social support and encouragement.4,5 Women have reported that when they were living with another person who smoked, it was much harder for them to quit smoking and remain a non-smoker. In addition to this, many women claim that they found quitting easier when their significant other was supportive of their decision.6 Another common option to aid the mother in her journey to quit smoking is nicotine replacement therapy. Nicotine replacement therapy involves substituting cigarettes with pure nicotine, so that the patient maintains the same level of nicotine in the blood to reduce withdrawal symptoms. The amount of nicotine the patient receives is gradually reduced overtime until the patient can comfortably quit smoking. The forms for this replacement therapy can come in patches, gums, lozenges (dissolved in mouth), inhalators, nasal sprays, and microtabs. Nicotine replacement therapy increases the chances for someone to quit smoking by approximately 80%.4 However, this therapy may cause some adverse pregnancy outcomes and potential malformations. Although malformations may occur, studies have shown that this side effect may be less harmful than those adverse effects that result from smoking during pregnancy.3 In addition to the potential side effects, nicotine is absorbed faster in pregnant women than in non-pregnant women, which means that standard uses of this therapy may not be applicable to pregnant women.4

Recently, a randomized, double-blind trial was conducted with one hundred fifty-nine newborns of pregnant smokers and seventy-six newborns of pregnant non-smokers. Smoking pregnant women were randomly placed in groups where sixty-three received vitamin C 500 mg and eighty-three received a placebo.1 Vitamin C was chosen for this study because there have been multiple studies that have shown that it has a protective effect on lung function.7 After the women had their babies, pulmonary function tests were performed on the babies within seventy-two hours after birth and again a year later. The tests that were conducted a year later were only for the babies of the smoking pregnant due to institutional review board regulations. The first outcome included the measured pulmonary function tests within seventy-two hours of birth and the second outcome included pulmonary function tests at one year as well as the incidence of wheezing. Results suggested that women who smoked while they were pregnant and taking vitamin C 500 mg improved their newborn pulmonary function and decreased the chance of wheezing within one year when compared to the offspring of women who were pregnant and smoking in the placebo group. This study was conducted because of a prior study that had been done on pregnant rhesus monkeys.1 This study had shown that the offspring of the pregnant monkeys with nicotine treatment and vitamin C supplementation had increased pulmonary functions when compared to the offspring of the pregnant monkeys who were only treated with nictotine.7 Thus, vitamin C can be an inexpensive and simple approach to decrease the adverse effects smoking has on pregnancy.4

Vitamin C supplementation can bring additional benefit to women who are smoking and pregnant. This can help the adverse effects that smoking has on the baby’s lung function after birth. Although quitting is still the best choice for pregnant women and their babies, vitamin C supplementation can be useful by helping the baby if the mother smokes intermittently (through part of the pregnancy or through the entire pregnancy.) My recommendation to patients would be to quit smoking as soon as possible and that the best way to do this is through the support of others. In addition to quitting, they should take a daily 500 mg vitamin C supplement which has shown benefits for the babies of women who smoke during pregnancy. Vitamin C can be found over the counter at a relatively low price.

What changes are you willing to make to help your baby?

 

References:

  1. McEvoy CT, Schilling D, Clay N,et al. Vitamin c supplementation for pregnant smoking women and pulmonary function in their newborn infants: A randomized clinical trial.JAMA. 2014;311(20):2074-2082.
  2. Pollack H, Lantz PM, Frohna JG. Maternal smoking and adverse birth outcomes among singletons and twins.Am J Public Health. 2000;90(3):395-400.
  3. Forinash AB, Pitlick JM, Clark K, Alstat V. Nicotine replacement therapy effect on pregnancy outcomes.Ann Pharmacother. 2010;44(11):1817-1821.
  4. Coleman T. Recommendations for the use of pharmacological smoking cessation strategies in pregnant women.CNS Drugs. 2007;21(12):983-993.
  5. Lando HA, McGovern PG, Barrios FX, Etringer BD. Comparative evaluation of american cancer society and american lung association smoking cessation clinics.Am J Public Health. 1990;80(5):554-559.
  6. Flemming K, Graham H, Heirs M, Fox D, Sowden A. Smoking in pregnancy: A systematic review of qualitative research of women who commence pregnancy as smokers.J Adv Nurs. 2013;69(5):1023-1036.
  7. Proskocil BJ, Sekhon HS, Clark JA, Lupo SL,

Yet Another Reason to Lose that Excess Weight

Monday, October 27th, 2014

By Courtney Noll, PharmD Student

An individual’s blood glucose levels assist in controlling the secretions of two major regulatory hormones in the body: Insulin and glucagon. Insulin works to bring down levels of glucose in the blood when they have risen too high, and glucagon works to raise the blood glucose levels when they have fallen too low. A significant problem that many individuals are developing is the condition of insulin resistance. This issue is caused by obesity, sedentary lifestyles, poor eating habits, and genetics etc. This physiological condition occurs when cells fail to respond to the normal effects of insulin. In some cases insulin is created in less than sufficient quantities in the body, and in other cases, the human body fails to use the hormone effectively.  As of now there is no specific medication approved by the Food & Drug Administration (FDA) for the treatment of insulin resistance, outside of diagnosis and treatment of diabetes, and the best form of conventional treatment is found to be weight loss and exercise. Smoking is also found to increase insulin resistance, and quitting the habit will contribute to an individual’s conventional treatment of the issue. Insulin resistance plays a significant role in the development of other serious medical conditions as well, including obesity, hypertension, type II diabetes, dyslipidemia (abnormal amount of lipids in the blood), and cardiovascular (heart) disease.1

A recent study was performed in order to evaluate the effects of weight loss on insulin resistance as well as other plasma and tissue markers of systemic and vascular inflammation. This was a prospective controlled study using 77 overweight and obese sedentary postmenopausal women. These women were split into 2 groups where 37 of the participants met 3 times a week and engaged in aerobic exercise and the remaining 40 participants did no aerobic exercising. This study used a state-of-the-art technique to measure insulin sensitivity, body composition, inflammatory biomarkers, and vascular adhesion molecules and carefully conducted weight loss and exercise regimes.2 In looking back at the results, evidence is shown that the markers that were measured and the level of insulin resistance was noticeably higher with a higher level of obesity.2 As the study progressed, it was also noticeable that with combined weight loss and aerobic exercise, the levels of insulin resistance and the other markers measured, also significantly decreased. Unfortunately, there were two limitations that came into play during this study. First of all, the study was done only in postmenopausal women and second, there was no nonintervention control group.2 By performing this study in exclusively postmenopausal women, the results cannot be applied accurately to different populations and/or groups of individuals.

This study may have had limitations, but it was not the only study showing the relationship between weight loss and reduced insulin resistance. In fact, there was no study that I found showing any opposing views or conflicting data. Another study showed the effects of weight loss on insulin resistance in adolescents and found that, weight loss at month 4 was associated with improved insulin sensitivity in obese adolescents.3 Another study published recently, was looking at the effects of weight loss, with and without exercise, on the measurements of blood pressure, blood glucose, and insulin resistance and found that: A reduction of 7% of the initial body weight, in overweight patients, improves systolic blood pressure, plasma glucose, and insulin resistance.4  Thirdly, another study found that using surrogate markers for insulin sensitivity, authors of the Diabetes Prevention Program showed that at one year, improvement in insulin sensitivity predicted lower risk for diabetes three years later.5

Study after study 6,7 shows the benefits of weight loss on various health measurements, but specifically focuses on insulin resistance. In my opinion, losing weight can be one of the most beneficial health choices an overweight individual can choose to accomplish. There are many rewarding diets and workout regimens that individuals have found to be successful. In addition, a gym membership and a simple 3 days per week attendance could be the start to a great beginning for any overweight individual. By decreasing their weight and, essentially decreasing insulin resistance, an individual will decrease their risk of hypertension, type 2 diabetes, dyslipidemia, and cardiovascular disease. With the positive effects of losing weight on insulin resistance, what is weight loss worth to you?

 

References:

  1. Reviews CT. Studyguide for Principles of Anatomy and Physiology by Gerard J. Tortora, Isbn 9780470565100. Academic Internet Publishers; 2012.
  2. Ryan A, Ge S, Blumenthal J, Serra M, Prior S, Goldberg A. Aerobic Exercise and Weight Loss Reduce Vascular Markers of Inflammation and Improve Insulin Sensitivity in Obese Women. Journal Of The American Geriatrics Society [serial online]. April 2014;62(4):607-614. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.
  3.  Abrams P, Levitt Katz L, Berkowitz R, et al. Threshold for improvement in insulin sensitivity with adolescent weight loss. Journal Of Pediatrics [serial online]. September 2013;163(3):785-790. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.
  4.  Trussardi Fayh A, Lopes A, Fernandes P, Reischak-Oliveira A, Friedman R. Impact of weight loss with or without exercise on abdominal fat and insulin resistance in obese individuals: a randomised clinical trial. British Journal Of Nutrition [serial online]. August 28, 2013;110(3):486-492. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.
  5.  McLaughlin T, Schweitzer P, Reaven G, et al. Persistence of improvement in insulin sensitivity following a dietary weight loss programme. Diabetes, Obesity & Metabolism [serial online]. December 2008;10(12):1186-1194. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed September 24, 2014.
  6.  Ling Chun K, Wuillemin P, Rizkalla S, et al. Insulin resistance and inflammation predict kinetic body weight changes in response to dietary weight loss and maintenance in overweight and obese subjects by using a Bayesian network approach. American Journal Of Clinical Nutrition [serial online]. December 2013;98(6):1385-1394. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.
  7.   Calleja Fernández A, Vidal Casariego A, Cano Rodríguez I, Ballesteros Pomar M. One-year effectiveness of two hypocaloric diets with different protein/carbohydrate ratios in weight loss and insulin resistance. Nutricion Hospitalaria [serial online]. December 2012;27(6):2093-2101. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.

The Coconut Oil Craze

Wednesday, October 22nd, 2014

By Danielle Grear, PharmD Student

Super-food, super-health, or super-hype? Coconut oil has been a trending topic in today’s society with its recent health claims for improving weight, fighting bacteria, treating Alzheimer’s, moisturizing skin, and the list goes on.1 Perhaps the most recent way coconut oil is being used today is in a process called “oil pulling,” which requires swishing a tablespoon of oil in the mouth for several minutes in order to detox the body and improve dental health. While the FDA has not yet approved the use of coconut oil for the treatment or prevention of disease, many consumers swear by the positive effects coconut oil has in improving their health.2

A recent article published by The Huffington Post explores the use of coconut oil pulling as a means to whiten teeth, reduce bacteria, strengthen the gums and jaw, and prevent bad breath.3 “It can be a good way to supplement recommended practices like tooth brushing, flossing, and regular dental visits,” says Michelle Hurlbutt, RDH, MSDH, an associate professor of dental hygiene at Loma Linda University in Southern California. Hurlbutt conducted a pilot study and found evidence that showed oil pulling can decrease the bacteria associated with dental cavities. Contrary to popular claims of coconut oil, however, she found that sesame oil had a 5-fold decrease in the level of Streptococcus mutans (a common bacteria associated with a high risk of cavities) compared to only a 2-fold decrease in the bacteria with coconut oil. Furthermore, after daily oil pulling stopped, the bad bacteria began to reemerge in both groups. While I believe that some may indeed have evidence supporting their experience of oil pulling’s benefits, I agree with Hurlbutt that the scientific evidence behind this process is lacking and needs further research to back these claims. The article does a good job in addressing that issue, and even states that oil pulling should not be used to replace regular oral health care.

To further investigate the use of coconut oil in oil pulling, a research study published in the Asia Journal of Public Health studied the effects of coconut oil pulling on oral microorganisms in biofilm models.4 A biofilm is a thin, slimy film of bacteria that adheres to a matrix. The bacteria that were used in this study on a saliva-coated plate were: Streptococcus Mutans, Lactobacillus Casei, and Candida Albicans, which are all predominately found in dental plaque and associated with infections. The study found that as coconut oil was exposed to the bacteria for one minute, it exhibited antimicrobial (anti-bacteria) activity on S. Mutans and C. Albicans. This allowed researchers to conclude that oil pulling therapy could be used as a preventative home therapy to maintain oral hygiene, especially in developing countries. However, while this article certainly shows the benefits of oil pulling, the study has its fair share of limitations. Predominately, because the mechanisms of oil pulling action are not known, further studies are needed to investigate the action of coconut oil on dental plaque and other microorganisms. Long-term effects in clinical trials on humans are also needed to provide significant data for its use in practice.

In addition, one of the main components of coconut oil is lauric acid. This saturated fat is a medium length fatty acid and has been shown in other studies to have an antimicrobial effect against certain bacteria (gram-positive) and yeasts.5 Even compared to other acids, lauric acid ultimately gave better results in fighting infections and inflammation.6 Because the bacteria Streptococcus mutans has been found in association with cavities3, there is a great possibility that further research can prove the benefits of lauric acid in oil pulling.

So what does this all mean? While the evidence for coconut oil in the use of oil pulling and treatment of various diseases is certainly unresolved, oil pulling has been found to have limited side effects as long as the technique is properly conducted.3 However, contrary to popular advertisements today, the articles studied showed that coconut oil is not a “means to cure all.” In fact, it should only be used as a supplement and not a way to treat serious conditions or infections. As a future pharmacist, I would inform patients inquiring about coconut oil pulling that while there have been reports of people experiencing benefits, this technique has not been fully researched and approved by the FDA. Patients must understand that while oil pulling will likely not harm them, it may not help them either. As research continues, hopefully more conclusive evidence will be produced, giving healthcare providers a better understanding of what to expect from the use of coconut oil in oil pulling.

Let’s hear from you. Have you had success with coconut oil pulling? Where else have you seen this product used to improve health?

References:

  1. Spera R. The best ways you’re probably not using coconut oil. ABC13 Eyewitness News Web site. http://abc13.com/society/the-best-ways-youre-probably-not-using-coconut-oil/315760/. Published September 29, 2014. Updated 2014. Accessed October 5, 2014.
  2. Select committee on GRAS substances (SCOGS) opinion: Coconut oil (packaging). U.S. Food and Drug Administration Web site. “Food.” Select Committee on GRAS Substances (SCOGS) Opinion: Coconut oil (packaging). N.p., 18 Apr. 2013. Web. 16 Oct. 2014. <http://www.fda.gov/Food/IngredientsPacka. Published April 18, 2013. Updated 2013. Accessed October 16, 2014, 2014.
  3.  Almendrala A. Oil pulling might be the next big thing–or not. The Huffington Post Healthy Living Web site.http://www.huffingtonpost.com/2014/03/12/oil-pulling_n_4943808.html. Published 3/12/2014. Updated 2014. Accessed October/16, 2013.
  4. Thaweboon S, Nakaparksin J, Thaweboon B. Effect of oil-pulling on oral microorganisms in biofilm models  . Asia Journal of Public Health. 2010;2(2).
  5. Salleh E, Muhamad II. Starch-based antimicrobial films incorporated with lauric acid and chitosan. AIP Conference Proceedings. 2010;1217(1):432-436.
  6. Huang W, Tsai T, Chuang L, Li Y, Zouboulis CC, Tsai P. Anti-bacterial and anti-inflammatory properties of capric acid against propionibacterium acnes: A comparative study with lauric acid. J Dermatol Sci. 2014;73(3):232-240.

 

Protein Pump Inhibitors and Heart Disease Link

Tuesday, December 10th, 2013

By Yevgeniy Solokha, PharmD Student Cedarville University

Proton pump inhibitors (PPIs) are commonly used to prevent the symptoms and complications of gastroesophageal reflux disease (GERD).1 They work by reducing acid secretion in the stomach by inhibiting the gastric proton pump.2 With several products available over-the-counter (OTC), patients have also been able to use them for the self-treatment of heartburn and indigestion.3 Although these medications are effective, their long-term use has been associated with potentially serious health risks, including bone fractures and reduced magnesium levels in the blood.Not only that, but there has been some evidence suggesting that prolonged use of PPIs may also lead to heart disease.2

This association is the main topic of a recent study that has been published in the Circulation Journal of the American Heart Association. It has evaluated the effects of PPIs on mice and human endothelial cells using cell assays as well as blood samples collected from mice in vivo. The results show that PPIs lead to increased levels of asymmetrical dimethylarginine (ADMA) in the blood by inhibiting dimethylarginine dimethylaminohydrolase (DDAH), an enzyme that breaks it down. This, in turn, prevents nitric oxide synthase (NOS) from generating nitric oxide (NO), which decreases the ability of blood vessels to dilate.The article essentially calls for the need to perform additional studies to evaluate whether the general population using PPIs may be at risk for heart disease.2 This is the main limitation of the study because the results cannot be easily extrapolated to humans. Also, there may be other factors that can contribute to this association.

A similar relationship between ADMA elevations and cardiovascular events has also been discussed in an article published in the Annals of Medicine.It proposed essentially the same mechanism as the one mentioned in this study. Another Danish cohort study set out to investigate a relationship between the use of PPIs and clopidogrel with cardiovascular events. It concluded that, “the increased cardiovascular risk associated with PPI use independent of clopidogrel is caused by unmeasured confounders”.5 Basically, this means that there must be something else going on which has not been accounted for. The main objective of the mouse study discussed above was to try to identify a possible mechanism for this observation. Since this association seems to be fairly new, the literature largely seems to be inconclusive on the subject.

I feel like it is still too early to tell whether there truly is a valid relationship between PPI use and heart disease because there have not been any randomized-controlled trials conducted in humans yet. For this reason, I would not change my self-care recommendation for the short-term relief of persistent heartburn and indigestion because OTC PPIs are indicated for a limited duration of therapy consisting of 14 days, after which they have to be discontinued for at least four months.3 Nevertheless, I think that the results of this study may be good to just keep in mind in case we encounter patients who may be on unnecessary prolonged use of PPIs. The possible heart disease association would simply be another reason to contact their physician about discontinuation. In this regard, I believe that pharmacists are located within a unique position within the healthcare system to make sure that patient safety remains a priority.

Would this knowledge impact your self-care recommendation regarding PPIs?

References:

  1. Proton Pump Inhibitors for Gastroesophageal Reflux Disease (GERD). Available at: http://www.webmd.com/heartburn-gerd/proton-pump-inhibitors-for-gastroesophageal-reflux-disease-gerd. Accessed December 5, 2013.
  2. Ghebremariam YT, Lependu P, Lee JC, et al. Unexpected effect of proton pump inhibitors: elevation of the cardiovascular risk factor asymmetric dimethylarginine. Circulation. 2013;128(8):845-53.
  3. Berardi RR, Kroon LA, McDermott JH et al. Handbook of nonprescription drugs, an interactive approach to Self-care. APhA Publications; 2006.
  4. Böger RH. Asymmetric dimethylarginine (ADMA): a novel risk marker in cardiovascular medicine and beyond. Ann Med. 2006;38(2):126-36.
  5. Charlot M, Ahlehoff O, Norgaard ML, et al. Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study. Ann Intern Med. 2010;153(6):378-86.

Calcium Worth The Risk?

Tuesday, December 10th, 2013

By Jordan Long, PharmD Student Cedarville University

For years, calcium has been considered an essential nutrient to have in the daily diet. Intake of calcium is essential for many bodily functions including muscle contraction, nerve transmission, and bone remodeling.1 Some of the benefits from calcium are helping bone growth, prevent loss of bone density, and prevent osteoporosis development.2 But recent reports are questioning the actual efficacy in these different functions and if higher calcium levels could lead to adverse effects due to additional intake through supplementation.  These recent studies led the New York Times to post an article in April of 2013 stating that people should be Thinking Twice about Calcium Supplements.3 The article stated that not only is the efficacy of calcium supplementation in it’s prevention of bone fracture questionable, but calcium supplementation might be harmful. The views presented in this article are hard to believe, since calcium is a very common nutrient found in many foods found in the standard diet. However, recent literature is beginning to provide evidence to back up this view.

Studies have shown that calcium is essential for the increase of bone density in prepubescent children.4 Parents should highly encourage their kids to consume calcium in their diet to have strong bones. But the United States Preventative Risk Task Forces stated that there is currently insufficient evidence that the benefits from calcium supplementation over 1,000mg per day is worth the risk for the primary prevention of fracture in healthy, older woman. They also do not recommend taking less than 1,000mg a day of calcium supplementation, because it is not shown to decrease fracture at these low levels but increases risk of kidney stones.5 The National Institutes of Health recommends optimal calcium intake levels varying from 1,000mg to 1,300mg for anyone over the age of four, depending on age.1 Those numbers include the calcium from dietary intake and any calcium taken as a supplement. A lot of these studies are hard to compare and contrast their recommendations because of the high amount of variation in type of calcium supplementation and complementary supplementation, especially with vitamin D, which also plays an important role in the bones ability to absorb calcium.6

One of the primary concerns with calcium supplementation is that the risks of all cause mortality, attributed mostly to cardiovascular disease. A study observing all cause and cardiovascular mortality due to calcium found that there was an associated increase in all cause, cardiovascular, and ischemic heart disease mortality with people with an average intake of calcium above 1,400mg a day, but these results were not conclusive.7 A few other articles looking at the association of calcium and cardiovascular disease mortality found no hard evidence and said that no causality could be confirmed.8,9 Sadly, a limitation to the research of calcium effects is that randomized clinical trials might be unfeasible. The risks of high supplementation of calcium are to high and could be considered unethical to test for. But is the intake of calcium the issue? The National Institutes of Health states that calcium intake is not involved in the prevalence of cardiovascular issues, but the serum concentrations of calcium.1 Calcium serum concentrations are highly regulated by the body to obtain proper homeostatic balance, using the bones as a reservoir for excess calcium.10 But this balance could be thrown off by increased or decreased calcium intake over longer periods of time.  Even though there is some evidence that calcium supplementation could be reducing incidence of fractures, evidence is increasing regarding the incidence of cardiovascular issues.11

From the research, I would say that patients should be cautioned when thinking about taking a calcium supplement for an extended period of time. The New York Times pointed out some good points, people should try to stay away from supplements as much as possible.3 If someone is below his or her recommended daily value of calcium, higher intake of high-calcium food should be recommended. Some examples of foods that are high in calcium are milk, cheese, yogurt, kale, and spinach.1 The major thing causing problems in people that are taking calcium supplements is that they most likely have an adequate amount of calcium in there normal diet, and the additional supplement is putting them over the recommended daily amount. The supplements themselves might not be necessarily directly causing the higher risk of cardiovascular disease, but it is increasing the calcium levels above the recommended daily amount. People wanting to take calcium supplements should consult their local pharmacist or primary care provider to make sure it is appropriate. For another great resource, check out Dr. Mercola’s article on the relationship between vitamin K2, vitamin D, and calcium (Link found in references section below). It explains the proper balance of these dietary supplements and how to control your calcium levels through them.12

With all of these risks, do you know what your daily calcium intake is? Maybe it’s time you checked for yourself.

 

 

References

1. Dietary Supplement Fact Sheet: Calcium. Offices of Dietary Supplements of the National Institutes of Health Website. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/#en82. Accessed December 4, 2013.

2. Top Foods for Calcium and Vitmain D. WebMD Website. http://www.webmd.com/food-recipes/guide/calcium-vitamin-d-foods. Accessed on December 4, 2013.

3. Thinking Twice about Calcium Supplements. New York Times Website. http://well.blogs.nytimes.com/2013/04/08/thinking-twice-about-calcium-supplements-2/. Accessed December 3, 2013.

4. Johnston, CC; Miller, JZ; Slemenda, CW; Reister, TK; Hui, S; Christian, JC; Peacock, M. Calcium Supplementation and Increases in Bone Mineral Density in Children. NEJM. 1992;327(2):82-87. Accessed December 4, 2013.

5. Vitamin D and Calcium Supplementation to Prevent Fractures in Adults. U.S. Preventative Services Task Force Website. http://www.uspreventiveservicestaskforce.org/uspstf12/vitamind/finalrecvitd.htm. Published February, 2013. Accessed December 4, 2013.

6. Calcium and Vitamin D; What you need to know. National Osteoporosis Website.

http://nof.org/articles/10. Accessed of December 7th, 2013.

7. Michaëlsson, K; Melhus, H; Lemming, EW; Wolk, A; Byberg, L. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ. 2013;346(228). Accessed December 4, 2013.

8. Bolland, M; Grey, A; Reid, I. Calcium and Cardiovascular Risks. Australian Prescriber. 2013;36(1):5-8. Accessed December 4, 2013.

9. Van Hemelrijck, M; Michaelsson, K; Linseisen, J; Rohrmann, S. Calcium Intake and Serum Concentration in Relation to Risk of Cardiovascular Death in NHANES III. PLOS One. 2013;8(4): 1-9. Accessed December 4, 2013.

10. Marks, AR. Calcium and the heart: a question of life and death. The Journal of Clinical Investigation. 2003;1(5):597-600. Accessed December 4, 2013.

11. Reid, IR. Cardiovascular Effects of Calcium Supplements. Nutrients. 2013;5:2522-2529. Accessed December 4, 2013.

12. What You Need to Know About Vitamin K2, D and Calcium. Mercola.com Website.

http://articles.mercola.com/sites/articles/archive/2012/12/16/vitamin-k2.aspx. Published in December of 2012. Accessed on December 7th, 2013.

Is Aspirin a Viable Option for the Prevention of Dementia?

Saturday, December 7th, 2013

by Nick Daniels, PharmD student

Dementia is one of the most prevalent health issues facing the elderly today. The disease state is characterized as a decline in memory or thinking skills severe enough to reduce a person’s ability to perform everyday activities.1 It is heavily correlated with Alzheimer’s in that 60 to 80% of those affected by the disease also suffer from dementia.1 One study estimates that 13.9%, which accounts for roughly 3.4 million people, of the population in the United States who are 71 years of age or older are affected by the disease with numbers increasing steadily as they progressed in age, with it ultimately effecting over 37% of the population older than 90.2 The severity of the symptoms associated with dementia, and its prevalence among the elderly, makes it a critical problem for which a preventative solution must be found.

The article, “Aspirin may Prevent Dementia and Cancers, World’s Largest Study Shows” published by ABC News discusses how researchers working in Australia are trying to do just that. The study, involving the participation of over 15,000 healthy Americans and Australians aged over 70, is using aspirin as a preventative agent to stop the development of the disease state through a suppression of stroke incidence.3 Researchers involved with the ASPREE study are using the aspirin in this case in an effort to keep constant the flow of blood to all areas in the brain in hopes of preventing tissue necrosis, microinfarcts, caused by ischaemic stroke.3 Tissue necrosis in the brain would result in reduced ability to think thereby causing advancement in dementia.3 Researchers began this double blind clinical trial in January of 2010 and they are expecting a reliable primary outcome measure by August of 2016.4 This sample is expected to be the most large scale available in regards to measuring aspirin preventative outcomes for dementia.5

While the aforementioned study into this area seems promising given the proven cardiovascular benefits of moderate aspirin usage and the study’s statistical power provided by its large sample size, I would advise caution to patients looking to dive headfirst into this type of preventative plan thinking it will be the guaranteed answer to solving the problem of dementia. To this point there is just not enough of a sample base to prove that the benefits of aspirin usage for the prevention of stroke outweigh the negatives, such as stomach bleeding and increased risk of massive stroke due to advanced movement of blood through the brain, associated with the medication.6 Hopefully the study currently being conducted can bring to light the answers to some of these questions. To this point, being so early on in the study, only the initial speculation by the researchers is available.

Without further evidence that validates the effectiveness of aspirin use in the prevention of dementia I cannot recommend its use for this indication. A previous study done by the NHMRC Psychiatric Epidemiology Research Centre in Australia tracking aspirin’s potential in use for preventing dementia actually found no difference between control and study groups.In cross-sectional data obtained in the study, those who had been taking NSAIDs or aspirin performed no better on the cognitive tests after account had been taken of other confounding variables.7

There are a few reasons behind the questionable results of some of these studies. The most important is they fail to acknowledge that stroke related dementia is only a portion of the larger problem of dementia as a whole.1 As was mentioned previously, up to 80% of all cases of dementia can be related to the development of Alzheimer’s which is different than the microinfarct dementia addressed by these studies.1 Many articles, like the one published by ABC, have the potential to heavily exaggerate the applicability of research being done. This could serve to mislead the public into adopting preventative strategies that could be ineffective, and at worst detrimental to their health. Also, the sample size in the NHMRC study is much smaller which could affect its validity in comparison to the larger study currently being conducted. Results from the larger study should give a more accurate representation of the medication’s effectiveness. I feel the ASPREE study also limits itself through a constrained diversity of ages. It would be more advantageous to begin the study using individuals who were much younger than 70 in order to reasonably ensure that patients had not already experienced some of the symptoms of dementia onset.

As health care professionals it is important to spread awareness in regards to dementia and the potential benefits, or shortcomings, of various preventative measures. Do you believe the limited base of evidence available for aspirin usage in the prevention of dementia is enough to warrant its use for this indication? What future do you believe the medication has in the prevention, or treatment, of neurodegenerative diseases?

References

[1] What is Dementia? Available at: http://www.alz.org/what-is-dementia.asp. Published June 28, 2013. Accessed December 2, 2013

[2] Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology. 2007;29(1-2):125-32

[3] Ogilvie, Felicity. Aspirin may Prevent Dementia and Cancers, World’s Largest Study Shows. ABC News. http://mobile.abc.net/news/2013-11-28/aspirin-may-prevent-dementia-cancers-world-largest-study-shows/5122836. Published November 28, 2013. Accessed December 3, 2013.

[4] Nelson M, http://clinicaltrials.gov/show/NCT01038583. Accessed December 6, 2013.

[5] ASPREE Study. Available at: http://www.aspree.org/AUS/aspree-content/aspree-study-details/about-aspree.aspx. Accessed December 6, 2013.

[6] Paikin JS, Eikelboom JW. Cardiology patient page: Aspirin. Circulation. 2012;125(10):e439-42.

[7] Henderson AS, Jorm AF, Christensen H, Jacomb PA, Korten AE. Aspirin, anti-inflammatory drugs and risk of dementia. Int J Geriatr Psychiatry. 1997;12(9):926-30.