Testosterone Therapy: “Significant Reduction” in Heart Attack, Stroke Risks

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Large-scale Veterans Affairs database study reaffirms safety and benefits of testosterone replacement, in men.

A US Veterans Affairs database study of more than 83,000 male subjects found that men whose low testosterone was restored to normal through gels, patches, or injections had a lower risk of heart attack, stroke, or death from any cause, versus similar men who were not treated.  Rajat Barua and colleagues analyzed data collected on 83,010 male veterans with documented low total testosterone levels, dividing them into three clinical groups: those who were treated to the point where their total testosterone levels returned to normal (Group 1); those who were treated but without reaching normal (Group 2); and those who were untreated and remained at low levels (Group 3).  Importantly, all three groups were “propensity matched” so the comparisons would be between men with similar health profiles. The researchers took into account a wide array of factors that might affect cardiovascular and overall risk. The average follow-up across the groups ranged from 4.6 to 6.2 years. The sharpest contrast emerged between Group 1 (those who were treated and attained normal levels) and Group 3 (those whose low testosterone went untreated). The treated men were 56% less likely to die during the follow-up period, 24%less likely to suffer a heart attack, and 36%less likely to have a stroke.  The differences between Group 1 and Group 2 (those who were treated but did not attain normal levels) were similar but less pronounced.  The study authors conclude that: “normalization of [total testosterone] levels after [testosterone replacement therapy] was associated with a significant reduction in all-cause mortality, [myocardial infarction], and stroke.”

Sharma R, Oni OA, Gupta K, Chen G, Sharma M, Dawn B, Sharma R, Parashara D, Savin VJ, Ambrose JA, Barua RS. “Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men.”  Eur Heart J. 2015 Aug 6. pii: ehv346.

Article Source: https://www.worldhealth.net/news/testosterone-therapy-significant-reduction-heart-a/

 

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New ways to conquer sleep apnea compete for place in bedroom

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Every night without fail, Paul Blumstein straps on a mask that prevents him from repeatedly waking up, gasping for air.

It’s been his routine since he was diagnosed with a condition called sleep apnea. While it helps, he doesn’t like wearing the mask.

“It’s like an octopus has clung to my face,” said Blumstein, 70, of Annandale, Virginia. “I just want to sleep once in a while without that feeling.”

It’s been two decades since doctors fully recognized that breathing that stops and starts during sleep is tied to a host of health issues, even early death, but there still isn’t a treatment that most people find easy to use.

Airway pressure masks, the most common remedy, have improved in design, getting smaller and quieter, but patients still complain about sore nostrils, dry mouths and claustrophobia.

Now, new ways of conquering sleep apnea, and the explosive snoring that comes with it, are vying for a place in the bedrooms of millions of people craving a good night’s sleep. Products range from a $350 restraint meant to discourage back sleeping to a $24,000 surgical implant that pushes the tongue forward with each breath.

Mouthpieces, fitted by dentists, work for some people but have their own problems, including jaw pain. Some patients try surgery, but it often doesn’t work. Doctors recommend weight loss, but diet and exercise can be challenging for people who aren’t sleeping well.

So far, no pills for sleep apnea exist, but researchers are working on it. One drug containing THC, the active ingredient in marijuana, showed promise in a study this year.

What is sleep apnea? In people with the condition, throat and tongue muscles relax and block the airway during sleep, caused by obesity, aging or facial structure. They stop breathing, sometimes for up to a minute and hundreds of times each night, then awake with loud gasping and snoring. That prevents them from getting deep, restorative sleep.

They are more likely than others to have strokes, heart attacks and heart rhythm problems, and they’re more likely to die prematurely. But it’s hard to tease out whether those problems are caused by sleep apnea itself, or by excess weight, lack of exercise or something else entirely.

For specialists, the first-choice, most-studied remedy remains continuous positive airway pressure, or CPAP. It’s a motorized device that pumps air through a mask to open a sleeper’s airway. About 5 million Americans have tried CPAP, but up to a third gave up during the first several years because of discomfort and inconvenience.

Martin Braun, 76, of New York City stopped using his noisy machine and awkward mask, but now he’s trying again after a car crash when he fell asleep at the wheel. “That’s when I realized, OK this is serious stuff already,” said Braun, who has ordered a quieter CPAP model.

Sleep medicine is a relatively new field. The most rigorous studies are small or don’t follow patients for longer than six months, said Dr. Alex Krist of Virginia Commonwealth University, who served on a federal guidelines panel that reviewed sleep apnea treatments before recommending against screening adults who have no symptoms.

“We don’t know as much about the benefits of treating sleep apnea as we should,” said Krist, vice-chair of the U.S. Preventive Services Task Force.

While scientists haven’t proved CPAP helps people live longer, evidence shows it can reduce blood pressure, improve daytime sleepiness, lessen snoring and reduce the number of times a patient stops breathing. CPAP also improves quality of life, mood and productivity.

With noticeable results, many CPAP users, even those like Blumstein with a love-hate relationship with their devices, persist.

Blumstein was diagnosed about 15 years ago after he fell asleep behind the wheel at a traffic light. He shared his frustrations with using a mask at a recent patient-organized meeting with the Food and Drug Administration, as did Joelle Dobrow of Los Angeles, who said it took her seven years to find one she liked.

“I went through 26 different mask styles,” she said. “I kept a spreadsheet so I wouldn’t duplicate it.”

Researchers are now focused on how to get people to use a mask more faithfully and predicting who is likely to abandon it and could start instead with a dental device.

“It’s the bane of my existence as a sleep doctor,” said Dr. James Rowley of Wayne State University in Detroit. “A lot of what sleep doctors do in the first few months after diagnosis is help people be able to use their CPAP.”

Getting it right quickly is important because of insurers’ use-it-or-lose-it policies.

Medicare and other insurers stop paying for a rented CPAP machine if a new patient isn’t using it enough. But patients often have trouble with settings and masks, with little help from equipment suppliers, according to Dr. Susan Redline of Brigham and Women’s Hospital in Boston.

All told, it can drive people toward surgery.

Victoria McCullough, 69, of Escondido, California, was one of the first to receive a pacemaker-like device that stimulates a nerve to push the tongue forward during sleep. Now, more than 3,000 people worldwide have received the Inspire implant. Infections and punctured lungs have been reported; the company says serious complications are rare.

McCullough said she asked her doctor to remove the device soon after it was activated in 2015.

“It was Frankenstein-ish. I didn’t like it at all,” McCullough said. “My tongue was just thrashing over my teeth.”

Others like the implant. “My quality of life is 100 percent better,” said Kyleene Perry, 74, of Edmonds, Washington, who got one in February after struggling with CPAP for two years. “People are saying, ‘You look so much better.’ I have a lot more energy.”

The THC pill, known as dronabinol, already is used to ease chemotherapy side effects. A small experiment in 73 people suggests it helps some but wasn’t completely effective. It may work better in combination with CPAP or other devices, said researcher David Carley of the University of Illinois at Chicago. He owns stock in Respire Rx Pharmaceuticals, which has a licensing agreement with the university for a sleep apnea pill.

As the search for better treatments continues, listening to patients will be key, said Redline.

“We are actually just treating a very tiny percentage of people effectively,” she said.

Article Source: https://medicalxpress.com/news/2018-07-ways-conquer-apnea-bedroom.html

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Low Plasma Testosterone Is Associated With Elevated Cardiovascular Disease Biomarkers

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BACKGROUND:

The relation between testosterone (T) plasma concentration and cardiovascular (CV) risk is unclear, with evidence supporting increased risk in men with low and high T levels. Few studies have assessed CV risk as a function of plasma T levels using objective biomarkers.

AIM:

To determine the relation between T levels and high-sensitivity CV risk biomarkers.

METHODS:

Ten thousand forty-one male patients were identified in the database of a commercial clinical laboratory performing biomarker testing. Patients were grouped by total T concentration and associations with the following biomarkers were determined: cardiac troponin I (cTnI), endothelin-1 (ET-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-17A, N-terminal pro-B-type natriuretic peptide (NTproBNP), high-density lipoprotein (HDL) cholesterol, high-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c (HbA1c), and leptin.

OUTCOMES:

Association of CV risk markers with levels of T in men.

RESULTS:

The median age of the cohort was 58 years (interquartile range = 48-68), and the median plasma T level was 420 ng/dL (interquartile range = 304-565); T levels did not vary with patient age. An inverse relation between plasma T levels and CV risk was observed for 9 of 10 CV markers: cTnI, ET-1, IL-6, TNF-α, NTproBNP, HDL cholesterol, hs-CRP, HbA1c, and leptin. Even after adjusting for age, body mass index, HbA1c, hs-CRP, and HDL cholesterol levels, the CV markers IL-6, ET-1, NTproBNP, and leptin were significantly associated with a T level lower than 250 ng/dL.

CLINICAL IMPLICATIONS:

Men with low T levels could be at increased risk for increased CV disease as seen by increased CV risk markers.

STRENGTH AND LIMITATIONS:

This study was performed in a group of 10,041 men and is the first study to examine CV risk associated with circulating T levels using a large panel of 10 objective biomarkers. This study is limited by an absence of clinical data indicating whether men had pre-existing CV disease or other CV risk factors.

CONCLUSION:

Men with low plasma T levels exhibit increases in CV risk markers, consistent with a potential increased risk of CV disease. Pastuszak AW, Kohn TP, Estis J, Lipshultz LI. Low Plasma Testosterone Is Associated With Elevated Cardiovascular Disease Biomarkers. J Sex Med 2017;XX:XXX-XXX.

Article Source: https://www.ncbi.nlm.nih.gov/pubmed/28757119

 

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Low levels of the DHEA prohormone predict coronary heart disease

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Men with low levels of DHEA in the blood run an increased risk of developing coronary heart disease events. The Sahlgrenska Academy study has been published in the Journal of the American College of Cardiology.

The term prohormone refers to the precursor of a hormone. DHEA is a prohormone that is produced by the adrenal glands and can be converted to active sex hormones. While the tendency of DHEA levels to fall with age was discovered long ago, the biological role of the prohormone is largely unknown.

Researchers at Sahlgrenska Academy, University of Gothenburg, have now shown that elderly men with low levels of DHEA in the blood run an increased risk of developing coronary heart disease events.

Lower level – greater risk

The study–which monitored 2,614 men age 69-80 in Gothenburg, Uppsala and Malmö for five years–assessed DHEA levels. The findings demonstrated that the lower the DHEA level at the study start, the greater the risk of coronary heart disease events during the five-year follow-up.

“Endogenous production of DHEA appears to be a protective factor against coronary heart disease,” says Åsa Tivesten, who coordinated the study. “High DHEA levels may also be a biomarker of generally good health in elderly men.”

Clear correlation

According to Professor Claes Ohlsson, “While the study establishes a clear correlation between DHEA in the blood and coronary heart disease, the discovery does not indicate whether or not treatment with DHEA will reduce the risk in individual patients.”

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“Dehydroepiandrosterone and its Sulfate Predict the 5-Year Risk of Coronary Heart Disease Events in Elderly Men” was published in the Journal of the American College of Cardiology on October 28.

Link to article: http://content.onlinejacc.org/article.aspx?articleid=1918789

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Selenium and CoQ10 Combo Cuts Heart Disease Deaths in Half

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Five year study reveals that combining selenium with CoQ10 has been found to dramatically slash the risk of death from cardiovascular disease

Cardiovascular disease is the leading cause of death in the developed world, killing more than 17 million per year, which is more lives than cancer claims. This is due to arterial plaque caused by poor diets, lack of exercise, obesity, and smoking.  A remarkable study to come out of Sweden shows that taking two supplements (CoQ10 and selenium) in combination may slash mortality risks by almost 50%. Researchers found that these nutrients may have many benefits including:

  • overall improved heart function
  • reduction of hospital stays due to surgeries
  • protection lasts years after stopping supplements

Swedish researchers published the study in the International Journal of Cardiology that revealed the health benefits of CoQ10 and selenium. Current studies already show these nutrients have the ability to protect damaged tissue from oxidative stress.

The Health Benefits of CoQ10 and Selenium

A study lasting five years was conducted on 443 healthy adults between the ages of 70 and 80. Half received placebos, and the other half received 200mg of CoQ10 and selenium supplements. After the five-year study was concluded, 12.6% of the placebo group had died of cardiovascular disease, while only 5.9 percent of those taking the supplements had died. The group who took the supplements also scored higher on cardiac functions after an echocardiogram examination. More importantly, they had lower levels of a biomarker NT-proBNP known as an indicator of heart failure, which is good because lower levels reduce the risks of cardiovascular disease.

The team of researchers did a 4-year follow-up study on the participants and found that the group taking the supplements reported two positive results:

  • a higher quality of life compared to the placebo group
  • 246 fewer days of hospitalization

More astonishing is that after 10 years, CoQ10 and selenium seemed to still deliver health benefits, including a reduction in cardiovascular deaths, this despite the group having stopped taking the supplements. At this 10 year mark, participants had a 49% lower risk of heart attack, stroke, or heart failure compared to the placebo participants. Both genders received the same level of protection.

What are CoQ10 and Selenium & How do They Work

CoQ10 and selenium work together to improve cell efficiency. CoQ10 is a type of antioxidant that helps protect the outer membrane (mitochondria) of sick cells, thereby making cells more efficient at releasing energy. Selenium is a mineral that assists certain enzymes in the body that have an antioxidant effect against free radicals.

Oxidative stress is known to accelerate the aging process and chronic disease, and both CoQ10 and selenium have been well known by researchers for their ability to protect people, especially the elderly. As we reach old age around 80 years or so, almost half the mitochondria in our cells have been depleted. CoQ10 is known to replenish the compounds in the mitochondria thus giving a boost in energy output. Because the human heart requires so much energy it is easy to see why CoQ10 is so beneficial.

Good sources of CoQ10 include salmon, tuna, liver, and whole grains. Good sources of selenium include wheat germ, brewer’s yeast, shellfish, sunflower seeds, and brazil nuts. In addition to the goal of life extension, the researchers wanted to improve people’s lives as they grow older. It appears that CoQ10 and selenium supplementation has an appreciable impact on both. In combination, these nutrients may be the answer to reducing the number one cause of death – cardiovascular diseases.

Article Source: http://www.worldhealth.net/news/coq10-and-selenium-supplements-cut-heart-disease-d/

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Playing golf can add five years to your life

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People who play golf could live five years longer than those who don’t according to new research from Scotland.

Scientists in Edinburgh claimed the sport was helpful in preventing 40 different chronic diseases as well as offering improved mental health.

Researchers reviewed 5,000 studies into golf and found while it had health benefits for people of all ages, the gains were more pronounced among older players.

Golf was seen to aid balance and improve muscle strength but was also found likely to improve cardiovascular, respiratory and metabolic health.

Dr. Andrew Murray, from the physical activity for health research center at Edinburgh University, said Wednesday that regular golf can help players beat official recommended levels for physical activity.

“Evidence suggests golfers live longer than non-golfers, enjoying improvements in cholesterol levels, body composition, wellness, self-esteem and self-worth,” he said in the report’s release.

The study claimed playing golf could also help those who suffer chronic diseases including heart disease, type 2 diabetes, colon and breast cancer and stroke.

 

According to the data, golfers typically burnt a minimum of 500 calories over 18 holes and those walking the course could trek up to eight miles.

Even golfers using a motorized cart were found to walk as much as four miles over a full round.

Three-time major golf title winner and ambassador for the Golf and Health project, for which the study was published, Padraig Harrington said in the report’s release that the finding was no surprise.

“I have seen how impactful golf can be on peoples’ wellbeing, now it is time to get the message out there,” he said.

The study was published in the British Journal of Sports Medicine and is part of the Golf and Health Project, which is led by the World Golf Foundation.

Article Source: http://www.cnbc.com/2016/10/06/playing-golf-can-add-five-years-to-your-life.html

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Researchers find molecular link behind aspirin’s protective powers

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Aspirin’s ability to reduce the risk of both cardiovascular disease and colon cancer has been a welcome, yet puzzling, attribute of the pain reliever that has been a mainstay in medicine cabinets for more than 100 years.

Now researchers at Duke Health have identified a new mechanism of aspirin’s action that appears to explain the drug’s diverse benefits.

Publishing in the journal EBioMedicine, the researchers describe how aspirin directly impacts the function of a gene regulatory protein that not only influences the function of platelets, but also suppresses tumors in the colon.

“This research identifies a new way in which aspirin works that was not predicted based on the known pharmacology,” said lead author Deepak Voora, M.D., assistant professor in Duke’s Center for Applied Genomics & Precision Medicine. Voora said aspirin’s pain-reducing and blood thinning powers have long been traced to its ability to block COX-1, an enzyme involved in both inflammation and blood clotting.

“But COX-1 has only partially explained how aspirin works for cardiovascular health,” he said, “and it has not been shown to be implicated in cancer at all.”

Instead, Voora and colleagues focused on a pattern of gene activity they call an aspirin response signature the team had previously developed. The signature identified a network of genes that correlated with platelet function and heart attack.

“This approach to comprehensively evaluate the actions of a drug using genomic data — as we have done here with aspirin — is a paradigm shift that could change how drugs are developed and positioned for clinical use, said co-author Geoffrey Ginsburg, M.D., director of the Center for Applied Genomics & Precision Medicine. “We intend to use this approach to explore the pleiotropic effects of drugs more broadly to anticipate their side effects and understand their full repertoire of actions clinically.”

Article Source: http://www.eurekalert.org/pub_releases/2016-09/dumc-rfm090716.php

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