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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Vitamin D-3 could ‘reverse’ damage to heart

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By probing the effect that vitamin D-3 has on the cells that make up the lining of blood vessels, scientists at Ohio University in Athens, OH, have identified for the first time the role that the “sunshine vitamin” plays in preserving cardiovascular health.

In a paper published in the International Journal of Nanomedicine, they describe how they used nanosensors and a cell model to identify the molecular mechanisms that vitamin D-3 can trigger in the endothelium, which is the thin layer of tissue that lines blood vessels.

It was previously believed that the endothelium served no other purpose than to act as an inert “wrapper” of the vascular system, allowing both water and electrolytes to pass in and out of the bloodstream.

However, advances over the past 30 years have revealed that the endothelium acts more like an organ that lines the whole of the circulatory system from the “heart to the smallest capillaries,” and whose cells carry out many unique biological functions.

Changes to the endothelium have been linked to several serious health problems, including high blood pressure, insulin resistance, diabetes, tumor growth, virus infections, and atherosclerosis, which is a condition wherein fatty deposits can build up inside arteries and increase the risk of heart attack and stroke.

Vitamin D-3 has role beyond bone health

The new study suggests that vitamin D-3 — a version of vitamin D that our bodies produce naturally when we expose our skin to the sun — plays a key role in preserving and restoring the damage to the endothelium that occurs in these diseases.

Some other natural sources of vitamin D-3 include egg yolks and oily fish. It is also obtainable in the form of supplements. Vitamin D-3 is already well-known for its role in bone health.

“However,” explains senior author Tadeusz Malinski, a professor in the department of chemistry and biochemistry, “in recent years, in clinical settings people recognize that many patients who have a heart attack will have a deficiency of D-3.”

“It doesn’t mean that the deficiency caused the heart attack,” he adds, “but it increased the risk of heart attack.”

Nanosensors probed effect of D-3 on cells

For their study, Prof. Malinski and colleagues developed a measuring system using nanosensors, or tiny probes that are 1,000 times smaller than the thickness of human hair and can operate at the level of atoms and molecules.

They used the nanosensors to track the impact of vitamin D-3 on molecular mechanisms in human endothelial cells that had been treated to show the same type of damage that occurs from high blood pressure.

The findings suggest that vitamin D-3 is a powerful trigger of nitric oxide, which is a molecule that plays an important signaling role in the control of blood flow and the formation of blood clots in blood vessels.

The researchers also found that vitamin D-3 significantly reduces oxidative stress in the vascular system.

They note that their study “provides direct molecular insight to previously published observations that have suggested that vitamin D-3 deficiency-induced hypertension is associated with vascular oxidative stress.” The effects of vitamin D-3 were similar in both Caucasian and African American endothelial cells.

Could D-3 reverse cardiovascular damage?

The study authors note that while their findings came from tests performed on a cellular model of high blood pressure, “[T]he implications of the influence of vitamin D-3 on dysfunctional endothelium is much broader.”

They suggest that vitamin D-3 has the potential to significantly reverse the damage that high blood pressure, diabetes, atherosclerosis, and other diseases inflict on the cardiovascular system.

“There are not many,” Prof. Malinski adds, “if any, known systems which can be used to restore cardiovascular endothelial cells which are already damaged, and vitamin D-3 can do it.”

 

Article Source: https://www.medicalnewstoday.com/articles/320802.php

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Testosterone Therapy Beneficial to Men with Heart Disease

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New study finds that testosterone supplementation enables a reduction in the risks of major cardiovascular events, such as strokes, heart attacks, and death.

In a recent study, a research team from the Intermountain Medical Center Heart Institute studied 755 male patients, ranging from 58-78 years, who all had severe coronary artery disease, the most common type of heart disease. They were separated into three different groups, receiving varied doses of testosterone, administered intravenously or by gel. At the end of the first year, 64 patients who weren’t taking any testosterone supplements had serious adverse cardiovascular events, whereas only 12 who were taking medium doses of testosterone and 9 who were taking high doses did. At the end of 3 years, 125 patients who had not received testosterone therapy suffered severe cardiovascular events, whereas only 38 medium-dose and 22 high-patients did. Patients who were given testosterone as part of their follow-up treatment did much better than patients who had not been given testosterone supplementation. The non-testosterone-therapy patients were 80 percent more likely to suffer an adverse event. “Although this study indicates that hypo-androgenic men with coronary artery disease might actually be protected by testosterone replacement, this is an observational study that doesn’t provide enough evidence to justify changing treatment recommendations,” said Dr. Muhlestein, co-director of cardiovascular research at the Intermountain Medical Center Heart Institute. “It does, however, substantiate the need for a randomized clinical trial that can confirm or refute the results of this study.” This new study confirms the findings of a previous study from the Intermountain Medical Center Heart Institute, which found that testosterone therapy did not increase the risk of experiencing a heart attack or stroke for men with low testosterone levels and no prior history of heart disease.

The Intermountain Medical Center research team will presented their study at the American College of Cardiology’s 65th Annual Scientific Session on Sunday, April 3 at 12:15 p.m., CDT.

The Intermountain Medical Center Heart Institute is made up of clinical and research professionals who aim to advance cardiovascular treatment. Intermountain Medical Center is the flagship facility for the Intermountain Healthcare system, which is based in Salt Lake City.

Article Source: https://www.worldhealth.net/news/testosterone-supplementation-beneficial-men-heart-/

 

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Testosterone decline associated with increased mortality risk

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Men experiencing a pronounced, age-related decline in testosterone level are more likely to die of any cause during a 15-year period vs. men who have testosterone levels in the 10th to 90th percentile, according to findings reported in the European Journal of Endocrinology.

Stine A. Holmboe, MSc, a doctoral student in the department of growth and reproduction at the University of Copenhagen, Denmark, and colleagues analyzed data from 1,167 men aged 30 to 60 years participating in the Danish Monitoring Trends and Determinants of Cardiovascular Disease (MONICA1) study, conducted between November 1982 and February 1984, as well as the follow-up examination 10 years later (MONICA10), conducted between 1993 and 1994. Researchers measured levels of testosterone, sex hormone-binding globulin and luteinizing hormone at baseline and follow-up, and then followed the cohort for up to 18 years (mean, 15.2 years) using data from national mortality registries. Researchers used Cox proportional hazard models, with age as the underlying time scale, to assess the association between intra-individual hormone changes and all-cause, CVD and cancer mortality.

During follow-up, 421 men (36.1%) died (106 cancer-related deaths; 119 CVD-related deaths). The estimated mean intra-individual percentage change in hormone levels per year for the cohort were –1.5% for total testosterone, 0.9% for SHBG, –1.9% for free testosterone and 1% for luteinizing hormone. When estimated cross-sectionally, however, mean percentage changes in hormone levels per year were –0.4% for total testosterone, 1.2% for SHBG, –1.1% for free testosterone and 1.1% for luteinizing hormone, according to researchers.

Researchers observed that men who experienced the most pronounced decline in total testosterone — men in the lowest 10th percentile — saw the greatest increased risk for all-cause mortality (HR = 1.6; 95% CI, 1.08-2.38) vs. the reference category. The risk corresponded with an annual total testosterone decline of at least –0.6 nmol/L.

Across tertiles of SHBG levels, researchers found no significant differences in all-cause mortality; however, there was a U-shaped trend observed, with increases in all-cause mortality for those with a change in SHBG levels below the 10th percentile (< –0.7 nmol/L per year) or above the 90th percentile (> 1.1 nmol/L per year) vs. the middle group.

Men with the most pronounced decline in free testosterone also saw an increased risk for all-cause mortality; however, this was significant only in the tertile model (HR = 1.45; 95% CI, 1.09-1.92), according to researchers. There were no disease-specific associations observed, and associations were independent of age, baseline hormone levels and lifestyle factors.

“A possible causal link between an increased tempo in age-related [testosterone] decline and subsequent health is unknown and remains to be investigated,” the researchers wrote. – by Regina Schaffer

Article Source: https://www.healio.com/endocrinology/reproduction-androgen-disorders/news/in-the-journals/%7Bb9ffabec-a385-4c19-b01b-4981f05e01d1%7D/testosterone-decline-associated-with-increased-mortality-risk

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The Benefits of High Cholesterol

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People with high cholesterol live the longest.

This statement seems so incredible that it takes a long time to clear one´s brainwashed mind to fully understand its importance.

Yet the fact that people with high cholesterol live the longest emerges clearly from many scientific papers.

Consider the finding of Dr. Harlan Krumholz of the Department of Cardiovascular Medicine at Yale University, who reported in 1994 that old people with low cholesterol died twice as often from a heart attack as did old people with a high cholesterol.

Supporters of the cholesterol campaign consistently ignore his observation, or consider it as a rare exception, produced by chance among a huge number of studies finding the opposite.

But it is not an exception; there are now a large number of findings that contradict the lipid hypothesis.

To be more specific, most studies of old people have shown that high cholesterol is not a risk factor for coronary heart disease.

This was the result of my search in the Medline database for studies addressing that question.

Eleven studies of old people came up with that result, and a further seven studies found that high cholesterol did not predict all-cause mortality either.

Now consider that more than 90 % of all cardiovascular disease is seen in people above age 60 and that almost all studies have found that high cholesterol is not a risk factor for women.

This means that high cholesterol is only a risk factor for less than 5 % of those who die from a heart attack.

But there is more comfort for those who have high cholesterol; six of the studies found that total mortality was inversely associated with either total or LDL-cholesterol, or both.

This means that it is actually much better to have high than to have low cholesterol if you want to live to be very old.

High Cholesterol Protects Against Infection

Many studies have found that low cholesterol is in certain respects worse than high cholesterol.

For instance, in 19 large studies of more than 68,000 deaths, reviewed by Professor David R. Jacobs and his co-workers from the Division of Epidemiology at the University of Minnesota, low cholesterol predicted an increased risk of dying from gastrointestinal and respiratory diseases.

Most gastrointestinal and respiratory diseases have an infectious origin.

Therefore, a relevant question is whether it is the infection that lowers cholesterol or the low cholesterol that predisposes to infection?

To answer this question Professor Jacobs and his group, together with Dr. Carlos Iribarren, followed more than 100,000 healthy individuals in the San Francisco area for fifteen years.

At the end of the study those who had low cholesterol at the start of the study had more often been admitted to the hospital because of an infectious disease.

This finding cannot be explained away with the argument that the infection had caused cholesterol to go down, because how could low cholesterol, recorded when these people were without any evidence of infection, be caused by a disease they had not yet encountered?

Isn´t it more likely that low cholesterol in some way made them more vulnerable to infection, or that high cholesterol protected those who did not become infected? Much evidence exists to support that interpretation.

Written By: Uffe Ravnskov, MD, PhD

Article Source: https://www.functionalmedicineuniversity.com/public/924.cfm

 

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Exercise can boost brain power, prevent heart damage

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Looking for a magic elixir for health? There’s more evidence exercise may be it, improving thinking skills in older adults and protecting against heart damage in obese people, two separate studies published Monday show.

“Exercise has many, many benefits. … I don’t know that we fully understand why it has so many beneficial effects for so many organs and systems,” Dr. Roberta Florido, a cardiology fellow at the Johns Hopkins Hospital, told TODAY, as she listed some of the other known benefits, including improving depression, lowering blood pressure and strengthening muscles.

“We should do a better job of telling our patients to exercise,” she added.

In the first paper, published in the British Journal of Sports Medicine, researchers at the University of Canberra in Australia analyzed 39 previous studies looking into the effect of exercise on thinking skills in people over 50. That included things like memory, alertness and the ability to quickly process information.

They found physical activity improved all of those skills regardless of a person’s cognitive status.

The key was 45-60 minutes of moderate to vigorous exercise per session “on as many days of the week as feasible.” A combination of both aerobic exercise and resistance training worked best.

Each type of exercise seemed to have different effects on the factors responsible for the growth of new neurons and blood vessels in the brain, said co-author Joe Northey, a PhD student at the University of Canberra Research Institute for Sport and Exercise.

Tai chi was also helpful, though more evidence is needed to confirm this effect, the researchers note.

“Age is a risk factor no one can avoid when it comes to cognitive decline,” Northey said. “As our study shows, undertaking just a few days of moderate intensity aerobic and resistance training during the week is a simple and effective way to improve the way your brain functions.

Written By: A. Pawlowski

Article Source: http://www.today.com/health/exercise-can-boost-thinking-skills-protect-against-heart-damage-t110740

 

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