Antioxidants May Not Help Alzheimer's Patients

Clickbank Products Antioxidants May Not Help Alzheimer's Patients



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By Steven Reinberg
HealthDay Reporter

MONDAY, March 19 (HealthDay News) -- Researchers have suggested that antioxidants might help thwart Alzheimer's disease, but a new study finds that a "cocktail" of vitamins E, vitamin C and alpha-lipoic acid has no effect on certain indicators of the brain disorder.

The supplements may even have hastened mental decline, the researchers said.

"The benefit on oxidative stress in the brain was small and is of unclear significance," said lead researcher Dr. Douglas Galasko, a professor in residence in the department of neurosciences at the University of California, San Diego.

"Patients did not show cognitive improvement in this short-term study; in fact, there was a slight worsening on one test of cognition in patients who received the antioxidant combination," Galasko said.

Aging causes oxidative damage in the brain, which is extensive in people with Alzheimer's disease. Clinical trials looking at whether a diet rich in antioxidants could reduce that risk have had mixed results, the researchers said.

This study does not support using any of these antioxidants once a diagnosis is made of established Alzheimer's disease, Galasko said. "If antioxidants continue to be tested against Alzheimer's disease, newer approaches or drugs may be needed," he said.

This study, published in the March 19 online edition of the Archives of Neurology, does not address whether taking antioxidants could help to prevent Alzheimer's disease, he noted. Alzheimer's disease is the most common form of dementia among older people.

For the study, Galasko's team gave antioxidant supplements to 78 patients with Alzheimer's disease who were part of a study funded by the U.S. National Institute on Aging. The patients were placed into three groups. One group received daily doses of vitamin E, vitamin C and alpha-lipoic acid. A second group was given coenzyme Q (a compound made naturally in the body to protect cells from damage) three times a day. The third group received a placebo. After 16 weeks, 66 patients had their cerebrospinal fluid analyzed.

Among the three groups, the researchers found no difference in markers related to Alzheimer's disease in the cerebrospinal fluid. These markers included the amyloid-beta protein and the proteins tau and P-tau.

Galasko's group did see lower levels of one marker called F2-isoprostane, which could indicate a reduction in oxidative stress in the brain. However, the use of vitamins might have increased the pace of the disease, causing faster decline in mental ability, they cautioned.

Greg Cole, associate director of the Alzheimer's Disease Research Center at the University of California, Los Angeles David Geffen School of Medicine, said that vitamin E alone has shown some limited benefits in Alzheimer patients, but with no evidence that it really works to reduce oxidative damage, and that alpha lipoate -- a form of alpha-lipoic acid -- alone has also had some reported benefits, he said.

"Unfortunately, these researchers found no impact on pathological protein levels, and in their small group of patients, their cognitive function actually declined more than in the placebo group," Cole noted.

The increased cognitive decline might be due to random variation, he said, "or it may be a surprising but real adverse effect from something as seemingly innocuous as an antioxidant cocktail."

His research group has seen similar adverse effects from some, but not all, antioxidant mixes, he said.

"This should be a caution to the supplement manufacturers who typically sell products throwing in some mix of what seems like a great group of sensible antioxidants," he added. "Everyone assumes that they will work well together and are good for you, but they don't test them."

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Douglas R. Galasko, M.D., professor in residence, Department of Neurosciences, University of California, San Diego; Greg M. Cole, Ph.D., neuroscientist, Greater Los Angeles VA Healthcare System, and associate director, Alzheimer's Disease Research Center, University of California, Los Angeles, David Geffen School of Medicine; March 19, 2012, Archives of Neurology, online

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FDA Mulls Expanding Patients' Access to Certain Drugs

Clickbank Products FDA Mulls Expanding Patients' Access to Certain Drugs



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By Amanda Gardner
HealthDay Reporter

THURSDAY, March 22 (HealthDay News) -- Americans troubled by a range of ailments might someday more easily obtain medications that are now only available by prescription.

On Thursday and Friday, experts at the U.S. Food and Drug Administration (FDA) are holding hearings on whether to expand the availability of certain prescription drugs by giving them "conditional" over-the-counter, or OTC, status.

The details of the new plan are sketchy, but certain drugs used to treat such conditions as high blood pressure, high cholesterol, diabetes, asthma and migraine may no longer require a prescription.

Dispensing of these drugs would vary on a case-by-case basis and would include "conditions of safe use," possibly to be determined by the consumer with the help of a pharmacist.

"There are a lot of unanswered questions right now but we're advocating that the pharmacist would be involved with the patient as they . . . determine if the product is right for them," explained pharmacist Ronna Hauser, vice president of policy and regulatory affairs at the National Community Pharmacists Association. "The information would be relayed back to a physician if necessary."

According to Brian Gallagher, senior vice president of government affairs at the American Pharmacists Association, many of the discussions that have taken place with the FDA on the issue so far have involved emergency medications, such as asthma inhalers.

For example, he said, "if someone had already had an inhaler [prescribed] and they had it confiscated at the airport, they could go in, talk to their pharmacist who has access to medical records and get a refill on their inhaler," he said.

Farther down the road, the plan might give pharmacists the ability to screen a person who has already been diagnosed with high blood pressure by their doctor and restart them on medication if needed.

"The pharmacist could urge them to go see a physician before they get into a really bad situation," Gallagher added.

The idea behind the plan is to get millions of untreated or undertreated Americans back into the health care system, experts said.

The move is being driven partly by computer technology, such as the touch-screen kiosks found in pharmacies that help patients self-diagnose common diseases, an idea that has raised inevitable concerns about patient safety.

But the kiosks, said Gallagher, would be less for self-diagnosing than for making decisions in conjunction with a pharmacist in the drug store.

"It might say 'You need to see a doctor right away' rather than 'I've made a diagnosis. Here's some medication,'" Gallagher said.

In particular, concerns about drug interactions, specifically interactions that would lessen the effectiveness of certain cancer drugs, have been voiced.

Without knowing details of the new initiative, Diane Pinakiewicz, president of the National Patient Safety Foundation, said the intent of making it easier for patients to obtain certain types of medications for certain types of conditions is "reasonable."

"Patients today are better informed and want to play a more active role and that's what we're trying to encourage patients to do," she said. "Patient engagement is a key piece of patient care."

But coordination of care with a physician is still critical, she added.

Dr. Sandra Adamson Fryhofer, chair-elect of the American Medical Association's Council on Science and Public Health, testified at the hearing Thursday and expressed concern about the potential lack of physician involvement.

"A patient's confidence in their physician and the prescriber's emphasis on the need to take the medicine as prescribed is one of the most motivating influences in promoting medication adherence," she explained in a statement. "For a program to be successful on this front, it must be delivered by a trusted source, be personalized to the patient's situation, reinforce medical need and expected outcomes, segment and target at-risk populations and reinforce and reward initiation and maintenance of treatment," Fryhofer added.

"We also have concerns about patients taking certain drugs without physician involvement, especially for patients with chronic disease," she continued.

"While the increased availability of certain prescription-based antidotes, such as Epi-Pens [which administer adrenaline for severe allergic reaction], appear to have few if any safety concerns, the FDA has not offered evidence that patients with hypertension [high blood pressure], hyperlipidemia [high cholesterol], asthma or migraine headaches can self-diagnose and manage these serious chronic medical conditions safely on their own," Fryhofer stated.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Brian Gallagher, R.Ph., J.D., senior vice president, government affairs, American Pharmacists Association; Ronna Hauser, Pharm.D., vice president of policy and regulatory affairs, National Community Pharmacists Association; Diane Pinakiewicz, president, National Patient Safety Foundation; statement of Sandra Adamson Fryhofer, M.D., chair-elect, Council on Science and Public Health, American Medical Association

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Medicaid Patients Go to ERs More Often: Study

Clickbank Products Medicaid Patients Go to ERs More Often: Study



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MONDAY, March 19 (HealthDay News) -- Medicaid patients have more difficulty getting primary care and visit hospital emergency departments more often than those with private insurance, a new study finds.

An analysis of data from more than 230,000 adults who took part in the U.S. National Health Interview Survey between 1999 and 2009 showed that about 16 percent of Medicaid beneficiaries had one or more barriers to primary care, compared to 9 percent of people with private insurance.

Barriers to care included not being able to reach a doctor by phone, not being able to get a timely appointment with a doctor, and lack of transportation to the doctor's office.

The researchers also found that nearly 40 percent of Medicaid patients visited a hospital emergency department during the previous year, compared with 18 percent of patients with private insurance.

When the researchers looked at all patients with barriers to primary care, they found that Medicaid patients still were more likely to visit the emergency department than those with private insurance.

Among patients with two or more barriers to primary care, 61 percent of Medicaid patients and 29 percent of privately insured patients visited a hospital emergency department during the previous year.

The study was published online in the Annals of Emergency Medicine.

"Even those Medicaid patients who have primary care physicians -- and that is less likely than for people with private insurance -- report significant barriers to seeing their doctor," senior study author Dr. Adit Ginde, of the University of Colorado School of Medicine, said in a journal news release.

"Medicaid patients tend to visit the ER more, partly because they tend to be in poorer health overall," Ginde added. "But they also visit the ER more because they can't see their primary care provider in a timely fashion or at all."

"The efforts by some states to keep Medicaid patients out of the ER do not take this lack of access to primary care into account," Dr. David Seaberg, president of the American College of Emergency Physicians, said in the news release. "It puts both patients and providers into an impossible position that will only get worse as more people enroll in Medicaid."

-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCE: Annals of Emergency Medicine, news release, March 14, 2012

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Low-Dose Daily Aspirin Enough to Help Heart Attack Patients: Study

Clickbank Products Low-Dose Daily Aspirin Enough to Help Heart Attack Patients: Study



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SATURDAY, March 24 (HealthDay News) -- Heart attack patients who take either a high or low dose of aspirin daily have the same level of protection against another heart attack or other cardiovascular events such as stroke, according to a new study.

Along with anti-clotting drugs, a daily aspirin is recommended for nearly all of the more than one million Americans who suffer a heart attack each year, but the most effective dose hasn't been determined.

Higher doses of aspirin typically come with higher bleeding risks, so determining whether a high dose is needed or not has patient safety implications.

To clarify the issue, researchers analyzed data from more than 11,000 heart attack patients around the world who were prescribed either a low daily dose (150 milligrams or less) or a high daily dose (more than 150 milligrams) of aspirin along with anti-clotting medications.

The findings were to be presented Saturday at the annual meeting of the American College of Cardiology in Chicago.

"We observed no difference between patients taking a high dose versus a low dose of aspirin as it relates to cardiovascular death, heart attack, stroke or stent thrombosis [clot]," lead author Dr. Payal Kohli, a cardiology fellow at Brigham and Women's Hospital, said in a hospital news release.

"Interestingly, we did find a dramatic difference in practice patterns of physicians in North America compared to those in the rest of the world," Kohli added. "North American physicians prescribed a high dose of aspirin for two-thirds of all their patients, while the exact reverse was true of the rest of the world. International physicians prescribed a low dose of aspirin to more than two-thirds of their patients."

Patients who received high doses of aspirin were more likely to have cardiac risk factors and higher cholesterol levels, while those who received low doses were more likely to be white and have no prior history of high blood pressure.

One expert said the study confirms there is "no role for high-dose aspirin" in this type of scenario. Dr. Jenifer Yu, a cardiologist and research fellow at Mount Sinai Medical Center in New York City, said she and her colleagues published similar findings at the American Heart Association annual meeting in 2011.

In that study, "after adjusting for baseline differences in the two groups, we found that the use of high-dose aspirin (greater than 200 milligrams) afforded no additional protection with respect to ischemic events [such as heart attack or stroke] in comparison to low-dose aspirin (less than 200 milligrams)," Yu noted. "However, patients on high-dose aspirin experienced more major bleeding," she added.

The newer study from Brigham & Women's also found that the anti-clotting drug prasugrel (brand name Effient) was more effective at preventing major cardiovascular events than the anti-clotting drug clopidogrel (brand name Plavix), regardless of whether patients took low- or high-dose aspirin.

Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCES: Jenifer Yu, M.B.B.S., F.R.A.C.P., cardiologist and research fellow at Mount Sinai Medical Center, New York City; Brigham & Women's Hospital, news release, March 24, 2012

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Showing Patients Images of Their Clogged Arteries a Powerful Wake-Up Call

Clickbank Products Showing Patients Images of Their Clogged Arteries a Powerful Wake-Up Call



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SATURDAY, March 24 (HealthDay News) -- Showing patients with clogged arteries evidence of their condition makes them more likely to stick with treatments such as weight loss and cholesterol-lowering statins, two related studies found.

Coronary artery disease is the most common type of heart disease in Americans, but many patients fail to adhere to therapies that can treat or prevent heart disease. For example, patient compliance with statin therapy has been reported to be as low as 20 percent to 50 percent, the researchers said.

The two studies included patients who underwent coronary artery calcium scoring with cardiac CT, a test that takes clear, detailed pictures of the heart.

Patients with the most severe coronary artery disease who saw images of their heart were 2.5 times more likely to take statins as directed, and more than three times more likely to lose weight as those whose scans showed little or no evidence of disease.

The studies were scheduled for presentation Saturday at the American College of Cardiology (ACC) annual meeting in Chicago.

"Beyond the diagnostic and predictive value of cardiac computed tomography, it is also quite beneficial in terms of motivating people to pursue behaviors that we know result in a reduction in cardiovascular" disease and death, Dr. Nove Kalia, one of the lead investigators for both studies, said in an ACC news release.

"Seeing a coronary artery calcium scan gives patients a visual picture of how severe their disease is, and this picture seems to have a really big impact," Kalia added. "With increasing use of noninvasive imaging, it seems we already have a powerful tool in helping to motivate patients to be compliant. While we haven't clarified whether this increased compliance results in reductions in [heart] event rates, we have extrapolated that this would likely be the case. I think we may find this can also help improve outcomes."

-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCE: American College of Cardiology, news release, March 24, 2012

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