Breast-fed children top the class: By age of five they show better academic development than those given formula, claim researchers

http://www.dailymail.co.uk/health/article-2527408/Breast-fed-children-class-age-five.html
By JENNY HOPE

Breastfeeding can boost a child’s educational performance within a few months of them starting school, researchers have claimed.

According to a study, children who were breast-fed showed better academic development by the time they were five than classmates who were given formula.

The research looked at assessments carried out by teachers at the end of year one – which revealed that children who were breast-fed for the longest reached the highest overall levels of achievement.

Importantly, the teachers making the assessments were not aware whether the children had been given mainly breast milk or formula milk.

A team led by the National Perinatal Epidemiology Unit at the University of Oxford said the study proved that breastfeeding children for longer periods could improve their performance at primary school.

Breastfeeding was linked to better achievement in all areas – but the gains were strongest in communication, language and literacy, knowledge and understanding of the world and physical development.

Breast-fed children also tended to get higher scores for personal, social and emotional development, problem solving, reasoning and numeracy and creative development.

The researchers said essential fatty acids in breast milk can help cognitive development, while babies not getting breast milk are more prone to infections – which could slow down their development.

The study, published in the journal Maternal and Child Nutrition, involved 5,489 children in England.

When their child was nine months old, mothers were interviewed about their breastfeeding habits.

Two thirds of the children had been breast-fed at some stage, 32 per cent had been breast-fed for at least four months and 16 per cent had been exclusively breast-fed for at least four months.

Educational achievement was measured using the Foundation Stage Profile – an assessment made by teachers at the end of the first year of school, before the child reaches their fifth birthday.

Teachers rated children on 13 scales covering six areas of development, with ratings based on continuous assessment throughout the year.

Half of all children in the study reached the expected standard of achievement for their age – but the figure was only 37 per cent for children who had never been breast-fed.

It was 49 per cent for those breast-fed for under two months, 56 per cent for those breast-fed for between two and four months and 60 per cent for those who were breast-fed for four months or more.

The results were adjusted to take into account factors such as the mother’s educational level, their socioeconomic status and their childcare arrangements.

Children breast-fed for up to two months were 9 per cent more likely to have reached a good level of overall achievement than children who had never been breast-fed.

Those breast-fed for between two and four months were 17 per cent more likely to have a good level of overall achievement and the effect was similar in children breast-fed for more than four months.

The study comes after the introduction of a controversial scheme, which gives women shop vouchers in return for breastfeeding. Currently one in four women in the UK does not attempt to breastfeed – one of the worst rates in the world.

A report on the research said: ‘The longer the children had been breast-fed, the more likely they were to have reached a good level of educational achievement at age 5 – an important predictor of later life academic and employment outcomes.’

11 EFFECTIVE HOME REMEDIES FOR HIGH CHOLESTEROL

http://greenyatrablog.com/11-effective-home-remedies-for-high-cholesterol-2/

High cholesterol or hypercholesterolemia is a disorder consisting in excess or surplus cholesterol in blood stream. Cholesterol is a wax like substance present in the cell walls or membranes all over the body. Our heart, brain, liver, skin, muscles, and intestines naturally bear cholesterol that produce certain hormones, bile acids and vitamin D needed to digest fat. However the requirement of cholesterol for the purpose is quite low. If the blood contains excess cholesterol, it may get deposited in major arteries like coronary arteries, carotid arteries to the brain or arteries that carry blood to legs, resulting in narrowing down or blockage of the passage way and decreased blood supply.

Blockage of coronary arteries leads to angina or chest pain and heart attack. This happens due to the accumulation of cholesterol on artery walls and deprivation of heart muscles of oxygen. Blockage of carotid artery by cholesterol deposits leads to brain stroke and blockage of arteries supplying blood to legs leads to claudication or pain with walking. Women after menopause and men below 55 are at the risk of developing hypercholesterolemia. LDL or bad cholesterol, HDL or good cholesterol and triglycerides make up for the total measure of cholesterol in the body. High cholesterol can be very dangerous, for it produces no symptoms. However some people with high cholesterol may have breathlessness, general fatigue, excessive sweating, heaviness in chest region, yellowish patches around eyelids, cholesterol deposits around cornea and whitish edges of cornea.

Factors Causing HDL

1. Aging
2. Heredity
3. Obesity
4. Sedentary life style
5. Intake of fat rich diet
6. Mental stress
7. Alcoholism
8. Smoking
9. Underlying diseases like thyroid, high blood pressure, diabetes, that of kidney, liver etc.

Home Remedies

1. Onion juice can lower cholesterol to a large extent.

2. Simply drinking 8-10 glasses of water can bring down cholesterol by enabling proper excretion.

3. Soy products, rich in isoflavones can effectively regulate cholesterol levels.

4. An infusion may be prepared by boiling 2 tablespoon coriander seeds in a glass of water. It has to be drunk thrice a day and can greatly lower cholesterol.

5. Sunflower seeds also regulate cholesterol levels to a large extent.

6. One may boil 10 cinnamon sticks in 6 cups water, add one tablespoon honey and drink while the solution is hot. This is a beneficial home remedy for lowering cholesterol.

7. Drinking a glass of water every morning by mixing one teaspoon lime juice and one teaspoon honey is an effective cholesterol lowering remedy.

8. Consuming fenugreek seeds would help to control high serum cholesterol.

9. Indian bedellium extracts have cholesterol lowering agents.

10. Almonds and walnuts can help to bring down cholesterol levels.

11. Fiber rich diet can keep cholesterol within check.

Killing cancer like the common cold

http://edition.cnn.com/2013/12/07/health/cohen-cancer-study/index.html?sr=fb120713cancer12p
By Elizabeth Cohen

(CNN) -- Nick Wilkins was diagnosed with leukemia when he was 4 years old, and when the cancer kept bouncing back, impervious to all the different treatments the doctors tried, his father sat him down for a talk.

John Wilkins explained to Nick, who was by then 14, that doctors had tried chemotherapy, radiation, even a bone marrow transplant from his sister.

"I explained to him that we're running out of options," Wilkins remembers telling his son.

There was one possible treatment they could try: an experimental therapy at the University of Pennsylvania.

He asked his son if he understood what it would mean if this treatment didn't work.

"He understood he could die," Wilkins says. "He was very stoic."

A few months later, Nick traveled from his home in Virginia to Philadelphia to become a part of the experiment.

This new therapy was decidedly different from the treatments he'd received before: Instead of attacking his cancer with poisons like chemotherapy and radiation, the Philadelphia doctors taught Nick's own immune cells to become more adept at killing the cancer.

Two months later, he emerged cancer-free. It's been six months since Nick, now 15, received the personalized cell therapy, and doctors still can find no trace of leukemia in his system.

Trusting her intuition led to two cancer diagnoses

Twenty-one other young people received the same treatment at The Children's Hospital of Philadelphia, and 18 of them, like Nick, went into complete remission -- one of them has been disease-free for 20 months. The Penn doctors released their findings this weekend at the annual meeting of the American Society of Hematology.

"It gives us hope that this is a cure," Nick's father says. "They're really close. I think they're really onto something."

'A whole new realm of medicine '

At the conference, two other cancer centers -- Memorial Sloan-Kettering in New York and the National Cancer Institute -- will be announcing results with immunotherapies like the one Nick received. The results are promising, especially considering that the patients had no success with practically every other therapy.

"This is absolutely one of the more exciting advances I've seen in cancer therapy in the last 20 years," said Dr. David Porter, a hematologist and oncologist at Penn. "We've entered into a whole new realm of medicine."

In the therapy, doctors first remove the patient's T-cells, which play a crucial role in the immune system. They then reprogram the cells by transferring in new genes. Once infused back into the body, each modified cell multiplies to 10,000 cells. These "hunter" cells then track down and kill the cancer in a patient's body.

Essentially, researchers are trying to train Nick's body to fight off cancer in much the same way our bodies fight off the common cold.

Tumor Paint: Changing the way surgeons fight cancer

In addition to the pediatric patients, Penn scientists tried the therapy out in 37 adults with leukemia, and 12 went into complete remission. Eight more patients went into partial remission and saw some improvements in their disease.

The treatment does make patients have flulike symptoms for a short period of time -- Nick got so sick he ended up in the intensive care unit for a day -- but patients are spared some of the more severe and long-lasting side effects of extensive chemotherapy.

Penn will now work with other medical centers to test the therapy in more patients, and they plan to try the therapy out in other types of blood cancers and later in solid tumors.

A university press release says it has a licensing relationship with the pharmaceutical company Novartis and "received significant financial benefit" from the trial, and Porter and other inventors of the technology "have benefited financially and/or may benefit financially in the future."

Searching for one-in-a-million cancer cells

The big question is whether Nick's leukemia will come back.

Doctors are cautiously optimistic. The studies have only been going on since 2010, but so far relapse rates have been relatively low: of the 18 other pediatric patients who went into complete remission, only five have relapsed and of the 12 adults who went into complete remission, only one relapsed. Some of the adult patients have been cancer-free and without a relapse for more than three years and counting.

Relapses after this personalized cell therapy may be more promising than relapses after chemotherapy or a bone marrow transplant, Porter explained.

First, doctors have been delighted to find the reengineered T-cells -- the ones that know how to hunt down and attack cancer -- are still alive in the patients' bodies after more than three years.

Stigma lingers for deadliest cancer

"The genetically modified T-cells have survived," Porter said. "They're still present and functional and have the ability to protect against recurrence."

Second, before declaring patients in remission, Penn doctors scoured especially hard for errant leukemia cells.

Traditionally, for the kind of leukemia Nick has, doctors can find one in 1,000 to one in 10,000 cancer cells. But Penn's technology could find one in 100,000 to one in a million cancer cells, and didn't find any in Nick or any of the patients who went into complete remission.

'It's not a fluke'

One of the best aspects of this new treatment is that it won't be terribly difficult to reproduce at other medical centers, Porter said, and one day, instead of being used only experimentally, it could be available to anyone who needed it.

"Our hope is that this can progress really quite quickly," he said. "It won't be available to everyone next year, but I don't think it would take a decade, either."

Right now patients can only get this therapy if they're in a study, but Dr. Renier Brentjens, director for cellular therapeutics at Memorial Sloan-Kettering, says he thinks it could become available to all patients in just three to five years.

"When you have three centers all with a substantial number of patients seeing the same thing -- that these cells work in this disease - you know it's not a fluke," he said.

Two days ago, Brentjens became the co-founder of Juno Therapeutics, a for-profit biotech start-up company that's working on immunotherapies.

"Fifteen years ago I was in the lab looking at these cells kill tumor cells in a petri dish and then I saw them kill tumor cells in mice, and then finally in humans," Brentjens said.

He says he'll never forget the first patient he treated, who initially had an enormous amount of cancer cells in his bone marrow. Then after the therapy, Brentjens looked under the microscope and, in awe, realized he couldn't find a single cancer cell.

"I can't describe what that's like," he said. "It's fantastic."

CNN's John Bonifield contributed to this report.

How sperm reveals if a man suspects INFIDELITY: Men produce extra ‘kamikaze fighters' to kill off competing sperm

http://www.dailymail.co.uk/sciencetech/article-2518022/How-sperm-reveals-man-suspects-CHEATING.html
By VICTORIA WOOLLASTON

If you think your partner is cheating on you, your sperm may give you and your suspicions away.

According to clinical sexologist Dr. Lindsey Doe, up to 40 per cent of male ejaculate is made up of so-called ‘kamikaze’ or ‘fighter sperm’ designed to prevent another man’s sperm from fertilising the egg.

When a man suspects their partner is being unfaithful, the number of these aggressive sperm increase to tackle this perceived threat.

Speaking to Hank Green on SciShow, Dr. Doe said: ‘Researchers have looked into the microscope and seen that maybe we have what are called kamikaze sperm; killer sperm; fighter sperm. 

‘40 per cent of sperm that is in an ejaculate are actually designed to fight off another man’s sperm.’

 

This means the fighter sperm isn’t designed to inseminate the egg. Instead its included purely to prevent another male’s sperm from doing so.

Dr. Doe describes this method of preventing other sperm from reaching the egg as ‘blocking’.

The fighter sperm use their tails as coils to set up traps by weaving them together to create walls and barricades.

Previous experiments believed these sperm were rigid because they had died or were weak.

Dr. Doe, who regularly presents the Sexplanations YouTube series, additionally said that some fighter sperm will go and attack any it sees as a threat in order to kill them. These particular fighter sperm are referred to as ‘kamikaze sperm’. 

When males suspect their partners are not being monogamous, Dr. Doe continued that their body will produce more ‘fighter sperm’ as the threat is perceived to be greater.

This does the job of increasing the level of protection against sperm from other males, however, it can significantly reduce the number of sperm whose job it is to inseminate the egg and therefore reduce the chances of the female getting pregnant at all.

Elsewhere, during ovulation, a woman’s ‘cervical plug’ transforms into channels that are approximately a sperm’s head wide. These then act as channels or 'ladders' for the sperm to climb closer to the egg. 

Studying sperm competition is difficult in lab conditions. By genetically engineering sperm of fruit flies to glow in the dark, pictured, researchers have at least been able to confirm the phenomenon takes place in certain species

Dr. Doe said that some of the older, fighter sperm additionally block these channels to stop another man’s sperm from entering.

Or they wait until a number of their own sperm enter the channel before blocking it off, giving those sperms a greater chance.

However, Dr. Doe did explain that this theory, known as sperm competition, is under debate and some deny happens at all.

Earlier this year, Professor John Belote from Syracuse University studied the mating habits of fruit flies by engineering glow-in-the-dark sperm.

In many species, including humans, when a female is promiscuous ejaculates from multiple males may be inside her reproductive tract at the same time, meaning they are competing to fertilise the egg.

This is called postcopulatory sexual selection and is a series of changes that take place in the sperm, and the female body.

However such changes are difficult to study in lab conditions.

By genetically altering the flies, Professor Belote created some with sperm heads that glow red, and others where the heads glow green.

He was then able to closely observe how sperms competed inside the female and times when the female tract rejected or discarded certain sperms to discover that the process does take place.

What does your pee say about your health? New diagram shows when to be alarmed - and what you might be suffering from

http://www.dailymail.co.uk/health/article-2518197/What-does-pee-say-health-New-diagram-shows-alarmed--suffering-from.html
By EMMA INNES

From healthy 'pale straw' to potentially dangerous 'brown ale', urine comes in a wide range of colours.

Now doctors at a U.S. medical centre have drawn up a diagram to illustrate what is normal and what is not.

The chart, developed at the Cleveland Clinic, in Ohio, says urine usually ranges from a deep amber or honey colour to a light straw colour, with many shades in between.

It says the colour of a person's urine says a lot about what is going on inside their body, and that people should take heed of its warnings.

The diagram shows that if a person's urine has no colour, it suggests they are drinking too much water and should consider cutting back.

If it is a pale straw colour, the person's water consumption is at a healthy level and they are well-hydrated.The same applies if their urine is transparent yellow.

However, if it is dark yellow, this suggests they should drink some water soon.

As a person becomes more dehydrated, their urine will turn an amber or honey colour.

This suggests they are not getting enough water and that they should drink some immediately.

The colour of a person's urine can also be influenced by factors other than hydration.

The diagram shows that if it is the colour of brown ale, this could be a sign of severe dehydration, but it could also be a sign of liver disease.

Experts recommend that if a person notices their urine is this colour, they should drink some water and visit their doctor if it persists.

Most people would, rightly, be concerned if their urine turned red.

The diagram shows that if a person has not just eaten beetroot, blueberries or rhubarb their urine should not be pink or red. If it is, they should visit a doctor as it could be a sign of blood.

This can be caused by kidney disease, tumours, prostate problems or a urinary tract infection.

It could even be a sign of mercury poisoning.

Having orange urine can also be suggestive of a problem.

The diagram shows it can be a sign of dehydrations but it could also be a symptom of a liver or bile duct condition.

In very rare cases, urine can turn blue or green.

This can be caused by food dye or medication, but it could also be indicative of a rare genetic disease or of bacteria in the urinary tract.

As a result, if a person's urine turns green, and stays that way, they are advised to visit a doctor.

Finally, some people notice their urine has turned 'fizzy'.

This can be caused by a harmless hydraulic effect, however, it can also be a sign of excessive protein in the diet, or of a kidney problem.

The picture that reveals why men and women's brains really ARE different: The connections that mean girls are made for multi-tasking

http://www.dailymail.co.uk/sciencetech/article-2516990/Sorry-chaps-brains-arent-multi-tasking-But-women-hard-wired-juggle-jobs.html
By BEN SPENCER

• Scientists used MRI imaging to scan the brains of young men and women
• Male brains are designed to make them better at carrying out single tasks
• While female brains are designed to carry out many tasks simultaneously
• Women are also better at socialising in busy situations, claims the study
• Younger brains have fewer gender differences compared to older brains

Scientists found women are better at multi-tasking but men are better at concentrating on a single task after they scanned the brains of 949 people (men's brains, top, and women's brains, bottom). Undated handout photo issued by National Academy of Sciences of brain networks showing significantly increased within hemispheres in males (upper) and between hemispheres in females (lower)

Women have known it for generations – and the proof has finally arrived.

Scientists have found that the female brain is ‘hard-wired’ to be better at multitasking.

Men’s brains, in comparison, are better at concentrating on single complex tasks – whether it be reading a map or cooking a meal.

Scientists scanned the brains of 949 young men and women in the biggest investigation of its kind to date. Using hi-tech diffusion MRI imaging, they mapped the connections between the different parts of the brains.

The researchers discovered that women have far better connections between the left and right sides of the brain, while men display more intense activity within the brain’s individual parts, especially in the cerebellum, which controls motor skills.

Men also have better connections between the front and back of the brain, giving them a better ability to quickly perceive information and use it immediately to carry out complex tasks.

This means they are better at things such as learning to swim or, as the old bone of contention has it, parking a car. Women are better at, for example, remembering a face, which means making connections between different parts of the brain.

The results are likely to be seen as  supporting the theory behind best-selling pop psychology book Men Are From Mars, Women Are From Venus – that the sexes are as different as alien races.

Dr Ragini Verma, who carried out the study with colleagues at the University of Pennsylvania, said: ‘Of course individuals will differ, always.

‘But we said, if you take 1,000 people and analyse the data statistically, what would the male brain look like and what would the female brain look like?’

She explained: ‘The research shows that if women and men are given a task that involves both logical thinking and intuitive thinking, women will do it better – they are better at connecting the left and the right sides of the brain.

‘If you have an instant action to be performed and you need to do it now, male brains are more attuned to it because the front-back action is more intensely connected.’

Speaking about men’s aptitude for motor skills, she said: ‘The intense activity in the cerebellum means men would be better at learning to ride a bike, learning to swim, reading maps.’

The study, involving 428 males and 521 females aged between eight and 22, found that female brains were better at bringing varied pieces of information together.

Dr Verma said: ‘If you had to do a task like remembering a face, picking somebody out in a party, that would require you to connect several parts of the brain. Where did I see that face last, what do I see in this person, do I remember this person from somewhere?

‘That requires the connection of various sub-networks in the brain – something women are better able to do.’

She said that although it has been known for some time that abilities differ by gender, the study showed that these differences are ‘hard-wired’.

‘These are connections that exist in your brain no matter what,’ she said.

‘Of course, individually, this will have variability. The next step would be to quantify this variability.’

The findings, published in the Proceedings of the National Academy of Sciences, also revealed that the difference between genders became pronounced only after puberty.

The participants were split into three age groups, aged eight to 13, 13 and four months to 16, and 17 to 22. The youngest group’s brains showed far less difference than those of the older two.

The report said: ‘The results showed fundamental sex differences in the architecture of the human brain.

‘Male brains facilitate connectivity between perception and co-ordinated action, whereas female brains facilitate communication between analytical and intuitive processing modes.'

7 Caffeine-Free Ways To Boost Your Energy

http://www.huffingtonpost.com/2013/11/18/boost-energy-without-caffeine_n_4267059.html?utm_hp_ref=healthy-living
By Laura Tedesco


Philipp Nemenz via Getty Images

When your energy level falls into the red zone, you probably reach for our culture's quick fix: caffeine. In fact, women in their 30s consume about 165 milligrams of the stuff each day, but by age 50, the daily average leaps to 225 milligrams, a recent USDA report reveals. "We have an energy crisis of historic proportions going on," says Dr. Jacob Teitelbaum, M.D., an internist and fatigue expert. "We are reaching for anything that will give us energy -- and we're over-relying on coffee now more than ever."

That said, scrapping your daily Starbucks isn't necessary -- the antioxidants in java are good for you -- but you shouldn't rely on a seven-cup habit to carry you through the day, either. That's just putting a bandage on your exhaustion. Instead, beat fatigue for real with these out-of-the-box energy boosters.

Pop a piece of gum.

Gum doesn't just refresh your breath -- it can also revitalize your body. In a 2012 study from the UK, people who chewed gum for 15 minutes felt more alert than those who didn't pop a piece. "Chewing gum increases heart rate, which increases blood flow to the brain," says study author Andy Smith, Ph.D. "It also stimulates the autonomic nervous system, which can increase alertness." Pick a mint-flavored pack: "Mint stimulates your nerve fibers -- it's kind of like splashing cold water on your face," says Teitelbaum.

Find your whole-grain sweet spot.



Carbs = crash, right? Yes -- but only if you eat the stripped-down kind that modern foods favor. "White flour will give you a boost, but then a crash so you feel sluggish," says Teitelbaum. "But whole grains give you real energy." In fact, people who replaced three servings of refined carbs with whole grains each day reported an increase in energy, a recent study in the journal Appetite found. More isn't better, though: Those who worked in six servings of good carbs just felt sluggish. Why? OD'ing on whole grains triggers a surge of serotonin, which makes you feel drowsy, explains Teitelbaum. 

Consider breakfast prime time for packing them in. In the study, people felt that front-loading their whole grains -- say, by eating whole-grain cereal and a slice of toast with breakfast (while still including protein, of course) -- made it easier to meet their quota.

Lighten up.



There's a reason darkness and bedtime go hand-in-hand: Bright light awakens your brain. But not all rays are equally stimulating. A 2013 study from the Lighting Research Center in New York found that red light is a stronger afternoon wake-up call than blue light. However, Teitelbaum cautions, "With red light, you'll have more of an irritable, edgy alertness, whereas with blue, you're going to have more of a calm alertness." (He likens it to a coffee buzz versus a green tea zen.) His advice: Install blue bulbs in your desk lamp (which you can switch on after lunch), and save red light for the bedroom, since edgy alertness can translate to sexual energy.

Learn something new.



It's 3 p.m. on a workday. How do you beat the slump? According to a recent University of Michigan study, the most common strategies are checking email, switching tasks, or making a to-do list. However, none of these tactics actually improved employees' sense of energy. What did: learning something new. 

"The more actively you can engage your brain, the more alerting an activity is going to be," says John Caldwell, Ph.D., a fatigue management specialist and former NASA researcher. "You can actually overcome a good bit of sleep pressure just by engaging in something interesting." So brush up on your Excel skills, for example, or listen to a short work-related podcast.

Plant a garden.



It’s no surprise that physical activity puts a pep in your step. But gardening -- which can count as a workout -- may have a leg up on the stationary bike. Why? It’s fun. "If you hate exercise, don't bother -- all you're going to do is quit, then feel guilty," says Teitelbaum. "Doing something you love is one of the most powerful ways to get sustained, healthy energy." Recent German research found that active hobbies, like gardening, are more energizing than sedentary ones, like reading. 

Digging in the dirt is especially stimulating: Skin-to-skin contact with soil can fight oxidative stress in your body, which, in turn, energizes you. "All the electrical devices in your house are linked to a wire that grounds them to the outside. People also need to ground," says Teitelbaum. "The act of touching soil is grounding -- the positive electrons flow out of your body, and negative charge flows from the earth." That's why he suggests ditching your gloves, or even better, going barefoot in your garden. This practice, called "earthing," may sound a little far-fetched, but regardless, research has proven that time outside is energizing.

Belt out your favorite song.



Ever noticed how cranking up the radio makes you drive faster? That's because music is energizing -- especially if you sing along. Researchers in London found that singing solo increases energetic arousal and decreases tension nearly as much as a cardio workout. "You disconnect from the big U-Haul of worries that people carry around with them," explains Teitelbaum. "You're just being free for a while." Choose a tune that really engages you -- the one that makes you want to sing at the top of your lungs. Then sing it, sister! Bonus if you get out of your chair for your solo: Caldwell's research shows that standing up can provide an instant surge of energy.

Massage your ears.



This one's a little wonky, but trust us, when you're dragging, you'll be all ears: Applying pressure to the outer rim of your ear may help invigorate your entire body, says Teitelbaum. That's because all of your body's "acupressure meridians" -- that is, your energy pathways -- pass through your outer ear. "Massaging the ear unites all of the meridians, and gets the energy flowing," he says. Simply pinch the rim of each ear between your thumb and pointer finger, and rub up and down for 10 to 30 seconds.

Lowering cholesterol under new clinical guidelines

Panel Unveils Shake-up in Strategy to Cut Heart Risk
Long-standing strategy jettisoned under new guidelines

http://online.wsj.com/news/articles/SB10001424052702304868404579194101530086112?mod=e2fb

By Ron Winslow

ByB

The current strategy of reducing a person's heart-attack risk by lowering cholesterol to specific targets is being jettisoned under new clinical guidelines unveiled Tuesday that mark the biggest shift in cardiovascular-disease prevention in nearly three decades.

The change could more than double the number of Americans who qualify for treatment with the cholesterol-cutting drugs known as statins.

The guidelines recommend abandoning the familiar and easy-to-understand guidance to keep LDL, or bad cholesterol, below 100 or below 70 for people at high risk—a mainstay of current prevention policy. Instead, doctors are being urged to assess a patient's risk more broadly and prescribe statins to those falling into one of four risk categories.

The aim is to more effectively direct statin treatment to patients with the most to gain, and move away from relatively arbitrary treatment targets that are less reliable in predicting risk of attack than is widely believed.

"We're trying to focus the most appropriate therapy to prevent heart attack and stroke...in a wide range of patients," said Neil J. Stone, professor of medicine at Northwestern University Feinberg School of Medicine and head of the panel that wrote the guidelines.

Cardiovascular disease is the Western world's leading killer. In the U.S., it accounts for about 600,000 deaths each year, or about one in four. About 130,000 Americans die annually of stroke.

Numerous studies show that statins reduce the risk of heart attack and stroke. But solid data demonstrating the benefit of reaching specific targets are lacking, said Dr. Stone.

While lowering the LDL number remains a critical goal, the focus is on the risk reduction achieved with statins rather than the effect on LDL, said Donald Lloyd-Jones, chief of preventive medicine at Northwestern and a member of the guidelines panel.

Cardiologists expect the recommendations, jointly developed by the American College of Cardiology and the American Heart Association, to substantially change the conversation between doctors and millions of patients over the best way to lower their risk of heart attack or stroke.

The risk groups identified in the guidelines include patients who have already had a heart attack, stroke or major symptoms of cardiovascular disease; those with an LDL of 190 or higher, which typically has a genetic cause; people with diabetes; and anyone ages 40 to 79 who faces a 7.5% risk of having a heart attack over the next 10 years, according to a new risk score. That score—with a lower threshold than under current guidelines—takes into account cholesterol level, smoking status, blood pressure and other factors.

All are recommended to take high or moderate statin doses that would result in LDL reductions of about 30% to more than 50%. If fully implemented, the guidelines could more than double the number of people who qualify for statins, to more than 30 million, the authors said.

The new approach is likely to have a modest immediate effect on the pharmaceutical industry. All but one of the statins available, including Lipitor, have lost patent protection and are available as inexpensive generics.

AstraZeneca AZN.LN +0.59% PLC's Crestor, the one remaining branded statin and the most powerful on the market, could get a boost from the recommendations. MerckMRK +0.52% & Co.'s Zetia, a non-statin cholesterol-reducer that is also an ingredient in Vytorin, could take a hit because the guidelines discourage use of agents that haven't been proven to reduce risk of bad events, unless patients can't tolerate the recommended level of statin treatment. Zetia hasn't been shown to reduce bad events even though it lowers LDL.

But both supporters and critics of the guidelines worry they will confuse patients and physicians, and disrupt an easy-to-understand and successful strategy. While statins haven't been the only factor, research shows there has been a significant reduction in heart attacks and death from cardiovascular disease in the past two decades since the drugs were introduced.

Having targets for LDL "gives doctors and patients something to shoot for" as well as a motivation to try to get there, said Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. "The elimination of target levels is going to be a huge change for physicians and patients," he said.

The authors of the guidelines say a change was needed because the numerical targets are too blunt a tool. The targets have never been tested in a clinical trial, but a review of the evidence suggested they could lead to undertreatment of some patients and overtreatment of others, doctors said.

For instance, a high-risk patient with an LDL of 180 who reduces it with a statin to 90 will substantially reduce his risk. Yet under current guidelines he may be viewed as failing therapy by not getting to 70. Doctors often prescribe additional, non-statin cholesterol agents for patients not reaching targets with a statin alone, but there is no evidence getting another 20 points lower would bring a further meaningful reduction in risk.

Similarly, said Dr. Lloyd-Jones, an older patient who had accumulated other risk factors but had an LDL of 99 might be missed under the current strategy, even though statins could offer significant benefit.

Statins "seem to work no matter what your lipids are," said Harlan Krumholz, a Yale University cardiologist, using a term referring to blood fats including cholesterol. He wasn't an author of the guidelines, but he has argued for moving away from LDL targets as a cornerstone of prevention. "Knowing your number can be useful in understanding your risk, but not in chasing it as a strategy to improve your outcome," he said.

Targeting LDL has been a strategy since the National Cholesterol Education Program was established to promote heart health in 1985. It became a dominant approach in the mid-1990s, after research demonstrated the ability of statins not only to lower LDL but to prevent heart attacks and death. As research linked higher doses of statins with further reductions in heart attacks, lower is better became the mantra for LDL.

Now, even without the emphasis on hitting LDL targets, the guidelines are expected to significantly boost statin use, in part because they add stroke reduction as a goal and thus include more women and minorities, who are more prone to strokes than heart attacks.

The researchers identified the 7.5% risk threshold as the point where the benefits of statin therapy to prevent first heart attacks or strokes clearly outweighed the risks, including muscle pain and a small risk of diabetes.

The cholesterol guideline was issued with three other heart-related recommendations to guide doctors on assessing risk, treating obesity and encouraging healthy diet and exercise habits.

The cholesterol document in particular is expected to generate controversy and will be discussed at a major session next week at the American Heart Association scientific meeting in Dallas.

"There will be a lot of controversy," said Dr. Stone, of Northwestern University. "You can't go anywhere new without creating a lot of questions. The hope is that we can answer those questions in a way that provides better patient care."

Write to Ron Winslow at ron.winslow@wsj.com

New guidelines urge wider use of cholesterol-lowering drugs to reduce heart attacks, strokes

http://www.washingtonpost.com/national/health-science/new-guidelines-urge-wider-use-of-cholesterol-lowering-drugs-to-reduce-heart-attacks-strokes/2013/11/12/4515de96-4bd7-11e3-bf60-c1ca136ae14a_story.html

By Associated Press

The American Heart Association and American College of Cardiology released new guidelines to prevent heart attacks and strokes, focusing on cholesterol-lowering statin drugs.

The nation’s first new guidelines in a decade for preventing heart attacks and strokes call for twice as many Americans — one-third of all adults — to consider taking cholesterol-lowering statin drugs.

The guidelines, issued Tuesday by the American Heart Association and American College of Cardiology, are a big change. They offer doctors a new formula for estimating a patient’s risk that includes many factors besides a high cholesterol level, the main focus now. The formula includes age, gender, race and factors such as whether someone smokes.

The guidelines for the first time take aim at strokes, not just heart attacks. Partly because of that, they set a lower threshold for using medicines to reduce risk.

The definition of high cholesterol isn’t changing, but the treatment goal is. Instead of aiming for a specific number, using whatever drugs get a patient there, the advice stresses statins such as Lipitor and Zocor and identifies four groups of people they help the most.

“The emphasis is to try to treat more appropriately,” said Dr. Neil Stone, the Northwestern University doctor who headed the cholesterol guideline panel. “We’re going to give statins to those who are the most likely to benefit.”

Doctors say the new approach will limit how many people with low heart risks are put on statins simply because of a cholesterol number. Yet under the new advice, 33 million Americans — 44 percent of men and 22 percent of women — would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for only about 15 percent of adults.

Some doctors not involved in writing the guidance worry that it will be tough to understand.

“It will be controversial, there’s no question about it. For as long as I remember, we’ve told physicians and patients we should treat their cholesterol to certain goal levels,” said the Cleveland Clinic’s Dr. Steven Nissen. “There is concern that there will be a lot of confusion about what to do.”

The government’s National Heart, Lung and Blood Institute appointed expert panels to write the new guidelines in 2008, but in June said it would leave drafting them to the Heart Association and College of Cardiology. New guidelines on lifestyle and obesity also came out Tuesday, and ones on blood pressure are coming soon.

Roughly half the cholesterol panel members have financial ties to makers of heart drugs, but panel leaders said no one with industry connections could vote on the recommendations.

“It is practically impossible to find a large group of outside experts in the field who have no relationships to industry,” said Dr. George Mensah of the heart institute. He called the guidelines “a very important step forward” based on solid evidence, and said the public should trust them.

Heart disease is the leading cause of death worldwide. High cholesterol leads to hardened arteries that can cause a heart attack or stroke. Most cholesterol is made by the liver, so diet changes have a limited effect on it.

Millions of Americans take statins, which reduce cholesterol dramatically and have other effects that more broadly lower the chances of heart trouble.

The patents on Lipitor, Zocor and other statins have expired, and they are widely available in generic versions for as little as a dime a day. One that is still under patent protection is AstraZeneca’s Crestor, which had sales of $8.3 billion in 2012.

Despite a small increased risk of muscle problems and accelerating diabetes in patients already at risk for it, statins are “remarkably safe drugs” whose benefits outweigh their risks, said Dr. Donald Lloyd-Jones, preventive-medicine chief at Northwestern.

Current guidelines say total cholesterol should be under 200, and LDL, or “bad cholesterol,” under l00. Other drugs such as niacin and fibrates are sometimes added to statins to try to reach those goals, but studies show they don’t always lower the chances of heart problems.

“Chasing numbers can lead us to using drugs that haven’t been proven to help patients. You can make someone’s lab test look better without making them better,” said Yale University cardiologist Dr. Harlan Krumholz, who has long urged the broader risk approach the new guidelines take.

They say statins do the most good for:

—People who already have heart disease.

—Those with LDL of 190 or higher, usually because of genetic risk.

—People ages 40 to 75 with Type 2 diabetes.

—People ages 40 to 75 who have an estimated 10-year risk of heart disease of 7.5 percent or higher, based on the new formula. (This means that for every 100 people with a similar risk profile, seven or eight would have a heart attack or stroke within 10 years.)

Aspirin — widely used to lower the risk of strokes and heart attacks — is not addressed in the guidelines. And many drugs other than statins are still recommended for certain people, such as those with high triglycerides.

Patients should not stop taking any heart drug without first checking with their doctor.

The guidelines also say:

—Adults 40 to 79 should get an estimate every four to six years of their chances of suffering a heart attack or stroke over the next decade using the new formula. It includes age, sex, race, cholesterol, blood pressure, diabetes and smoking. If risk remains unclear, doctors can consider family history or three other tests. The best one is a coronary artery calcium test, an X-ray to measure calcium in heart arteries.

—For those 20 to 59, an estimate of their lifetime risk of a heart attack or stroke can be considered using traditional factors like cholesterol and blood pressure to persuade them to change their lifestyle.

—To fight obesity, doctors should develop individualized weight loss plans including a moderately reduced calorie diet, exercise and behavior strategies. The best ones offer two or three in-person meetings a month for at least six months. Web or phone-based programs are a less-ideal option.

—Everyone should get at least 40 minutes of moderate to vigorous exercise three or four times a week.

—People should eat a “dietary pattern” focused on vegetables, fruits and whole grains. Include low-fat dairy products, poultry, fish, beans and healthy oils and nuts. Limit sweets, sweet drinks, red meat, saturated fat and salt.

“I don’t like the concept of ‘good foods’ and ‘bad foods,’” said Dr. Robert Eckel, a University of Colorado cardiologist who worked on the guidelines. “We really want to emphasize dietary patterns.”

Online:

Risk formula: http://my.americanheart.org/cvriskcalculator

Guidelines on cholesterol: http://bit.ly/1j2hDpH

Lifestyle: http://bit.ly/16ZnV7e

Overweight: http://bit.ly/1bsdFG2

Risk Assessment: http://bit.ly/19hzaV9

Cholesterol info: http://tinyurl.com/2dtc5vy

Heart facts: http://circ.ahajournals.org/content/127/1/e6

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Copyright 2013 The Associated Press. All rights reserved.