LiveLongAgeWell

If you have high cholesterol, and are taking or considering taking (prescription) “statin” medication to lower cholesterol and decrease heart attack risk, you might be interested in this large Israeli study. The results suggested that those who faithfully took their statin medication over a four- to five-year period had a significantly lower death rate (45 percent) than those who took their medication only occasionally. It’s interesting research—worth talking to your doctor about if you are in a high risk group—but it’s not a perfect study. It may be that those who took their medication faithfully also took better care of themselves in other ways, and those other ways were more responsible for their better survival than the statin drug.

(This dedicated to my brother for his birthday today…he’s a faithful and accomplished marathon runner. I hope he avoids cataracts based on his running, because he doesn’t use sunglasses, and that increases his risk.) Particularly if you have a family history of AMD (age-related macular degeneration, the biggest cause for blindness in adults) or cataracts, you will be interested to know that people who run faithfully may have a much decreased risk of developing those eye diseases. For example, one report showed that those who run over 4 kilometers per day (2.5 miles) cut their risk of AMD by up to 54 percent. Much more detail here.

Do you know people who still smoke, and are crazy about their pets? More about this later, but it seems that pets really suffer the effects of secondhand smoke too, and that many smokers might be motivated to quit once they realize they are harming their pets!

To Live Long and Age Well, it’s a good idea to avoid unnecessary radiation, and for most people, that means unnecessary CT scans. A typical CT scan results in much greater radiation exposure than a regular X-ray.

One new test, the cardiac 64-slice CT scan is used to look for blockages in the arteries of the heart, which indicate heart attack or high risk of heart attack. These scans give fantastic 3-D images, like the one below. You might see this or a CT brochure and think: I want one! But don’t be mesmerized by color and hype, because medicine is also a business, subject to market forces.

Cardiac CT scanning is often used in cases when someone comes to the emergency room with chest pain, and the doctor wants to know if the pain is due to a blocked coronary artery or some other cause. The use of this scan has tripled in the past two years, and the cardiac CT commonly exposes the patient to the equivalent radiation as 600 regular chest X-rays. Still, this scan can give much useful information, but due to the radiation exposure, you only want it when it’s really needed and when other less risky tests aren’t adequate.

Doctors are trained to always balance the risk of any procedure or test with the benefits received (the risk: benefit ratio), but the companies that sell the equipment do their best to convince doctors that the benefits are high, and the risks low. And doctors—used to being pushed around and mistreated by insurance companies—can be seduced by the fawning attention of the medical device sales force.

Last week in the Journal of the American Medical Association (JAMA), a report was issued by a group of American and German researchers, who evaluated how much radiation patients were exposed to while undergoing the 64-slice cardiac CT scans, and they found the radiation exposure varied from center to center by a factor of six, meaning a patient at some X-ray facilities received six times the radiation dose as someone having the same test at another center.

One reason for this center-to-center difference is that several new radiation-lowering techniques are available, but some centers don’t use them. It’s still not clear yet which are the best methods to lower the dosage, but it would be good to know your facility was employing at least one of those methods.

Below are some basic questions you might ask if a CT is recommended for you or a loved one. (Of course in an emergency situation, you might not want—or be in a position—to question the necessity of the test.)

1. Could another test, one without radiation exposure such as MRI or ultrasound, be done instead of the CT? If the answer is: “The CT is better.” then you might ask: How much better? Does the difference between CT and the other test justify the radiation exposure?

2. If you have already had a CT scan of the same type and your doctor orders a repeat scan, question him/her carefully if another scan is truly necessary.

3. Explain you have read about the radiation dose from CT and you want to go to a facility that takes measures (or has a “protocol”) to diminish unnecessary radiation.

For more detailed questions, check this link.

If you ever wondered if restaurant and workplace indoor smoking bans have really improved the public health—beyond just clearing the air—consider this dramatic recent study from the Centers for Disease Control and Prevention (CDC). The authors found that after three years of an indoor smoking ban in Pueblo, Colorado, local heart attack hospital admissions dropped 41%. This large drop in the rate of heart attacks is surprising and unexpected, so let’s look at the study closer to see if the conclusions are accurate and reliable.

When doctors read a medical research report, particularly one with unexpected findings, they should examine how the study was done (“study design”), to see if there were any defects, and if so, how serious they were…are they enough that the conclusions can’t be trusted? Unfortunately, many medical studies have bad design, but often that fact is not reported in the media article.

Fortunately the scientists at the CDC are good, and this study was well designed. For example, the researchers studied what is called a control group at the same time they studied the people in Pueblo. The control group was two other municipal areas close to Pueblo which did not enact a smoking ban. They looked at their heart attack rates also, and found no drop as there was in Pueblo. So most likely, the smoking ban was responsible for the big drop in heart attacks.

Actually there have been eight studies before this one looking at the same issue, and all have shown a rapid drop in heart attacks following a smoking ban, but only this CDC study covered a long time period.

Often when we think of the bad effects of cigarettes, we think about lung cancer, but this study emphasizes how smoke seriously affects our hearts also. If we want to live long, one hint is to stay clear of it. Wherever you are—inside or outside—this study suggests that it’s really worthwhile to move away…