Interstroke Study published in the Lancet identified that 10 risk factors caused 88-90% of all strokes (both hemorrhagic and ischemic).
1. Hypertension
2. Current smoking
3. Low waist to hip ratio
4. Unhealthy diet
5. Lack of regular exercise
6. Moderate or high alcohol intake
7. Psychosocial stress
8. Depression
9. High ratio of apoB to apoA1 lipoprotein (i.e. high cholesterol)
10. Diabetes
Reference: Interstroke Study, Lancet
I am a vegetarian.
Often people are surprised and they ask me – “How do you get your proteins (i.e. without eating meat)?”
My answer – “Vegetables also contain proteins.”
Now a new study published in Circulation compared the blood pressure between individuals who ate vegetable protein (specifically glutamic acid along with 4 other amino acids which are relatively higher in vegetable than animal protein) with people who ate non-vegetable protein (read animal meat).
They found a difference of about -2.7/-2.0 mm Hg in blood pressure in people eating more vegetables. Although that may sound small, individual results may be different (and maybe higher for you).
Reference: Glutamic Acid, the Main Dietary Amino Acid, and Blood Pressure (The INTERMAP Study)
Watch this amazing video from the British Medical Journal archives:
“Richard Doll was a luminary of clinical research whose case control study, published in the BMJ in 1950, first identified smoking as an important cause of cancer and other diseases.
He carried his research out on doctors in the UK who smoked, and tracked their mortality over the course of 50 years. The latest paper being published in the BMJ in 2004.”
Smoking now is linked to a large number of disease and it affects virtually every organ system of the body.
Information on how to quit smoking from Medline Plus: Quitting Smoking
Statins are probably the best medications to reduce cholesterol level and also have associated anti-inflammatory activities. Both these properties lead to a marked decrease in atherosclerosis and related diseases.
Muscle pain is quite common in people (up to 10%) who take one of the several statins for lowering their cholesterol levels. However, there is no strict consensus on how to define, diagnose and manage such muscle pains.
The Annals of Internal Medicine recently published an excellent review on “Statin related myopathy.” Here is a brief summary of the article.
Definition:
There is no consensus definition. Each group (ACC/AHA, FDA etc) have their own definitions. For most clinical purposes the following definitions should be adequate:
Myopathy: Muscle disease with creatine kinase > 10 time upper limit
Rhabdomyolysis: Creatine kinase elevation with end organ damage
Pathophysiology:
Incompletely understood. Proposed mechanisms include:
Risk factors for developing myopathy:
Clinical Features:
Major site of muscle pain were in the thighs, calves or it was generalized. Pain was described as heaviness, stiffness or cramping and sometimes was associated with exertion. Physical exertion was a common trigger of myalgia. Tendon pain may also be present.
Management:
A recent meta-analysis published in the British Medical Journal compared the efficacy of different classes of blood pressure medications in preventing coronary artery disease (CAD) and stroke.
The investigators found that all blood pressure medicines are equally effective in preventing CAD and stroke.
Beta Blockers (e.g. metoprolol, carvedilol) were more effective in preventing future episodes of heart attacks in people who already had one. For primary prevention of CAD beta blockers were no more effective than other blood pressure lowering medications.
For 10mm reduction in systolic BP and 5mm diastolic BP:-
Risk reduction in CAD = 22%
Risk reduction in stroke = 41%
Calcium channel blockers (e.g. amlodipine) were slightly more effective in preventing stroke than other classes of medicines.
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