Cholesterol has been at the center of much research for a long time – ever since it was identified that stroke and heart attacks result from a process happening in blood vessels called atherosclerosis. What is Atherosclerosis? Atherosclerosis simply means hardening of the blood vessel walls; what it entails is a progressive deposition of cholesterol …View full post
See on Scoop.it – Nerve Health Sleep and wake times are strongly influenced by genetics. Dr Rajshekher‘s insight: Are you a morning lark or a night owl? New research is beginning to show that night-owls are more prone to depression and white matter lesions (something euphemistically labelled as ‘decreased white matter integrity’); but they are …View full post
See on Scoop.it – Nerve Health Studies of napping have shown improvement in cognitive function creative thinking and memory performance. Ready set . . . snooze. Dr Rajshekher‘s insight: Do you take cat naps during the day? I do: it helps me improve my thinking, concentration and memory for the rest of the day, not …View full post
Grandfather tells a story During our summer holidays, I loved going to our grand – parents’ home in the hills. I especially enjoyed the evenings when our grand – father would tuck us in and regale us with a story. Some of them would be short, while others would go on for days. Many …View full post
See on Scoop.it – Nerve Health MINNEAPOLIS Propelled by technological breakthroughs in neuroscience allowing researchers to monitor brain activity, the medical community is increasingly aware that meditation has beneficial physical effects on the brain. Dr Rajshekher‘s insight: I know and a lot of my friends, teachers, mentors, parent figures will second this one! Please let …View full post
See on Scoop.it – Nerve Health Den Of Geek The top 25 must-see movies of 2014 Den Of Geek Rosamund Pike co-stars (hopefully in better fitting clothes than she was made to wear in Jack Reacher), alongside Tyler Perry and Neil Patrick Harris, and the plan is for Fincher’s tenth… Dr Rajshekher‘s insight: A sneak-peak …View full post
See on Scoop.it – Nerve Health Europe’s best online university offers cutting-edge degree-programs & open enrolment courses incl. Motorsports-, Hospitality- and Luxury Management. Dr Rajshekher‘s insight: About Swiss eLearning Institute The adage ‘time is money’ is truer than ever in our modern world. With the fast-paced lifestyle that is the hallmark of busy people these …View full post
Nov 23 2013
Nov 22 2013
Nov 20 2013
Cholesterol has been at the center of much research for a long time – ever since it was identified that stroke and heart attacks result from a process happening in blood vessels called atherosclerosis.
What is Atherosclerosis?
Atherosclerosis simply means hardening of the blood vessel walls; what it entails is a progressive deposition of cholesterol in specific regions of the vessel wall with subsequent changes, all of which lead to formation of ‘plaques’ in the vessels walls. These plaques undergo further changes and can become unstable, rupture, and form clots or thrombus (plural, thrombi) on their surfaces.
The clots on the surfaces of these plaques can block the blood vessel or lead to “” in which the clot breaks up into smaller pieces of “emboli”, and these smaller pieces then migrate along the blood stream. A shower of such emboli can lodge in a smaller blood vessel, blocking it, and leading to damage to the underlying tissue ( a kind of damage called ischemic ).
This whole process of cholesterol deposition to plaque formation tomay take many years – so the time course for prevention can also work over many years. Prevention strategies are also aimed at different levels.
People who have diabetes and high blood pressure are more prone to develop the negative consequences of high cholesterol levels in the blood. Uncontrolled diabetes is especially potent in increasing the risk of heart disease and stroke through this mechanism.
One strategy to reduce the risk of stroke or heart disease is to lower the levels of cholesterol in the blood. This is not such a straight – forward goal as it may be thought.
Cholesterol does not enter or leave the body so easily. In fact, Cholesterol is entirely synthesized in the body – inside the liver, in fact. It travels around in the blood stream using different vehicles, called lipoproteins. We know these as ‘good cholesterol’ which is HDL (or High Density Lipoprotein), ‘bad cholesterol’ , which is LDL (or Low Density Lipoprotein), and so on. What we absorb from the diet are in fact the fatty acids which are used to synthesize cholesterol.
Beyond this, things in the Cholesterol World start getting murkier. Why isn’t it such a simple matter to reduce the cholesterol level in the blood? Why did a new Expert Panel have to come and change the guidelines and completely upset the apple cart?
Existing guidelines for lowering cholesterol
In the ATP III report, which published the existing guidelines for cholesterol control, lipid lowering was based on targets such as treat – to cholesterol target, lower cholesterol is better, and risk – based treatment approaches, etc. Over the last few decades, these guidelines spawned the use of many different drugs to lower cholesterol in people who were barely at risk for heart attack or stroke. If somebody had chest pain, bang, he had a Lipid profile done; if his LDL was over a 100 mg/dL, Bang! he was prescribed a statin. Even women in their thirties (pre-menopausal), who were always traditionally considered to be protected from heart disease were evaluated for heart disease.
It became fashionable for men and women in their twenties and thirties to undergo TMTs and Lipid Profile evaluations and for everyone to be on lipid lowering therapies. Based on the previous guidelines, an army of clinicians had broadened the scope of the guidelines to included more and more patients from diverse ethnic backgrounds and with minimal risk factor profiling to be treated with lipid lowering drugs.
Industry – Driven
A large part of this was industry – driven. The result of this was that a majority of results seen in trials was not replicated in real life. The Expert Panel was therefore constituted to exclude certain levels of evidence not considered robust enough, and to frame new guidelines based on only the best evidence, which basically means Randomized Controlled Trials (RCTs).
RCTs are limited in number at the moment, owing to the fact that they are difficult to design and expensive to conduct. The new set of guidelines are not comprehensive, nor do they entirely replace the older set of guidelines.
So What’s new in the Guideline?
Here is a link to the pdf to the Full Guideline on Circulation
- The Expert Panel recommended that Statins should be used in 4 identified “Benefit Groups” (see below)
- They do not support specific LDL – Cholesterol treatment targets
- They also do not support specific HDL – Cholesterol treatment targets
- For the “Benefit Groups” Statin therapy should be used in appropriate intensity/dose
- Non – statin therapy not recommended
- They recommend a new Pooled Cohort Equation to estimate 10 year risk for heart disease or stroke
The 4 “Benefit Groups” identified by the Expert Panel are:
- Those with clinical Atherosclerotic Cardiovascular disease i. e., those who had a heart attack past or present, or unstable/stable angina, those having undergone a coronary revascularization procedure such as or bypass, those who had a stroke or TIA, or those with peripheral vascular disease
- Those whose LDL – C levels are >= 190 mg/dL
- Diabetes aged 40 – 75 years, with LDL – C between 70 – 189 mg/dL even without clinical evidence of Atherosclerotic Cardiovascular Disease i.e., never had heart attack or stroke
- Those with an estimated risk of heart attack/stroke/peripheral vascular disease using the new Pooled Cohort Equation > 7.5% (even if they don’t have Diabetes and elevated LDL – C).
The factors considered in this Risk Estimator are: Gender, Age, Race, Total Cholesterol, HDL – C, Systolic BP, Treatment for BP, Diabetes, and (Whether or not a) Smoker.
Submit your information using the form below, and I will get back to you with your Heart Attack and Stroke Risk Estimation using the Pooled Cohort Equation created by the Expert Panel.
I am working on getting this latest Pooled Cohort Equation online for my readers to use.
Nov 18 2013
Sleep and wake times are strongly influenced by genetics.
Are you a morning lark or a night owl? New research is beginning to show that night-owls are more prone to depression and white matter lesions (something euphemistically labelled as ‘decreased white matter integrity’); but they are also identified as people who are more productive, with greater analytical ability, have more stamina throughout the day, have greater reasoning abilities, and so on. I don’t know: with recent demands of business and work in my life, I have changed from a morning lark to a night lark/owl! Do you want to know what role genetics plays in this? Do you want to know how to override the infulence of genetics on our sleep pattern and on our circadian rhythms? Then this article is definitely for you!!
See on www.psychologytoday.com
Nov 18 2013
Studies of napping have shown improvement in cognitive function creative thinking and memory performance. Ready set . . . snooze.
Do you take cat naps during the day? I do: it helps me improve my thinking, concentration and memory for the rest of the day, not to speak of behaviour, mood, and performance. Here is some scientific information to support your pet activity!
See on m.fastcompany.com
Nov 12 2013
Grandfather tells a story
During our summer holidays, I loved going to our grand – parents’ home in the hills. I especially enjoyed the evenings when our grand – father would tuck us in and regale us with a story. Some of them would be short, while others would go on for days. Many of them were later on adapted for TV serials – though I suspect it could have been the other way around. But the fun part of it was the way he told them; he would be totally absorbed, he would make animal noises, and change his voice to suit character, the mood and the moment. He had been an actor at one time, but then he got married; and you know what happens after that: somebody else takes over all the talking part.
How the story began
The story I am about to tell is one such, and was especially meaningful, because we had had an argument over arriving late for appointments. Grandpa had had a stint with the Army, which had made him a stickler for time all his life, as old – timers tend to be, and many of his stories centered around the importance of being on time. This one is a lot more than just that, but it started with that.
Getting late for the Doctor’s appointment
We had planned a visit to the village fair for a couple of hours before the scheduled appointment with the doctor. I learnt that day that village fairs cannot be planned affairs. That is, you can plan when you enter, but you cannot plan your exit time. We ended up spending rather more time and money than we intended, with the result that we were several hours late for the doctor’s appointment. Another thing: in villages, loud protestations will usually get you into the doctor’s room, but grandpa was really peeved by this behavior. This seemed to rankle in his mind even after dinner, because he was talking about it even at bed – time.
The Troubled King
It was story – telling time, so he started it in the same mood.”You know,” he began, “this reminds me of the story about this kingdom in the foothills of the Himalayas. The King was very benevolent and just, and most of the kingdom was peaceful and prosperous. But the region right at the foothills was not so very prosperous; the people living there were mostly tribes. The land was not very easy to cultivate, it was barren. The hills did not provide an easy living, and the people lived in hardship. There were many small tribes and they were in constant war and conflict. It was a big headache for the king, and he could do very little for their uplift. He worried about it night and day, and dearly wished some way could be found to improve the situation.
“Now, in the foot-hills lived a mendicant, a detached soul. In all such stories, you will always find such characters – they provide you a contrast from the other characters who are either greedy, or jealous, or selfish, or cruel.”
The Raging River
“There, in the foot-hills, also was a river – not a very helpful river, I am afraid! It was in spate most years – during the monsoon, it flooded the region, and people lost their lives trying to swim across it. They could not save their crops due to the flooding. They dearly wanted a dam to be built, and a bridge over it; but the lack of peace in the region meant that such construction was not easily possible. It was at best a treacherous proposition.
To Build a Dam
“The King, hearing about the Monk, and learning he was well – respected, and hoping he would be the right person to find a way for the improvement of this region, summoned this mendicant, and asked him what could be done. The Monk spelled out the needs of the region – the dam and the bridge to be built, the cost and the resources that would be needed. The King instantly sanctioned everything. ‘What else?’ he asked of the Monk. ‘I will,’ said the Monk, ‘ speak to the leaders of that region and make sure they cooperate.’ In this way a plan was hatched for improvement of this region.
The Minister Arrives
“One day, a Minister arrived at the Monk’s hermitage. He was the King’s envoy, bringing with him the requisite gold and resources for constructing the dam and the bridge. He was, however, a day late; the Monk’s disciples informed him that after waiting for him till late evening, their Gurudev had left at night for the foothills, to attend another meeting – it was a secret meeting they knew nothing about, the only thing they knew was that he would be back the following day.
The Construction Begins
“The minister was very angry for not being received and for being made to wait. When the Monk returned, he fussed and fumed. He threatened to return without handing over the things the King had sent. Before the Monk could explain anything, he ordered his soldiers to put him in chains, and thereafter began construction of the bridge.
“Over the next few weeks, work started at a fast pace and the soldiers, who were well – trained, started building the dam. But soon they were faced with resistance. The warring tribes began sabotaging their work. They would find the work done in the morning undone by night. Their best engineers would be found dead with their throats slit. Some of their laborers were ambushed.
“The commander in charge of construction summoned the Minister, who panicked and informed the King. When the King heard the Monk had been put in chains, he rushed to the spot, freed him, begged him for his forgiveness, and asked him to explain everything.
“With folded hands, the Monk explained, ‘O King! On that day, when Mantriji came with his entourage, I was to meet the opposing war – lords of the major tribes in the region. They have been at war for centuries. A glimmer of hope was appearing at that time. The daughter of one is madly in love with the son of another. I was negotiating between them to join this young couple in wedlock. Should these two tribes unite through marriage, peace could reign in the Valley. To me, peace in the Valley through this marriage is far more important than the dam through your money; so which meeting was more important? When Mantriji got delayed, I had no choice but to let him be received by my disciples. But these chains didn’t allow me to complete the negotiations, and lead to the unfortunate events that followed.’
“Off With His Head”
“The King turned to the minister, trembling with rage, and for a few terrifying moments everyone thought that was the end of Mantriji. Gradually, the King controlled his breathing, and then said, ‘Mantriji, if I were to be as impatient and angry as you were, your head would roll on the ground. But as the just ruler of this kingdom, I give you one chance to undo what has happened here.’
All’s Well That Ends Well
“So the humbled Minister then set about to make peace between the warring tribes, and then with their help completed the construction of the dam and bridge over the river, which helped control it, preventing floods, bringing peace, harmony, and prosperity to the region.”
Nov 05 2013
MINNEAPOLIS Propelled by technological breakthroughs in neuroscience allowing researchers to monitor brain activity, the medical community is increasingly aware that meditation has beneficial physical effects on the brain.
I know and a lot of my friends, teachers, mentors, parent figures will second this one! Please let me know what you think through the comment sections!
See on www.timesdispatch.com
Nov 05 2013
Den Of Geek The top 25 must-see movies of 2014 Den Of Geek Rosamund Pike co-stars (hopefully in better fitting clothes than she was made to wear in Jack Reacher), alongside Tyler Perry and Neil Patrick Harris, and the plan is for Fincher’s tenth…
A sneak-peak at the 25 top Hollywood movies to look-out for in 2014 – or, more realistically, the author’s list of what he thinks should be on the list – have a look and let me know if it excites you as much as it did me!
See on www.denofgeek.com
Nov 04 2013
Europe’s best online university offers cutting-edge degree-programs & open enrolment courses incl. Motorsports-, Hospitality- and Luxury Management.
About Swiss eLearning Institute
The adage ‘time is money’ is truer than ever in our modern world. With the fast-paced lifestyle that is the hallmark of busy people these days, there is precious little time left to fit in the things we would like to do, especially with regards to education and the enhancement of personal knowledge. Traditional education courses require a commitment in time and resources that many of us don’t have – not only do you have to go to class at a fixed time and place, there is also the need to consider travelling times too. All of this represents a large frame of time just for attending class, never mind the time you need for studying!
See on www.smcuniversity.com
Oct 31 2013