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Cholesterol-lowering drugs and the risk of hemorrhagic stroke

Contact: Angela Babb
ababb@aan.com
651-695-2789
American Academy of Neurology

ST. PAUL, Minn. – People taking cholesterol-lowering drugs such as atorvastatin after a stroke may be at an increased risk of hemorrhagic stroke, or bleeding in the brain, a risk not found in patients taking statins who have never had a stroke. But researchers caution the risk must be balanced against the much larger overall benefit of the statin in reducing the total risk of a second stroke and other cardiovascular events when making treatment decisions. The research is published in the December 12, 2007, online issue of Neurology®, the medical journal of the American Academy of Neurology.

For the study, researchers conducted a secondary analysis of the results of the Stroke Prevention with Aggressive Reduction in Cholesterol Levels (SPARCL) clinical trial. The trial enrolled 4,731 people who were within one to six months of having had a stroke or transient ischemic attack, or mini-stroke, and with no history of heart disease. Half of the participants received atorvastatin and half received a placebo. The participants were then followed for an average of four and a half years.

Overall, treatment was associated with a 16-percent reduction in total stroke, the study’s primary endpoint, as well as significant reductions in coronary heart events. However, secondary analysis found that the overall reduction in stroke included an increase in the risk of brain hemorrhage. Of those people randomized to atorvastatin, the study found 2.3 percent experienced a hemorrhagic stroke during the study compared to 1.4 percent of those taking placebo. The study also found there was a 21-percent reduction in ischemic stroke, a more common type of stroke involving a block in the blood supply to the brain, among people taking atorvastatin.

Other factors were also found to increase the risk of brain hemorrhage. For example, those who had experienced a hemorrhagic stroke prior to the study were more than five times as likely to suffer a second stroke of this kind. Men were also nearly twice as likely as women to suffer a hemorrhagic stroke. People with severe high blood pressure at their last doctor’s visit prior to the hemorrhagic stroke had over six times the risk of those with normal blood pressure.

“Although treatment of patients with a stroke or transient ischemic attack was clearly associated with an overall reduction in a second stroke, hemorrhagic stroke was more frequent in people treated with atorvastatin, in those with a prior hemorrhagic stroke, in men and in those with uncontrolled hypertension,” according to study author Larry B. Goldstein, MD, with Duke University Medical Center in Durham, North Carolina, and Fellow of the American Academy of Neurology. “This risk of hemorrhagic stroke also increased with age.”

“Treatment with atorvastatin did not disproportionately increase the frequency of brain hemorrhage associated with these other factors. The risk of hemorrhage in patients who have had a transient ischemic attack or stroke must be balanced against the benefits of cholesterol-lowering drugs in reducing the overall risk of a second stroke, as well as other cardiovascular events,” said Goldstein.

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The SPARCL trial was funded by Pfizer, the maker of atorvastatin.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit http://www.aan.com.

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December 13, 2007 Posted by | American Academy of Neurology, Baltimore, Barcelona, Bethesda, Boston, Calgary, Canada, FMS Global News, France, Germany, Global, Global Health Vision, Global News, Hemorrhagic Stroke, Italy, London, London UK Feed, Medical Journals, Newfoundland, News, News Australia, News Canada, News France, News Germany, News Israel, News Italy, News Jerusalem, News Switzerland, News UK, News US, News USA, Nova Scotia, Ottawa, Ottawa City Feed, Quebec, Research, RSS Feed, Slovakia, Spain, Statin Drugs, Stroke, Toronto, Toronto City Feed, UK, US, Virginia, Washington DC, Washington DC City Feed, World News | , , | Leave a comment

New gene mutation identified in common type of dementia

ST. PAUL, MN — Researchers have identified a new gene mutation linked to frontotemporal dementia, according to a study published in the July 10, 2007 issue of Neurology®, the medical journal of the American Academy of Neurology.

Frontotemporal dementia, one form of which is known as Pick’s disease, involves progressive shrinking of the areas of the brain that control behavior and language. Symptoms include language problems and personality changes, often with inappropriate social behavior. Unlike Alzheimer’s disease dementia, the disease does not affect memory in the early stages. The genetic form of the disease is rare; most cases occur randomly.

“We are hopeful that this finding will help us better understand how this disease works and eventually help us develop new therapies for the disease,” said study author Amalia Bruni, MD, of the Regional Neurogenetic Centre in Lamezia Terme, Italy.

The researchers discovered a new mutation in the gene named progranulin in an extended family in southern Italy. The genealogy of this family has been reconstructed for 15 generations, going back to the 16th century; 36 family members have had frontotemporal dementia. For this study, DNA tests were conducted on 70 family members, including 13 people with the disease. “This is an important result that we pursued for more than 10 years,” said study co-author Ekaterina Rogaeva, PhD, with the Centre for Research in Neurodegenerative Diseases at the University of Toronto.

The mutation identified in this study is in a gene on chromosome 17. The mutation leads to a loss of progranulin, a protein growth factor that helps brain cells survive. The mutation causes only half of the protein to be produced, because only one copy of the gene is active. Production of too much progranulin has been associated with cancer.

The new gene mutation was found in nine of those family members with the disease and 10 people who are currently too young to have the symptoms of the disease. But four people with the disease did not have the gene mutation. Bruni noted that these four people belong to a branch of the family with the disease in at least three generations. “These results are intriguing, since the family has two genetically distinct diseases that appear almost identical,” said Bruni.

The Italian family had no cases with two copies of the mutated gene. “We would have expected to see cases with two copies of the mutated gene, especially since this family shares much of the same genetic material, as there have been at least five marriages between first cousins over the years,” Bruni said. “It’s possible that loss of both copies of the progranulin gene leads to the death of embryos, and that’s why there were no cases with two copies of the mutated gene.”

“Another intriguing aspect in this Italian family is the variable age at onset, which ranged from 35 to 87 years in the family members who inherited the same mutation. Our future research will try to identify the modifying factors responsible for the severity of the disorder,” said Rogaeva.

Rogaeva says their studies will also try to identify the second gene responsible for dementia in this family.

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The study was supported by grants from the Canadian Institutes of Health Research, Howard Hughes Medical Institute, Canada Foundation for Innovation, Japan-Canada and Canadian Institutes of Health Research Joint Health Research Program, Parkinson Society of Canada, W. Garfield Weston Fellows, Japanese Society for the Promotion of Science, National Institute on Aging Intramural Program, Italian Ministry of Health, and the Calabria Regional Health Department.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit http://www.aan.com.

Contacts:

Angela Babb
ababb@aan.com
651-695-2789

Robin Stinnett
rstinnett@aan.com
651-695-2763

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July 10, 2007 Posted by | Alberta, Alzheimers, Baltimore, Barcelona, Bethesda, Calabria Regional Health Department, Calgary, Canadian Institutes of Health Research, Cancer, Chromosome 17, Epilepsy, Genes, Genetic, Genetic Link, Genetics, Global, Global Health Vision, Global News, Howard Hughes Medical Institute, Italy, Japanese Society for the Promotion of Science, Joint Health Research Program, Lamezia Terme, Multiple Sclerosis, Neurodegenerative Diseases, News, News Australia, News Canada, News Israel, News Italy, News Jerusalem, News Switzerland, News UK, News US, News USA, Ottawa, Parkinson Society of Canada, Parkinson's, Pick's Disease, Progranulin, Protein Growth Factor, Research, RSS, RSS Feed, Stroke, The American Academy of Neurology, Toronto, University of Toronto, Virginia, W. Garfield Weston Fellows, WASHINGTON, Washington DC, Washington DC City Feed, World News | Leave a comment

New Risk Factors Discovered for Alzheimer’s Disease

Pittsburgh, Pa. – July 06, 2007 – A recent study in Journal of Neuroimaging suggests that cognitively normal adults exhibiting atrophy of their temporal lobe or damage to blood vessels in the brain are more likely to develop Alzheimer’s disease. Older adults showing signs of both conditions were seven-times more likely to develop Alzheimer’s than their peers.

“Alzheimer’s disease, a highly debilitating and ultimately fatal neurological disease, is already associated with other risk factors such as poor cognitive scores, education or health conditions,” says study author Caterina Rosano. “This study, because it focused on healthy, cognitively normal adults, shows that there other risk factors we need to consider.”

MRI images of participants’ brains were examined to identify poor brain circulation, damaged blood vessels and/or atrophy of the medial temporal lobe. Subjects showing any one or a combination of these symptoms were more likely to develop Alzheimer’s in the following years.

“Similarly to heart disease, brain blood vessel damage is more likely to occur in patients with high blood pressure, high cholesterol or diabetes,” says Rosano. “Since we know that prevention of these conditions can lower risk of heart attack and stroke, it is likely that it would also lower the risk of developing Alzheimer’s.”

This study is published in Journal of Neuroimaging. Media wishing to receive a PDF of this article may contact medicalnews@bos.blackwellpublishing.net.

Dr. Caterina Rosano is a physician neuroepidemiologist and assistant professor of epidemiology with the Center for Aging and Population Health at the University of Pittsburgh. She is currently developing a model to predict the incidence of cognitive and physical functional limitations in older adults. She can be reached for questions at rosanoc@edc.pitt.edu .

Journal of Neuroimaging addresses the full spectrum of human nervous system disease including stroke, neoplasia, degenerative and demyelinating disease, epilepsy, infectious disease, toxic-metabolic disease, psychoses, dementias, heredo-familial disease and trauma. Each issue offers original clinical articles, case reports, articles on advances in experimental research, technology updates, and neuroimaging CPCs. For more information, please visit http://www.blackwellpublishing.com/jon.

Wiley-Blackwell was formed in February 2007 as a result of the merger between Blackwell Publishing Ltd. and John Wiley & Sons, Inc.’s Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,250 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit http://www.blackwellpublishing.com or http://interscience.wiley.com.

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July 6, 2007 Posted by | Alberta, Alzheimers, Baltimore, Barcelona, Bethesda, Blackwell Publishing Ltd., Calgary, Global, Global Health Vision, Global News, Heart Disease, Irvine, Japan, Medical Journals, Neurology, News, News Australia, News Canada, News Israel, News Jerusalem, News UK, News US, News USA, Osaka, Research, Research Australia, Slovakia, Spain, Stroke, University of Pittsburgh, Virginia, WASHINGTON, Washington DC, World News | Leave a comment

Online education program better source of information for patients

Contact: Karen Astle
karen.astle@heart.org
214-706-1392
American Heart Association

American Heart Association meeting report

WASHINGTON, May 11 – Patients who used the American Heart Association’s online heart disease education program were more aware of treatment options than other patients, researchers reported at the American Heart Association’s 8th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

Those who used Heart ProfilersTM — the American Heart Association’s Internet-based education program developed with Thomson Healthcare — also were more likely to ask their doctors about their care, according to survey results. Researchers examined the association between use of the Heart Profilers program and patient knowledge and behavior. Patients with coronary artery disease (CAD), atrial fibrillation (AF), heart failure (HF), high cholesterol or hypertension who registered to use Heart Profilers were invited to answer an Internet questionnaire. Their responses were compared with a randomly selected control group who had not used the Heart Profilers.

“Patients who used the Heart Profilers, particularly those with HF and AF, reported a greater understanding of their heart medications than other heart patients who used other Internet sources,” said Ileana Piña, M.D., professor of medicine at Case Western Reserve University and senior author on the study.

“Patient education and empowerment are key pathways in reducing complications of cardiovascular disease,” she said.

“The Heart Profilers tool empowers patients to take control and manage their condition by providing personalized information in lay language so patients have a complete picture of their condition and treatments relevant to their diagnosis profile.”

Chronic disease is an ever-growing problem among patients with heart disease. Patient education is critical for improving compliance and for patients to partner with their health care providers in managing their own cardiovascular issues. The Heart Profilers provide accurate information in lay language in the safe setting of the home.

Upon registration with Heart Profilers, patients are asked to complete a questionnaire to receive a free, confidential, personalized treatment options report. Users receive information, based on peer-reviewed, scientifically based literature, regarding success rates of various treatment options, potential medication side effects and questions to ask their healthcare providers. Patients also have access to medical journal abstracts and research studies written in an easy-to-understand format.

“Again, this format takes the patient to accurate and up-to-date information,” Piña said. “Other Internet sites may be replete with misinformation. It may be difficult for the average patient to separate accurate education from false information. The trust in the American Heart Association allows them to be confident in what education they receive and access for themselves.”

Researchers divided respondents into three groups: those who completed the Heart Profiler questionnaire (users), those who registered but did not complete it (registrants) and a control sample of non-users with one of the five heart conditions, who were identified via a nationally representative telephone survey, (controls). There were 1,039 users, 389 registrants and 1,564 controls.

Users and registrants were younger (average age 53.9 and 55.9 years) versus controls (average age 64.4). Nearly half of users and registrants held a four-year college degree, compared to one-third of controls. Users took 2.8 heart medications, registrants took 3.0 and controls 2.3. However, they had a similar number of heart conditions.

Consistent with their greater understanding of medications, HF and AF patients reported a greater tendency to use their medications as prescribed by their doctor, researchers said.

“It’s beneficial for patients to be educated in this way,” Piña said. “When patients understand the different treatment options available to them, they can become more active participants in their healthcare decision-making by asking appropriate questions and understanding what their doctor is telling them.

“In essence, when there is a two-way dialogue between patient and doctor (referred to as ‘shared decision-making’), there is a greater chance that patients believe treatment decisions made with the doctor are the best for them personally. When patients believe the treatment is the right one, they will be more likely to stick with it,” she added.

“This is the same logic for having better knowledge about medications — if you believe in the necessity and importance of the medication, you will be more likely to take it as prescribed,” Piña said.

According to researchers, users were 1.58 times more likely than controls to be aware of four or more AF treatments. And they were 1.56 times more likely to ask their doctors about medications or treatments that they had heard about outside the doctor’s office.

Heart Profilers seemed to benefit patients with HF and AF more than others, possibly because “HF and AF are more chronic conditions, so they have a greater impact on overall health and functioning and patients may be more symptomatic,” Piña said. “Patients literally feel these conditions more, whereas you don’t feel high cholesterol. Therefore, when patients with HF and AF access the Heart Profilers, they may be ready to make more active use of the information provided than other patients. Physicians are increasingly expected to provide education for patients with chronic cardiovascular diseases. Heart Profilers can serve as a powerful adjunct for physicians to recommend to their patients, as well.”

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Co-authors are lead author Kathleen A. Foley, Ph.D.; Gayle R. Whitman R.N., Ph.D. and Karen Robb. Disclosure: Thomson Healthcare, co-developer of the Heart Profilers, is the leading provider of decision support solutions that help organizations across the healthcare industry improve clinical and business performance. Thomson Healthcare products and services help clinicians, hospitals, employers, health plans, government agencies and pharmaceutical companies manage the cost and improve the quality of healthcare. Thomson Healthcare is a part of The Thomson Corporation.

Editor’s Note: Patient and Professional Heart Profilers® have been developed for the following topics: Coronary Artery Disease (CAD), Heart Failure, Atrial Fibrillation, Cholesterol and High Blood Pressure (HBP). These tools can be accessed on the American Heart Association main Web site at americanheart.org/heartprofilers.

Statements and conclusions of abstract authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The associations make no representation or warranty as to their accuracy or reliability.

Note: Presentation time is 9:30–11 a.m. EDT, May 11, 2007.

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May 11, 2007 Posted by | American Heart Association, Cardiovascular Disease, Global, Global Health Vision, Global News, News, Stroke, WASHINGTON, Washington DC | 1 Comment