All the women were without cardiovascular
disease or diabetes mellitus at baseline, and were evaluated
annually. Information was collected on age,
ethnicity, body mass index (BMI), waist circumference,
physical activity, tobacco and alcohol use, family history
of diabetes, and current hormone use. Blood levels of
TNF-cx-R2, IL-6, and hsCRP were also measured at baseline.
Baseline insulin resistance was estimated from
basal fasting glucose and insulin plasma levels using the
homeostasis model assessment (HOMA-IR). Outcome
of new-onset diabetes was defined as self-report of
new diabetes treatment with oral hypoglycemic drugs
or insulin, or hospitalization for diabetes during the
follow-up period.
Results: Over the follow-up period, 1581 women developed
clinical diabetes. The control subjects without
diabetes (n=2198) were similar to the cases in age,
ethnicity, and duration of follow-up. Overall, 61% of the
cases were white, 23% black, 10% Hispanic, and 6%
Asians/Pacific Islanders. As expected, women with newonset
diabetes had higher BMI and waist circumference
at baseline and a family history of diabetes. Women with
PRCE 09-11 (A) October 30.200?
new diabetes had higher median levels of the 3 inflammatory
cytokines (TNF-«-R2, IL-6, and hsCRP). Older
women in the highest quartiles of the cytokines were
approximately^ to 4 times more likely to have new
onset of diabetes compared with those in the lowest
quartiles, independent of physical activity level, BMI,
alcohol and tobacco use, family history of diabetes, and
other known risk factors for diabetes. With additional
adjustment for the 3 cytokines, only IL-6 and hsCRP
were predictive of new-onset diabetes.
Conclusions: Elevated levels of IL-6 and hsCRP
predict new onset of clinical diabetes in initially nondiabetic
older women.



ORIGINAL ARTICLE
Simvastatin vs Therapeutic Lifestyle Changes and Supplements:
Randomized Primary Prevention Trial
DAVID J. BECKER, MD; RAM Y. GORDON, MD; PATTI B. MORRIS, RD; JACQUEUNE YORKO, MED;
Y. JEROLD GORDON, MD; MINGYAOLI, PHD; AND NAYYAR IQBAL,MD, MSCE
OBJECTIVE: To compare the IIpld-lowering effects of an alternative
regimen (lifestyle changes, red yeast rice , and fish 011) with a
standant dose of a 3-hydloxy-3-methylglutaryl coenzyme A reductase
Inhibitor (statln).
PATIENTS AND METHODS: this randomked trial enrolled 74 patients
with hypercholesterolemia who met Adult Treatment Panel
III criteria for primary prevention using statln therapy. All particIpants
were randomized to an alternative treatment group (AG) or
to receive slmvastatln (40 mg,td) In this open-label trial conducted
between Aprlll, 2006, and June 30, 2006. The alternative
treatment InclUded therapeutic lifestyle changes, Ingestion of red
yeast rlce, and fish 011 supplements for 12 weeks. The slmvastatln
group received medication and traditional counseling. The primary
outcome measure was the percentage change In low-denslty lipoprotein
cholesterol (LDL.c). secondary measures were changes In
other Dpoprotelns and weight loss.
RESULTS: There was a statistically significant reduction In LDl.c
levels In both the AG(-42.4%~) (PC.001) and the slmvastatln
group (-39.6%:20%) (PC.001). No significant differences were
noted between groups. The AG also demonstrated slgnlOcant
reductlonaln trlglycerldes (-29% va -9.3%; 96% confidence Interval,
-61 to -11.7; 1'=.003) and weight (-5.6% V8 -0.4%; 95%
conOdence Interval, -5.5 to -3.4; PC.001) compared with the
slmvastatln group.
CONCLUSION: Ufestyle changes combined with Ingestion of red
yeast rice and fish 011 reduced LDL.c In proportions similar to
standard therapy with sImvastatln. Pending confirmation In larger
trt_a_~,_t.l.!1.s. ~~~I~~o!,~I!_~~!~~!~P'P'!!~.C:~ _~_ !leJ_~. ~~werl..!'~
levels In both the AG(-42.4%~) (PC.001) and the slmvastatln
group (-39.6%:20%) (PC.001). No significant differences were
noted between groups. The AG also demonstrated slgnlOcant
reductlonaln trlglycerldes (-29% va -9.3%; 96% confldence Interval,
-61 to -11.7; 1'=.003) and weight (-6.6% V8 -0.4%; 95%
conOdence Interval, -5.5 to -3.4; PC.001) compared with the
slmvastatln group.
CONCLUSION: Ufestyle changes combined with Ingestion of red
yeast rice and flsh 011 reduced LDL.c In proportions similar to
standard therapy with slmvastatln. Pending conflrmatlon In larger
trtals, this multifactorial, alternative approach to lipid lowering
has promise for a subset of patients unwilling or unable to take
statlns.
Tltal Registration: clinicaltrials.gov identifier: NCTO042
Mayo enn Proc. 2008;83(7):758-784
AO = a1tematlYe treatment group: CI =canfideftCe Interval; CK =
creatine kinase: HDL-C =h1g1Htenslty lipoprotein cholestefOl; LDLC =
Iowdenslty lipoprotein cholellterol; RYR = red yeast rice; TC = total
chol811terol;TO=t1tgIycerlcles
Overwhelming scientific evidence shows that 3-hydroxy-
3-methylglutaryl coenzyme A reductase inhibitors
(statins) are beneficial to patients for primary prevention
of coronary artery disease" Although the safety of
these medications is established.' adherence can be troublesome.
As many as 40% of patients who receive a prescription
for a statin are thought to take it for less than I year.3•4
Possible reasons include the cost of these medications,
adverse effects, poor explanations of their benefits by phy-
We have used a combination of fish oil and red yeast
rice (RYR) as an allemative regimen for hyperlipidemia.
This regimen is nonprescription, is readily available, and
seems to be tolerated with few adverse effects. However,
to date, no data show a benefit to patients.
The primary purpose of this study was to test whether an
"alternative" regimen reduced serum low-density lipoprotein
cholesterol (LDL-C) in a primary prevention population,
Specifically, the efficacy and safety of RYR, fish oil,
and therapeutic lifestyle changes (altemative regimen) was
compared to those of a standard dose of a cholesterollowering
agent (simvastatin, 40 mg/d) and traditional diet
and exercise counseling.
PATIENTS ANDMETHODS
Patients were recruited from a cardiology practice in suburban
Philadelphia, PA. The trial was approved by the
Institutional Review Board of Chestnut Hill Healthcare,
and written informed consent was obtained from all participants.
All authors had complete access to the primary
data.
PATIENTS ANDMETHODS
Patients were recruited from a cardiology practice in suburban
Philadelphia, PA. The trial was approved by the
Institutional Review Board of Chestnut Hill Healthcare,
and written informed consent was obtained from all participants
. All authors had complete access to the primary
data.
Men and women aged 18 to 80 years with known or
newly detected hypercholesterolemia were eligible for enrollmenI
if they met the Adult Treatment Panel III guidelines,"
Inclusion criteria included baseline LDL-C of 130
mg/dL or more (to convert to mmol/L, multiply by 0.0259)
and 2 or more cardiovascular risk factors or baseline LDLC
between 160 and 210 mg/dL for patients with no or I risk
factor. Risk factors included age (men >45 years or women
>55 years or postmenopausal), hypertension requiring
medical treatment, high-density lipoprotein cholesterol
(HDL-C) less than 40 mgldL, current cigarette smoking,
From the Division of Cardiology, Chestnut Hill Hospital, University of Pennsylvania
Health System, Philadelphia (D.J.B.. R.Y.G.. P.B.M., J.Y.): Department
of OphthalmOlOgy. University of Pittsburgh SChool of Medic ine . Pittsburgh, PA
(Y.J.G.): Department of Biostatistics and Epidemiology, University of Pennsylvania
School of Medicine, Philadelphia (M.L.): and Division of Endocrinology.
Philadelphia VA Medical Center/University of Pennsylvania, Philadelphia

  Colon Cancer:

    Unfortunately colon (large intestine) cancer is one of the most common cancers. It can be deadly when it isn’t diagnosed and treated early before it travels outside of the colon to other organs.

    Therefore prevention via diet {low or no red meat, leaning towards if not total vegetarianism, low fat and high fiber, adequate selenium, and lutein (both of which may reduce colon cancer) regular colon screening tests (colonoscopy, stool occult blood – guiac, virtual cat scans, etc)}.

    New screening, prognostic and possibly a new treatment tool called MicroRNA expression / miR-21.

    MicroRNA expression / miR-21 testing was discussed in The Journal of the American Medical Association January 30, 2008. It was found that a high expression of miR-21 indicates poor therapeutic outcome and poor survival. 

    Therefore patients who have adenomas (benign growths of the colon) that have a high expression of miR-21 should be followed more closely and treated more aggressively. 

    Patients that have overt adenocarcinoma (colon cancer) should be treated more aggressively and possibly with experimental agents. 

    This marker miR-21 could be a new target for future therapies.  

     I will be utilizing this new marker in my practice due to the findings in this study.

 Please see our other blogs or go to our web site . If you have any questions or suggestions for other topics please call 631-361-6160 or 212-935-1700. Please allow 24-48 hours for a reply. You can also view our T.V. show. Call the office for the channel and time schedual for your area.


                                    Exercise 

Exercise can improve gait (walking) speed which in turn improves functional status and survival.

This is according to an article in the Journal of American Geriatric Soc 2007;55 (Nov.)

Improvement of gait speed over 1 year predicted 58% reduction in relative risk and a 17 % reduction in absolute risk of death over subsequent 8 years.

The study was performed on persons 65 years of age or older.

Walking can be enjoyed by the vast majority of people. This as does other articles proves that exercise can actually improve and prolong your life span!  

              
                       Bioidentical Hormonal Replacement

The “American Medical News’’ ( Volume 51,No. 7, February 18, 2008) published by the American Medical Association stated “Data analysis suggests the treatment (hormonal replacement) is safer in the decade after menopause than later on. Also, the FDA acts to rein bioidentical hormones.� 
  
                 Abdominal obesity triples the incidence of stroke for women

According to a recent study led by Dr. Amytis Towfighi, a neurologist at the University of Southern California in Los Angeles strokes triple for women.

The primary cause was abdominal obesity. This was in spite of medicines that were being given to control blood pressure, and cholesterol. The study was presented at the International Stroke Conference in New Orleans Febuary 2008.

The female patients study were found to have increased body mass index from 27 to 29. There waist lines were found to be nearly two inches larger than a decade earlier. It was also noted that there blood sugars were higher.

It was concluded that abdominal obesity was a stronger risk factor in women than men. 

           Vitamin D

A vitamin D analogue called calcitriol appeared to be associated with significantly greater survival in patients with chronic kidney disease. According to Archives of Internal Medicine Feb. 25, 2008.


        Selenium Decreases All- Cause and Cancer Mortality

It was found in the Archives of Internal Medicine Feb. 25, 2008 that increasing selenium levels up to 130 ng/ml were associated with decreased all-cause and cancer mortality.
However higher levels may be associated with increased mortality.

Therefore if you are taking or are planning to take selenium a baseline level and repeat selenium blood tests should be taken (other vitamins, mineral and or hormones should always be followed with blood testing).

       Hormone Replacement (Female Menopause)

Conjugated equine (horse) estrogens plus medroxyprogesterone acetate (synthetic progesterone) hormonal replacement and Breast Cancer Detection:

It was found that conjugated equine (horse) estrogens plus medroxyprogesterone acetate (synthetic progesterone) had a negative breast cancer detection and outcome result.

The results indicated that patients on these medicines had increased mammogram abnormalities, less sensitivity for cancer detection and increased breast biopsies. Breast cancers were significantly increased and were diagnosed at higher stages. This according to an article in the Archives of Internal Medicine Feb. 25, 2008. 

Not all patients should have hormone replacement. 

Bio-identical hormonal replacement at low dose and monitored with regular complete blood testing {several forms of estrogen (some estrogens such as estrone are associated with cancer), progesterone, DHEA, pregnenolone, testosterone (total, free), dihydrotestosterone, etc.}
has been found to have fewer side effects and more positive effects.
Regular self breast examinations, mammograms, ultrasounds of the breast and pelvis, pap smears, medical examinations, blood testing, and other tests should be utilized for optimal results. 

                
               Low testosterone in males/ Wall Stret Journal Feb. 26, 08

Discussed low testosterone in males. Entitled: Grumpy Old Men: Maybe It's Your Testosterone
The St. Louis University Androgen Deficiency in Aging Men questionaire asks ten questions to determine if you might have low testosterone. This includes:

1. Decreased sex drive                           6. Sad and/or grumpy mood  
2. Weaker erections                           Â Â Â Â  7. Lack of energy
3. Decreased strength or indurance       8. Difficulty staying awake after dinner
4. Decline in height                                 9. Recent deterioration in ability to play sports
5. Decreased enjoyment of life              10. Recent deterioration in work performance

You might have low testosterone if you have either of the first two and at least three of the other symptoms.

IT SHOULD BE NOTED THAT THERE ARE MANY REASONS FOR LOW TESTOSTERONE.

The cause should be found and corrected. It is an over simplification to assume that low testosterone is all ways due to decreased testicular function.

There are many causes and different appropriate treatments for low testosterone.

One should seek a physican that has experience treating low testosterone. 
You might not need to have injections, creams or jells of testosterone. 

I have found several ways of making ones own body make testosterone naturally. 
                                                                
Several specific blood tests should be performed to find the cause or causes of low testosterone.

The treatments should be as natural as possible and focused on the cause.

Repeat blood tests should be performed to ensure that the results desired are objectively obtained.

This syndrome has also been called male menapause.

Treatment of Symptomatic Androgen (testosterone) Deficiency / Archives Of Internal Medicine May 26, 2008
 
     This study found that 87.8%  of men with known testosterone deficencies were not getting replacement treatment despite apparently adequate access to care. The reasons were thought to be possibly because of unrecognizing the deficiency as a cause of various symptoms or unwillingness to prescribe testosterone.

Please see my web site and blog entitled male menapause (to be created by 2008).









    


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