We know that our blood pressure (BP) can reveal a lot about our cardiovascular risk factor for heart disease. About 50 years ago, the diastolic, or lower number, was the one causing more concern if elevated and more predictive of cardiovascular events (CV) than the systolic number. More recently, The systolic, or top number, may be deemed more important although both are important to maintain at normal levels (NEJM JW Gen Med Dec 15 2017 and J Am Coll Cardiol 2018; 71:e127).

A multivariable analysis (data collected on systolic and diastolic blood pressures) were collected to determine the 8 year CV outcomes (heart attack, stroke) in more than 1 million adults, average age 53, from North California’s Kaiser Permanente health system. The researchers found that for systolic BP’s of 136 and 160 mm Hg, the predicted 8 year risks for CV events were 1.9% and 4.8% respectively. On the other hand, for diastolic BP’s of 81 and 96 mmHg, CV event rates were 1.9% and 3.6% respectively.

This shows that both systolic and diastolic BP are independent predictors of adverse cardiovascular outcomes. In general, an ideal BP should be less than 130/80. Do you know your blood pressure?

Reference: Flint AC et al. Effect of systolic and diastolic blood pressure on cardiovascular outcomes. N Engl J Med 2019 Jul 18; 381:243

The current definition of a healthy body mass index (BMI) has been under some scrutiny after a new research study found that the BMI we consider “normal” may actually be too low and unhealthy.
A recent study collected data and adjusted results using a wider range of potential confounders (other variables) than in prior studies looking at measuring and interpreting BMI. The new data showed the impact of newer treatments to reduce cardiovascular disease illness and death while past studies relied on data from earlier times when less cardiovascular disease protection occurred. The current study included people from lower-income countries, although the finding is just as applicable to people who live in high-income countries, who were also included in the study population, noted Salim Yusuf, MBBS, principal investigator for the study.
The study showed that middle-aged adults with a body mass index of 25-29 kg/m2 (currently considered “overweight”) had a significantly better adjusted survival during an average follow-up of nearly 10 years than did people with a “normal” body mass index of 20-24 kg/m2 in a worldwide study of more than 140,000 people. This suggests that the current, widely accepted definition of normal body mass index is wrong.

This is where other tools come into play that can be better predictors for survival. One is the ratio of hand-grip strength to body weight. This assesses the importance of muscle mass to overall weight. The optimal strength/weight ratio is 0.42 in women and 0.50 in men according to Dr. Darryl Leong, a cardiologist at McMaster University and the Population Health Research Institute, both in Hamilton, Ont.
In a large longitudinal population study, it was found that grip strength measurement can be a strong predictor of cardiovascular mortality and a moderate strong predictor of cardiovascular disease. This new study, called the Prospective Urban-Rural Epidemiology Study (PURE) included about 140,000 people that were examined between 2003-2009. Grip strength was measured using a hand grip dynamometer.
Another very important and good predictor of weight is the waist/hip ratio which adds the dimension of the location of body fat rather than just the amount. An optimal waist/hip ratio for survival according to Dr. Leong is 0.83 in women and 0.93 in men. This means that a man whose hand/grip strength (in Kg) is half of the person’s body weight, then his chance for survival is very good.
So even though being “overweight” according to the BMI readings we currently use seems to lower mortality rates, we need to remember that the link between total mortality and BMI was strongest in the group of people that were on 1 or more treatments aimed at preventing cardiovascular disease (which may include being on a Statin drug or anti-hypertensive med) while there was no benefit among people not receiving any cardiovascular disease preventative measures.

https://www.mdedge.com/clinicianreviews/article/207836/lipid-disorders/survival-overweight-bmi-surpasses-normal
https://www.mdedge.com/anticoagulationhub/article/99720/acute-coronary-syndromes/grip-strength-predicts-cardiovascular

The CDC (centers for disease control) has now issued notices to warn people who are traveling to Europe about the risk for measles exposure. Measles outbreaks are occurring in England, France, Italy Greece and Germany. (https://wwwnc.cdc.gov/travel/notices/watch/measles-global).

Measles cases in Europe topped 41,000 in the first half of 2018 and included 37 deaths, with the highest incidence in children less than 1 year of age. This is more than twice as many reported annually between 2010 and 2017!! As in the U.S., low immunization rates are responsible for the rise. The popularity and ease of traveling to and from Europe accounts for many measles cases in the U.S.

In the U.S., measles cases have just exceeded 1000 which seems minimal compared to Europe even though it’s still quite high. The problem is that children who are unvaccinated are at risk while at home, but even more so when traveling to areas with continued measles circulation.

If you are traveling to Europe, consider:

1. Review your immunizations to assess the need for additional vaccinations. If you were born in 1957 or later then you should
get a measles titer to see if you still carry immunity to this virus.
2. Infants should be vaccinated starting at age 6 months if traveling to areas with measles outbreak.
3. Infants less than 6 months should delay travel until the child reaches 6 months of age.
4. Children over the age of 1 year should receive two-measles containing vaccines separated by at least 28 days prior to travel.
5. If you have traveled to these areas and develop a fever and rash, contact your health practitioner ASAP.

Although I understand the divided opinions about vaccines to be a real issue, I often stress to my patients when they are at significant risk for contracting the illness. This would be it!

Measles is a very contagious respiratory disease that spreads through the air by coughing or sneezing. Symptoms don’t appear until 10-14 days after exposure, so you could be a carrier and spread this virus and not know it. Complications include ear infections, pneumonia, encephalitis (brain infection) and problems during pregnancy. There are no treatments to this virus except treating symptoms with over the counter remedies to help discomfort. Those at highest risk are young children and the elderly. Don’t take chances and please talk to your practitioner about prevention through a vaccine.

Reference: Angelo KM et al. Spread of measles in Europe and implications for US travelers. Pediatrics 2019 Jul 1; 144e20190414

Glucosamine sulfate is a natural occurring chemical found in the body. It is used in the body to produce other chemicals that help build tendons, ligaments, cartilage and the fluid surrounding joints. This is where the supplement is touted as a pain reliever for osteoarthritis, especially with osteoarthritis of the knees. It may also slow the breakdown of joints and prevent the condition from getting worse. The effectiveness of glucosamine in patients with osteoarthritis and joint pain continues to be debated.

Now there’s another reason to consider using glucosamine…to lower the risk of cardiovascular disease (CVD). A prospective study was done in the U.K. where researchers examined the association between regular use of glucosamine and CVD risk in close to 500,000 people without known CVD at baseline. They completed a supplement use questionnaire where 20% of the respondents answered “yes” when asked if they used glucosamine regularly.

During a 7-year follow-up, 10,200 adverse CVD events occurred. After adjusting for multiple variables, regular glucosamine users had significantly lower risks for overall adverse CVD events including CV-related death, coronary heart disease and nonfatal stroke than did non-users.

These results are plausible considering glucosamine has anti-inflammatory properties and regular use is associated with lower levels of C-reactive protein, which is a marker for inflammation. It is best to wait for a randomized trial to repeat and confirm these findings as the study design (questionnaires) may not be as reliable.

One last thing is that the form of glucosamine supplement (glucosamine sulfate, glucosamine hydrochloride, N acetyl glucosamine) was not collected. Therefore it’s difficult to assess whether the association between various forms of glucosamine supplement and CVD risk might differ. Glucosamine is closely regulated in most European countries where it is only sold by prescription. However, in the U.S. and Australia it is a dietary supplement and sold over-the-counter where it is not regulated.

Ma H et al. Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in U.K. Biobank. BMJ 2019 May 14;365:l1628.

Most of us have been exposed to Epstein-Barr virus (EBV). We were probably exposed as a kid or teen since it’s transmitted by saliva, kissing, shared drinks or utensils and even coughing or sneezing. It is the primary causative agent in infectious mononucleosis. So what’s the big deal? And why is there a vaccine in progress against this innocuous “kissing disease”?

What you may not know is that EBV causes about 200,000 cases of cancer (nasopharyngeal and gastric cancer, Burkitt and Hodgkin lymphomas) and about 140,000 deaths annually. It’s also a co-factor in other serious illnesses, including multiple sclerosis. Symptoms of infectious mono include extreme fatigue, sleep abnormalities, pain and other symptoms that worsen with activity. These symptoms can last for over 6 months which makes it debilitating and difficult to work.

An international team identified the specific antibodies that block binding of the virus to epithelial and B cells (EBV molecules attach to specific B cell receptors). This team developed a vaccine using nanoparticles that enhanced the immune system’s production of these blocking antibodies. The vaccine potentially neutralized EBV’s ability to infect the epithelial and B cells in both mice and nonhuman primates.

The next step would be to perform randomized clinical trials and safety studies in humans. Both of these are planned for the next few years.

References: Komaroff, A. Progress in developing a vaccine against Epstein-Barr virus. JWatch.org June 15, 2019; p. 95.Photo by The U.S. National Archives