Presidential Healthcare center

We provide the same Preventive Executive Physical Program as received by the President of the United States.


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Prevalence of the Metabolic Syndrome in the United States

meta 2Roughly a third of U.S. adults have the metabolic syndrome — and nearly half of those aged 60 and older have it — according to a research letter in JAMA.  Researchers evaluated National Health and Nutrition Examination Survey data from 2003 through 2012. The metabolic syndrome contributes to cardiovascular morbidity and mortality.   Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 reported a metabolic syndrome prevalence of 34%.  Understanding updated prevalence trends may be important given the potential effect of the metabolic syndrome and its associated health complications on the aging US population. We investigated meta 3trends in the prevalence of the metabolic syndrome through 2012.  Among the other findings:

  • The prevalence of the metabolic syndrome increased from 2003–2004 to 2007–2008 (from 33% to 36%) and remained stable thereafter.
  • Women were more likely than men to be affected: in 2011–2012, the prevalence was 37% and 33%, respectively.
  • Hispanics had the highest prevalence, at 39% in 2011–2012.
  • The metabolic syndrome was more common among older than younger adults, ranging from 18% for those aged 20–39 years to 47% for those aged 60 and older.

Source: JAMA


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Study: ‘Fat Tongue’ May be a Factor in Sleep Apnea

Sleep apnea is a potential health risk for millions of Americans, and a new study points to a possible culprit behind the disorder: a “fat” tongue.

“This is the first study to show that fat deposits are increased in the tongue of obese patients with obstructive sleep apnea,” study senior author Dr. Richard Schwab, co-director of the Sleep Center at the University of Pennsylvania Medical Center, said in a news release from Sleep, which will publish the findings Oct. 1.Sleep Apnea Tongue

Sleep apnea is a common disorder in which the airways constrict during sleep, leading to repeated stops and starts in breathing. The telltale signs include chronic loud snoring, with periodic gasps or choking — and, for many people, daytime drowsiness because of poor sleep.

But the effects go beyond fatigue. Studies suggest those pauses in breathing stress the nervous system, boosting blood pressure and inflammation in the arteries.

Obese people tend to be at higher risk for sleep apnea, and Schwab’s team say the new findings may help explain the link between obesity and the breathing disorder.

The study included 90 obese adults with sleep apnea and 90 obese adults without the disorder.

The participants with sleep apnea had significantly larger tongues, tongue fat and percentage of tongue fat than those without sleep apnea, the researchers found. The tongue fat in the people with sleep apnea was concentrated at the base of the tongue.

Sleep ApneaIn addition to increasing the size of the tongue, higher levels of tongue fat may prevent muscles that attach the tongue to bone from positioning the tongue away from the airway during sleep, Schwab’s group explained.

While the study found an association between tongue fat content and sleep apnea, it could not prove cause and effect.

However, the researchers believe future studies should assess whether removing tongue fat through weight loss, upper airway exercises or surgery could help treat sleep apnea.

“Tongue size is one of the physical features that should be evaluated by a physician when screening obese patients to determine their risk for obstructive sleep apnea,” American Academy of Sleep Medicine President Dr. Timothy Morgenthaler added in the news release.

“Effective identification and treatment of sleep apnea is essential to optimally manage other conditions associated with this chronic disease, including high blood pressure, heart disease, type 2 diabetes, stroke and depression,” he said.

Nearly 35 percent of U.S. adults — 78.6 million people — are obese, according to the U.S. Centers for Disease Control and Prevention.

Source: Detroit Free Press

The Presidential Healthcare Center now offers home sleep studies.  


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Sleep Apnea Linked To Hearing Loss In New Study

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People with sleep apnea may have a higher risk of hearing loss, according to a new study.

The research, which was presented at the American Thoracic Society’s 2014 International Conference, found that of the 13,967 participants sampled, about 10 percent had at least moderate sleep apnea. These patients had a 31 percent increased risk of high frequency hearing impairment, a 90 percent increased risk of low frequency hearing impairment and a 38 percent increased risk in combined high and low frequency hearing impairment after controlling for other causes of hearing loss and potentially confounding factors like age and sex.

“The mechanisms underlying this relationship merit further exploration,” lead author Dr. Amit Chopra, M.D., of the Albany Medical Center in New York, said in a statement. “Potential pathways linking sleep apnea and hearing impairment may include adverse effects of sleep apnea on vascular supply to the cochlea [part of the inner ear] via inflammation and vascular remodeling or noise trauma from snoring.”

Snoring is caused by relaxed throat muscles narrowing the airways during sleep, leading to sound-causing vibrations. Sleep apnea, while it may also include some snoring, results in temporary pauses in breathing, sometimes up to hundreds of times a night.

Chopra pointed out that people with sleep apnea “are at an increased risk for a number of comorbidities, including heart disease and diabetes,” both good reasons to seek treatment for the condition. The current study did not account for how sleep apnea treatment might affect the link to hearing loss.

Researchers at the conference also presented findings linking acute respiratory failure to sleep apnea. They found that the majority of acute respiratory failure patients, defined as having needed mechanical ventilation for at least 48 hours, met sleep apnea criteria.

Source: Huffington Post

 


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May is National Stroke Awareness Month!

Stroke_Awareness_MonthA stroke occurs when blood flow to part of the brain is blocked; we sometimes refer to it as a “brain attack.” Two million brain cells die every minute during stroke, increasing the risk of permanent brain damage, disability or death.

In the United States, stroke is the fourth leading cause of death, killing over 133,000 people each year, and a leading cause of serious, long-term adult disability. Stroke can happen to anyone at any time, regardless of race, sex or age.

High blood pressure is the leading risk factor for stroke. However, other risk factors include:

  • Atrial fibrillation
  • Diabetes
  • Family history of stroke
  • High cholesterol
  • Increasing age (esp. over 55)
  • Race (black people have almost twice the risk of first-ever stroke than white people)
  • Heart disease
  • Lifestyle factors (smoking, poor diet, lack of exercise)

 Women are twice as likely to die from stroke than breast cancer annually. The estimated direct and indirect cost of stroke in the United States in 2010 is $73.7 billion.

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Learning the signs of stroke are crucial, because time is of the essence when a stroke is occurring. Two million brain cells die every minute during stroke, increasing risk of permanent brain damage, disability, or death. Recognizing the symptoms and acting FAST to get emergency medical attention can save a life and limit disabilities.

To learn more, see the National STROKE Association‘s fact sheet or the U.S. National Library of Medicine.


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As Statins Boost Erectile Function, Adherence May Rise Too

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Among men with high cholesterol and erectile dysfunction, a short course of statin therapy was associated with improvements in both measures, shows a new meta-analysis. The study was presented at the American College of Cardiology (ACC) 2014 Scientific Sessions and simultaneously published online in the Journal of Sexual Medicine

These findings “may improve adherence to statin therapy . . . [because] we know that in primary prevention a large proportion of patients stop talking [a statin] or take a much lower amount than prescribed,” lead investigator Dr John B Kostis (Rutgers Robert Wood Johnson Medical School New Brunswick, NJ) said during a press briefing. For example, in a 90 000-patient study, 35% took less than a quarter of prescribed statins and 60% took less than half, and in an 11 000-patient study, 47% of patients stopped taking the statin, he said.

Erectile dysfunction is often the first sign of CVD, like the canary in the coal mine, Kostis pointed out. “What do you do with a person who has erectile dysfunction? You evaluate them for CVD.”

“Over the years, it’s become apparent that erectile dysfunction is an indication of decreased vascular health in men and is considered by many to be a significant CV risk factor,” moderator Dr Jeffrey Kuvin (Tufts Medical Center, Boston, MA) echoed. “Whether erectile function improves due to a reduction in LDL-C or perhaps other pleiotropic effects of statins still remains unclear. I think [this] meta-analysis strongly shows that statin therapy improves erectile dysfunction after only a short duration of therapy.”

Erectile dysfunction affects an estimated 18 to 30 million American men, more often after age 40, and common causes include heart disease, high cholesterol, high blood pressure, diabetes, obesity, tobacco use, depression, and stress, according to an ACC statement.

Many older men have erectile dysfunction along with diabetes and atherosclerotic disease, for which they are frequently prescribed statins, Kostis noted. Previous research has suggested, however, that statin therapy may lower testosterone levels.

The investigators searched for randomized controlled trials that examined the effect of statin therapy on erectile function. They identified 11 such trials in which men completed the International Inventory of Erectile Function survey, which consists of five questions, each scored on a five-point scale, where low values represent poor sexual function.

The trials had an average of 53 patients per study, for a total of 647 patients. Men had an average age of 57.8 years and received statins for about 3.8 months.

During this time, average LDL-C levels dropped significantly from 138 to 91 mg/dL in the treated men but were virtually unchanged in control groups.

In men who took statins, erectile-function scores increased by 3.4 points, from 14.0 to 17.4 points—a 24.3% increase. The increase in erectile-function score was about one-third to one-half of that reported with phosphodiesterase inhibitors, such as sildenafil (Viagra, Pfizer), tadalafil (Cialis, Lilly), or vardenafil (Levitra, Bayer/GlaxoSmithKline), and larger than the effect of lifestyle modification or testosterone, Kostis said.

Some people have called statins a “double-edged sword,” he noted. On one hand, they improve endothelial function, which may improve blood flow to the penis; but on the other hand, they lower the level of cholesterol, a precursor of testosterone. However, these 11 studies showed that “the beneficial effect [of statins on erectile dysfunction] predominates.”

Strengths of the meta-analysis were that it included all published randomized trials about the topic, and the benefit remained after multiple sensitivity analyses. However, limitations were the inclusion of small studies with few participants and diverse statins, treatment duration (1.5 to six months), and patient types.

“A well-powered, placebo-controlled trial with a factorial design (for example, phosphodiesterase inhibitors, testosterone, and statin) would clarify the effect of statins in relevant patient subsets,” Kostis concluded. These drugs are not recommended as a primary treatment for erectile dysfunction in patients with normal cholesterol levels, he cautioned—another potential area for further rigorous research.

Source: Medscape


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13 Million More Could Get Statin Therapy in U.S.

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A new study published in the New England Journal of Medicine reports that the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) guidelines for the treatment of cholesterol would increase the number of U.S. adults eligible for statin therapy by nearly 13 million. Older adults without cardiovascular disease would comprise the majority of the increase.

The previous Third Adult Treatment Panel (ATP III) guidelines of the National Cholesterol Education Program (ATP-III) recommended statin therapy for patients with cardiovascular disease or diabetes and low-density lipoprotein (LDL) cholesterol levels of >100mg/dl. For primary prevention, LDL cholesterol level plus the Framingham risk score (10-year cardiovascular disease risk calculator) were used to determine whether statin therapy was warranted.

The new ACA/AHA guidelines recommend the following:

  • Statin      therapy to all adults with known cardiovascular disease regardless of LDL      cholesterol level;
  • Statin      therapy for patients with an LDL cholesterol level of ≥190mg/dL      (4.91mmol/L);
  • Statin      therapy for patients 40–75 years of age with diabetes or a 10-year risk of      cardiovascular disease of >7.5% with an LDL cholesterol level of      ≥70mg/dL (1.81mmol/L) or higher.

Michael J. Pencina, PhD, from the Duke Clinical Research Institute, and colleagues analyzed fasting sample data from 3,773 individuals ages 40–75 in the National Health and Nutrition Examination Surveys (NHANES) collected from 2005–2010. Of the total patients,1,583 (42.0%) were receiving or would be eligible for statin therapy based on the ATP III guidelines, vs. 2,135 participants (56.6%) who would be eligible based on the 2013 ACA/AHA recommendation. Using these statistics, the authors estimate that nearly half of the adult U.S. population between the ages of 40–75 with triglyceride level of <400mg/dL would be eligible for statin therapy (56 million, 48.6%). This is a net increase of 12.8 million potential new statin users and an increase of 11.1 percentage points over those eligible under the ATP III guidelines.

With the increase in adults eligible for statin therapy, the authors suggest that there will be higher treatment rates among both those who are and are not expected to have future cardiovascular events, particularly in men. The effect would be seen in older (ages 60–75) vs. younger (ages 40–59) cohorts, as 77% in the older age group would be eligible compared to 30% in the younger group.

Read more in the New England Journal of Medicine here.


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95% of All Women Have At Least One Risk Factor for Heart Disease

heart disease women

While overall mortality from heart disease is declining, the number of younger women with heart disease is growing. A new study by the Canadian-led global INTERHEART group shows that nine factors account for 90% of the risk for a first myocardial infarction:

  • Smoking
  • Lipids
  • Hypertension
  • Diabetes
  • Obesity
  • Diet
  • Physical Activity
  • Psychosocial Factors

Cardiovascular disease has been the leading killer of American women since 1908. Death rates from heart disease are increasing in women aged 35 to 54 years, most likely as a result of obesity. Cardiovascular disease causes one death per minute in the U.S.– that amounts to a staggering 421,918 deaths every year. More than 12 million women in the U.S. are suffering from Type II diabetes. Across the globe, heart disease is the leading cause of death in women in every major developed country and most emerging economies.