Making heart disease reversible
Jeremy Laurance

Millions of sufferers from heart disease have been given new hope as doctors have revealed that the condition might be reversible. But previous research has suggested it is a chronic, progressive disease that can be slowed but not reversed.

Now scientists have found that very intensive treatment with a powerful cholesterol lowering drug may reduce the fatty deposits in the arteries. But the drug, Crestor, manufactured by Astra Zeneca and launched in 2003, has been the focus of controversy after evidence emerged that it could cause a muscle wasting disease. Warning labels were strengthened by the US Food and Drug administration last year.

Heart disease is caused by the build up of fatty deposits, called atheroma. This narrows the arteries, increasing the risk of a blockage caused by a blood clot, triggering a heart attack. Previous treatment has focused on reducing the build up of atheroma by cutting the level of cholesterol.

Results of an international study now show that two years treatment with Crestor, whose chemical name is rosuvastatin, cut cholesterol levels by over half and reduced the thickness of the atheroma by 6.8 per cent.

The research found almost four out of five patients (78 per cent) showed some form of reduction in the level of atheroma. Neal Uren, consultant cardiologist at Edinburgh’s Royal Infirmary, said reduction of atheroma was the Holy Grail in the fight to combat heart disease.

“It suggests that very aggressive lowering of cholesterol can actually have an effect on the plaque (fatty deposits) in each of the blood vessels,” he said Dr Sarah Jarvis, a London GP and member of the Royal College of General Practitioners, said the news was “dramatically exciting” and its importance “cannot be underestimated”.

The British Heart Foundation warned that the study was small with just 349 patients and the drug was the most powerful cholesterol lowering medication on the market, used in the highest dose.

The authors write: “Traditional thinking has viewed atherosclerosis as an inexorably progressive disease for which even the most active therapies can merely slow advancement. The current study suggests that there is potential for a more optimistic strategy, in which aggressive lipid-modulating strategies can actually reverse the atherosclerotic disease process.”

— The Independent

Take care before you have pain in the neck
Dr Ravinder Chadha

Neck pain is one of the most common complaints a doctor encounters in day-to-day practice. It is multifactorial in origin, hence not always very easy to treat.

Common causes could be over-use, an incorrect posture, injury, aging, deformity, etc. The most common diagnostic label in such cases is cervical spondylitis, which is, in fact, not a disease, but a term used to describe the normal aging changes in the spine.

There could be disc herniation in the neck vertebrae. Such cases manifest with pain/ and numbness, which is referred to the arm (the area depending on the site of disc herniation). Neck pain could also present with episodes of nausea/ dizziness, etc.

The correct posture brings stability to the neck. A healthy posture implies a position in which the neck muscles/ ligaments are least stressed. The brain ends in the spinal cord, which passes through the inter-vertebral canal. Irritation of spinal nerves relates to the area of distribution of the pain and headache, upper back pain, chronic arm pain and breast pain (in females) could also be a manifestation of neck pathology. The causes of failure of neck pain treatment can be attributed to psychological and emotional factors.

Treatment
* Usually prescribed medicines are analgesics.

* Ice massage for a period of 10-minutes provides immediate relief whereas heat may be used to decrease the muscle tightness and improve the range of motion.

* In acute cases short-term immobilisation with cervical collar provides relief. This collar should be removed ideally for one hour every three hours except in cases of disc herniation where long-term use is advocated. Pain-free exercise aiming to facilitate easy motion should be performed several times daily. Cervical collar should not be used for prolonged periods as it causes weakening of the neck muscle.

* Manipulation and mobilisation, if done correctly, brings immediate pain relief in most cases. Manipulation is performed on an individual pattern and can only be undertaken by individuals possessing adequate knowledge and technique.

Massage also is beneficial as it brings in fresh supply of oxygen and nutrient-rich blood by flushing the exudate, which is the result of inflammation.

* Dissolving of trigger points: There are certain tender spots around the neck, which are associated with referred pain as the original pain spot is located at some distance. Ideal treatment is to treat the cause of pain in the neck and also dissolve the trigger points with local injection, vapocoolant spray, massage or stretching of the concerned muscle.

* Disc herniation patients require a firm cervical collar and cervical traction continuously for two or three weeks. In certain cases where pain is not controlled, epidural injection is given.

* Chronic neck pain sufferers require a combination of therapies integrating an exercise regimen that improves aerobic conditioning and the range of motion. Some such individuals are put on anti-depressant medicines, which are helpful.

Exercises are important during all stages of recovery from neck pain.

Ideally, in early stages the neck should be moved only in the pain free range to provide nutrition and lubrication to the injured/inflamed area.

As the neck becomes less painful, stretching and strengthening exercises of muscles controlling the neck can be initiated. The following exercises help in overcoming neck pain:

* Turn your head to the right bringing the chin over the right shoulder. Hold for a count of three and roll your head back to the neutral position. Repeat the same on the left side.

* Bend your head to the right the bringing right ear to the right shoulder. Pause and return to neutral position. Repeat it on the left side.

* Sitting upright, slowly draw the chin and head straight backwards, keeping the jaw parallel to the floor. Hold, count to three and relax.

* Shoulder shrug: While standing erect, arms held loosely at sides, breathe deeply and lift your shoulders as high and far back as possible. Now breathe out (exhale) and lower your shoulder to the starting position. Relax and repeat this 15 times thrice a day. Gradually, increase to 20 or 40 repetitions thrice a day.

Neck pain should be diagnosed and treated early so that it does not become “pain in the neck”.

The writer is a former doctor/physiotherapist, Indian cricket team.

Blood pressure levels decline

LONDON: There has been a decline in blood pressure levels in many countries in the mid-1980s to the mid-1990s, but experts say this cannot be attributed to medications or drugs.

High blood pressure is a leading risk factor for cardiovascular disease.

British researchers analyzed patterns of blood-pressure decreases taken from data from 38 populations in 21 countries from the mid-1980s to mid-1990s in the World Health Organization MONICA study.

The results showed that the 38 populations had equal blood-pressure drops at all levels of readings.

Though researchers are not sure what exactly drove blood-pressure rates downward, they said their study suggested that the declining rates might be due to the fact that doctors target people with widespread adoption of lifestyle changes. — ANI