Red Yeast Rice to treat high cholesterol?

From Geriatric Pharmacy Intern Yariagna Rollan Pharm.D(c)
University of Florida College of Pharmacy

Statins (3-hydroxy-3-methylglutaryl coenzyme A or HMG-
CoA reductase inhibitors) are the most effective medications to lower low-density lipoprotein (LDL) cholesterol or bad cholesterol and the risk of cardiovascular events. Although generally well tolerated, many patients taking statins may experience adverse effects including statin-associated myopathy and rhabdomyolysis, elevated liver enzyme levels, and gastrointestinal symptoms. In older adults there is a higher risk of cardiovascular events due to accumulated coronary atherosclerosis and also an increased risk for severe myopathy not only from statins but from fibrates as well.

Statin-associated rhabdomyolysis is a rare, life-threatening condition, with a rapid breakdown of skeletal muscle that leads to the release of muscle fiber contents (myoglobin) into the bloodstream causing weakness and diffuse muscle pain. Myoglobin is a protein that is harmful to the kidneys and may result in Acute Kidney Failure. Rhabdomyolysis is dose related and there is no alternative treatment for patients who still require management for hyperlipidemia.
In some cases is possible to reduce the dose of the statin or completely discontinue the medication. However, each patient needs to be treated as an individual, considering the necessary goals in order to continue to reduce the risk of cardiovascular events.

Red yeast rice is the fermented product of the yeast species Monascus purpureus that grows on rice. It could be used as an alternative treatment for patients with statin associated myopathy. It is a readily available dietary supplement that has been used for centuries in China and helps decrease LDL cholesterol levels. Red yeast rice contains monacolin K, a strong HMG-CoA reductase inhibitor. Recent studies have reviewed the effectiveness, safety, and tolerability of red yeast rice in patients with ages ranging from 21 to 80 years of age and with a history of myopathy related to the use of statins.

The studies have shown reductions of approximately 18% of total cholesterol, 22% of LDL cholesterol, and 7% reduction of serum triglyceride levels. No significant effect was seen on high-density lipoprotein (HDL) cholesterol levels or good cholesterol. Most importantly there was no significant difference found between the red yeast rice and placebo groups in adverse events and muscle pain. Further studies are required in order to recommend this treatment as an alternative. There are still concerns with toxicity and the ability of red yeast rice to lower cardiovascular related events effectively. Consult your pharmacist before starting any supplement.

Obesity and Risk for Heart Disease

From Geriatrics Student Dana Ross Pharm.D.(c)
Palm Beach Atlantic University School of Pharmacy

Researchers found that obese patients were two times more likely to develop heart disease and related conditions than their normal-weight counterparts. Researchers looked at patients for 5 years in the United States in office visits. They monitored disease progression and onset of obese patients versus normal weight individuals by chart reviews for certain disease states. These disease states included diabetes, hypertension, and dyslipidemia.

The study looked at patients BMI (Body Mass Index) to classify their weight category.
Investigators claim to have confirmed a correlation between obesity and heart disease related diseases. They found patients with obesity to be at greater than double the risk for developing chronic disease states, specifically relating to coronary, or heart conditions and health.

These findings are important for the medical community because obesity is such a growing health problem in the United States, the Centers for Disease Control says obesity is found in greater than 33% of American adults! This will open the publics eyes about obesity and its health risks and hopefully spark some changes.

Fish Oil Supplement Safe to Use with Other Antiplatelets?

From Geriatric Pharmacy Intern Phuong Pham, PharmD(c)
University of Florida College of Pharmacy

Patients with cardiovascular disease typically are prescribed an anti-platelet drug, called Plavix, in combination with aspirin, to prevent the formation of blood clots. However, several studies have shown a small increase in the risk for major and minor bleeding when this combination is used. Omega-3 fatty acid, or fish oil, have been popular among consumers as a dietary supplement to lower triglycerides and as a secondary prevention of heart disease. It also has an anti-platelet property, similar to Plavix and aspirin, which raises concern about the increase risk of bleeding. In a study done by Pauline D. Watson and her colleagues at Drexel University College of Medicine in Philadelphia, they set out to study the effects of taking high-dose fish oil, Plavix, and aspirin to see if the addition of fish oil further contributes to an increase risk of bleeding when taken with the other two antiplatelets. They reviewed the medical records of 182 patients, most with coronary artery disease, being treated with high-dose fish oil (mean dose 3 g), aspirin (mean dose 161 mg), and Plavix (mean dose 75 mg), and 182 patients of similar age and gender being treated with aspirin and Plavix alone. During an average follow-up of 33 months, the researchers found one major bleeding episode in the fish oil group, no major bleeding in the control group, four minor bleeding episodes in the fish oil group, and seven minor bleedings in the control group. However, the results were not significantly different between the fish oil and control group. The authors concluded that high-dose fish oil is safe in combination with aspirin and Plavix and does not increase the risk of bleeding compared with that seen with aspirin and Plavix alone.

Tai Chi Can Reduce Osteoarthritis Pain in the Elderly

From Geriatric Pharmacy Intern, Wendy Fisher, PharmD (c)
Nova Southeastern University College of Pharmacy

Tai Chi (pronounced “tie chee”) is an old Chinese practice of martial arts designed to exercise the mind and body. It combines mental concentration with slow, rhythmic movements to challenge the body and focus the mind. Tai Chi helps to stimulate mental relaxation and improves balance, strength and flexibility. Almost anyone can do Tai Chi, even people with conditions that may exclude them from other forms of exercise.
Knee Osteoarthritis (OA) is a common form of arthritis that causes deterioration of joint cartilage. This results in pain, limitations of function and reduced quality of life. The elderly population is at the greatest risk for developing this type of arthritis.
According to researchers, patients over the age of 65 with knee osteoarthritis who engage in Tai Chi exercise improve physical function and experience less pain. "Tai Chi is a mind-body approach that appears to be an applicable treatment for older adults with knee OA," said Dr. Chenchen Wang, M.D., M.Sc. of Tufts University School of Medicine. Researchers have observed an improvement in physical function, depression, health status and a decrease in pain in knee osteoarthritis patients after doing Tai Chi for 12 weeks.
The current exercise recommendations for OA are identical to the physical components of Tai Chi. This seems like a feasible therapy to help ease the horrible pain from OA and it is fun and relaxing. I actually did Tai Chi in China and it felt amazing. J As always, please speak with your Doctor before starting any new exercise programs.

Other Cognitive Abilities Declining in Alzheimer's Disease

From Geriatric Pharmacy Intern, Phuong Pham, PharmD(c)
University of Florida College of Pharmacy

Researchers have been trying to identify the signs and symptoms that can lead to the diagnosis of Alzheimer's disease as early as possible. Alzheimer's disease has been commonly linked to a loss of episodic memory, in which a person fails to remember a past event that has occurred in his or her life. However, according to a study done, they found that other cognitive abilities, besides memory, may start to decline years before the diagnosis of Alzheimer is made. The study had enrolled 444 individuals without dementia between 1979 and 2006. These individuals had a clinical evaluation and a psychometric assessment done, including four cognitive factors: global cognition, verbal memory, visuospatial skill, and working memory. Visuospatial skill means the ability to process and interpret the relationship between objects and their location in space. After an average follow-up of 5.9 years, they found that 134 individuals had developed dementia and 44 with dementia died with a confirmed diagnosis of Alzheimer’s disease. When the researchers graphed the data from the psychometric assessments, they found that there was a sudden and steeper decline in the slope of the visuospatial skills three years before patients with dementia were diagnosed. The global cognition graph showed a steep decline two years before clinical diagnosis of dementia, while verbal and working memory did not show until one year before. The authors concluded, "Some of the earliest signs of preclinical disease may occur on tests of visuospatial and speeded psychomotor skills. Furthermore, the greatest rate of preclinical decline may occur on executive and attention tasks. These findings suggest that research into early detection of cognitive disorders using only episodic memory tasks, such as word lists or paragraph recall, may not be sensitive to either all of the earliest manifestations of disease or the most rapidly changing domain."

Top 10 exercises for weight control

1. Walking
2. Crunches/sit-ups
3. Jogging
4. biking
5. Swimming
6. Resistance training
7. Dancing
8. Aerobic exercise
9. Yoga
10. Hiking
    

My first 5K road race in two years

Sunday morning, the day after Halloween, I awoke at 4am to drive up to Boca Raton for the Citibank 5K- in conjunction with the PBA Half-Marathon. since the start time was 6:30 am, I needed to be up early. As you know, Sunday began Eastern Standard Time, so I set my alarm an hour early, just in case the clock wasn't smart enough to change on it's own. My wife's alarm clock changed last week- it's a little older and has the old dates built in.

So, what about the race? I arrived in Boca on time. But I was so worried about being there at the right time, I forgot to wear my watch. More about that in a bit.

It's great to run a road race. On most days, I run in my neighborhood, and many days in the dark, before sunrise. I only pass by a few people on my route- doing my best to avoid cranky dogs! But at a road race, there are hundreds of people all out there to run the same route with you. It's encouraging to see all these people. There are even children that run with their parents!

Back to my watch. When I train, I wear my watch and my iPod. I know how I'm doing by how my split times are at 1/2-mile, 1 mile, 2 miles, etc. Sunday I didn't have either with me. I pace myself with some folks that ran slower than my normal pace, but I didn't know it until I heard my 3 mile time. That's when I sprinted to the finish. Since Sunday, I've sliced over 2 minutes off my best time. It pays to keep track of your progress. Something I always stress in my Health & Wellness Coaching

My next race will be the Turkey Trot 5K at Tropical Park in Miami. I can bet I'll wear my watch!