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About one-fifth of ischemic stroke survivors don’t take medications that can reduce their risk of another stroke, a U.S. study has found.

Ischemic stroke is caused by blocked blood flow in the brain. Several types of medications can reduce the risk of another ischemic stroke. These include blood thinners (antithrombotic medications), of which aspirin is the most common.

This seven-year study of 4,168 ischemic stroke survivors found that about 19 percent of patients didn’t take blood thinners. Men, older patients and non-Hispanic patients were more likely to take blood thinners.

Further research is needed to determine exactly why patients who can benefit from these medications don’t take them, said the University of California, Los Angeles researchers.

Prepared by the U.S. Centers for Disease Control and Prevention, AARP and the American Medical Association, the report also lays out ways to improve the health of these adults by increasing the breadth of preventive services.

“This is really looking at untapped opportunities to improve the health of adults,” said report co-author Lynda A. Anderson, director of the CDC’s Healthy Aging Program. “It really talks about broadening the use of these potentially lifesaving preventive services.”

Areas of special attention in the report include influenza vaccine, cholesterol screening, colorectal cancer screening and for women, breast and cervical cancer screening. Also included are screenings for other behaviors that could hurt health such as binge drinking.

Anderson said they hope to institute programs for adults that are like those for children in keeping their health care up-to-date. “We are trying to get adults to think in the same way — are you really up-to-date- on your services?” she explained.

By 2015, middle-aged adults will make up 20 percent of the U.S. population. These people are at the greatest risk of developing chronic diseases such as heart disease and cancer. In addition, about one-third of these adults are uninsured or underinsured, increasing the challenges of providing preventive services, the report noted.

In addition, most people go to their doctor with a specific complaint and often preventive screening is never mentioned, Anderson noted. The new effort is “really looking for ways to support providers,” she said.

“This report highlights that national experts agree on a set of recommended clinical preventive services,” Dr. Matthew T. McKenna, associate director for medical affairs at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, said during a late morning news conference Thursday.

“We are talking about a concerted effort to align messages that build awareness, about creating environments that make services readily available and convenient and adopting public policies that promote healthy behaviors and increase access to services,” McKenna said. “This can make a discernable impact on our nation’s health, health care and social services.”

In addition, the report discusses model programs, policies and strategies that communities can adopt together with health-care partners, to ensure services get to those who need them. It also highlights proven strategies that clinics and communities have used to promote preventive services.

One such program, called SPARC (Sickness Prevention Achieved through Regional Collaboration), is an organization in the community responsible for looking at what services are needed and organizing these services, as well as getting services to people, Anderson said.

Individuals should look at “what kind of services do you need–what do I need to do to maximize my own health? What are the things I can do make sure as I am growing older that I avoid having chronic illnesses? That I make sure I get the physical activity I need, I make sure I am the right weight, so I can do the things I want to do,” Anderson said.

“It’s not just about health — it’s really quality of life,” she said.

In a study linking sounds to what is called spatial memory, researchers at Northwestern University in Chicago showed 50 objects on a screen to study participants and played corresponding sounds, like a cat meowing and a tea kettle whistling. Then they played some of the sounds as participants napped.

The participants didn’t consciously hear the sounds, but they still did better in tests of remembering where the objects belonged on the screen.

“The research strongly suggests that we don’t shut down our minds during deep sleep,” said John Rudoy, lead author of the study and a neuroscience post-graduate student, in a news release issued by the university. “Rather this is an important time for consolidating memories.”

“While asleep, people might process anything that happened during the day — what they ate for breakfast, television shows they watched, anything,” Ken Paller, senior author of the study and professor of psychology at Weinberg College of Arts and Sciences at Northwestern, said in the statement. “But we decided which memories our volunteers would activate, guiding them to rehearse some of the locations they had learned an hour earlier.”

The new study adds to the growing research that memories are processed during sleep. And it substantiates past studies showing that the brain is active during sleep, reviewing recently acquired information and integrating it with other knowledge “in a mysterious consolidation process that sustains our memory abilities when awake,” the researchers said.

New data suggest that when patients take both Prilosec and Plavix, Plavix’s ability to block platelet aggregation (anti-clotting effect) may be reduced by about half.

“Both of these drugs, when used properly, provide significant benefits to patients.” said Mary Ross Southworth, Pharm.D., of the Division of Cardiovascular and Renal Products in the FDA’s Center for Drug Evaluation and Research. “However, patients at risk for heart attacks or strokes who use Plavix to prevent platelet aggregation will not get the full effect of this medicine if they are also taking Prilosec.”

Plavix is used to prevent blood clots that could lead to heart attacks or strokes in at-risk patients. Omeprazole, the active ingredient of Prilosec and Prilosec OTC, is a proton pump inhibitor (PPI) used to reduce the production of stomach acid and prevent stomach irritation.

Plavix does not have anti-clotting effects until it is converted or metabolized into its active form with the help of the liver enzyme, CYP2C19. Prilosec blocks this enzyme, thereby reducing the effectiveness of Plavix.

After issuing an Early Communication in January about possible drug interactions involving Plavix, the FDA requested new studies from the drug’s manufacturers, sanofi-aventis and Bristol-Myers-Squibb. These new studies support the existence of a significant interaction that could negatively impact a person’s health. Based on the current scientific information, the Plavix label has been updated with new warnings about the use of Prilosec and other drugs that inhibit the CYP2C19 enzyme and that could interact with Plavix in the same way.

The new studies compared people who took Plavix and Prilosec together with people who took Plavix alone. A reduction in Plavix’s anti-clotting effect was found in those individuals who took the combination. Similar results were seen irrespective of whether the two drugs were taken at the same or different times of day.

It is unknown how other PPIs may interfere with Plavix. Other drugs that should not be used with Plavix because they may have a similar interaction with CYP2C19 include Nexium (esomeprazole), Tagamet and Tagamet HB (cimetidine), Diflucan (fluconazole), Nizoral (ketoconazole), VFEND (voriconazole), Intelence (etravirine), Felbatol (felbamate), Prozac, Serafem, Symbyax (fluoxetine), Luvox (fluvoxamine) and Ticlid (ticlopidine).

Patients who take Plavix and need to take a drug to reduce stomach acid should discuss their therapy with a health care professional. Zantac (ranitidine), Pepcid (famotidine), Axid (nizatidine), and antacids do not inhibit the CYP2C19 enzyme and aren’t expected to interfere with the anti-clotting activity of Plavix.

Plavix’s manufacturers have agreed to continue conducting studies to explore this and other drug interactions. When the FDA has reviewed additional data, the agency will communicate any new recommendations or conclusions.

The thiazide-type diuretic chlorthalidone outshone three other treatments — a calcium channel blocker, an ACE inhibitor and an alpha-receptor blocker — in most areas, especially in lowering the incidence of stroke and heart failure, according to the most current data from a large ongoing study known as ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

“We believe thiazide-type diuretics should still be preferred,” said study investigator Dr. William Cushman, professor and chief of preventive medicine at the Veterans Affairs Medical Center in Memphis, Tenn., at a news conference on the findings Wednesday at the annual meeting of the American Heart Association (AHA) in Orlando, Fla.

“The message is largely unchanged, and the main message is that treating hypertension [high blood pressure] is very necessary,” added Dr. Clyde Yancy, president of the AHA. “Treating hypertension with chlorthalidone resulted in a significant reduction in heart failure and stroke.”

The original trial, begun in 1994, involved more than 42,000 patients with hypertension and at least one other risk factor for cardiovascular disease. The participants were randomly assigned to take one of the following anti-hypertensive drugs: chlorthalidone (the diuretic), amlodipine besylate (the calcium channel blocker), doxazosin mesylate (the alpha blocker) or lisinopril (an ACE inhibitor).

The five-year follow-up, which ended in 2002, was intended to see if new differences emerged with long-term use of the medications, especially regarding coronary heart disease, total mortality, heart failure and aggregate cardiovascular disease.

“This is the largest hypertension trial to date,” Cushman said.

Earlier results from ALLHAT had also found that diuretics were as good or better than other blood pressure-lowering drugs for treating hypertension in patients with metabolic syndrome (a collection of factors that put people at risk of heart disease), especially black patients.

“None of the newer drugs were superior to chlorthalidone for reducing death from cardiovascular disease or end-stage renal disease, although the calcium channel blocker was very similar,” Cushman stated.

Strokes were much more common in black study participants taking the newer drugs, and patients on the calcium channel blocker had much higher rates of heart failure.

Cushman also presented some 10-year follow-up data, which were essentially the same as the five-year data. No new adverse events cropped up, he noted.

“Chlorthalidone treatment is superior to each in preventing one or more major cardiovascular events as long as participants continued taking the drug,” he said.

In 2006, almost 380 million diagnostic and interventional radiological procedures were performed in the United States, on top of 18 million nuclear medicine examinations.

“Back in about 1980, 15 percent of radiation that the U.S. population got was from medicine and the rest was predominantly from natural background radiation,” noted Dr. Fred Mettler Jr., U.S. Representative to the United Nations Scientific Committee on the Effects of Atomic Radiation and a professor of radiology at the University of New Mexico in Albuquerque. “In the last 20 years, medical exposure has gone up between 600 and 700 percent from what it was, and it is now the biggest source of radiation to the U.S. population.”

“The issue,” Mettler continued, “is that this is a controllable source. We regulate the effluent from nuclear power plants so the public doesn’t get exposure but medical exposure is essentially unregulated. The largest source in the U.S. is essentially unregulated, and it’s up to your family doctor or any other doctor to hand it out.”

Mettler is lead author of a paper appearing in the November issue of Radiology that summarizes the conclusions of two previous reports on radiation sources in the U.S. Those reports were issued by the U.S. National Council on Radiation Protection and Measurements and the United Nations Scientific Committee on Effects of Atomic Radiation.

The findings are in line with previous studies, one of which attributed up to two percent of all cancers to CT scans alone and another which concluded that cumulative exposure to radiation from CT scans increases the risk for malignancy by as much as 12 percent.

The last comprehensive assessment of radiation exposure was conducted in 1980-1982, a veritable eternity by medical and scientific standards.

“We needed to get a grip on how much radiation the U.S. was getting and where it was coming from,” Mettler said.

In the intervening years, the number of procedures performed has risen “by leaps and bounds,” he said. “The biggest chunk of that is CT scanning, which has been growing at better than 10 percent a year while the U.S. population is growing at less than 1 percent.”

Widely used as a diagnostic tool, CT scans provide detailed images of organs, allowing more accurate diagnoses of conditions such as cancer. But CT involves a higher radiation dose than most other imaging tests. According to this paper, CT provides half of the country’s total radiation dose, even though it represents only 17 percent of total procedures.

Emergency room physicians may be at the epicenter of the surge in scan use, Mettler said. “Twenty-five to 40 percent of CT scans are ordered out of the ER,” he noted. “The emergency physicians are in a tough box because they’re worried about getting sued. And they tend to get patients who they haven’t seen before. This is a one-time walk-in and their mantra is, ‘We can’t afford to miss anything.’”

Of course, the trend is not limited to the U.S., although it may be more extreme here. Globally, the per-capita annual dose from medicine has doubled in the past decade or so.

Still the U.S. leads the pack, with 12 percent of all radiologic procedures and half of nuclear medicine procedures performed here.

“We have a little under 5 percent of the world’s population and 25 percent of X-ray studies in the world and double and triple that of other developed countries,” Mettler said. “Nobody thought about how much radiation goes with this.”

But not all of uptick in scans has been unnecessary, said Dr. Robert Zimmerman, executive vice chair of radiology at Weill Cornell Medical Center in New York City.

“We don’t really know how much of it is overuse. We do know some of it is overutilization, but CT is a valuable imaging modality. CT is a great test. There’s no question that in the appropriate cases it’s going to save lives.”

There are things radiologists can do to curb its use, including reducing the doses, while manufacturers are working on new and improved machines, Zimmerman said.

Physicians can also tailor their use, thinking twice about using this type of technology in children, who are more sensitive to radiation and have longer to develop side effects.

“When I get a call for a CT scan, my first question is, ‘How old is the patient?’ If it’s 40 or under my antennas go up and if they’re 70 my antennas don’t get so excited. Mostly my idea is a CT might be a good thing but you would like to think about radiation beforehand,” Mettler said. “There’s a lot of stuff going on now that isn’t justified. Nobody’s ever shown that many of these things we do make a difference in outcome.”

The dosage — 50,000 international units (IU) every week or two — was large but did not appear to be toxic, according to the study published in the Oct. 26 issue of Archives of Internal Medicine.

Vitamin D is crucial for the body. Among its attributes, it strengthens bones by helping the body absorb calcium and phosphorus from food. Low levels of vitamin D can cause rickets in children and an adult bone disorder called osteomalacia.

A deficiency can also lead to osteoporosis, and research has suggested that it also has something to do with higher risks for such diseases as cancer, heart disease, diabetes, autoimmune diseases and flu, the study’s senior author, Dr. Michael F. Holick, director of the Bone Healthcare Clinic and the Vitamin D, Skin and Bone Research Laboratory at Boston University School of Medicine, said in a university news release.

For their study, the researchers treated 41 people who had low levels of vitamin D with 50,000 IU of the vitamin each week for two months. On average, their vitamin D levels nearly doubled after eight weeks, the study found.

Another 45 people were given 50,000 IU of vitamin D2 every two weeks. The researchers found that their levels also went up, but not quite as much.

“Vitamin D2 is effective in raising [vitamin D] levels when given in physiologic and pharmacologic doses and is a simple method to treat and prevent vitamin D deficiency,” Holick said. “While treating and preventing vitamin D deficiency, these large doses of vitamin D2 do not lead to vitamin D toxicity.”

The U.S. National Institutes of Health Office of Dietary Supplements recommends that you always talk to your health care provider before taking any supplements.

The condition called peripheral artery disease, or PAD, occurs when arteries in the legs become narrowed or clogged with fatty deposits, reducing blood flow to the legs. PAD affects about 8 million Americans.

PAD is as serious as heart disease, Dr. Ross Tsuyuki of the University of Alberta in Edmonton noted in a telephone interview with Reuters Health, “but, in general, it is under-recognized by the public and by our health care system.”

In 10 pharmacies in Central and Northern Alberta, Tsuyuki and colleagues had five pharmacy students screen 362 adults over age 50 for PAD. The screening procedure, which is fairly simple, compares the blood pressure in the leg to that of the arm.

Seventeen people who were screened — about 5 percent — had PAD. And, importantly, Tsuyuki said, 80 percent of the people found to have PAD were previously unaware they had the dangerous condition.

“PAD is a very strong risk factor for poor outcome, including heart disease, stroke and lower limb amputation,” Tsuyuki said.

“We informed them of what we found and followed up with them and most of them had gone to see their family physician for treatment,” Tsuyuki said, which may include aspirin or other anti-blooding clotting therapies and aggressive cholesterol-lowering treatments.

While the US Preventive Services Task Force currently does not recommend routine screening for PAD, Tsuyuki thinks it is worthwhile to screen people at high risk for PAD. “That would include people who already have heart disease and people who’ve suffered a stroke. They would be the highest priority,” he told Reuters Health.

“The second highest priority,” he added, “would be people middle-aged and beyond who are at high risk for heart disease and stroke, such as people with high blood pressure, diabetes and high cholesterol.”

The researcher reported his team’s findings over the weekend at the 2009 Canadian Cardiovascular Congress, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

In a statement from the meeting, Heart and Stroke Foundation spokesperson Dr. Beth Abramson said: “People don’t recognize that leg cramps while walking may be due to circulation problems that put them at risk for heart disease and stroke.”

While PAD may have no symptoms, there often are some warning signs, such as leg pain during exercise, open leg sores that don’t heal, feeling of coldness or numbness in one or both legs, pain in the toes at night.

Current or ex-smokers are at increased risk for PAD as are people with diabetes, high blood pressure, high cholesterol and heart disease.

The U.S. National Library of Medicine offers these suggestions to minimize jet lag:
Stick to a good bed time and sleep schedule before departing. Don’t miss out on sleep in an attempt to beat jet lag.
Adjust your bed time by a few hours before you leave, depending on which time zone to which you’ll be traveling.
If you’re only traveling for a few days, don’t worry about adjusting to a new time zone.
Don’t sleep on the flight, unless the flight includes your usual bed time.
Don’t consume alcohol or caffeine, but do drink plenty of fluids.
Keep up with your exercise routine, just not too close to bed time.