Chronic pain linked to higher risk of heart attack and stroke

(From Harvard Medical School)

People with chronic pain may be more likely to have a heart attack or stroke than those without chronic pain, according to a study published online May 7, 2020, by the journal Pain Medicine. From 2001 to 2005, researchers identified 17,614 Taiwanese people who had used pain relievers for at least three months. The most common causes of pain were spinal disorders, arthritis, and headaches; the pain relievers included both over-the counter drugs and prescription opioids. For the comparison group, researchers used 35,228 people without chronic pain who were matched by age and sex to those in the first group.

During the follow-up, which lasted until 2015, people with chronic pain were 20% more likely to experience a heart attack and 30% more likely to have a stroke than those without chronic pain.

What might explain the connection? Pain may trigger a number of factors linked to poor heart health, including stress, reduced ability to exercise, poor sleep, and depression, the authors say.

Brain health and walking speed often decline together

Slower gait speed and cognitive decline may be related, according to a study published online April 12, 2020, by the International Journal of Geriatric Psychiatry.

Scientists recorded the gait speed and cognitive health of 370 people in the San Antonio Longitudinal Study of Aging (SALSA). Cognitive health was measured with a test that assessed orientation to time and place, attention, recall, language, and other aspects. Gait speed was measured with a timed 10-foot walk.

Following up for almost 10 years, the researchers found a direct link between slower speeds and lower cognitive scores. In fact, those who had both poor cognition and slow gait speed at the beginning showed the steepest decline. In comparison, those who had stable gait speeds over time scored well on the cognitive tests.

According to the researchers, cognition and gait speed may be altered by similar factors, such as atherosclerosis (hardening of the arteries) and abnormal deposits of beta-amyloid and tau proteins in the brain, which are associated with Alzheimer’s disease, other dementias.

Aspirin linked to fewer digestive tract cancers

Scientists continue to explore the health benefits versus risks of aspirin therapy. One new analysis suggests that taking aspirin may protect against several types of digestive tract cancers. The results were published online April 1, 2020, by Annals of Oncology.

Researchers examined 113 observational studies of cancer in the general population. They found that individuals who took aspirin regularly — at least one or two tablets a week — had significantly lower rates of cancers of the bowel, stomach, gall bladder, esophagus, pancreas, and liver, compared
with people who did not take aspirin.

Specifically, aspirin use was linked to 27% fewer bowel cancers, 33% fewer esophageal cancers, 36% fewer stomach cancers, and 22% fewer pancreatic cancers.

The researchers also focused on the effect of daily aspirin dose specifically on bowel cancer. They looked at three dose levels: low (100 mg), regular (325 mg), and high (500 mg). The results showed that higher doses were linked with greater protection.

For instance, an aspirin dose of 75 to 100 mg a day (equal to one low-dose tablet) was associated with a 10% reduction in bowel cancer compared with not taking aspirin. A daily dose of 325 mg was linked with a 35% reduction, and 500 mg per day was associated with a 50% reduction.

The researchers speculated that the benefit might reflect aspirin’s ability to fight inflammation and blood clots. However, they also noted that the connection between aspirin and cancer was only an association and that the studies do not prove that aspirin actually reduces cancer risk. And, aspirin may raise the risk of side effects like stomach bleeding. People should always consult their doctor before taking aspirin regularly.

How to improve your cholesterol profile

You can’t change your age or family medical history, both of which can affect your cholesterol levels. However, you can lose weight and boost physical activity, which will help lower your LDL cholesterol (bad cholesterol) and boost HDL (good cholesterol). But probably the most important step, though, is changing the way you eat.

Focus on fats. Most of the cholesterol in our body does not come directly from cholesterol containing foods like eggs. Rather, it is made by our body from components of food. To improve your cholesterol profile, avoid saturated fats (found in animal products). These fats increase unhealthy LDL levels. Instead, replace some of the saturated fats in your diet with healthier unsaturated fats, which are found in fish, nuts, avocados, and vegetable oils, such as olive oil, canola oil, and safflower oil.

Choose whole grains. Whole-grain breads, pasta, and cereal help prevent dramatic ups and downs in blood sugar and make you feel full longer. Many of these foods contain fiber that lowers LDL levels.

Make healthy substitutions. Eat more fruits and vegetables, especially if you substitute these for processed foods like potato chips. And make healthy dairy substitutions, such as plain yogurt instead of sugar-laden versions.

Take a cholesterol-lowering drug if you are at high risk for heart disease even if your cholesterol is normal. Statin drugs first became available in the 1980s and proved far better at lowering total cholesterol and LDL cholesterol than previous drugs. These medications reduce the body’s production of LDL cholesterol and help it reduce existing LDL. When studies showed that taking statins reduced the chance of getting heart disease, most doctors assumed that this was exclusively through their ability to lower cholesterol. However, statins also lower the chance of heart disease even if you have normal levels of total cholesterol or LDL cholesterol. The likely reason: statins dampen inflammation and help prevent arterial plaques from rupturing and causing a heart attack.

The decision to go on a statin depends on your age and overall cardiovascular risk. If your cholesterol is high-normal but your overall risk of a heart attack is low, it may be unnecessary to take a statin. Conversely, if your cholesterol is average but your overall risk is high, taking a statin may be a smart move.

To help people determine their 10-year risk of a heart attack, the American Heart Association and American College of Cardiology created an online calculator; you can find it at www.health. harvard.edu/heartrisk.

A second class of cholesterol-lowering drugs, the PCSK9 inhibitors, is also available. The two drugs in this class are alirocumab (Praluent) and evolocumab (Repatha). These are approved for people who are already taking the maximum tolerated doses of a statin and either have known heart disease (a previous heart attack or stroke) or a genetic condition called familial hypercholesterolemia that causes very high LDL levels.