Endocrine Society experts call for expanded screening for primary aldosteronism

Washington, DC–The Endocrine Society today issued a Clinical Practice Guideline calling on physicians to ramp up screening for primary aldosteronism, a common cause of high blood pressure.

People with primary aldosteronism face a higher risk of developing cardiovascular disease and dying from it than other people with high blood pressure. As many as one in ten people with high blood pressure may have primary aldosteronism. Uncontrolled high blood pressure can put these individuals at risk for stroke, heart attack, heart failure or kidney failure.

The guideline, entitled “The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the May 2016 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of the Endocrine Society. The guideline updates recommendations from the Society’s 2008 guideline on primary aldosteronism.

“In the past eight years, we have come to recognize that primary aldosteronism, despite being quite common, frequently goes undiagnosed and untreated,” said John W. Funder, MD, PhD, of the Hudson Institute of Medical Research in Clayton, Australia, and chair of the task force that authored the guideline. “This is a major public health issue. Many people with primary aldosteronism are never screened due to the associated costs. Better screening processes are needed to ensure no person suffering from primary aldosteronism and the resulting risks of uncontrolled high blood pressure goes untreated.”

Primary aldosteronism occurs when the adrenal glands — the small glands located on the top of each kidney – produce too much of the hormone aldosterone. This causes aldosterone, which helps balance levels of sodium and potassium, to build up in the body. The resulting excess sodium can lead to a rise in blood pressure.

The Endocrine Society recommends primary aldosterone screening for people who meet one of the following criteria:

  • Those who have sustained blood pressure above 150/100 in three separate measurements taken on different days;
  • People who have hypertension resistant to three conventional antihypertensive drugs;
  • People whose hypertension is controlled with four or more medications;
  • People with hypertension and low levels of potassium in the blood;
  • Those who have hypertension and a mass on the adrenal gland called an adrenal incidentaloma;
  • People with both hypertension and sleep apnea;
  • People with hypertension and a family history of early-onset hypertension or stroke before age 40; and
  • All hypertensive first-degree relatives of patients with primary aldosteronism.

Other recommendations from the guideline include:

  • The plasma aldosterone-to-renin ratio (ARR) test should be used to screen for primary aldosteronism.
  • All patients diagnosed with primary aldosteronism should undergo a CT scan of the adrenal glands to screen for a rare cancer called adrenocortical carcinoma.
  • When patients choose to treat the condition by having one adrenal gland surgically removed, an experienced radiologist should take blood samples from each adrenal vein and have them analyzed. This procedure, called adrenal vein sampling, is the gold standard for determining whether one or both adrenal glands is producing excess aldosterone.
  • For people with primary aldosteronism caused by overactivity in one adrenal gland, the recommended course of treatment is minimally invasive surgery to remove that adrenal gland.
  • For patients who are unable or unwilling to have surgery, medical treatment including a mineralocorticoid receptor (MR) agonist is the preferred treatment option.

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The Hormone Health Network offers resources on primary aldosteronism athttp://www.hormone.org/questions-and-answers/2012/primary-aldosteronism.

Other members of the Endocrine Society task force that developed this guideline include: Robert M. Carey, of the University of Virginia Health System in Charlottesville, VA; Franco Mantero of the University of Padova in Padua, Italy; M. Hassan Murad of the Mayo Clinic in Rochester, MN; Martin Reincke of the Klinikum of the Ludwig-Maximilians-University of Munich in München, Bavaria, Germany; Hirotaka Shibata of Oita University in Oita, Japan; Michael Stowasser of the University of Queensland in Brisbane, Australia; and William F. Young, Jr. of the Mayo Clinic in Rochester, MN.

The Society established the Clinical Practice Guideline Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each guideline is created by a task force of topic-related experts in the field. Task forces rely on evidence-based reviews of the literature in the development of guideline recommendations. The Endocrine Society does not solicit or accept corporate support for its guidelines. All Clinical Practice Guidelines are supported entirely by Society funds.

The Clinical Practice Guideline was co-sponsored by the American Heart Association, the American Association of Endocrine Surgeons, the European Society of Endocrinology, the European Society of Hypertension, the International Association of Endocrine Surgeons, the International Society of Hypertension, the Japan Endocrine Society and The Japanese Society of Hypertension.

The guideline was published online at http://press.endocrine.org/doi/10.1210/jc.2015-4061, ahead of print.

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society, which is celebrating its centennial in 2016, has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

From http://www.eurekalert.org/pub_releases/2016-04/tes-ese042616.php

How women can spot heart attack warning signs

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According to the CDC, heart disease is the leading cause of death in the U.S. But shockingly, the World Health Organization says that 80 percent of heart disease is preventable. That’s right, 80 percent. The most common risk factors for heart disease are smoking, high cholesterol, high blood pressure, inactivity, obesity and diabetes. You can prevent heart disease by doing things like exercising, eating right and quitting smoking, but that’s for another article.

First, let’s talk a little science so you know why heart attacks happen. A heart attack happens when the blood flow that brings oxygen to the heart is severely reduced or stopped. This occurs because over time, the arteries that supply the heart with blood can slowly become thicker and harder from a buildup of fat, cholesterol and other substances. This process is known as atherosclerosis. If the plaque breaks open and a blood clot forms, it can block the blood flow in the vessel, causing a heart attack. Heart attacks are perhaps the most feared complication of heart disease, so it’s important to learn how to spot the signs. We’ve all seen the classic signs of a heart attack in movies. It can be dramatic and sudden, and can include:

  • Chest pain in the center of your chest that can feel like squeezing, pressure or fullness and can radiate down the left arm or to other areas. The pain can come and go and lasts longer than a few minutes. It has often been described as “having an elephant sit on your chest” or “having your chest in a vise.”
  • Shortness of breath
  • Palpitations or heart racing
  • Sweating

The American Heart Association and a body of recent research suggest that this typical picture of a heart attack is more typical for men who experience symptoms. A report by BlueCross BlueShield revealed that while heart attacks are more common in men, women “who experience heart attacks have worse outcomes — they are more likely than men to die within one year of a heart attack, to have another heart attack within six years, and to be disabled because of heart failure within six years.” Women receive less aggressive treatment after a heart attack than men and often delay care longer than men. This is why it is especially important that women learn to identify signs of a heart attack. For women, the picture can be more insidious than the dramatic Hollywood heart attack. While chest pain is still a common symptom for women, many have atypical symptoms that can seem more like the flu than a heart attack. Some don’t even have chest pain. For women, signs of a heart attack can include more than the typical symptoms above, such as:

  • Unusual fatigue
  • Indigestion
  • Trouble sleeping
  • Pain in neck, jaw or back
  • Nausea
  • Vomiting
  • Stomach pain

There’s a story circulating in national news about a local woman who believed she was suffering symptoms of a viral illness. She wanted to sleep it off, but at the insistence of her husband, she went to the emergency room and discovered she was in the throes of a heart attack. These stories are common, so it’s important to listen to your body. If you don’t feel right, go in to the hospital and get checked out. If you do believe that you are suffering the symptoms of a heart attack call 911 immediately and, according to a suggestion by Harvard Medical School, chew a tablet of aspirin.

By 2020, the American Heart Association wants to improve the cardiovascular health of Americans by 20 percent and reduce death from cardiovascular disease by 20 percent. The key to this goal is education. Let’s all work together to spread awareness of the preventable nature of heart disease and the subtle signs of a heart attack.

From http://www.tennessean.com/story/life/entertainment/12th/2016/04/28/how-women-can-spot-heart-attack-warning-signs/83539580/

February is American Heart Month

February is American Heart Month. Learn about heart disease in women and what you can do to keep a healthy heart.

Get Informed: Facts on Women and Heart Disease

  • Heart disease is the leading cause of death for women in the United States.
  • Although heart disease is sometimes thought of as a “man’s disease,” around the same number of women and men die each year of heart disease in the United States.
  • Some conditions and lifestyle choices increase a person’s chance for heart disease, including diabetes, overweight and obesity, poor diet, physical inactivity, and excessive alcohol use.
  • High blood pressure, high LDL (low-density lipoprotein) cholesterol, and smoking are key risk factors for heart disease. LDL is  considered the “bad” cholesterol because having high levels can lead to buildup in your arteries and result in heart disease and stroke. Lowering your blood pressure and cholesterol and not smoking will reduce your chances for heart disease.

Symptoms

While some women have no symptoms of heart disease, others may experience heavy sharp chest pain or discomfort, pain in the neck/jaw/throat, or pain in the upper abdomen or back. Sometimes heart disease may be silent and not diagnosed until a woman has signs or symptoms including:

  • Heart Attack: Chest pain or discomfort, upper back pain, indigestion, heartburn, nausea/vomiting, extreme fatigue, upper body discomfort, and shortness of breath.
  • Arrhythmia: Fluttering feelings in the chest.
  • Heart Failure: Shortness of breath, fatigue, swelling of the feet/ankles/legs/abdomen.
  • Stroke: Sudden weakness, paralysis (inability to move) or numbness of the face/arms/legs, especially on one side of the body. Other symptoms may include confusion, trouble speaking or understanding speech, difficulty seeing in one or both eyes, shortness of breath, dizziness, loss of balance or coordination, loss of consciousness, or sudden and severe headache.
Stethoscope with plastic heartHealthy Hearts

Heart disease is largely preventable.
Listen to CDC’s Dr. Bowman discuss ways to prevent heart problems.
[00:04:06 minutes]

What You Can Do for Heart Health

You can lower your chance of heart disease and a heart attack by taking simple steps.

  • Eat a healthy diet with fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products. Choose foods low in saturated fats, cholesterol, salt (sodium), and added sugars.
  • Exercise regularly. Adults needs 2 hours and 30 minutes (or 150 minutes total) of exercise each week. You can spread your activity out during the week, and can break it up into smaller chunks of time during the day.
  • Be smokefree. If you are ready to quit, call 1-800-QUIT-NOW (1-800-784-8669) or 1-855-DÉJELO-YA (1-855-335-3569 for Spanish speakers) for free resources, including free quit coaching, a free quit plan, free educational materials, and referrals to other resources where you live.
  • Limit alcohol use, which can lead to long-term health problems, including heart disease and cancer. If you do choose to drink, do so in moderation, which is no more than one drink a day for women. Do not drink at all if you are pregnant.
  • Know your family history. There may be factors that could increase your risk for heart disease and stroke.
  • Manage any medical condition you might have. Learn the ABCS of heart health. Keep them in mind every day and especially when you talk to your health provider:
    • Appropriate aspirin therapy for those who need it
    • Blood pressure control
    • Cholesterol management
    • Smoking cessation

From http://www.cdc.gov/features/wearred/index.html

New ibuprofen patch delivers drug without risks posed by oral dose

ibuprofen
Some people, such as me!, can’t take Ibuprofen or NSAIDs.  This might be a good solution…
Ibuprofen is used by many people to relieve pain, lessen swelling and to reduce fever. Though there are many worrying side effects linked to overuse of the drug, a new ibuprofen patch has been developed that can deliver the drug at a consistent dose rate without the side effects linked to the oral form.

The patch was developed by researchers at the University of Warwick in the UK, led by research chemist Prof. David Haddleton.

The Food and Drug Administration (FDA) have recently strengthened the warning labels that accompany nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

New labels warn that such drugs increase the risk of heart attack or stroke, and these events happen without warning, potentially causing death. Furthermore, such risks are higher for people who take NSAIDs for a long time.

Ibuprofen can also cause ulcers, bleeding or holes in the stomach or intestine.

With these risks in mind, finding an alternative way to relieve pain without the risks is a worthwhile endeavor. Though there are commercial patches on the market designed to soothe pain, this is the first patch that delivers ibuprofen through the skin.

“Many commercial patches surprisingly don’t contain any pain relief agents at all,” says Prof. Haddleton, “they simply soothe the body by a warming effect.”

Patch drug load 5-10 times that of current patches

Working with a Warwick spinout company called Medherant, the researchers were able to put significant amounts of ibuprofen into a polymer matrix that adheres the patch to the patient’s skin, enabling the drug to be delivered at a steady rate over a 12-hour period.

The researchers say their patch paves the way for other novel long-acting pain relief products that can be used to treat common conditions – such as back pain, neuralgia and arthritis – without taking potentially damaging oral doses of the drug.

Prof. Haddleton explains that, for the first time, they can “produce patches that contain effective doses of active ingredients such as ibuprofen for which no patches currently exist.”

He adds that they are able to “improve the drug loading and stickiness of patches containing other active ingredients to improve patient comfort and outcome.”

The team notes that the drug load made possible by their new technology is 5-10 times that of current medical patches and gels. Furthermore, because the patch adheres well to skin, it stays put even when the drug load reaches levels as high as 30% of the weight or volume of the patch.

Other potential uses for the patch

There are currently a number of ibuprofen gels available, but the researchers say it is difficult to control dosage with these gels, and they are not convenient to apply.

“There are only a limited number of existing polymers that have the right characteristics to be used for this type of transdermal patches – that will stick to the skin and not leave residues when being easily removed,” says Prof. Haddleton, who adds:

“Our success in developing this breakthrough patch design isn’t limited to ibuprofen; we have also had great results testing the patch with methyl salicylate (used in liniments, gels and some leading commercial patches).

We believe that many other over-the-counter and prescription drugs can exploit our technology, and we are seeking opportunities to test a much wider range of drugs and treatments within our patch.”

Medherant CEO Nigel Davis says they anticipate their new patch will be on the market in around 2 years. He adds that they “can see considerable opportunities in working with pharmaceutical companies to develop innovative products using our next-generation transdermal drug-delivery platform.”

Despite the risks associated with long-term use of NSAIDs, Medical News Today recently reported on a study that suggested use of the drugs could reduce risk of colorectal cancer.

Are Exercise Recommendations Really Enough to Protect the Heart?

When it comes to preventing heart failure, even the recommended amounts may not be enough, finds a new study

Being inactive is solidly linked to heart problems like heart attack and stroke, and exercise can help lower risk factors—such as high blood pressure and narrowed blood vessels—that are connected to those heart events.

But when it comes to another type of heart condition, heart failure, the effect of physical activity isn’t as clear. If coronary heart disease can be traced to more physical issues, such as blocked arteries or excessive pressure from blood pumping around the body, heart failure is more of a body-wide problem affecting not just the heart but almost every tissue.

In heart failure, the heart gradually loses its ability to effectively pump oxygen-rich blood to the rest of the body, and it can’t keep up with supplying muscles and cells with what they need to function properly. 5.1 million people in U.S. have heart failure.

Source: Are Exercise Recommendations Really Enough to Protect the Heart? | TIME

Consumer Updates > FDA Strengthens Warning of Heart Attack and Stroke Risk for Non-Steroidal Anti-Inflammatory Drugs

Next time you reach into the medicine cabinet seeking relief for a headache, backache or arthritis, be aware of important safety information for non-steroidal anti-inflammatory drugs.

FDA is strengthening an existing warning in prescription drug labels and over-the-counter (OTC) Drug Facts labels to indicate that nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the chance of a heart attack or stroke, either of which can lead to death. Those serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might rise the longer people take NSAIDs. (Although aspirin is also an NSAID, this revised warning doesn’t apply to aspirin.)

The OTC drugs in this group are used for the temporary relief of pain and fever. The prescription drugs in this group are used to treat several kinds of arthritis and other painful conditions. Because many prescription and OTC medicines contain NSAIDs, consumers should avoid taking multiple remedies with the same active ingredient.

via Consumer Updates > FDA Strengthens Warning of Heart Attack and Stroke Risk for Non-Steroidal Anti-Inflammatory Drugs.

Don’t Ignore These Early Signs Of Heart Disease In Men | Michael Lazar

Early Signs Of Heart Disease In Men

While many men may be unaware that they suffer from heart disease until a major incident, like a heart attack, occurs, there are several red flags that you should be aware of to better detect problems with the heart during the earliest and most treatable phases, explains WebMD.

The early stages of heart disease may have come-and-go symptoms that include:

Out of breath after moderate exercise, like climbing stairs.

A feeling of achiness or squeezing in the chest that can last 30 minutes or longer.

Pain in the upper extremities that can’t be explained.

Sometimes heart disease is caused by blood vessels. Key early signs include:

Chest pain

Shortened breath

Pain or tingling in the upper extremities

These symptoms could mean that your blood vessels have narrowed and are constricted. This can sometimes be caused by the build-up of plaque, which forces the heart to work harder to pump blood.

via Don’t Ignore These Early Signs Of Heart Disease In Men | Michael Lazar.