Gout: Sleep apnea can increase the risk

Gout: Sleep apnea can increase the risk - Gout is the most common type of inflammatory arthritis and affects more than 8 million adults. Men have a higher risk than women.  

And according to a new study, the risk of gout also increases if you suffer from sleep apnea, a condition in which breathing stops the repeatedly during sleep.

What exactly is gout?

The reduction was triggered by the crystallization of uric acid in the joints. It goes like this: Your body produces uric acid breaks down purines, natural waste product of living cells. Normally, uric acid dissolves in blood and passes through the kidneys into the urine.

However, sometimes the body produces too much uric acid or secreted very little. This causes uric acid to accumulate and form urate crystals in the needle form a joint or surrounding tissue. The result flare-ups that cause severe pain, inflammation, swelling and redness.

While the large joint of the big toe is the most affected area, gout can occur in any joint, including their ankles, knees, hands and wrists. The episodes can last from days to weeks.

The relationship between sleep apnea and gout 

For the study, published in Arthritis & Rheumatology, the researchers spent combing through the records in a health database of British comparing people with and without sleep apnea. A total of 9.865 persons were screened with sleep apnea (average 54 years) and are entitled to a "control" group of 43.958 persons without trouble. After one year, people with sleep apnea were 50% more likely to have had an attack of gout compared with the control group.

The exact nature of the relationship between gout and sleep apnea is unknown, but there are two possible explanations, the researchers said. First, the two conditions share common risk factor: overweight. "Although it is not clear how being overweight is associated with gout, many people who suffer from the condition tend to be overweight," says Dr. Robert Shmerling clinical chief of rheumatology at Harvard University affiliate Beth Israel Deaconess Medical Center.

The other theory may be related to hypoxia, a sleep apnea causes complication levels of a person of oxygen to fall during sleep. "This can cause tissue damage and decomposition of the cell, which can cause uric acid levels increase," says Dr. Shmerling.

Even if you have sleep apnea, the risk of a gout attack gets up at night - gout attacks are twice as likely to strike during the night or early morning. It is believed that the main reasons for this drop in body temperature and dehydration that occur during sleep. "The crystals are more likely to crystallize at lower temperatures, and dehydration can prevent excess uric acid is flushed from the body," explains Dr. Shmerling.

The treatment of gout

Gout can be confirmed by analysis of the liquid in a joint by their level of urate crystals. Their level of uric acid in the blood may also be useful for the diagnosis of gout - the higher the level, the greater your risk.

In sudden acute crises, the first line of treatment is a drug, says Dr. Shmerling. These include anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve) and prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex). Colchicine and corticosteroids can also help relieve pain and reduce inflammation. 

Changes in diet and lifestyle can reduce the risk of another attack. Avoid eating seafood and red meat (which can increase levels of uric acid) and limit alcohol and drinks with high fructose corn syrup. Stay well hydrated and adopt an exercise program to help lose excess weight. 

Try to include foods rich in lowering uric acid in your diet, including coffee (caffeinated or decaffeinated) and cherry juice. It also helps to increase your intake of vitamin C through supplements or foods such as peppers, broccoli, strawberries and oranges.

What to do

The investigation has not yet been confirmed whether treating sleep apnea will reduce the risk of gout, but worth discussing with your doctor that sleep apnea is associated with other serious problems health, such as heart disease, hypertension and stroke. There are several ways to treat sleep apnea - and many health benefits to be gained by doing so. 

By: Matthew Solan 
 

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The high cost of low cholesterol

The high cost of low cholesterol - You've probably heard of new drugs to reduce cholesterol Repatha Praluent and approved by the FDA in recent weeks. Maybe you've even started taking one yourself.

These drugs are miraculous in its ability to reduce LDL (cholesterol low-density lipoprotein), the type that leads to heart disease. But this power comes at a price - literally. Both drugs have an annual cost of about $ 14 600 per year.

The domino effect of drug prices through the roof 

Of course, people who take these medications can not pay the full cost themselves - which will fall to your insurance company. Exactly what a person would have to pay out of pocket depends on your health insurance plan in particular, but many people could end up paying a significant portion of the bill. So if your doctor prescribes these drugs for you, it is important to check with your insurance company about coverage before you start taking it.

But the prices of these drugs can still affect you, even if you take one of them personally. If enough people enrolled in their health plan of the individual, they are prescribed one of these drugs, the total cost of your insurance could be high enough to cause an increase in the premium for all.The high price of new drugs for cholesterol is not unique. New drugs for hepatitis C, arthritis and cancer (called "specialty drugs") are also quite expensive, and together we put a strain on the budgets of health care - and to offset the savings by use of generic medicines cost.

Why new medicines for cholesterol - and other specialty drugs - so expensive? In the US, pharmaceutical companies can set prices based on what the market will bear. Unlike Canada and Europe, the US government can not establish price controls on drugs, so that our drug prices are generally higher than the prices of these same drugs in these regions.

In fact, a new report from the Institute for Clinical and Economic Review (CIRE), which analyzes the cost-effectiveness of the new drug relationship, concluded that the cost of new medicines for cholesterol is too high . ICER recommends annual price tag of $ 2,177.

What to do with new medicines for cholesterol price 

Although we still have no evidence that the new cholesterol-lowering drugs actually reduce the rate of heart disease, for people with a rare genetic form of high cholesterol (called familial hypercholesterolemia, or FH) they are a godsend. But for people who have the most common form of high cholesterol, there are other options, much less than should be tried first.

Change in diet and regular exercise can help reduce cholesterol levels low, and (generic), an inexpensive statin therapy remains the drug of choice for treatment. A drug called ezetimibe (Zetia) can be added to a statin if statin alone is not fully effective.
 
Democratic candidates Hillary Clinton and Bernie Sanders have both proposed legislation to control drug costs, but it is unlikely that these laws were adopted in the short term. Until then, consumers must be aware of the price of drugs that doctors prescribe for them. Often there are less expensive alternatives that should be considered first.
By: Gregory Curfman, MD

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Too little sleep and overweight: a dangerous duo

You walk down the street early in the morning after spending all night to complete a project for your boss. The coffee shop is called as usual. But today siren song is more than a cup of coffee. In a way, there is an irresistible urge to buy a donut or two as well.

If ever you wondered why, read on.The number of Americans say they get sleep every night has fallen from an average of about 8.5 hours in 1960 to just under 19 hours today. 
There are probably many reasons why, but probably include 24/7 Professional extension of the "day" with artificial lighting, use of electronic devices before bedtime (blue light wavelength of these devices delays sleep onset) and widespread belief that sleep is a lower priority compared to other activities, whether work-related or pleasure.

And today, not only do most of us sleep less, but tend to weigh more, too. Over 30% of US adults are obese, compared with less than 15% of adults in the 1960s this "obesity epidemic" has been extended to children, with about 17% considered obese today. This is an alarming trend because obese children are likely to become obese adults.

Is there a relationship between sleep duration and increased the reduced obesity? Irrefutable evidence suggests there. A number of large studies involving thousands of adults have generally found that short sleepers (defined as five hours or less a night, but sometimes six hours or less) were up to 45% more likely to be obese. We do not have much data on children, but a study has shown that children who slept less than 7.5 hours per night were three times more risk of developing obesity in a period of 5 years.

Studies also show that short sleepers do not eat healthily. Above all, their diet have less variety of food, a higher percentage of calories from snacks, and a greater amount of sugar, caffeine and alcohol. They also tend to skip meals (breakfast, lunch and dinner) and also tend to snack more. These habits promote weight gain and the possible development of obesity.

Is there a scientific explanation of the feeding behavior of short sleepers? Experimental studies suggest that sleep restriction leads to abnormalities in the processing of blood sugar (glucose) and variations of hormones that control appetite. For example, ghrelin hormone stimulates the appetite, and reducing the hormone leptin. With sleep restriction, increased ghrelin levels and leptin decrease, resulting in increased hunger and appetite. In addition, these studies have shown that individuals with restricted sleep have a greater desire for high-calorie carbohydrate-rich foods.So what evidence linking lack of sleep to weight gain told us?

The bottom line is that getting enough sleep is one way to reduce the risk of weight gain and obesity. There is a tendency to put on pounds as you age. Lack of sleep will only worsen this trend. If a person is already overweight or obese, losing weight will be more difficult without adequate sleep.  

From a social perspective, the obesity epidemic, associated with increases in rates of several chronic diseases (eg, heart disease, diabetes), puts a greater burden on the health care system and contributes to rising health care costs. Adequate sleep should be included with exercise and good nutrition as one of the essential elements of good health.
By: Stuart Quan, MD,

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A tight glycemic control of type 2 diabetes linked to fewer heart attacks and strokes

Diabetes damages each part of the body, the brain in the feet. A high blood glucose, characteristic of diabetes wreaks havoc on blood vessels. It makes sense that keeping blood sugar levels under control to prevent damage related to diabetes - but how to push blood sugar is an open question.

A study published in today's issue of the New England Journal of Medicine (NEJM) provides reassuring evidence that tight glucose call control is good for the heart and circulatory system.

"Strict control of blood glucose represents a new era in diabetes care," said Dr. David Nathan, professor of medicine at Harvard Medical School and director of both the Clinical Research Center and the Center for Diabetes Massachusetts General Hospital. 

The hazards of high levels of blood sugar
 Type 2 diabetes is characterized by high levels of blood sugar. Over time, hypertension sugar damages small blood vessels throughout the body. This is called microvascular disease. The damage can lead to kidney failure, nerve pain, amputations and blindness.

But the main cause of complications and death in people with diabetes is cardiovascular disease, which affects larger blood vessel of the body. (This is also known as macrovascular disease.) About two-thirds of people with diabetes die from heart disease, stroke and other cardiovascular problems.A good measure of sugar in the blood is tested for hemoglobin A1c (HbA1c).  

Reveals the average concentration of sugar in the blood of a person over the previous three months. People without diabetes have HbA1c 5.7%; HbA1c of 6.5% or more usually indicates diabetes.

For some people with type 2 diabetes, a healthy diet and regular exercise can keep the blood sugar under control, but many also need medication. People with diabetes are normally invited to aim for tight control of blood sugar, resulting in an HbA1c below 7%.

Research has shown that tight blood glucose control can reduce the risk of microvascular complications. But the effect of tight control of blood sugar in cardiovascular diseases was murkier. The new report suggests NEJM tight blood sugar control also has cardiovascular benefits.

The benefits of tight control
 The report is 10 years followed Veterans Affairs Diabetes Trial. This study involved 1,791 veterans with type 2 diabetes who were on average 60 years. These veterans were randomized to therapy "intensive" intended to put sugar in the blood to a lower target HbA1c, or "standard" therapy with a higher HbA1c target. In each group, the level of sugar in the blood objective was achieved with a combination of oral drugs for diabetes and insulin injections, if necessary.

During the trial of five and a half days, the intensive therapy group had an average HbA1c level around 6.9%. The standard treatment group had a mean HbA1c of approximately 8.4%.More than 1,600 trial participants were followed for five years. Meanwhile, the researchers compared the number of participants had a cardiovascular event such as heart attack or stroke between intensive therapy and standard therapy groups.

The results were encouraging for both physicians who defended the control of blood sugar and people tight with diabetes who have worked hard to achieve. Heart attack and stroke risk in the strict control group was 17% lower than in those whose blood sugar floated a little higher. This translates into about 9 fewer heart attacks and strokes per 1,000 people. 

Metabolic memory
 The studio had another positive result. It reinforced what Dr. Nathan calls "metabolic memory". As he explains, "an early intervention period appears to have lasting effects over time."The active part of the VA trial lasted about five and a half years. After that, the health care of veterans were more supervised by the team of the research study. In three years, the average HbA1c in the intensive therapy group had slipped up, reducing the level difference between the intensive group and 1.5% standard to somewhere between 0.2% and 0.3 %. Yet the intensive therapy group continued to reap cardiovascular benefits years later.

The effect of intensive treatment do not last forever, says Dr. Nathan. At some point, he says, "metabolic memory becomes metabolic amnesia." But the more you keep your blood sugar under tight control, the more benefits tend to last. 

Balancing Act
 Although tight control of blood sugar can help prevent diabetes-related damage, it has some drawbacks. People in order to strict control may experience low blood sugar episodes in the blood (hypoglycemia), which can be very dangerous. Tight control can also be difficult, sometimes requiring several medications that can have adverse side effects of their own.

Previous research had suggested that people with longstanding diabetes and heart disease may not benefit from established a strict glycemic control as well as people with newly diagnosed diabetes. But the new report NEJM shows that it is never too late to control blood sugar.  

Veterans who participated in this study had poorly controlled diabetes for several years before the start of the study. And 40% had cardiovascular disease when they enrolled in the trial. So not only intensive treatment to reduce the risk of cardiovascular disease, it was in the elderly longtime diabetes, many of which already had heart problems.

Good control of blood glucose is important for all people with diabetes. Current guidelines from the American Diabetes Association recommends a target HbA1c less than 7%. But the guidelines also recognize that there is no single rule size. If you have diabetes, check with your doctor if tight control of blood sugar is good for you. 

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