Category Archives: Research

Health, Medical, Research, Science, Scotland

Clot-busting drug boosts recovery for stroke victims…

STROKE victims who are given a vital clot-busting drug within six hours are more likely to have a long-lasting recovery than those who do not receive the treatment, new research has revealed.

A Scottish-led study of more than 3,000 patients across a dozen different countries reviewed the effects of the clot-busting drug rt-PA, which is given intravenously to patients who have suffered an ischaemic stroke.

An ischaemic stroke happens when the brain’s blood supply is interrupted by a blood clot. The damage caused can be permanent or fatal. Stroke symptoms include paralysis down one side and speech problems.

The international trial, led by Edinburgh scientists, found that 18 months after being treated with the drug, more stroke survivors were able to look after themselves. Patients who received rt-PA had fewer long-term problems with self-care and mobility, and experienced less pain and discomfort than those who did not.

Treatment also reduced the number of patients who needed help from other people from 51 per cent to 43 per cent.

However, the benefits of using rt-PA come at a price. Patients are at risk of death within seven days of treatment because the drug can cause a secondary bleed in the brain.

Stroke experts stress that these mortality figures need to be taken in context of deaths from stroke. Without treatment, one third of people who suffer a stroke die, with another third left permanently dependent and disabled.

Professor Peter Sandercock, the Chief investigator from Edinburgh’s University Centre for Clinical Brain Sciences, said:

… The trial team is delighted that, even for the elderly, rt-PA significantly improves life after stroke in the longer-term.

… Our results underline the benefits of treating patients with the drug as soon as possible and justify extending treatment to those aged 80 and over. We hope that this new data will encourage wider use.

Researchers said that because of the threat of death and disability, many stroke patients are prepared to take the early risks of being treated with rt-PA to avoid being disabled.

About half of those who took part in the trial were aged over 80.

The study builds on the results of the world’s largest ever trial of the drug, which was published last year. It found that treatment with rt-PA improved health for stroke survivors up to six months following an ischaemic stroke.

The latest results from the trial show the quality of life of stroke patients 18 months after receiving rt-PA.

It involved stroke patients in 12 countries between 2000 and 2011 – half of whom were treated with intravenous rt-PA and half of whom were not.

Researchers found that for every 1,000 patients given rt-PA within six hours of stroke, by 18 months, 36 more will not need help from others than if they had not been given the drug.

The multi-centre, randomised trial was supported by the University of Edinburgh, the Stroke Association UK, the Medical Research Council, the Health Foundation UK, NIHR Stroke Research Network and NHS Lothian Health Board. The results have been published in the academic journal The Lancet Neurology.

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Health, Medical, Research, Science

HRT and the menopause: benefits now thought to outweigh risks…

After more than a decade of controversy, medical experts say that Hormone Replacement Therapy (HRT) for women in their 50s is safe in combating the menopause.

Taking medication to reduce the symptoms of the menopause is now deemed safe and the benefits for women on HRT are now thought to far outweigh the potential risks. Freshly released guidance from the British Menopause Society (BMS) has sought to reassure patients.

Medical experts say hundreds of thousands of women have suffered unnecessarily as a result of the decade-long controversy over the effects of HRT.

They say that General Practitioners (GPs) should prescribe the treatment to any woman who has unpleasant menopausal symptoms, such as hot flushes and mood changes. HRT is also known to provide bone protection in later life.

However, the debate over HRT use is likely to rage on as The Royal College of Obstetricians and Gynaecologists continues to advise HRT prescription only for women with serious menopausal symptoms ‘for the shortest time possible’.

After a period of five years doctors are not expected to continue prescribing HRT medication without discussing potential risks with their patients.

Uptake of HRT halved after two studies linked it to an increased risk of heart disease and breast cancer. An estimated one million women in the UK stopped having the treatment.

But the emerging consensus now is that the benefits of HRT outweighed the risks for most women, and that GPs should consider the updated BMS advice when treating the condition.

Consultant Endocrinologist Dr Helen Buckler, from the University of Manchester, speaking at the Cheltenham Science Festival, said the two studies linking HRT to breast cancer and heart disease were ‘scientifically unreliable’.

She said:

… The new advice is HRT should be used for a slightly wider age, if need be. If a woman has symptoms affecting the quality of her personal or professional life, then the benefits outweigh the risk.

The scare of taking HRT began in 2002, when the US Women’s Health Initiative study was halted some three years early because researchers claimed women using HRT were at a higher risk of breast cancer, heart disease and strokes. Yet, this contradicted previous (and later) research which suggested its use guarded against heart problems.

HRT is normally prescribed to menopausal women in their 50s, but according to the WHI study it was also given to women in their 60s and 70s who had gone through the menopause more than a decade earlier.

Shortly afterwards the UK Million Women Study, part funded by Cancer Research, a charity, said HRT doubled breast cancer risk, but a review in 2012 said it was ‘unreliable and defective’.

The advice from Cancer Research remains that there is still convincing evidence that women who take HRT have an increased risk of breast cancer. Dr Buckler, though, said the organisation was ‘out of step’ and its approach had tended to ‘put women off’ taking the treatment.

Some younger doctors have never prescribed HRT because they assume the risks outweigh the benefits.

Cancer Research UK said there was ‘convincing evidence’ that women who take HRT have an increased risk of breast cancer, but says that risk returns to normal around five years after the medication is stopped being used.

The BMS guidance is also opposed to the ‘arbitrary’ five year limit on treatment, and says it should be continued if symptoms persist.

The BMS, a registered charity and medical foundation, receives no government funding. Its medical advisory council comprises leading international experts in post reproductive health management, who regularly draw up guidelines for health professionals.

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Health, Medical, Research

Statins can weaken muscles and joints…

New research warns that taking statins will make you more likely to be diagnosed with muscle pain, joint disease and injuries.

Researchers found a 20 per cent increased risk of muscle problems in those patients on the cholesterol-lowering drugs compared with those not taking them.

The risk is deemed to be relatively small but it is important because millions of older patients with heart conditions take statins and their use may eventually widen to include healthy younger people.

Statins are the most widely prescribed drugs in Britain. The number of patients taking them is estimated to be as high as 8 million. There have been persistent complaints about side effects such as muscle pain and weakness.

The most serious adverse reaction of taking statins is myopathy, and affects around one in every 1,000 users. The reactions include muscle pain, tenderness and weakness. This condition can progress to rhabdomyolysis, a complete breakdown of muscle cells that can lead to kidney failure and death.

In some patients muscle weakness may persist even after stopping the drugs. And a British Heart Foundation survey found that one in three patients prescribed statin drugs doesn’t take them, partly because of the side effects.

The latest study carried out in the United States investigated the scale of illnesses linked to statins, including muscle weakness, muscle cramps and tendon diseases.

Researchers based at the Veterans Association in North Texas, Dallas, used data from the US military health care system.

Patients were divided into two equal groups: 6,967 who used statins for at least 90 days in 2005, and 6,967 non-users.

A report published by JAMA internal medicine says that statin patients were almost 20 per cent more likely than non-users to have a diagnosis of a musculo-skeletal disease, a 13 per cent higher risk of dislocation, strain or sprain, and slightly higher risk of muscle pain.

But statin users were no more at risk of joint-diseases such as osteoarthritis than non-users. The report states: ‘To our knowledge, this is the first study to show statin use is associated with an increased likelihood of diagnoses of musculoskeletal conditions, joint diseases and injuries.’ (sic)

Calls have been growing for healthy over-50s to take statins, not just those at extra risk of a heart attack. The researchers also said that any significant effect on general health, however small, needs to be carefully considered. These findings are concerning because starting statin therapy at a young age for primary prevention of cardiovascular diseases has been widely advocated.

Warnings from statin drug manufacturers’ include muscle pain and weakness, memory loss, fatigue, sleep disturbances, sexual dysfunction and depression. There is also a higher risk of developing diabetes.

Scientists in the UK say the study shows a very small impact of statins, increasing the risk of musculoskeletal disorders overall from 85 per cent in those not on statins to 87 per cent on a statin.

The Royal Pharmaceutical Society fears that more patients might stop taking the drugs. Citing that the UK has some five million people taking statins to prevent heart attacks and strokes, the Society says that if 1 per cent of these patients stop taking their statins due to concerns about muscle pains we will see at least 2,000 more heart attacks and strokes over the next ten years as a result, but avoid only 1,000 musculoskeletal problems. The Society also points out that musculoskeletal disorders occur commonly and are rarely due to taking statins.

It is argued, too, that statins save lives when used in the right type of patient – generally those at higher risk of stroke or heart attack because of other medical problems. With statins the benefits are hidden because many people who otherwise would have had a heart attack today were prevented from having a cardiac arrest because of the taking of these drugs. Doctors point out that the side effects of statins are often all too obvious, and this biases many people against a life-saving tablet.

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