Gluten sensitivity: new epidemic or new myth?

Fueled in part by recent bestselling books that warn of the evils of gluten in our diets, a significant proportion of our population is now either avoiding foods that contain gluten or eliminating gluten entirely from their diets, and these numbers continue to grow. The gluten-free trend-and the accompanying multibillion-dollar industry it has created-stems from the spreading belief that eating foods containing wheat or other gluten-laden grains may not only result in weight gain and obesity, but can also lead to a laundry list of ailments ranging from depression and anxiety to arthritis and autism. One popular book contends that current recommendations for a high-grain/low-fat diet underlie much of today's chronic health problems and that a low-carbohydrate, high-fat/cholesterol diet is ideal.

Gluten sensitivity: new epidemic or new myth? Every major change in our diet carries with it the possibility of unforeseen risks.

Fueled in part by recent best-selling books that warn of the evils of gluten in our diets, a significant proportion of our population is now either avoiding foods that contain gluten or eliminating gluten entirely from their diets, and these numbers continue to grow. The gluten-free trend-and the accompanying multibillion dollar industry it has created-stems from the spreading belief that eating foods containing wheat or other gluten-laden grains may not only result in weight gain and obesity but can also lead to a laundry list of ailments ranging from depression and anxiety to arthritis and autism. One popular book contends that current recommendations for a high-grain, low-fat diet underlie much of today's chronic health problems and that a low-carbohydrate, high-fat/cholesterol diet is ideal.

Translating current knowledge into dementia prevention.

Considerable knowledge has been gained from epidemiologic studies and randomized clinical trials regarding risk factors for dementia, including Alzheimer disease (AD) and vascular dementia (VaD). Most identified risk factors for dementia are similar to vascular disease risk factors for heart disease and stroke. In 2010, the National Institutes of Health Conference concluded that there are no validated modifiable factors to reduce the incidence of AD or to change its course.

Cholesterol, lipoproteins, and cognitive impairment.

This article discussed the central role of the deposition of amyloid beta in the pathogenesis of Alzheimer disease. (AD), and the animal data which supports the role of cholesterol on its deposition. The effect of mid-life cholesterol is discussed, and the presence of cardiovascular disease risk factors in the patients with evidence for AD and vascular disease.

Valsartan combination therapy in the management of hypertension - patient perspectives and clinical utility.

The morbidity and mortality benefits of lowering blood pressure (BP) in hypertensive patients are well established, with most individuals requiring multiple agents to achieve BP control. Considering the important role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of hypertension, a key component of combination therapy should include a RAAS inhibitor. Angiotensin receptor blockers (ARBs) lower BP, reduce cardiovascular risk, provide organ protection, and are among the best tolerated class of antihypertensive therapy.

Nuts as part of a healthy cardiovascular diet.

The increasing trend of obesity has been associated with a greater prevalence of type 2 diabetes mellitus and may lead to more vascular disease. Nuts, a rich source of monounsaturated fatty acids and fiber, have been shown to decrease the risk of cardiovascular disease and the risk of developing type 2 diabetes mellitus. Numerous studies have demonstrated that nuts favorably affect serum lipids.

Ranolazine for chronic stable angina.

Ranolazine is a new and unique antianginal drug that has been approved for the treatment of chronic stable angina pectoris. The drug is administered as a sustained-release formulation. Although the drug's mechanism of action has not been fully elucidated, current thinking is that ranolazine, a selective inhibitor of late sodium influx, attenuates the abnormalities of ventricular repolarisation and contractility associated with ischaemia.

Achieving BP goals with valsartan and HCTZ alone and in combination: pooled analysis of two randomized, double-blind, placebo-controlled studies.

Background: Most patients with hypertension will require combination therapy to achieve blood pressure (BP) goals, especially the elderly, obese, or those with stage 2 hypertension.

Objective: To assess BP response and time to achieve BP goals in a diverse population of hypertensive patients treated with hydrochlorothiazide, valsartan, or a combination.

Methods: For this secondary post-hoc analysis, data were pooled from two similar randomized, double-blind, 8-week trials that evaluated hydrochlorothiazide (12.

Cardiovascular risk factors and dementia.

Background: Dementias, such as Alzheimer's disease (AD) and vascular dementia, are disorders of aging populations and represent a significant economic burden. Evidence is accumulating to suggest that cardiovascular disease (CVD) risk factors may be instrumental in the development of dementia.

Objective: The goal of this review was to discuss the relationship between specific CVD risk factors and dementia and how current treatment strategies for dementia should focus on reducing CVD risks.

Use of vascular ultrasound in clinical trials to evaluate new cardiovascular therapies.

Though progress has been made in the fight against cardiovascular disease (CVD), the increasing global prevalence of cardiovascular (CV) risk factors ensures that CVD rates remain high. In order to reduce CVD incidence, a huge effort has been made to uncover additional targets for therapy and novel methods of identifying patients at risk. A low level of high-density-lipoprotein (HDL) cholesterol is recognized as an important independent risk factor for occurrence of a CV event, and new therapies capable of producing effective, clinically relevant increases in this key lipoprotein particle are in development.

Nutritional and exercise aspects of cognitive impairment.

According to recent evidence, our aging society is in the early phases of an epidemic of cognitive decline. Accordingly, efforts directed at reducing the risk of Alzheimer's disease and dementia will be an important goal of health care efforts. While there are a paucity of successful treatment options currently available, diet and other lifestyle changes can play an important role in such an approach.

Rationale for combination therapy in hypertension management: focus on angiotensin receptor blockers and thiazide diuretics.

Despite recognition that hypertension is a major risk factor for cardiovascular events and mortality, blood pressure control rates remain low in the US population. Reflecting clinical trial results, hypertension management guidelines assert the clinical benefit of achieving current blood pressure goals and indicate that most patients will require 2 or more drugs to reach goal. Well-designed drug combinations counter hypertension via complementary mechanisms that increase antihypertensive efficacy, potentially with lower rates of adverse events than higher dose monotherapy regimens.

Systolic hypertension.

Approximately one-third of the adult population has hypertension. Large-scale clinical trials have convincingly demonstrated that the treatment of isolated systolic and systolic/diastolic hypertension reduces rates of total mortality, cardiovascular mortality, and stroke in older adults, yet control of systolic hypertension remains poor. This article reviews systolic blood pressure as a cardiovascular risk factor and discusses effective management of elevated systolic blood pressure.

The clinical implications and management of concomitant hypertension and dyslipidemia.

Hypertension and dyslipidemia often coexist, increasing the risk of cardiovascular disease. Evidence suggesting that concomitant hypertension and dyslipidemia are compelling candidates for a unified approach to treating cardiovascular risk is reviewed in this article. The authors also discuss important new findings documenting the need for, and benefits of, a more integrated approach to treating this dangerous duo.

Cardiovascular disease risk factors and cognitive impairment.

The role of cardiovascular disease risk factors in the occurrence and progression of cognitive impairment has been the subject of a significant number of publications but has not achieved widespread recognition among many physicians and educated laymen. It is apparent that the active treatment of certain of these cardiovascular disease risk factors is accompanied by a reduced risk for cognitive impairment. Patients with hypertension who are treated experience fewer cardiovascular disease events as well as less cognitive impairment than similar untreated patients.

Relationship of C-reactive protein, metabolic syndrome and diabetes mellitus: potential role of statins.

Atherosclerosis and the metabolic derangements of insulin resistance, metabolic syndrome and diabetes mellitus are all associated with underlying inflammatory processes. C-reactive protein (CRP), a marker of inflammation, has been shown to be a strong independent predictor of vascular events. It adds to cardiovascular disease risk at all levels of low-density-lipoprotein cholesterol and Framingham risk scores, and elevated levels are also associated with increasing severity of the metabolic syndrome.

Cardiovascular risk beyond LDL-C levels. Other lipids are performers in cholesterol story.

High levels of low-density lipoprotein cholesterol (LDL-C) are an obvious culprit in coronary artery disease (CAD). However, the search for lipid factors that influence cardiovascular health does not end there. In this article, Dr Nash presents the various lipid factors involved, for better or worse, in CAD.

Statins. Evidence of effectiveness in older patients.

As the population ages, increasing numbers of older adults are becoming candidates for lipid-lowering therapy with HMG CoA reductase inhibitors (statins) and lifestyle modification. Available evidence shows that statins reduce cardiovascular events and invasive revascularization in older adults. Statins have not only been shown to be safe and effective for lowering LDL cholesterol, but appear to have ancillary pleiotropic effects that are beneficial in other conditions to which older adults are prone.