Vitamin Therapy Can Still Reduce Stroke, Researchers Contend

ScienceDaily (Dec. 21, 2011) A commentary by University of Western Ontario's David Spence and Harvard School of Public Health's Dr. Meir Stampfer in this week's Journal of the American Medical Association argues vitamin therapy still has a role to play in reducing stroke.
Vitamin B therapy was once widely used to lower homocysteine levels and too much of this amino acid in the bloodstream was linked to increased risk of stroke and heart attack. But several randomized trials found lowering homocysteine levels with B vitamins did not result in a cardiovascular benefit. A study by Spence, a scientist with the Robarts Research Institute at Western's Schulich School of Medicine & Dentistry, found Vitamin B therapy actually increased cardiovascular risk in patients with diabetic nephropathy. He says this commentary provides insights that overturn the widespread belief that homocysteine is dead. He says two key issues have been overlooked in the interpretation of several clinical trials: the key role of vitamin B12, and the newly recognized role of renal failure. "It is now clear that the large trials showing no benefit of vitamin therapy obscured the benefit of vitamin therapy because they lumped together patients with renal failure and those with good renal function, says Spence, the author of How to Prevent Your Stroke. "The vitamins are harmful in renal failure, and beneficial in patients with good renal function, and they cancel each other out." The commentary also contends most of the trials did not use a high enough dose of vitamin B12.

'Good' HDL Cholesterol Can Also Be 'Bad'

ScienceDaily (Jan. 13, 2012) Generally speaking, a distinction has been made so far between "good" HDL cholesterol and "bad" LDL cholesterol. LDL contributes to cardiovascular diseases such as myocardial infarction and stroke, while the "good" HDL protects against them. Now, however, experts at the MedUni Vienna have discovered that the anti-inflammatory effect of HDL was not detected in patients on renal dialysis. "In fact, the HDL amplified inflammatory reactions several times over and could explain the latent chronic inflammation that is associated with high cardiovascular risk," says Semann.
On closer investigation of HDL levels in dialysis patients, i.e. people with renal failure, it was learned that levels of a specific molecule, known as serum amyloid A (SAA), were significantly raised in these individuals. SAA is a highly likely cause for the defect in the HDL. Says Weichhart: "If you integrate SAA into healthy HDL, it ceases to function properly." Quality over quantity This discovery could change the evaluation of HDL cholesterol. Until now, a high level of HDL was regarded as ideal. "Much more important than the quantity, however, is of course the quality of the HDL. Non-functioning HDL cholesterol is useless -- even high HDL levels would cease to be healthy," says Weichhart. Explaining another finding, Semann adds: "Lowering the LDL level is therefore still even more important than raising the HDL level." It is currently not possible, however, to identify "bad" HDL quickly with a simple test. Weichhart and Semann are currently working on the development of such a test. Together with the Medical University of Vienna, they have obtained a patent that will allow them to determine the changes in HDL using a simple laboratory test and therefore enable the risk of future cardiovascular disease to be estimated more accurately -- allowing treatment to be commenced sooner. In recent years, it has been found that certain conditions such as coronary heart disease (CHD), diabetes mellitus and rheumatoid arthritis have their own, characteristic HDL. Some of the proteins that have just been discovered in the HDL of patients with renal failure have also been found in the HDL of these conditions, causing HDL to lose its beneficial, anti-inflammatory and vessel-protecting properties. "With the new laboratory test, we have now been able to investigate whether modified HDL is associated with a

poorer prognosis in patients with renal failure at an early stage of their condition, and whether this is also the case for patients with diabetes or after a heart attack, for example. This would mean that a simple test principle would enable us to commence therapy early on, thereby decisively changing the overall prognosis for the better," say the MedUni Vienna researchers.

Continued Treatment for Lupus May Boost Survival of Those Patients With End-Stage Kidney Disease
ScienceDaily (Sep. 20, 2011) Researchers at Albert Einstein College of Medicine of Yeshiva University have shown that close supervision by rheumatologists and the use of immunosuppressant drugs improve the survival of lupus patients with end-stage kidney disease -- a finding that could reverse long-standing clinical practice. Their study appeared in the September 1 online edition of the Journal of Rheumatology.
At least 1.5 million Americans (more than 90 percent of them women) have lupus (officially known as lupus erythematosus), a chronic autoimmune disease that can damage many organs of the body. Treatment usually involves using immunosuppressive drugs to blunt the immune system's attack on the body. Kidney disease is a common complication of lupus, and up to 30 percent of patients with lupus-related kidney disease ultimately develop end-stage renal failure. "The lupus disease process was thought to become inactive once kidney failure develops," said lead author Anna Broder, M.D., assistant professor of medicine at Einstein. "As a result, patients generally haven't been encouraged to continue with immunosuppressant medications or to follow up with their rheumatologists after developing end-stage kidney disease. But recent studies have suggested that lupus can indeed remain active after patients start dialysis or receive a kidney transplant." "Our research shows for the first time that under-supervising and under-treating these lupus patients was associated with an increased risk of death," said Dr. Broder. The Einstein researchers reviewed the charts of 80 lupus patients with end-stage renal disease who had been started on renal replacement therapy (i.e., either kidney dialysis or kidney transplant). Twenty-two of the patients had been seen frequently in rheumatology clinics (two or more visits per year), while the other 58 patients had been followed infrequently (fewer than two visits per year). Four years after beginning renal replacement therapy, patients who continued to be treated with immunosuppressive medications were less likely to have died compared with patients who took only low doses of prednisone or no medication. (In fact, patients receiving no medication were 13 times more likely to have died compared with patients treated with a combination of immunosuppressive therapies.) The study also found that lupus patients who visited their rheumatologist at least twice a year after starting dialysis had significantly higher four-year survival rates compared with patients who went for fewer follow-up visits. "If these findings are confirmed by future studies," said Dr. Broder, "they may significantly change the way lupus patients with end-stage renal failure are managed while on dialysis or after receiving kidney transplants." Other authors of the study were Saakshi Khattri, M.D., Montefiore Medical Center; Ruchi Patel, M.D., Jacobi Medical Center; and senior author Chaim Putterman, M.D., professor of medicine and chief of rheumatology at Einstein. This research was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health.