Jugular Vein Distention (JVD): Causes and Treatments
COPD Identified As Independent Risk Factor For Stroke
Chronic obstructive pulmonary disease (COPD) is associated with fatal events in the long-term prognosis of stroke, but the association between COPD and short-term death in patients with stroke is insignificant.
Chronic obstructive pulmonary disease (COPD) is an independent risk factor for stroke, and the risk is significantly higher during acute exacerbations of COPD (AECOPD), according to a study published in Medicine.
The researchers explained that some studies concluded patients with COPD have a higher risk of stroke than those without it. Consequently, meta-analyses conducted several years ago explored the risk of stroke in patients with COPD, but the prognosis of patients with stroke had not been explained. Also, some studies found that patients with COPD have an increased risk of death after stroke, while other studies reported the opposite.
Because of the range of findings concerning the relationship between COPD and stroke, the researchers analyzed past studies on the risk of stroke in patients with COPD, the correlation between AECOPD and stroke risk, patients' short-term mortality risk after stroke, and patients' long-term mortality risk after stroke.
Two reviewers independently searched for relevant studies in databases like PubMed from its creation to February 17, 2023. The researchers used the Newcastle-Ottawa score (NOS) to evaluate the quality of studies with those given a 7 or above considered high quality.
COPD
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Initially, the reviewers retrieved 8039 relevant articles. After further review, they only included 27 articles within their analysis. Most studies were of high quality as they had NOS scores of 7.0 or higher; conversely, 2 studies had NOS scores of 6.0, meaning they were of moderate quality.
Of the included articles, 14 reported the risk of stroke in combination with COPD, 12 reported the risk of death after stroke, and 6 reported the risk of stroke in combination with AECOPD. Within the studies, 8 cohorts in 6 publications reported short-term patient prognosis outcomes, and 10 cohorts in 8 publications provided data on long-term patient prognosis outcomes.
Overall, the researchers found that COPD was an independent risk factor for stroke-associated pneumonia (OR, 1.40; 95% CI, 1.24-1.59; I2, 98.4%; P = .000). They also found that patients who experienced AECOPD had a significantly higher stroke risk than patients with COPD (OR, 1.53; 95% CI, 1.44-1.63; I2, 49.2%; P = .066).
Additionally, in the short term, COPD was not significantly associated with the risk of death from stroke (OR, 1.12; 95% CI, 1.08-1.16; I2, 37.4%; P = .131). Conversely, there was evidence that COPD can be an independent risk factor for death after more than 1 year of follow-up after stroke (OR, 1.20; 95% CI, 1.13-1.27; I2, 56.8%; P = .014).
The researchers also acknowledged their study's limitations, one being that most studies analyzed were from retrospective cohorts, meaning the medical records involved may not be comprehensive and accurate. Also, most included studies determined patients with COPD using diagnostic codes in medical databases, which did not reflect disease severity. Despite these limitations, the researchers made treatment suggestions based on their findings.
"…when treating patients with AECOPD, close coagulation monitoring is often required, and when combined with other risk factors for stroke, further prophylactic treatment must be considered," the authors concluded.
Reference
Ding C, Wang R, Gong X, Yuan Y. Stroke risk of COPD patients and death risk of COPD patients following a stroke: A systematic review and meta-analysis. Medicine (Baltimore). 2023;102(47):e35502. Doi:10.1097/MD.0000000000035502
Could Statins Reduce Death Risk In Chronic Kidney Disease?
A statin was the most prescribed drug in the United States in 2020, and guidance is continually being updated recommending the expansion of the use of this type of drug.
Initially prescribed in the late 1980s to people who had had a heart attack to prevent them from having another one, statins provided a way to lower levels of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol. This prevents the hardening and narrowing of the arteries which can lead to high blood pressure.
Previously, the only interventions that had been available to people at greater risk of heart disease had been lifestyle interventions, such as diet and exercise. However, research has since shown that statins are more effective than many lifestyle interventions at lowering LDL cholesterol.
The maximum safe dose of some statins can reduce LDL cholesterol levels by up to 55% on their own, and potentially further in conjunction with other drugs.
Understanding the role of cholesterol to health is so critical that the Nobel Prize in Physiology or Medicine 1985 was awarded jointly to Michael Brown and Joseph Goldstein "for their discoveries concerning the regulation of cholesterol metabolism."
A study published in The Lancet in 2002 showed that people who were at high risk of cardiovascular disease had their risk of heart attack and stroke reduced by 25% over 5 years when they took 40 milligrams (mg) of simvastatin daily.
Since the introduction of statins in the late 1980s, their use has been expanded to include more people deemed to be at risk of cardiovascular disease or major cardiovascular events in the next 10 years.
Recently, the REPRIEVE trial reported its results on the impact of statins in people with HIV. Results published in the The Lancet show that the statin pitavastatin lowers the risk of cardiovascular events by 35% in people with HIV.
Campaigners are now calling for guidelines to be updated to outline that all people with HIV over the age of 40 should be offered statins.
Now, a study published in JAMA Network Open, has shown that older people, mainly men, with chronic kidney disease could benefit from taking statins.
Data on U.S. Veterans over the age of 65 was collected from Veterans Affairs, Medicaid and Medicare, focusing on those with moderate chronic kidney disease, stages 3 or 4. The cohort was 99% male and had a mean age of 76.9 when they received a diagnosis of chronic kidney disease.
Researchers analyzed data from 17,609 veterans, and they identified 14,685 individuals with chronic kidney disease but who were not taking statins, and 2,924 with kidney disease who were offered statins. All these participants were followed up for 3.6 years.
Results showed that taking statins reduced overall mortality in veterans with chronic kidney disease by 9%.
While there was also a reduction in the number of major adverse cardiovascular events seen among the group who took statins, this difference was not significant.
The study authors did not speculate over the mechanism underpinning these findings in their paper, but they called for a randomized control trial to investigate the discovery further. This would allow for the collection of data on any side effects and harms caused by the medication to be collected, as these were not in this analysis.
Dr. Barry Sears, a researcher in inflammation and founder of the Inflammation Research Foundation, not involved in the current study, offered a hypothesis to Medical News Today:
"Statins can activate AMPK [the 5′-adenosine monophosphate-activated protein kinase pathway], which is a major controller of inflammation at the molecular level by inhibiting NK-κB activity. This would reduce mortality in any chronic disease associated with inflammation such as chronic kidney disease."
"The effect on cardiovascular mortality is less than on [chronic kidney disease] mortality," he added. "However, statins do have side effects, such as muscle damage and diabetes which may explain the differences between mortality data from [chronic kidney disease] and cardiovascular events. Thus, the efficacy of statins in treating other chronic diseases associated with inflammation is a very open question."
The lead author of the current study, Dr. Ariela Orkaby, suggested to MNT that inflammation could be one of the mechanism underpinning the findings.
She said: "Statins lower inflammation. People with chronic kidney disease have higher rates of inflammation than the general population but also importantly, people with chronic kidney disease have a high risk of cardiovascular events. "
"So these are people who at baseline have a higher risk of cardiovascular disease. Part of our hypothesis was — if we we look and see whether they started statins or not, that [those who were taking statins] would also benefit just like other people who don't have cardiovascular disease yet," she added.
Dr. Orkaby also said she and her colleagues had chosen to study this group of participants because there was a lack of information available on the impact of statins in older people.
A study published in 2022 by the U.S. Preventative Services Task Force showed that there was not sufficient evidence to determine the harms and benefits of statin use in people over 76.
Dr. Orkaby said:
"You know, the big class of people that we don't have enough evidence in, is the growing aging population. So that's people over 75. And there's an ongoing trial right now called PREVENTABLE that is testing this. And that is really key because the largest group of people who are at the highest risk of cardiovascular events [are] older adults, and yet in the past they were routinely excluded from clinical trials."
They were not the only group who had been underrepresented, and many could benefit from an analysis of how beneficial statins are in those groups, she added.
Dr. Orkaby emphasized: "Women historically have been underrepresented. If we look across autoimmune disorders, people with rheumatoid arthritis and similar conditions. These are people who have not been included in trials and yet there's emerging evidence that statins may play a role for lowering the risk of future heart attacks."
The researchers hope that future clinical trials will include more representative cohorts.
Conditions That Cause Chronic Inflammation
And What Symptoms Indicate Low- and High-Grade Inflammation
Medically reviewed by Stella Bard, MD
Inflammation is the body's natural defense against injury and infection. Chronic inflammation happens when the body's inflammatory response activates—sometimes even without injury or illness—and persists over months or years. When chronic inflammation persists, it can cause severe damage to the body, leading to long-term health problems such as heart disease, cancer, autoimmune disease, or diabetes.
This article discusses the signs and symptoms of chronic inflammation, its long-term effects on the body, and its associated conditions. It also covers what to do if you suspect you have chronic inflammation and treatments that may help.
Conditions Linked to Chronic InflammationChronic, low-grade inflammation can damage healthy cells, tissues, organs, and DNA. Over time, it can weaken your immune system and lead to health problems, including autoimmune and inflammatory diseases. Many conditions are linked to chronic inflammation, including:
Cardiovascular disease: Chronic inflammation can damage blood vessels, causing them to narrow or thicken, increasing the risk of heart disease, stroke, and other cardiovascular problems.
Cancer: Chronic inflammation can damage the DNA in healthy cells, causing them to mutate (change) into abnormal cells. Cancer develops when these abnormal cells grow and multiply uncontrollably. Research suggests chronic inflammation contributes to 15 to 20% of all cancers.
Type 2 diabetes: Chronic inflammation contributes to insulin resistance—a hallmark of type 2 diabetes. Persistent inflammation disrupts normal insulin signaling, resulting in elevated blood sugar levels and the development of diabetes.
Rheumatoid arthritis (RA): RA is an autoimmune disease in which the immune system mistakenly attacks the body's healthy joint tissues. Research shows rheumatoid arthritis develops years after systemic (widespread) inflammation begins.
Asthma: Exposure to allergens (e.G., pollen, pet dander) and environmental irritants (e.G., air pollution, cigarette smoke) can initiate an immune response and chronic inflammation in the airways, leading to asthma.
Obesity: A diet high in processed foods, sugar, and saturated fats can trigger chronic low-grade inflammation and contribute to weight gain.
Endometriosis/Adenomyosis: Chronic inflammation in the uterus or pelvic area can cause endometrial tissue to grow outside of the uterus (endometriosis) or within the uterine muscle (adenomyosis), causing pelvic pain, severe menstrual cramps, and heavy menstrual bleeding.
Depression: Researchers exploring the link between depression and inflammation discovered that chronic inflammation plays a role in the development of depression in some people.
Acute inflammation is the body's natural, short-term defense to injury infection. Chronic inflammation persists long after the threat (e.G., illness) has passed and can damage tissues and organs over time. Acute inflammation is beneficial, helping fight bacteria and viruses and promote healing, while chronic inflammation can be harmful and increase the risk of chronic diseases.
Chronic Inflammation Symptoms and SignsChronic inflammation affects nearly every body tissue, process, and system, leading to various bodywide symptoms, which may initially seem mild or vague but worsen over time.
Signs and symptoms of chronic inflammation include:
Widespread pain, including joint and muscle pain
Persistent fatigue
Insomnia (sleep problems)
Depression
Anxiety
Mood disorders
Digestive issues, such as abdominal pain, constipation, diarrhea, and acid reflux (heartburn)
Frequent infections
Weight changes
Skin problems, like eczema or rashes
Chronic inflammation is often subtle, and people may not recognize the signs and symptoms immediately, as they are often vague and nonspecific, meaning they can be associated with numerous conditions. With chronic inflammation, you might feel constant, low-level fatigue or be too tired to do much beyond your daily responsibilities.
Some people may experience a general feeling of being unwell (malaise) for no discernible reason or have occasional discomfort or pain, such as joint stiffness or low-back pain. Unexplained weight gain or loss is common with chronic inflammation, and some people may experience a fever or swollen lymph nodes.
Symptoms can worsen over time, and other symptoms may develop, such as skin problems (e.G., rashes), digestive troubles, memory problems, difficulty focusing, and mood changes.
Flare CharacteristicsA flare is a period when chronic inflammation increases. The term "flare-up" is often used to describe when symptoms of an inflammatory or autoimmune disease worsen. Depending on the condition, several factors can trigger flares, including stress, infection, certain foods, injury, and weather changes. Flares can last for days or weeks and have a significant impact on your quality of life.
Some common characteristics of a flare include:
Long-Term Effects of Chronic Inflammation in BodyOnce the immune system is activated, inflammatory cells release a constant flow of proteins called cytokines, which signal the immune system to release other inflammatory cells and substances into the bloodstream. A prolonged inflammatory response can cause the immune system to become "hyperactive," creating a vicious cycle of inflammation.
When left unchecked over extended periods, chronic inflammation can take a profound toll on the body and may cause:
Treatments Intended to Improve Chronic InflammationSeveral medications help reduce inflammation. Treatments vary depending on the type of inflammatory condition you have and may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter and prescription NSAIDs, such as Advil (ibuprofen), Aleve (naproxen), and aspirin, can reduce inflammation and pain.
Corticosteroids: Strong anti-inflammatory drugs available in pill, injection, and cream forms to treat severe inflammation.
Disease-modifying antirheumatic drugs (DMARDs): DMARDs are immunosuppressive drugs (e.G., biologics) that target specific molecules involved in the inflammatory process to control inflammation.
Metformin: A first-line treatment for type 2 diabetes that has anti-inflammatory effects.
Healthy lifestyle habits and self-care practices can help reduce chronic inflammation and lower your risk of chronic disease. These include:
Proper nutrition: A diet with plenty of fruits, vegetables, whole grains, and lean proteins gives your body the nutrients it needs for optimal functioning and helps control inflammation. Many fruits and vegetables have anti-inflammatory properties, as do some fatty fish (e.G., salmon), nuts, and seeds. Limit your intake of foods that can trigger inflammation, including processed and fried foods, sugary drinks, and unhealthy fats.
Regular exercise: Regular physical activity, such as brisk walking, swimming, strength training, or cycling, can help reduce chronic inflammation and support a healthy immune system.
Quality sleep: Adults should get seven to nine hours each night to help control inflammation and prevent long-term health problems.
Regular health check-ups: Schedule regular checkups with a healthcare provider to monitor your overall health and assess inflammatory markers as needed.
Stress management: Stress can trigger inflammation and worsen symptoms. Stress-management techniques, such as exercise, yoga, meditation, and spending time in nature, can help manage inflammation.
Quitting smoking: Smoking worsens inflammation, and stopping (or never starting) is one of the best things you can do for your health.
Supplements: Some dietary supplements, such as omega-3 fatty acids, probiotics, and turmeric, have anti-inflammatory properties and can complement a healthy lifestyle.
Dental care: Poor dental hygiene can lead to inflammation in the gums and mouth, which can spread to other body areas. Regular dental checkups and cleanings can help prevent gum disease and control inflammation.
If you have symptoms of chronic inflammation, see a healthcare provider to discuss your symptoms and address your concerns. During your appointment, the healthcare provider will review your medical history, ask about your symptoms, and perform a physical examination. They may order blood tests or other diagnostic tests to provide an accurate diagnosis.
Be honest and forthcoming with the healthcare provider at your appointment. Your information will help them understand what's causing your symptoms. The healthcare provider will want to discuss the following:
Symptoms: When they started, how often they occur, and how they impact your day-to-day life
Medications: Medicines and supplements you take, including over-the-counter drugs and herbal supplements
Lifestyle habits: Your lifestyle habits, including activity levels, diet, and whether you smoke or drink alcohol
It may take some time to figure out what's causing your symptoms, arrive at a diagnosis, and develop a treatment plan. A primary care provider (PCP) may refer you to a specialist, such as a rheumatologist or a gastroenterologist if your PCP suspects you have a condition that requires specialized knowledge and treatment.
SummaryChronic inflammation can damage tissues, organs, and DNA over time, increasing the risk of many chronic diseases. Signs and symptoms of chronic inflammation include fatigue, joint pain and stiffness, muscle aches, skin rashes, digestive problems, depression, and unexplained weight changes.
See a healthcare provider if you have symptoms of chronic inflammation. They can determine the cause and develop a treatment plan, including medications and lifestyle modifications, to reduce inflammation and improve your health and well-being.
Read the original article on Verywell Health.
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