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Harvard Health Letter: March 2013

Articles in this issue:

Fighting back against allergy season

Allergy seasons are worsening, possibly because of the effects of climate change. Fighting back against allergy symptoms involves medications, such as antihistamines, corticosteroid nasal sprays, nonsteroidal nasal sprays, and decongestants. Other strategies to combat symptoms include starting a nasal steroid spray a few weeks before the spring allergies begin, making sure air conditioning and heating filters and vents are clean, closing windows and wearing a mask for outdoor yard duties, staying indoors when pollen levels are highest, using nasal saline irrigations in the nose after working in the yard, and avoiding irritants such as cigarette smoke and pollution. Read More »

Ask the doctor: Understanding the value of multivitamins

While foods rich in vitamins are indisputably good for health, vitamin pills do not provide benefits to everyone. Some exceptions are pregnant women who need folic acid, older adults who need vitamin D, and people with certain physical conditions.

Ask the doctor: Prediabetes: signaling a need for lifestyle change

People with a fasting blood glucose level of 100 to 125 mg/dL have a condition called prediabetes. They are at risk for type 2 diabetes. The risk can be reduced with regular moderate exercise and maintaining a healthy weight.

Vascular stent now, stable later?

Research shows that having a stent or stents put in now along with standard drug therapy significantly reduces the need for emergency interventions later, compared with treating stable CAD with medications alone. Determining when a stent is needed in someone with stable CAD and when medications and healthy lifestyle are still adequate depends on the severity of symptoms. Doctors consider the desired activity level of the individual (active versus sedentary), the type and number of blockages in the artery, and the presence or absence of other medical conditions, such as weak heart muscle.

Brain plaque vs. Alzheimer's gene

Two tests are available to determine if you are at increased risk for getting Alzheimer’s disease: a test for a gene known as APOE4 and a brain imaging test called a PET scan. Research shows that the brain scan is a better predictor. High amounts of beta-amyloid or brain plaque on the scan indicate that the disease has already taken hold. PET scans can be valuable because they can help determine if dementia is due to Alzheimer’s disease.

Weight loss for better sleep

Losing weight, especially in the belly, improves the quality of sleep for overweight and obese people. This may be because weight loss reduces the risk of sleep apnea. The best way to lteose weight in the belly is with exercise and a healthy diet. Doctors recommend 150 minutes of moderate-intensity physical activity (such as swimming or brisk walking) each week. Shorter but more frequent exercise sessions have the same physical impact as longer exercise sessions.

High tech ways to better shoe fit

High-tech machines in specialty shoe stores can provide information that leads to buying a better-fitting shoe. Foot scanners are usually computerized mats that map the pressure points on the soles of the feet and determine a person’s arch type. Gait analyzers record the characteristics and support needs of feet in motion. A trained salesperson with an understanding of shoe construction and the mechanics of mobility must interpret the data from the tests to help get the fit just right.

Lift weights for diabetes protection

For people who are unable to do aerobic activity, any kind of weight training is an effective way to reduce diabetes risk. That’s because muscles use glucose, and by creating more muscle that needs more glucose, weight training decreases blood glucose levels. This is encouraging for people who are unable to do aerobic exercise, but not an excuse for healthier people to get out of aerobic activity. Aerobic exercise and weight training are even more effective when combined, providing a risk reduction of up to 59%.

Boost your hearing aid success

When buying a hearing aid, it’s easy to be distracted by price and technology. Experts recommend that consumers insist on hearing aids they can make too loud with no feedback, as well as a volume control to adjust the device to the desired loudness. Basic devices may have enough technology for a person’s needs. Sometimes a larger, more powerful aid will do the job better than a small device. Audiologists know dozens of tricks to make sure a hearing aid will be comfortable and work properly. Hearing aids purchased on the Internet do not come with the assistance of an audiologist to help make sure it’s properly adjusted.

Researchers explore psoriasis-diabetes link

People with the chronic irritated, flaky skin condition called psoriasis may also be at risk for another chronic disease: type 2 diabetes. Both diseases are driven by inflammation. The same cells that trigger the inflammation of psoriasis are also associated with insulin resistance and type 2 diabetes. Because psoriasis is a systemwide inflammatory disease, there’s also a correlation between psoriasis and other inflammation-sensitive conditions such as arthritis and cardiovascular disease. People with psoriasis are advised to pay attention to cardiovascular risk factors such as obesity, hypertension, high cholesterol, and type 2 diabetes or insulin resistance. They are also advised to get yearly blood pressure checks and laboratory assessment of blood sugar and fats.

What you should know about: The latest blood thinners

For people who need an anticoagulant, warfarin (Coumadin) has been the only oral drug available until recently. It’s not especially expensive, and it’s generally effective. But there are problems with warfarin. Dosing with warfarin is complicated. Blood clots can form if the dose is too low, and bleeding can occur if the dose is too high. The FDA approved alternative anticoagulants for stroke prevention in atrial fibrillation: dabigatran (Pradaxa) in 2010, rivaroxaban (Xarelto) in 2011, and apixaban (Eliquis) late in 2012. These drugs are all either as effective or more effective in preventing stroke and have a reduced rate of bleeding into the brain. For new patients, all of the major guidelines recommend the new drugs as the best option to begin anticoagulation. People already taking warfarin can switch to the new drugs depending on how well they are staying in the targeted therapeutic range of warfarin.

News briefs: Long-term aspirin use linked to vision loss

Regular aspirin use may slightly increase the risk of age-related macular degeneration (AMD), which causes vision loss in the macula, the part of the eye that controls central vision. But that should not stop the use of aspirin for heart disease.

News briefs: Killing cancer by fixing cell metabolism

Research shows that regulating cancer cell metabolism may help inhibit cancer growth. This finding suggests an entirely new target for the treatment of many cancers.

News briefs: Inflammation and depression link may lead to treatment

Research shows that inflammation, marked by elevated blood levels of C-reactive protein, is linked to risk for depression. This raises the question of whether adding anti-inflammatory drugs to antidepressants will improve depression treatment.

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