Diseases & Conditions Archive

Timing may improve potency and help you cope with side effects.

We all want our medicines to be as effective as possible, and that requires effort on our part. It may be necessary to avoid taking pills with certain foods or drinks, and to check that medications won't interfere with each other.

And in some cases, it may be important to take a drug at a particular time of day. This approach, known as chronotherapy, is gaining attention as research suggests a relationship between when we take medications and how well they work.

Ask the doctor

Q. I've taken blood pressure medicines every morning for many years, and they keep my pressure under control. Recently, my doctor recommended taking them at bedtime, instead. Does that make sense?

A. It actually does make sense — based on recent research. For many years, there have been at least three theoretical reasons for taking blood pressure medicines before bedtime. First, a body system that strongly affects blood pressure, called the renin-angiotensin system, has its peak activity during sleep. Second, circadian rhythms cause differences in the body chemistry at night compared with daytime. Third, most heart attacks occur in the morning, before medicines taken in the morning have a chance to "kick in."

People monitor their cholesterol levels, but they should also watch their triglycerides.

Most people have heard of the two main kinds of cholesterol: the "good" HDL and the "bad" LDL. Doctors focus on controlling LDL, as high levels can lead to a buildup of fatty deposits in the arteries and block blood flow, which can trigger a heart attack or stroke.

A blood test called a lipid profile measures your HDL, LDL, and total cholesterol levels. But within that test is another number you should not ignore: your triglyceride levels.

Ask the doctors

Q. I recently started experiencing a lot of pain in my hand from osteoarthritis. Can I reverse this condition?

A. You can't reverse osteoarthritis, but there are things you can do to manage your pain and improve your symptoms. Osteoarthritis occurs when the protective cartilage that acts as cushioning between your bones starts to fray and wear down over time. Eventually this enables the bones to rub together, which causes the pain you are experiencing as well as swelling and stiffness that makes it difficult to move your hand freely. Typically, when you have arthritis, the pain and symptoms will be worse at some times than at others. You may experience a flare-up one day and feel better the next. To help reduce the discomfort of a flare-up, talk to your doctor about medication to relieve pain. She or he may recommend an over-the-counter pain reliever. Some people also get symptom relief using a topical pain reliever that is rubbed into the skin. Other strategies that can ease pain are splints or braces, heat or cold therapy, activity modification, and exercises or physical therapy to increase flexibility and strengthen your hand muscles.

Research we're watching

Late in 2019, the FDA approved a new use for icosapent ethyl (Vascepa), a drug that is a highly purified form of eicosapentaenoic acid (EPA), an omega-3 fatty acid found in fish.

The drug was originally approved in 2012 for treating people with very high levels of triglycerides, a type of fat in the blood. Now, icosapent ethyl is approved for people with triglyceride levels greater than or equal to 150 milligrams per deciliter who also have an elevated risk of cardiovascular disease despite taking the highest tolerable dose of a cholesterol-lowering statin. A large trial found that the drug decreases the risk of heart attack, stroke, and death from cardiac causes by 26% when compared with a placebo.

There is a lot you can do to lower your chances of having a stroke. Even if you've already had a stroke or TIA ("mini-stroke"), you can take steps to prevent another.

Controlling your weight is an important way to lower stroke risk. Excess pounds strain the entire circulatory system and can lead to other health conditions, including high blood pressure, diabetes, high cholesterol, and obstructive sleep apnea. But losing as little as 5% to 10% of your starting weight can lower your blood pressure and other stroke risk factors.

Could an ingredient in toothpaste be harmful to your bones? Triclosan, an antibacterial agent, has been banned from soaps and hand sanitizers by the FDA, and researchers have found that women with the highest levels of triclosan in their urine had low bone density measurements.

When it comes to understanding this link, the devil is in the details.

When we talk about LDL cholesterol, it's always described as bad or harmful — and with good reason. High blood levels of this artery-clogging substance boost the risk of heart disease, the nation's leading cause of death. The more you can lower your LDL cholesterol (through diet, exercise, or medications), the lower your risk of a heart attack. For heart attack survivors, national guidelines recommend aiming for an LDL cholesterol level of less than 70 milligrams per deciliter to prevent a second heart attack.

In the past year, however, two studies in the journal Neurology reported a higher risk of hemorrhagic (bleeding) stroke in people with LDL levels of 70 and lower. While that sounds worrisome, a closer look at the findings can put these results into perspective.

Research we're watching

Younger adults who use marijuana appear to face a higher risk of stroke compared with those who don't use the drug, according to a report published Nov. 11, 2019, in the journal Stroke.

Researchers pooled data from a nationally representative survey from the CDC that included nearly 44,000 participants ages 18 to 44. About 14% reported using marijuana within the past month. Young adults who recently used marijuana were 1.8 times more likely to experience a stroke compared with nonusers. The risk was 2.5 times higher among frequent users (more than 10 days a month). Frequent marijuana users who also smoked regular cigarettes had three times the risk for nonusers.

Chronic stress is associated with an increased risk of heart disease, heart attacks, and strokes. These strategies can help you manage it.

People often complain about stress, but it's actually a natural reaction with an essential purpose.

When the body senses danger, it starts its fight-or-flight response. Your nervous system releases hormones like adrenaline and cortisol, which jolt the body into a protective mode. Your heart pounds faster, muscles tighten, blood pressure rises, breathing quickens, and your senses sharpen.