Stroke Archive

In the journals

Even if you believe you're in excellent health, you could still be at risk for a heart attack or stroke, suggests a study of more than 6,800 people, average age 62, published Feb. 15, 2019, in JAMA Network Open. At the study's beginning, participants rated their health as excellent, very good, good, or poor/fair. (More than half the men reported being in very good or excellent health.)

Next, everyone had a coronary artery calcium (CAC) scan, which detects plaque buildup in the arteries of the heart. The scores range from zero to 100 and higher, with zero meaning no plaque buildup is present and cardio-vascular disease risk is at its lowest.

These two common conditions have many overlapping risk factors, but they both respond to healthy lifestyle changes.

The biggest organ inside your body, your liver, lies just below and to the right of your heart. This powerhouse organ performs many vital roles in the body, including processing cholesterol and making proteins that help your blood clot. But as many as one in four Americans has a potentially dangerous accumulation of fat inside the liver. This condition, known as non-alcoholic fatty liver (NAFL), often goes hand in hand with obesity and diabetes. Both of those conditions boost the risk of heart disease, and growing evidence also links NAFL with cardiovascular problems.

"The connection between fatty liver and early signs of plaque in the coronary arteries is increasingly compelling," says Dr. Tracey Simon, a hepatologist at Harvard-affiliated Massachusetts General Hospital (MGH). Excess fat around the liver and other organs in the abdomen—known as abdominal obesity — is another likely related problem. In fact, abdominal obesity seems to accelerate the progression of fatty liver to a more serious form of the problem, nonalcoholic steatohepatitis, or NASH (see "The many faces of fatty liver disease").

How a healthy lifestyle can make a difference in Alzheimer’s prevention.

Alzheimer's disease, the most common form of dementia, is characterized by the accumulation of two types of protein in the brain: tangles (tau) and plaques (amyloid-beta). Eventually, Alzheimer's kills brain cells and takes people's lives.

Alzheimer’s causes

What causes Alzheimer's? We still aren't sure. "For 1% of all cases, there are three genes that determine definitively whether or not you will have Alzheimer's, and all three relate to amyloid-beta production, which in these cases is likely the cause of Alzheimer's," says Dr. Gad Marshall, associate medical director of clinical trials at the Center for Alzheimer Research and Treatment at Harvard-affiliated Brigham and Women's Hospital. "For the other 99%, amyloid and tau are closely associated with Alzheimer's, but many things may contribute to the development of symptoms, such as inflammation in the brain, vascular risk factors, and lifestyle."

Ask the doctor

Q. I hear that there are outbreaks of measles in the United States. I think I had measles when I was young, but I'm not sure. Do I need to worry?

A. The measles virus has been infecting humans for at least 1,000 years. When I was very young, in the 1940s, I got the measles. So did nearly every kid I knew; it is very contagious. I had a high fever, sneezing, coughing, very red eyes, and then a rash on my face and all over my body. Fortunately, I didn't develop the severe complications of measles: pneumonia (which affects one in 20 people with measles) or encephalitis (which affects one in 1,000 and can be fatal). Still, I was miserable for more than a week.

New research aims to capture and eventually cure incessant ringing in the ears.

More than 50 million Americans struggle with tinnitus, a constant or recurring ringing in the ears that ranges from irritating to debilitating. Some treatments work for some people, but none seems to work for everyone.

Tinnitus is a tough condition for doctors to study. "There's no way to measure it directly. The only way we know you have tinnitus is if you tell us. Even if there were a cure, we wouldn't know how it worked because we have to rely on verbal descriptions of what your tinnitus sounds like and how loud it is," says Daniel Polley, director of the Lauer Tinnitus Research Center at Harvard-affiliated Massachusetts Eye and Ear.

Research we're watching

Contrary to observations that moderate drinking (one or two drinks per day) protects against stroke, a new study finds that stroke risk may rise with increasing alcohol intake.

The findings, which were published online April 4 by The Lancet, come from a study involving 160,000 Chinese adults who reported their drinking habits. They also were tested for gene variants common in Asian populations that cause an unpleasant flushing reaction after drinking. Only 2% of women reported drinking alcohol, compared with 33% of men, so the findings focus mainly on men.

Many Americans have fatty liver disease, a condition that can lead to serious liver problems.

If you're not a big drinker, you may not give much thought to the health of your liver. But there might be reason to be concerned. An estimated 64 million Americans have an often-symptomless liver condition called nonalcoholic fatty liver disease (NAFLD), which may put them at risk not only for serious liver disease, but for heart disease as well.

Many people — including doctors — didn't pay much attention to NAFLD until the 1980s, but life insurance companies have had this issue on their radar for years, says Dr. Michelle Lai, an assistant professor of medicine at Harvard Medical School. They knew that an abnormal liver blood test could reflect a lower life expectancy, and they set the premium higher or decline to insure people with the condition, she says.

Q. I've been taking Prilosec for many years for GERD. Recently, I once read that long-term use of proton pump inhibitors could increase the risk of stomach cancer. Your opinion?

A. Prilosec is a pump inhibitor (PPI). These drugs have revolutionized the treatment of gastroesophageal reflux disease (GERD), in which stomach acid flows back into the esophagus and causes heartburn.

The first accurate medical discussion of psoriasis dates back to 1801, but the disease itself is much older. In fact, its very name is borrowed from an ancient Greek word meaning an itchy or scaly condition. About 7 million Americans are plagued by this itching and scaling, and many of them have serious complications involving other organs. Although psoriasis is classified as a dermatologic disease, it doesn't start in the skin, and its damage may be more than skin deep.

Beneath it all

At a basic level, psoriasis is a disorder of the immune system. White blood cells called T-helper lymphocytes become overactive, producing excess amounts of cytokines, such as tumor necrosis factor, interleukin-2, and interferon-gamma. In turn, these chemicals trigger inflammation in the skin and other organs. In the skin, the inflammation produces three characteristic findings: widened blood vessels, accumulation of white blood cells, and abnormally rapid multiplication of keratinocytes, the main cells in the outer layer of the skin. In healthy skin, keratinocytes take about a month to divide, mature, migrate to the skin surface, and slough off to make way for younger cells. But in psoriasis, the entire process is speeded up to as little as three to five days. The result is thickened, red skin that sheds silvery scales of keratinocytes that have matured before their time (see Figure 1).

Water's good. Sugar-free gum helps. But Listerine may give you a dry mouth.

Saliva is like a health drink for your teeth and mouth. The three pints produced by the salivary glands each day contain antibacterial substances that protect teeth from cavities. Saliva contains calcium and phosphorus that teeth absorb. It also functions as an overall lubricant for the mouth, preventing food from sticking to your teeth and gums. By neutralizing gastric acid and keeping the flow of food and drink through the mouth and esophagus on the right course, saliva may help check gastroesophageal reflux (GERD), a leading cause of heartburn.