Stroke Archive

it is becoming increasingly clear that COVID-19 affects the nervous system along with the respiratory system. Research is suggesting that this may result in long-term neurologic damage in those who survive a COVID infection, including evidence of effects on cognitive function.

They're not yet FDA-approved, but the devices are available and safe — if you know what to look for.

When Congress passed the Over-the-Counter (OTC) Hearing Aid Act in 2017, it opened up a new world of possibility for people with hearing loss. Instead of paying $5,000 for a pair of FDA-approved hearing aids and follow-up service, you could pay hundreds of dollars for an OTC pair from any seller — no doctor appointments, hearing tests, or fittings needed. The devices would have the same fundamental technology as traditional hearing aids, they'd be targeted to people with perceived mild-to-moderate hearing loss, and the FDA would ensure quality by regulating and approving the OTC devices.

But almost four years later, the OTC hearing aid category and its safety and labeling rules are still tied up in red tape.

Research we're watching

People with atrial fibrillation (afib) who consume more than 14 alcoholic beverages a week may face a higher risk of stroke and other blood clot-related problems, according to a new study.

The study included 9,411 people with afib, who were divided into four groups based on how much they typically drank per week: abstainers or rare drinkers (less than one), light drinkers (less than seven), moderate (seven to 14), and heavy (14 or more). Researchers then tracked the participants for a median follow-up period of 17.4 months, noting the incidence of strokes, transient ischemic attacks (ministrokes), blood clots in a limb or organ (embolisms), or hospitalization for management of either atrial fibrillation or heart failure.

News briefs

Hold off before you follow new recommendations to treat mild, persistent asthma — or at least consult your doctor first. The updated guidelines from the National Institutes of Health, published online in the December 2020 issue of The Journal of Allergy and Clinical Immunology, say it's okay for people with mild, persistent asthma to stop daily use of inhaled corticosteroids and instead use them only as needed, along with short-acting beta agonists ("rescue" medications). That's considered a major shift in guidance. But that may not be a good idea for some older adults, notes Dr. Anna Wolfson, an allergist and immunologist at Harvard-affiliated Massachusetts General Hospital. "A lot of people have a harder time with the occasional use of medications than a routine practice of daily use," she says. "And you may not want to decrease your asthma regimen during the pandemic. Poorly controlled asthma could lead to a flare or an ER visit, and perhaps an increased risk for complications if you develop COVID-19." Dr. Wolfson says there are some people who might benefit from using inhaled corticosteroids only as needed, but she urges you to speak with your doctor before changing your medication regimen.

Image: Branimir/Getty Images

These drugs actually help stop dangerous blood clots from forming. Here's when you may need them.

Nearly everyone has heard of "blood thinners." Maybe you or someone you know takes one. But these drugs don't "thin" blood at all.

"They are actually anti-clotting drugs," says Dr. Gregory Piazza, a cardiologist with Harvard-affiliated Brigham and Women's Hospital. "They prevent potentially dangerous blood clots from developing in people at high risk, like those who have atrial fibrillation or a stent in a blood vessel, or who are immobile after surgery."

In the journals

Do you know if you have hypertension (high blood pressure)? And if you do, are you treating it effectively? Study findings published online Sept. 9, 2020, by JAMA found that people's awareness and control of their high blood pressure have both dropped in recent years, especially among older adults.

The study pulled data from the National Health and Nutrition Examination Survey. It found that the number of people who knew they had hypertension fell 8% from 2013 to 2018. Among those who were aware of their condition, more than half did not manage it adequately. In particular, adults ages 60 and older were less likely to control their high blood pressure than younger people. Lack of engagement could be a factor. Researchers noted that among people who hadn't been to their doctor in the past year, fewer than 10% had controlled their blood pressure.

In the journals

"Smell training" could help treat certain smell disorders, suggests a study published online Nov. 19, 2020, by the journal The Laryngoscope. Two common types of smell disorders are phantosmia, in which you smell an odor that isn't there, and parosmia, in which you smell strange and often unpleasant odors — for example, cinnamon smells rotten. Both disorders are believed to occur because of damage to the smell pathways (nerves that carry information from the nose to the brain), usually caused by a bacterial or viral infection. They also may result from a head injury or smoking.

The study enlisted 153 people who had experienced changes in their ability to smell after recovering from a viral infection, such as a cold or the flu. They were tested for how well they could smell a variety of odors. Smells related to phantosmia and parosmia also were identified. The people then received smell training kits that consisted of random odors as well as ones linked to their phantosmia or parosmia.

Ask the doctors

Q. I eat a lot of shellfish and recently developed gout in my knee. Did my diet cause the condition?

A. As you probably know, gout is a painful form of arthritis that occurs when high levels of a waste product called uric acid build up in the body. It can settle into joints, where it forms sharp crystals that can trigger inflammation, redness, and pain. Your diet may have aggravated the condition, but didn't cause it.

About one in five people has high levels of lipoprotein(a), a fatty particle linked to premature heart disease.

Most people probably haven't heard of lipoprotein(a), although that's not surprising. Cardiologists have known for years that having high levels of these fatty particles circulating in the bloodstream poses a risk to the cardiovascular system. But there wasn't much they could offer in terms of therapy, so widespread testing for lipoprotein(a) — also known as Lp(a) — didn't make sense.

Recent progress means the landscape may soon be shifting. Earlier research showed that injectable cholesterol-lowering drugs known as PCSK9 inhibitors, such as evolocumab (Repatha) or alirocumab (Praluent), may lower Lp(a) by up to 25%. Until last year, however, it wasn't clear whether that reduction actually helped people with high Lp(a).