Hoad A, Spickett G, Elliott J, Newton J.

From the Northern CFS/ME Clinical Network, Equinox House, Silver Fox Way, Cobalt Business Park, Newcastle upon Tyne ME NorthEast, Bullion Hall, County Durham and Falls and Syncope Service, Institute of Cellular Medicine, Newcastle University, Newcastle, UK.

QJM. 2008 Sep 19.

BACKGROUND:
It has been suggested that postural orthostatic tachycardia syndrome (POTS) be considered in the differential diagnosis of those with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).
Currently, measurement of haemodynamic response to standing is not recommended in the UK NICE CFS/ME guidelines.

Objectives:
To determine prevalence of POTS in patients with CFS/ME.

Design: Observational cohort study.

METHODS:
Fifty-nine patients with CFS/ME (Fukuda criteria) and 52 age- and sex-matched controls underwent formal autonomic assessment in the cardiovascular laboratory with continuous heart rate and beat-to-beat blood pressure measurement (Task Force, CNSystems, Graz Austria). Haemodynamic responses to standing over 2 min were measured. POTS was defined as symptoms of orthostatic intolerance associated with an increase in heart rate from the supine to upright position of >30 beats per minute or to a heart rate of >120 beats per minute on standing.

RESULTS:
Maximum heart rate on standing was significantly higher in the CFS/ME group compared with controls (106 +/- 20 vs. 98 +/- 13; P = 0.02). Of the CFS/ME group, 27% (16/59) had POTS compared with 9% (5) in the control population (P = 0.006). This difference was predominantly related to the increased proportion of those in the CFS/ME group whose heart rate increased to >120 beats per minute on standing (P = 0.0002). Increasing fatigue was associated with increase in heart
rate (P = 0.04; r(2) = 0.1).

CONCLUSION:
POTS is a frequent finding in patients with CFS/ME. We suggest that clinical evaluation of patients with CFS/ME should include response to standing. Studies are needed to determine the optimum intervention strategy to manage POTS in those with CFS/ME.

http://www.ncbi.nlm.nih.gov/pubmed/18805903?dopt=AbstractPlus

PMID: 18805903 [PubMed - as supplied by publisher]

Umehara M, Yamaguchi A, Itakura S, Suenaga M, Sakaki Y, Nakashiki K, Miyata M, Tei C.

Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduated School of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima 890-8520, Japan.

J Cardiol. 2008 Apr;51(2):106-13.

OBJECTIVES: Repeated Waon therapy, which uses a far infrared-ray dry sauna system, improved the vascular endothelial function and the cardiac function in patients with chronic heart failure. In patients
with chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PH) is associated with a poor prognosis. We investigated whether repeated Waon therapy improves PH, cardiac function, exercise tolerance, and the quality of life (QOL) in patients with COPD.

METHODS: Consecutive 13 patients with COPD, who met the Global Initiative for Chronic Obstructive Lung Disease criteria and had breathlessness despite receiving conventional treatments, were
recruited for this study. They underwent Waon therapy at 60 degrees C in sauna for 15 min following 30 min warmth with blankets outside of the sauna room. This therapy was performed once a day, for 4 weeks. Cardiac function, exercise tolerance, and St. George’s Respiratory Questionnaire (SGRQ) were assessed before and 4 weeks after Waon therapy.

RESULTS: Right ventricular positive dP/dt at rest elevated significantly from 397 +/- 266 to 512 +/- 320 mmHg/s (p = 0.024) after the therapy. While the PH at rest did not significantly decrease, the PH during exercise decreased significantly from 64 +/- 18 to 51 +/- 13 mmHg (p = 0.028) after Waon therapy. Furthermore, the therapy prolonged the mean exercise time of the constant load of
cycle ergometer exercise test from 360 +/- 107 to 392 +/- 97 s (p = 0.032). The total scores of SGRQ improved from 59.7 +/- 16.9 to 55.3 +/- 17.2 (p = 0.002). In addition, no adverse effects were observed related to Waon therapy.

CONCLUSIONS: Repeated Waon therapy improved right ventricular positive dP/dt, PH during exercise, exercise tolerance and the QOL in patients with severe COPD.

http://www.ncbi.nlm.nih.gov/pubmed/18522783?dopt=AbstractPlus

PMID: 18522783 [PubMed - in process]

http://www.mayoclinicproceedings.com/inside.asp?AID=4637&UID=
Mayo Clin Proc. 2008 Mar;83(3):324-32. Links

Omega3 Fatty acids for cardioprotection.
Lee JH, O’Keefe JH, Lavie CJ, Marchioli R, Harris WS.

Address correspondence to James H. O’Keefe, MD, 4330 Wornall Rd, Ste 2000, Kansas City, MO 64111 (jhokeefe@cc-pc.com).

The most compelling evidence for the cardiovascular benefit provided by omega-3 fatty acids comes from 3 large controlled trials of 32,000 participants randomized to receive omega-3 fatty acid supplements containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or to act as controls. These trials showed reductions in cardiovascular events of 19% to 45%. These findings suggest that intake of omega-3 fatty acids, whether from dietary sources or fish oil supplements, should be increased, especially in those with or at risk for coronary artery disease. Patients should consume both DHA and EPA. The target DHA and EPA consumption levels are about 1 g/d for those with known coronary artery disease and at least 500 mg/d for those without disease. Patients with hypertriglyceridemia benefit from treatment with 3 to 4 g/d of DHA and EPA, a dosage that lowers triglyceride levels by 20% to 50%. Although 2 meals of oily fish per week can provide 400 to 500 mg/d of DHA and EPA, secondary prevention patients and those with hypertriglyceridemia must use fish oil supplements if they are to reach 1 g/d and 3 to 4 g/d of DHA and EPA, respectively. Combination therapy with omega-3 fatty acids and a statin is a safe and effective way to improve lipid levels and cardiovascular prognosis beyond the benefits provided by statin therapy alone. Blood DHA and EPA levels could one day be used to identify patients with deficient levels and to individualize therapeutic recommendations.

PMID: 18316000 [PubMed - in process]

The environmental burden of disease in Canada: Respiratory disease, cardiovascular disease, cancer, and congenital affliction.
Boyd DR, Genuis SJ., School of Resource and Environmental Management, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6.

BACKGROUND: Exposure to environmental hazards contributes to many chronic diseases, yet the magnitude of their contribution to the total disease burden in Canada is not well understood.
OBJECTIVES: To estimate the environmental burden of disease (EBD) in Canada for respiratory disease, cardiovascular disease, cancer, and congenital affliction. Quantifying the contribution of environmental exposures to the overall burden of disease could play an important role in shaping public
health and environmental policy priorities.
METHODS: The World Health Organization (WHO) recently estimated the environmental burden of disease globally by using a combination of comparative risk assessment data and expert judgment to develop environmentally attributable fractions (EAFs) of mortality and morbidity for 85 categories of disease. We use the EAFs developed by the WHO, EAFs developed by other researchers, and data from Canadian public health institutions to provide an initial estimate of the environmental burden of
disease in Canada for four major categories of disease.
RESULTS: Our results indicate that: 10,000-25,000 deaths; 78,000-194,000 hospitalizations; 600,000-1.5 million days spent in hospital; 1.1 million-1.8 million restricted activity days for asthma sufferers;
8000-24,000 new cases of cancer; 500-2500 low birth weight babies; and between $3.6 billion and $9.1 billion in costs occur in Canada each year due to respiratory disease, cardiovascular illness, cancer, and congenital affliction associated with adverse environmental exposures.
CONCLUSIONS: The burden of illness in Canada resulting from adverse environmental exposures is significant. Stronger efforts to prevent adverse environmental exposures are warranted, including research, education, and regulation.

PMID: 17904543 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17904543&ordinalpos=1
&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
or
http://tinyurl.com/2c7hnc