Does screening and treating high cholesterol save money? KevinMD.com

by Richard Young, MD

A commenter (I believe a physician) on one of my posts wrote the following: “I can prevent heart attacks and strokes (caused by atherosclerosis – “blockage”) in people (minimal cost) who have no symptoms. If I wait for their heart attack or stroke – it costs a whole lot more.”

The implication is that screening and treating high cholesterol saves money in the long run. Unfortunately, the truth is the opposite. This is an extremely common misconception among most people in healthcare, physicians included. Therefore the American people believe the same thing.

If I give a person a pneumonia shot and that person lives the rest of her life never catching pneumonia, then there is a fair chance I prevented a case of pneumonia. On the other hand, she may not have ever gotten pneumonia any way, therefore the shot was useless. There’s no way to sort that out, but classifying  a vaccine as preventing a disease is certainly fair.

via kevinmd.com

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Common dietary fat and intestinal microbes linked to heart disease

A new pathway has been discovered that links a common dietary lipid and intestinal microflora with an increased risk of heart disease, according to a Cleveland Clinic study published in the latest issue of Nature.

The study shows that people who eat a diet containing a common nutrient found in animal products (such as eggs, liver and other meats, cheese and other dairy products, fish, shellfish) are not predisposed to cardiovascular disease solely on their genetic make-up, but rather, how the micro-organisms that live in our digestive tracts metabolize a specific lipid -- phosphatidyl choline (also called lecithin). Lecithin and its metabolite, choline, are also found in many commercial baked goods, dietary supplements, and even children's vitamins.

The study examined clinical data from 1,875 patients who were referred for cardiac evaluation, as well as plasma samples from mice. When fed to mice, lecithin and choline were converted to a heart disease-forming product by the intestinal microbes, which promoted fatty plaque deposits to form within arteries (atherosclerosis); in humans, higher blood levels of choline and the heart disease forming microorganism products are strongly associated with increased cardiovascular disease risk.

"When two people both eat a similar diet but one gets he

via sciencedaily.com

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The five hospital factors that affect heart attack survival, Science Daily

Until now, little has been known about the factors that may influence this variation in death rates. The Yale team reviewed 11 hospitals through interviews and site visits. Those selected were among the best and worst performers, as rated by the federal agency that administers Medicare and Medicaid.

"Previous research looked at whether hospital characteristics like urban location, teaching status, geographical region, and socio-economic status of patients are related to acute myocardial infarction (AMI) mortality rates, but these factors don't explain much of the variation in mortality," said Leslie A. Curry, Ph.D., research scientist at the Yale Global Health Leadership Institute and lead author on the paper. "We were particularly interested in the roles of social interactions and organizational culture, which are difficult to measure using common research approaches like surveys."

Hospitals in the high- and low-performing groups differed substantially in five ways: organizational values and goals, senior management involvement, broad staff presence and expertise in AMI care, communication and coordination, and problem solving.

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