Wake Up, Philippines!

Love’s in the head, not the heart

Posted in Love, News Feature by Erineus on February 13, 2009

Photo is loading...

WASHINGTON – Like any young woman in love, Bianca Acevedo has exchanged Valentine hearts with her fiance.

But the New York neuroscientist knows better. The source of love is in the head, not the heart.

She is one of the researchers in a relatively new field focused on explaining the biology of romantic love. And the unpoetic explanation is that love mostly can be understood through brain images, hormones and genetics.

That seems to be the case for the newly in love, the long in love and the brokenhearted.

“It has a biological basis. We know some of the key players,” said Larry Young of the Yerkes National Primate Research Center at Emory University in Atlanta. There, he studies the brains of an unusual monogamous rodent to get a better clue about what goes on in the minds of people in love.

In humans, there are four tiny areas of the brain that some researchers say form a circuit of love.

Acevedo, who works at the Albert Einstein College of Medicine in New York, is part of a team that has isolated those regions with the unromantic names of ventral tegmental area (VTA), the nucleus accumbens, the ventral pallidum and raphe nucleus.

The hot spot is the teardrop-shaped VTA. When people newly in love were put in a functional magnetic resonance imaging machine and shown pictures of their beloved, the VTA lit up. Same for people still madly in love after 20 years.

The VTA is part of a key reward system in the brain.

“These are cells that make dopamine and send it to different brain regions,” said Helen Fisher, a researcher and professor at Rutgers University. “This part of the system becomes activated because you’re trying to win life’s greatest prize – a mating partner.”

One of the research findings isn’t so complimentary: Love works chemically in the brain like a drug addiction.

“Romantic love is an addiction; a wonderful addiction when it is going well, a horrible one when it is going poorly,” Fisher said.

“People kill for love. They die for love.”

The connection to addiction “sounds terrible,” Acevedo acknowledged. “Love is supposed to be something wonderful and grand, but it has its reasons. The reason I think is to keep us together.”

But sometimes love does not keep us together. So the scientists studied the brains of the recently heartbroken and found additional activity in the nucleus accumbens, which is even more strongly associated with addiction.

“The brokenhearted show more evidence of what I’ll call craving,” said Lucy Brown, a neuroscientist also at Einstein medical college. “Similar to craving the drug cocaine.”

The team’s most recent brain scans were aimed at people married about 20 years who say they are still holding hands, lovey-dovey as newlyweds, a group that is a minority of married people. In these men and women, two more areas of the brain lit up, along with the VTA: the ventral pallidum and raphe nucleus.

The ventral pallidum is associated with attachment and hormones that decrease stress; the raphe nucleus pumps out serotonin, which “gives you a sense of calm,” Fisher said.

Those areas produce “a feeling of nothing wrong. It’s a lower-level happiness and it’s certainly rewarding,” Brown said.

The scientists say they study the brain in love just to understand how it works, as well as for more potentially practical uses.

The research could eventually lead to pills based on the brain hormones which, with therapy, might help troubled relationships, although there are ethical issues, Young said. His bonding research is primarily part of a larger effort aimed at understanding and possibly treating social-interaction conditions such as autism. And Fisher is studying brain chemistry that could explain why certain people are attracted to each other. She’s using it as part of a popular Internet matchmaking service for which she is the scientific adviser.

While the recent brain research is promising, University of Hawaii psychology professor Elaine Hatfield cautions that too much can be made of these studies alone. She said they need to be meshed with other work from traditional psychologists.

Brain researchers are limited because there is only so much they can do to humans without hurting them. That’s where the prairie vole – a chubby, short-tailed mouselike creature – comes in handy. Only 5 percent of mammals more or less bond for life, but prairie voles do, Young said.

Scientists studied voles to figure out what makes bonding possible. In females, the key bonding hormone is oxytocin, also produced in both voles and humans during childbirth, Young said.

When scientists blocked oxytocin receptors, the female prairie voles didn’t bond.

In males, it’s vasopressin. Young put vasopressin receptors into the brains of meadow voles – a promiscuous cousin of the prairie voles – and “those guys who should never, ever bond with a female, bonded with a female.”

Researchers also uncovered a genetic variation in a few male prairie voles that are not monogamous – and found it in some human males, too.

Those men with the variation ranked lower on an emotional bonding scale, reported more marital problems, and their wives had more concerns about their level of attachment, said Hasse Walum, a biology researcher in Sweden. It was a small but noticeable difference, Walum said.

Scientists figure they now know better how to keep those love circuits lit and the chemicals flowing.

Young said that romantic love theoretically can be simulated with chemicals, but “if you really want to get the relationship spark back, then engage in the behavior that stimulates the release of these molecules and allow them to stimulate the emotions,” he said. That would be hugging, kissing, intimate contact.

“My wife tells me that flowers work as well. I don’t know for sure,” Young said. “As a scientist it’s hard to see how it stimulates the circuits, but I do know they seem to have an effect. And the absence of them seems to have an effect as well.” AP

Source: Philippine Star
Updated February 13, 2009 12:00 AM
Link: http://www.philstar.com/Article.aspx?articleId=439896&publicationSubCategoryId=68

What triggers a heart attack?

Posted in Health by Erineus on February 3, 2009

Photo is loading...

Heart attacks, strokes, and cardiac arrests seem like they come out of the blue, but most don’t. They usually appear after cholesterol-rich plaque has festered for decades in arteries nourishing the heart and brain. So what makes one happen at a particular time? A trigger.

Researchers have identified about two dozens of these. They’re a diverse crew, ranging from anger and earthquakes to simply waking up in the morning. The ongoing search for triggers is generating ways to prevent potentially deadly cardiovascular events.

Some triggers cause a sudden surge in blood pressure. Some make the heart beat faster and harder. Others encourage the formation of blood clots, constrict blood vessels, or cause bursts of inflammation. Any of these changes can set into motion processes that culminate in the sudden formation of a blood clot (leading to a heart attack or ischemic stroke), a tear in a blood vessel (leading to a hemorrhagic stroke), or a wild heart rhythm (leading to sudden cardiac arrest).

One pathway common to many triggers is the activation of the sympathetic nervous system, which is responsible for the body’s fight-or-flight response. The stress hormone it sends into the bloodstream can be hard on the heart and on the vulnerable atherosclerotic plaque. The most important triggers include:

• Waking from sleep. Long before you wake up, your body prepares for a new day by trickling stress hormones into the bloodstream. They signal small blood vessels to constrict, make your heart beat faster, and begin boosting your blood pressure from its sleep-time low. This activity ensures adequate blood flow through your blood vessels by the time you are ready to get out of bed. It’s no coincidence that cardiovascular problems peak between 6 a.m. and noon. The slight dehydration that occurs during sleep may also contribute to this early morning peak, as may the overnight fade in protection from blood pressure drugs and other heart medicines.

• Heavy physical exertion. Lifting heavy objects, running, or shoveling snow (for those living in temperate countries), as well as other types of strenuous physical activity, can trigger heart attacks, strokes, and cardiac arrests. Don’t take this as a reason to stop exercising. In fact, the opposite is true — exertion is much less likely to cause trouble in people who exercise regularly than in those who don’t.

• Anger. A furious argument or gut-churning anger can provoke a heart attack, stroke, or cardiac arrest. In two large studies, a bout of anger increased the chances of having a heart attack between nine-fold and 14-fold over a two-hour period following the anger-provoking event. A study presented at the 2006 American Heart Association meeting showed that anger often preceded shocks from implanted cardioverter-defrillators, pacemaker-like devices used to halt potentially deadly, fast or chaotic heart rhythms.

• Natural disasters and war. Heart attacks and cardiac arrests spiked abruptly in the day of the early-morning earthquake in Northridge, California in 1994. Israeli researchers saw spikes in heart attacks during the first week of Iraqi missile attacks in 1991, while New Jersey researchers found a 49-percent increase in heart attacks within a 50-mile radius of the World Trade Center immediately after the attacks on September 11, 2001.

• Weather. Severe heat waves, such as the ones that struck Europe in 2003 or the US Midwest in 1995, increased heart-related deaths. Cold weather triggers cardiovascular problems, too — in the United States, deaths from heart disease peak in December and January.

• Air pollution. Breathing air full of tiny particles from car, bus, and truck tail pipes, and fuel-burning factories or electricity generators is a trigger for heart attack and stroke.

• Infections. Pneumonia, the flu, and upper respiratory tract infections are potent triggers for stroke and heart attack. Urinary tract infections have also been linked to strokes.

• Sexual activity. Sexual activity briefly raises heart attack risk. Sex with a new partner in an unfamiliar setting increases the risk more than sex with a familiar partner in a familiar setting. In one Japanese study, cardiac deaths were found to be more common in extramarital than in intramarital sexual activity.

• Overeating. A heavy meal, especially one that is chock-full of saturated fat or carbohydrates, can raise the risk of having a heart attack by temporarily making blood more likely to clot, interfering with the blood vessel’s ability to relax and contract, or increasing the heart rate and release of stress hormones.

• Other triggers. These include grief, lack of sleep, mental and work-related stress, the use of cocaine and other “recreational” drugs, holidays, and sporting events (if your team loses).

Silencing Triggers

With triggers lurking everywhere, waiting to assail you even before you wake up, what’s a person to do? Relax, for one thing. The vast majority of people, including those with cardiovascular disease, get out of bed in the morning, do heavy physical exertion, make love, get angry, and suffer through the flu just fine.

Still it’s scary to hear that something like a sexual activity doubles your risk. But keep in mind that the chance of having a heart attack, stroke, or cardiac arrest in any particular hour or during a particular activity is very low, in the order of one in a million. So sex increases the absolute risk from one in a million to two in a million. In other words, not that much. What’s more, the risks are averages, and so are lower for people without cardiovascular disease and higher for those with it. That said, there are ways to inactivate those triggers.

• Lower your absolute risk. The more flexible your arteries and the less plaque they contain, the lower your chances of having a heart attack, stroke, or cardiac arrest. Exercise, not smoking, eating a heart-healthy diet, and controlling your blood pressure, cholesterol, blood sugar, and weight go a long way to warding off all cardiovascular problems.

• Blunt specific triggers. The more you exercise, the less likely you are to have a heart attack while exercising or doing strenuous activity. If you are prone to stress, anger, or anxiety, learning to manage these emotions can nip these triggers in the bud. Get vaccinated against pneumonia and get a yearly flu shot. In the morning, give yourself a few extra minutes to wake up and get out of bed.

• Avoid some triggers. If you’ve already had a heart attack or stroke, or are at high risk for one, avoiding some triggers may minimize your risk. Hire someone younger and stronger to do the strenuous work. Wash your hands often, especially if you’ve been around someone with a cold or other respiratory infection. Walk away from confrontations. Try not to indulge in rich, high-calorie meals. Stay indoors where it’s cool during a heat wave or on days when air pollution is high.

• Stick with your medications. Many of the standard medications taken for cardiovascular disease prevent or interrupt triggered pathways. Aspirin makes it more difficult for blood clot to form. Beta blockers calm the activity of the sympathetic nervous system. Statins stabilize plaque, making it less likely to rupture. If you take one or more medications to control your blood pressure, make sure they last long enough to do their job through the night and into the early morning.

This description of triggers is meant to empower you, not frighten you. Knowing the things that can set off a heart attack, stroke, or cardiac arrest, can help you avoid them or blunt their power. Being aware of possible triggers can also help you respond faster if they do, indeed, set off a heart attack or stroke. The faster you act, the better off you’ll be.

But knowing your triggers doesn’t alter the conventional wisdom about preventing heart attacks and strokes, which is, that nothing truly works without changes in risk factors such as diabetes, eliminating smoking, relieving high blood pressure and lipid disorders. This is where medicine should focus its attention. Today, doctors are learning more about what triggers heart attacks — but prevention, not prediction, remains the prime strategy for helping patients.

Author:  TYRONE M. REYES, M.D.

Updated September 30, 2008 12:00 AM

Angioplasty or bypass surgery?

Posted in Health by Erineus on February 3, 2009

Angioplasty or bypass surgery?

Which is best when cholesterol-laden plaque narrows a coronary artery and chokes off blood flow to part of the heart muscle? There’s no simple answer. It depends on your situation: how many arteries are blocked, where the blockages are, your overall health, and your preferences. It also depends on how you define “best” — most durable, shortest recovery, fewest complications, or longest survival.

At first glance, angioplasty with stent placement seems to be a clear winner. It requires a small nick in the groin, local anesthesia, an overnight hospital stay, and a relatively rapid recovery. In comparison, bypass surgery requires opening the chest, general anesthesia, a several-day hospital stay, and weeks of sometimes painful recovery. These differences are one reason why in the US alone, nearly 1.3 million angioplasties were performed last year compared with 470,000 bypass surgeries. On the other hand, surgery is the king of the hill when it comes to durability and freedom from chest pain. Far fewer people need a repeat procedure after bypass surgery than angioplasty.

Simplest Cases

For an uncomplicated blockage in a single coronary artery, angioplasty is becoming the first choice of most cardiologists and their patients. It is quick, relatively painless, and has you back to your usual activities in a few days. A number of large studies show that survival after angioplasty is as good as after bypass surgery.

The convenience of angioplasty comes with a price. Up to one-quarter of people who have angioplasty must have it repeated, or have bypass surgery, within a few years. And anyone who gets a drug-eluting stent must take medicine for at least a year to prevent the formation of potentially deadly clots around the stent.

More Complicated Problems

Bypass surgery was once thought to be the only solution for blockages in two or three coronary arteries, at the junction of two arteries, in a heart with poor pumping power in the left ventricle, or in an individual with diabetes or kidney disease. But here, angioplasty is catching up. It’s hard to be sure how comparable the two procedures are, since there are no data yet from head-to-head trials for such complex situations. But there are inklings from other sorts of information.

The latest comes from a review of data collected by the state of New York. It included all 17,000 bypass surgeries and angioplasties performed in 2003 and 2004 in the state’s non-federal hospitals. Investigators compared deaths immediately after these procedures, deaths within 18 months, and heart attacks within 18 months. News reports about this work, which was published in the January 24, 2008 issue of the New England Journal of Medicine, bore headlines like “Surgery better than stents for multiple blockages.” That isn’t the whole story.

Bypass surgery was better but not by much. An extra 1.6 to 2 percent of people in the bypass group were still alive and had not had a heart attack after 18 months. Of course, that small difference isn’t anything to sneeze at when millions of these procedures are performed each year worldwide. The biggest difference between the two methods of treatment was in the need for repeat procedures. Among those who initially underwent angioplasty, 30 percent needed a second procedure within 18 months, compared with five percent in the bypass group.

This study collected information from 2003 to 2004, when the use of drug-eluting stents was in full swing. So the results are relevant today. But the cardiologists and patients chose which procedure to have. This could skew the results in favor of bypass surgery because doctors sometimes suggest angioplasty for frail patients or those with conditions that might increase the chances of dying soon after any cardiovascular procedure.

The risks versus benefits of the two procedures are noted in Table 1 (CABG-Coronary Artery Bypass Graft) and in Table 2 (PCI — Percutaneous Coronary Intervention or Angioplasty). Better answers to the angioplasty-or-bypass question should be coming in the next few years. At least three ongoing trials, dubbed FREEDOM, SYNTAX, and VA CARDS, are comparing the short-term and long-term effects of angioplasty and bypass surgery for multivessel or complex coronary artery disease.

Until then, the results of angioplasty and bypass surgery are close enough that you usually have a choice. And never hesitate to ask your doctor why he/she is recommending one over the other, or to seek a second opinion. The bottom line is this: When considering treatment for a blocked or narrowed coronary artery, it’s important to talk to your doctor about all treatment options. There’s no right or wrong therapy for everyone. Each option has its pros and cons. Deciding which is best for you depends on your individual situation.

Do you really need a procedure?

If you are having a heart attack, then undergoing emergency angioplasty or bypass surgery is absolutely the best remedy. The same isn’t true for mild chest pain brought on by physical activity (angina) or a narrowed coronary artery that doesn’t cause any symptoms at all. Before hopping on the train for these procedures, consider the advances of the medical approach: drugs that improve cholesterol, control blood pressure, stabilize the heart rhythm, fight blood clots, reduce the work of the heart muscle, relax tight arteries, stabilize vulnerable plaques, and manage diabetes. When these medications are added to lifestyle therapy that includes smoking cessation, diet, exercise, and stress reduction, they produce results that are hard to beat, even with invasive reperfusion therapy.

Medical therapy isn’t really an option. It should be an integral part of life after angioplasty or bypass surgery. Angioplasty squashes a plaque, bypass surgery creates a detour around it, but only medical therapy fights atherosclerosis, the disease that causes plaque to form. Without it, plaque keeps growing.

For people with stable angina or a narrowed but silent coronary artery, medical therapy alone is as good as angioplasty. It avoids the small but very real risk of complications from angioplasty or bypass surgery. These can range from infection to stroke or even death. The Clinical Outcome Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial showed that adding angioplasty to state-of-the-art medical therapy was no better than medical therapy alone at preventing future heart attacks and extending life. The lesson from COURAGE is that angioplasty can be a choice, not a necessity, for treating stable angina.

The other big thing to think about is how you’ll manage taking clopidogrel (Plavix) and aspirin every day for at least a year after getting a drug-eluting stent. These drugs are essential for preventing the sudden, and often deadly, formation of a clot on the stent. But they can be hard on the stomach or cause gastrointestinal bleeding, especially for people who also need to take a nonsteroidal anti-inflammatory drug. Moreover, some doctors don’t want their patients to stop taking this combination long enough to have a hip or heart valve replaced, a gall bladder removed, or other surgery. Before agreeing to have angioplasty with a drug-eluting stent, make sure your doctor has a strategy for protecting the stent if you end up needing surgery down the road.

The take-home message is this: Every form of treatment has just two goals — to help patients live better and to help them live longer. Each procedure has unique risks and benefits which must be considered relative to your own individual situation.

So, which form of treatment will it be for you? Angioplasty or bypass? Or maybe, even just medical therapy alone. It’s really up to you, and your doctor, to decide.

Author:  TYRONE M. REYES, M.D.

Updated February 03, 2009 12:00 AM