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Stroke risks linked to blood pressure drugs (beta blockers)
The Scotsman ^ | Oct. 18, 2005 | JOHN VON RADOWITZ

Posted on 10/17/2005 11:34:22 PM PDT by FairOpinion

A "FIRST-line" anti-high blood pressure drug is leaving patients at far greater risk of suffering strokes than if they take other medication for the condition, according to a major study.

People taking the commonly prescribed beta-blockers had a 16 per cent higher chance of stroke than if they took other drugs to treat high blood pressure, according to the findings by Swedish researchers. One particular beta-blocker, atenolol, was found to be associated with a 26 per cent higher stroke risk.

Medical experts warned yesterday that patients should not stop taking beta-blockers, which are beneficial for a range of other conditions. But an editorial in the medical journal the Lancet said the current endorsement of the drugs should be changed.

A team of researchers led by Professor Lars Hjalmar Lindholm, from Umea University Hospital, Sweden, pooled together data from 13 trials involving more than 105,000 patients.

In a further investigation involving 27,500 patients from seven studies, the scientists found that those taking beta-blockers were only 19 per cent less likely to have a stroke than those having no treatment at all. This was about half the benefit expected from previous trials.

The Lancet said: "It will be interesting to see how the many guideline committees respond to the latest information."

Alison Shaw, a medical spokeswoman at the British Heart Foundation, said: "People taking beta-blockers should not consider stopping or changing their medications on the basis of this study.

"However, they could discuss the other options for successful blood pressure lowering with their doctor."


TOPICS: Culture/Society; News/Current Events
KEYWORDS: betablockers; bloodpressure; health; medicine; stroke
There days there are much better blood pressure medications available, without such negative impacts.

Some are called ACE inhibitors, and even newer than those, ARB-s.

Read up on them and talk to your doctor.

Here is just one link that discusses the different classes of anti--hypertension drugs.

Blood Pressure Medications/Treatment Options

1 posted on 10/17/2005 11:34:22 PM PDT by FairOpinion
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To: neverdem

health & science ping


2 posted on 10/17/2005 11:34:48 PM PDT by FairOpinion (CA Props: Vote for Reform: YES on 73-78, NO on 79 & 80, NO on Y)
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To: FairOpinion
All meds will have a "negative impact."

The fact is that Beta Blockers do have a role to play in the management of hypertensions.

As an example, hypertensive blacks have a 28% decrease in mortality following an acute MI if placed on Beta Blockers.

Blacks and Asians also have a greater amount of angioedema and cough when placed on ACE inhibitors. ALL medications should be prescribed in a thoughtful manner and in full consideration of the big picture.

BTW, many of my patients who have chronic migraines do very well with low dose beta blockers. A nice side effect that occurs with beta blockers is that patients tend to be a bit less crabby, a side effect that is noticed by many spouses. ;-)

3 posted on 10/17/2005 11:50:07 PM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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To: Gamecock

Thanks for the info. I am sure there are situations, when some drugs are more appropriate than others, but as I understand doctors tend to typically prescribe beta blockers as a first drug, willy nilly.

I knew several friends who have had terrible side affects, such as not being able to go up a flight of stairs without almost passing out, though they were in excellent physical shape, used to run several miles a day. Needless to say, when the doctor changed their meds, they were fine again.

I think the point is that beta blockers shouldn't be the first blood pressure medication prescribed for everyone.


4 posted on 10/17/2005 11:58:42 PM PDT by FairOpinion (CA Props: Vote for Reform: YES on 73-78, NO on 79 & 80, NO on Y)
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To: FairOpinion
I believe this is the referenced article's abstract. Atenolol in hypertension: is it a wise choice? It's too bad they didn't do a subgroup analysis of hemorrhagic versus ischemic stroke. The former is usually more severe. The latter is about 4 - 5 times as common.
5 posted on 10/18/2005 12:00:07 AM PDT by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: FairOpinion

ping


6 posted on 10/18/2005 12:05:41 AM PDT by Gracey
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To: FairOpinion
You point out some very real concerns. But any drug can have undesirable side effects. That is why any patient should be followed closely whenever starting on long term medications.

Beta Blockers generally are not the first like of drugs for high blood pressure. The gold standard reccomendation is that the majority of patients should start out with thiazide diueretics. BTW, there is a rule of thumb that 1/3 of all patients will only require 1 drug, 1/3 will require 2 drugs, and 1/3 will require 3 drugs.

7 posted on 10/18/2005 1:09:20 AM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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To: Gamecock

Why is it that drugs are always prescribed by doctors? Isn't it ever possible that there are natural choices that could be tried first?


8 posted on 10/18/2005 4:38:49 AM PDT by Conservativegreatgrandma
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To: FairOpinion
Doggone!! I've just started taking Quinapril again this week... taking HCTZ again, too. I had let my prescriptions lag for months.

My mothers's kidneys were damaged, supposedly by high blood pressure, even though she took some other HBP medications for 40 years.

Quinapril supposedly "protects" kidneys (if they are not already damaged) and does not cause the excretion of potassium that, say, the water pills do.

Doctors are very aggressively attempting, nowdays, to lower blood pressure to close to 120. The acceptable limit had been 140.

Can this new goal, of BP of 120, be causing the problem with increased strokes?

Also, I am a little curious about the way in which beta blockers might upset the sodium-potassium balance. I thought that keeping the two minerals in balance was a good idea.

When I first heard I had hypertension (4 years ago), I told my doctor I bought the book on the DASH eating plan* and was going to try to follow it, as well as take my meds. He didn't seem to know what the DASH eating plan was and told me that I didn't need to lose weight. (I think my blood pressure would be helped if I lost about 15 pounds.)

*"The plan that is clinically proven to significantly reduce blood pressure"

9 posted on 10/18/2005 6:14:32 AM PDT by syriacus (Don't look for medical breakthroughs to be accomplished by pro-abort or pro-euthanasia doctors.)
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To: Conservativegreatgrandma
Such as?

IOW, are you referring to lifestyle modification or herbal products?
10 posted on 10/18/2005 6:15:39 AM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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To: Gamecock

Such as anything else other than drugs? Diet, exercise, supplements, etc.


11 posted on 10/18/2005 6:52:04 AM PDT by Conservativegreatgrandma
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To: Conservativegreatgrandma
That depends.

I spend a lot of my time discussing options with patients. I ask them two questions:

Do you know that once you start BP meds, you will be on them the rest of your life?

Can you seriously commit to changing your diet and lifestyle? (I give them two things to change every 2-3 weeks and then follow-up in three weeks with other changes. At some point I transition to a cheerleader.)

I've had some patients become normotensive after 3-4 months using that approach.


That being said, if my patients are honest and tell me that they enjoy eating super sized burger meals and won't change I will start them on meds.

As far as supplements go, I will try them on some conditions, but remember that supplements have side-effects as well. I try to keep up with the latest studies, but the fact remains that most supplements do not stand up to serious clinical studies. The overwhelming majority of results you see touted at your local GNC or health food store are based more on anecdotal evidence than clinical trials.
12 posted on 10/18/2005 7:13:47 AM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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Comment #13 Removed by Moderator

To: Gamecock
I have been on Diovan for my blood pressure for about 6 weeks. I noticed that I was feeling very tired in the middle of the day for no apparent reason. I had been taking Diovan first thing in the morning. Two days ago I started taking it at night and I feel better already. My doc never told me when to take it, should I call and discuss this with him or is taking it at night OK?

(I know you must just love getting medical questions from your freeper friends, forgive me)
14 posted on 10/18/2005 7:46:02 AM PDT by Ditter
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To: Ditter
I don't see any problem taking it at night. Two common side effects are dizziness and fatigue. I would mention it at your next visit.

(I know you must just love getting medical questions from your freeper friends, forgive me)

Next time you see a kid with a roadside lemonade stand, stop and buy some. Consider that my bill. ;-)

15 posted on 10/18/2005 10:32:29 AM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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To: Stingy Dog; Conservativegreatgrandma
Soooo, when you're not sure, "don't ask a doctor," listen to your body.

Bad idea. People with high blood pressure may show no symptoms for years. Your first clue that you are sick might be that you are dead.

If you have a trust issue with a doctor, find another doctor.

16 posted on 10/18/2005 10:36:09 AM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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To: Gamecock
...find another Dr.

I would like to find one who is not "practicing" &/or a whore for B I G D R U G !

17 posted on 10/18/2005 11:48:51 AM PDT by norraad ("What light!">Blues Brothers)
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To: Gamecock

OK I love lemonade! %;9) Thanks!


18 posted on 10/18/2005 12:06:09 PM PDT by Ditter
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To: norraad
I would like to find one who is not "practicing" &/or a whore for B I G D R U G !

Fine. When you come down with a life threatening disease, stay home.

You'll have your principles. That will look good on your headstone.

19 posted on 10/18/2005 12:50:03 PM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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Comment #20 Removed by Moderator

To: FairOpinion

for later reading


21 posted on 10/18/2005 7:10:47 PM PDT by kalee
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To: Stingy Dog
You don't have to convince me. I can tell you stories about lots of my relatives. The all-knowing doctors have made my mother a $700 a month drug addict and it's brought her years of misery and misery for our family.

Tomorrow she sees another doctor for chronic diarrhea. I know it means more drugs. Why not? A few more won't hurt. It's probably the drugs that are causing the current problems.

I have no confidence in any of them.

22 posted on 10/18/2005 7:23:43 PM PDT by Conservativegreatgrandma
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To: Conservativegreatgrandma
Like contestants on a gameshow, doctortutes get prizes from B I G D R U G for moving product.

While grandma $_its her pants, Dr. Whore wins a trip to France.

23 posted on 10/18/2005 7:33:23 PM PDT by norraad ("What light!">Blues Brothers)
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To: Stingy Dog
You make it sound that doctors have a monopoly over our lives.

I said or implied no such thing. Every post I have made on this thread has at least hinted at being an active partner in your health care. If you don't trust your current doctor, find another. If you want to manage your own healthcare without a doctor, have at it.

So, in essence, what you're saying, doc, is either we are subservient to the all-knowing, monopolistic doctor, or we'll die? LOL!

No, what I am saying is that in the early 1900's, the life expectancy was what, about 40? Now it's what? Late 70's? Walk through an old cematary in any big city. How many infants are there from the late 1800's? The increase in life expectancy with a phenomenal decrease in infant mortality was not the result of a fatalistic, humanistic philosophic system.

24 posted on 10/19/2005 1:46:59 AM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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To: norraad
Like contestants on a gameshow, doctortutes get prizes from B I G D R U G for moving product.

Send some of them my way. I have yet to recieve such an offer.

25 posted on 10/19/2005 1:48:51 AM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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To: Conservativegreatgrandma
If I may, it sounds like she is in a spiral of seeing specialists. What often happens is that the specialist focuses in on the complaint and other conditions aren't factored into the equation.

Is that wrong? Philosophically yes it is. But remember, when the only tool you have is a hammer, all the world looks like a nail.

Have ya'll have a long talk with your mother's primary care provider? (either a Family Practice Physician, Internist, Family Nurse Practitioner, or Physician Assistant)

The thing I would do is focus on any symptoms she is having and do a good scrub of the $700.00 a month of drugs she is on. What can happen (notice I said can happen) is a drug will cause a symptom that a specialist will treat with another drug. It does take some patience and time on the part of the patient, family, and "doc" to sort through this, but it might help.

Another thought is to see a gerontologist. Their specialty is to take care of old folks and they are quite skilled at getting to the bottom of such issues. (There are also Gerontological Nurse Practitioners who are great at doing this)

26 posted on 10/19/2005 2:32:11 AM PDT by Gamecock (Crystal meth is not a fruit of the Spirit.)
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To: Gamecock
Thanks for your concern. The problem is Mom is hopelessly addicted to serax. There's no getting her off it and the side effects have been horrific.

In order to counteract the side effects of the serax, she's been put on tons of other drugs.

She had a mastectomy a couple of years ago and was without her serax a few hours. I saw what a drug addict goes through on the withdrawal of the drugs.

There was some good news about the doctor she visited today. He sounds reasonable and he volunteered to put her on an antibiotic for the chronic diarrhea but my sister said she preferrs to make sure she really needs an antibiotic before she takes one.

Over the years she's had two doctors I respect. One told her she did not need chemo or radiation and the other one was today. Mom is 90 and in a nursing home.

27 posted on 10/19/2005 4:03:12 PM PDT by Conservativegreatgrandma
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To: FairOpinion; WhyisaTexasgirlinPA; El Gato; JudyB1938; Ernest_at_the_Beach; Robert A. Cook, PE; ...
When you enter an author's name in the correct format into PubMed, in this case it's Lindholm LH, you'll get a chronological listing of an author's professional articles starting from the latest back to the earliest.

The article that I linked in comment# 5 of this thread was the last that Lindholm had printed in Lancet according to an author search on PubMed.

It failed to find the latest Lancet article found by searching directly at Lancet. Here is its abstract:

The Lancet Early Online Publication, 18 October 2005

DOI:10.1016/S0140-6736(05)67573-3

Should β blockers remain first choice in the treatment of primary hypertension? A meta-analysis

Lars Hjalmar Lindholm a , Bo Carlberg a and Ola Samuelsson b

Summary

Background

Beta-blockers have been used widely in the treatment of hypertension and are recommended as first-line drugs in hypertension guidelines. However, a preliminary analysis has shown that atenolol is not very effective in hypertension. We aim to substantially enlarge the data on atenolol and analyse the effect of different β blockers.

Methods

The Cochrane Library and PubMed were searched for β blocker treatment in patients with primary hypertension. Data were then entered into the Cochrane Collaboration Review Manager package and were summarised in meta-analyses. 13 randomised controlled trials (n=105,951) were included in a meta-analysis comparing treatment with β blockers with other antihypertensive drugs. Seven studies (n=27,433) were included in a comparison of β blockers and placebo or no treatment.

Findings

The relative risk of stroke was 16% higher for β blockers (95% CI 4 - 30%) than for other drugs. There was no difference for myocardial infarction. When the effect of β blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all β blockers (CI 7 – 29%), about half that expected from previous hypertension trials. There was no difference for myocardial infarction or mortality.

Interpretation

In comparison with other antihypertensive drugs, the effect of β blockers is less than optimum, with a raised risk of stroke. Hence, we believe that β blockers should not remain first choice in the treatment of primary hypertension and should not be used as reference drugs in future randomised controlled trials of hypertension.

Affiliations

a Department of Public Health and Clinical Medicine, Umea University Hospital, Umea, Sweden b Department of Nephrology, Sahlgrenska University Hospital, Goteborg, Sweden

Correspondence to: Prof Lars H Lindholm, Department of Public Health and Clinical Medicine, Umea University Hospital, SE 901 85 Umea, Sweden

Here's the URL:
http://www.thelancet.com/journals/lancet/article/PIIS0140673605675733/abstract?iseop=true

You'll have to register, not subscribe, before you can access the abstract.

Check with your doc before you make any changes. The article doesn't differentiate between the two main types of stroke.

28 posted on 10/27/2005 12:44:47 PM PDT by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem

Thanks - I've been on atenolol for 13 years.......yikes!


29 posted on 10/27/2005 12:54:55 PM PDT by WhyisaTexasgirlinPA (Prayers for healing and relief from pain for Cowboy...........)
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To: Conservativegreatgrandma
Why is it that drugs are always prescribed by doctors? Isn't it ever possible that there are natural choices that could be tried first?

Let me tell you how that conversation often goes....

Dr: Well Mrs Jones, I'm going to give you drug x for your high blood pressure and drug y for your diabetes...here's your prescriptions.

Mrs. Jones: Do I have to take all these medications? I really don't understand...they are expensive and bothersome...isn't there anything else I could do?

Dr: Well, I suppose that you could lose, say, 100 or more pounds lbs to get down to ideal body weight, watch your diet to lower our cholesterol and start an exercise program...Quitting smoking would be advisable too. I have literature and a plan for you if you want it. Losing weight and exercising will help with your diabetes AND high blood pressure...

Mrs. Jones: Ummmm.....Now, where were those prescriptions again?

I did an internal medicine internship, and quickly realized that MOST people would rather take medicine than adjust their lifestyle. It's easier to take a pill than to diet etc. The number of patients that want 'other' choices is limited IMO.

30 posted on 10/27/2005 1:18:08 PM PDT by Ethrane ("semper consolar")
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To: Ethrane
Mrs. Jones: Do I have to take all these medications? I really don't understand...they are expensive and bothersome...isn't there anything else I could do?

Dr: Well, I suppose that you could lose, say, 100 or more pounds lbs to get down to ideal body weight, watch your diet to lower our cholesterol and start an exercise program...Quitting smoking would be advisable too. I have literature and a plan for you if you want it. Losing weight and exercising will help with your diabetes AND high blood pressure...

Mrs. Jones: Ummmm.....Now, where were those prescriptions again?

I did an internal medicine internship, and quickly realized that MOST people would rather take medicine than adjust their lifestyle. It's easier to take a pill than to diet etc. The number of patients that want 'other' choices is limited IMO.

Interesting, I never thought of it as an either/or, nice to know it is a choice. When I see a doctor and they ask for a list of my medicines, they're always surprised the list is: several aspirin a month. But I guess if I want to keep it that way, I should up the exercise, lose some weight etc.

31 posted on 10/27/2005 1:49:04 PM PDT by GOPJ (NYT: How many times do you ask for an error to be corrected before the "error" becomes a "lie"?)
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To: neverdem

Thanks for the information (and the ping).


32 posted on 10/27/2005 1:49:51 PM PDT by GOPJ (NYT: How many times do you ask for an error to be corrected before the "error" becomes a "lie"?)
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To: Ethrane
You are right but the age of the patient must be taken into account. For instance, docs nearly killed my sister with their drugs. She had rheumatoid arthritis, plus other auto immune disorders.

She was in her early 50s. The RA was not better and her liver was being harmed.

In my opinion, drugs do not effectively treat chronic disease. They only treat symptoms and if the drugs are piled on and at early enough age, you will run into real trouble.

What the docs have done to my mom is a total disaster. They've turned her into a $700 a month drug addict who has not found happiness with the drugs.

33 posted on 10/27/2005 2:44:16 PM PDT by Conservativegreatgrandma
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To: Ethrane
I did an internal medicine internship, and quickly realized that MOST people would rather take medicine than adjust their lifestyle. It's easier to take a pill than to diet etc. The number of patients that want 'other' choices is limited IMO.

It is hard, sometimes. My mom fought back after having a blockage in her aorta that left her paralyzed and with a lot of ischemic damage to her feet. Doctor really didn't expect her to walk again because of the pain involved, but she whipped that.

What she couldn't whip was the cycle she went through with her reaction to high carbohydrate foods. She'd eat carb foods, get the craves, eat more carb foods, and could never shed enough weight to keep her diabetes and blood fats from killing her.

I read some notes she wrote a couple of years before she died. It was so sad. She sounded so defeated.

But sometimes, we can break through. I managed to quit smoking. I have realized the games the insulin cycle can play with my head (not diabetic or even pre-diabetic yet, but my brother popped up pre-diabetic, and I decided enough games), and I eat totally different and have dropped about sixty pounds. I know I will have to think differently about food forever. But it's not easy. There is pain involved in all these things we go through. And it is good that medicine can make it possible for there to be help and alternatives.

Now if they could make an NSAID that doesn't eat my stomach lining up, or a narcotic pain reliever that doesn't give me biliary spasms...
34 posted on 10/27/2005 2:50:20 PM PDT by Knitting A Conundrum (Act Justly, Love Mercy, and Walk Humbly With God Micah 6:8)
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Comment #35 Removed by Moderator

To: Conservativegreatgrandma

Big Pharma got rid of that option eons ago.

Back then the natural options were outpulling the chemicals.

During the last major flu pandemic of the early 1900's the doctors using natural options so far out pulled the others that Pharma had to do something.


36 posted on 10/27/2005 3:17:45 PM PDT by Spirited
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To: Stingy Dog

Amen!


37 posted on 10/27/2005 3:21:25 PM PDT by Spirited
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To: FairOpinion

Very deceiving headline. It implies that the risk of stroke is increased by taking a beta blocker. Read the last paragraph- beta blockers DECREASE the risk of stroke, they just don't decrease the risk of stroke as much as previously thought; other antihypertensives are better at reducing stroke risk. Beta-blockers have well-proven advantages for heart attack prevention.


38 posted on 10/27/2005 3:30:52 PM PDT by armydoc
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To: Lizarde

I am very sorry about your Mother. Prayers go out to you and her.


39 posted on 10/27/2005 7:04:30 PM PDT by FairOpinion (CA Props: Vote for Reform: YES on 73-78, NO on 79 & 80, NO on Y)
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To: Gamecock
No, what I am saying is that in the early 1900's, the life expectancy was what, about 40? Now it's what? Late 70's? Walk through an old cematary in any big city. How many infants are there from the late 1800's? The increase in life expectancy with a phenomenal decrease in infant mortality was not the result of a fatalistic, humanistic philosophic system.

A lot of it is due to better plumbing. But much of it, and an increase in general quality of life for many, is due to inoculations and antibiotics.

My doctor told me, as part of his sales pitch (he knew I wasn't about to take or change anything without being convinced) for a change in medication that of all the cholesterol lowering drugs, only the statins have been demonstrated to actually increase life span. I changed, and my numbers are much lower. I was amazed and pleased, and so was he. Can't remember all the numbers but LDL went from 130 to 60, triglycerides down about 1/3 (and they weren't that bad to begin with). Actually the LDL went from 160 to 60, but that 160 was up from 130 due to a misfiling of a previous prescription by the pharmacy. I was taking zyrtec instead of zestril! (pills looked about the same, and I thought the difference was due to a change in generic brand when I changed pharmacies, not to the pharmacy having mis read the prescription) Had trouble sleeping for a week or so after stopping it. I had wondered why I was so drowsy in the afternoon, after taking it at lunch time. :) I was also taking Allegra at the same time. Well no long term harm done I guess, I hope.

40 posted on 10/28/2005 1:16:58 PM PDT by El Gato
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To: El Gato
Not denying public health efforts, to include plumbing, didn't have a role, but consider the following:

The overall improvement in the health of Americans over the 20th century is best exemplified by dramatic changes in 2 trends: 1) the age-adjusted death rate declined by about 74%, while 2) life expectancy increased 56%. Leading causes of death shifted from infectious to chronic diseases. In 1900, infectious respiratory diseases accounted for nearly a quarter of all deaths. In 1998, the 10 leading causes of death in the United States were, respectively, heart disease and cancer followed by stroke, chronic obstructive pulmonary disease, accidents (unintentional injuries), pneumonia and influenza, diabetes, suicide, kidney diseases, and chronic liver disease and cirrhosis. Together these leading causes accounted for 84% of all deaths.

/cut/

Beginning in 1936 and continuing to 1956, there was precipitous decline in maternal mortality from 582 deaths per 100 000 live births in 1935 to 40 in 1956. Since 1950 the maternal mortality ratio dropped by 90% to 7.1 in 1998.

/cut/

For children older than 1 year of age, the overall decline in mortality during the 20th century has been spectacular. In 1900, >3 in 100 children died between their first and 20th birthday; today, <2 in 1000 die. At the beginning of the 20th century, the leading causes of child mortality were infectious diseases, including diarrheal diseases, diphtheria, measles, pneumonia and influenza, scarlet fever, tuberculosis, typhoid and paratyphoid fevers, and whooping cough. Between 1900 and 1998, the percentage of child deaths attributable to infectious diseases declined from 61.6% to 2%.

From http://pediatrics.aappublications.org/cgi/content/abstract/106/6/1307
41 posted on 10/28/2005 10:48:36 PM PDT by Gamecock (Eternity is a long time to be wrong.)
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