Part Five Chapter XIV

XIV When Shirley opened the bedroom door, she saw nothing but two empty beds. Justice required a sleeping Howard; she would have to advise him to return to bed. But there was no sound from either the kitchen or the bathroom. Shirley was worried that, by taking the river road home, she had missed him. He must have got dressed and set off for work; he might already be with Maureen in the back room, discussing Shirley; planning, perhaps, to divorce her and marry Maureen instead, now that the game was up, and pretence was ended. She half ran into the sitting room, intending to telephone the Copper Kettle. Howard was lying on the carpet in his pyjamas. His face was purple and his eyes were popping. A faint wheezing noise came from his lips. One hand was clutching feebly at his chest. His pyjama top had ridden up. Shirley could see the very patch of scabbed raw skin where she had planned to plunge the needle. Howard's eyes met hers in mute appeal. Shirley stared at him, terrified, then darted out of the room. At first she hid the EpiPen in the biscuit barrel; then she retrieved it and shoved it down the back of the cookery books. She ran back into the sitting room, seized the telephone receiver and dialled 999. ‘Pagford? This is for Orrbank Cottage, is it? There's one on the way.' ‘Oh, thank you, thank God,' said Shirley, and she had almost hung up when she realized what she had said and screamed, ‘no, no, not Orrbank Cottage †¦' But the operator had gone and she had to dial again. She was panicking so much that she dropped the receiver. On the carpet beside her, Howard's wheezing was becoming fainter and fainter. ‘Not Orrbank Cottage,' she shouted. ‘Thirty-six Evertree Crescent, Pagford – my husband's having a heart attack †¦'

Origins of Nationalism in France

In terms of the origins of national identity in France it is agreed that the French Revolution was the single most important period of radical social and political upheaval and was henceforth a catalyst for the spread of nationalism in France aswell as throughout the rest of Europe. Despite the fact the French Revolution occurred over 200 years ago, in present day France, there remain various symbols of the revolution which have become deeply embedded in the national identity of the country.One of which being the tricolore flag which was created to oppose the flag of the King, which itself was a symbol of the Ancient Regime. Pre-revolutionary France was characterised by a social structure based on class and tradition, but more importantly, it was based on inequalities which were sanctioned by the force of law. The Ancient regime in France had been based on the division of society into legal categories. Membership of the first and second estates (clergy and nobility) conferred legal a nd social entitlements that were not available to the Third Estate.The idea of Absolutism meant that the Monarchy was entitled to expect the obedience of the people on the grounds that the King was the agent of God’s purpose. The French Revolution was the turning point in modern history. It was the first manifestation of nationalism in the Western world; it abolished the ancient regime and thus the absolute monarchy, giving birth to the French nation in a sudden burst of enthusiasm. In 1790 all the communities of France erected an altar to the fatherland with the inscription: â€Å"The citizen is born, lives and dies for the fatherland. The revolution began a new age in French political life, the old political order in France was destroyed and replaced by a new order that was based on individual rights, representative institutions and loyalty to the nation as opposed to the Monarch. This new era fostered new political ideals summarised in the French slogan; ‘Liberte, E galite et Fraternite which is still to this day a symbol of French nationalism. One of the key events in the development of nationalism in France which arose with the French Revolution was ‘The declaration of the rights of man of the citizen’ in 1789.This fundamental document harboured fervour that France belonged to its people, not Louis XVI and defined the individual and collective rights of all the estates of the realm as universal. It created shared values such as liberty, property, security, resistance to oppression and civil equality which bought the French people together as nation. Napoleon Bonaparte also had a significant role in creating a national identity in France. He was considered by some to be the ‘preserver of the French Revolution’ as he introduced the Napoleonic Code which attempted to unite the country by making everyone equal before the law.It spread the ideals of the revolution including legal equality and economic freedom and therefor e a sentiment of nationalism through France and the rest of Europe. However, often the nationalism that developed in reaction to Napoleon took one of two tracks. In some cases, it was a conservative nationalism, a desire to go back to the old ways that prevailed before Napoleon took over and started making reforms. On the other hand, there was liberal nationalism. Napoleon continued to spread some of the fruits of the French Revolution but some people wanted more: they wanted true self-government.As a result of the French Revolution and Napoleon, French people started taking great pride in the history, language, culture and religion of their country which helped create a strong French national identity. During the French Revolution, the National Assembly decreed that the Louvre should be used as a museum, to display the nation's masterpieces. Napoleon inspired national pride by reopening the Louvre in 1801 and bringing hundreds of famous paintings and other works of art to the natio n’s attention.The French nation-state unified the French people in particular through the consolidation of the use of the French language. The French language has been essential to the concept of ‘France' even though in 1789 only 50% of French people spoke it. Conscription, invented by Napoleon mixed the various groups of France into a nationalist mould which created the French citizen and his consciousness of membership to a common nation, while the various â€Å"patois† were progressively eradicated.Secularism in France is a fundament of the French nation. It is important when considering the national identity of France as it stems from the sense of ‘religious freedom’ which was a principle laid down by the French Revolution. It also emphasises the fact that the Republic has always recognised individuals, rather than groups and that a French citizen owes allegiance to the nation, and has no officially sanctioned ethnic or religious identity.

Cardiovascular Diseases

Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and

The UK Banking System Essay Example | Topics and Well Written Essays - 1750 words

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International trade Essay Example | Topics and Well Written Essays - 1000 words - 2

International trade - Essay Example It has made remarkable foreign investments, mostly in its nearby countries, owing to its huge capital reserve and high market prices. For LUKoil, foreign acquisitions are a means of acquiring experienced workers and technological know-how to gain efficiency and effectiveness in both domestic and global competition. It has acquired 800 U.S. stations from ConocoPhillips and 100 per cent of Getty Petroleum in the United States. It is imperative for both Russia and LUKoil to export petroleum in order to fulfil their economic goals. However, LUKoil’s future ability to export may be hampered by the sorry state of political relations of Russia both inside and outside the nation. Thus, to make sure that the company operates successfully, it must lay more emphasis on foreign investments and relations with the oil companies in the West. Russia’s position as an oil exporter can be explained on the basis of the theory of absolute as well as competitive advantage. Russia ranks eighth largest in the world in terms of its oil reserves and hence the country enjoys the natural gift of such a comparative advantage. As compared to Saudi Arabia, Russia presently has 15 more established oil reserves. Besides, the country enjoys not only natural but also acquired advantages with respect to oil production. In the global oil market the prices are determined by the basic laws of demand and supply. Of Russia’s total oil production, just 27 per cent is put to use for inland purposes and the remaining 73 per cent is exported. Moreover, its oil companies have come up as major players in the global competition. Thus, factor proportions theory is also valid for Russia’s competitive advantage. The country similarity theory can also be applied in this case if we consider the fact that a major part of its foreign expa nsion corresponds to the countries that were formerly a part of the Soviet Union. In addition to this, Russia’s global position as an oil exporter can be

A Footwear Manufacturing Company - New Balance Research Paper - 1

A Footwear Manufacturing Company - New Balance - Research Paper Example Today, the company is tasked with shifting line of corporate social responsibility from just doing what is right into an integrated business strategy and this is what the present case seeks to find means of getting done in a very resounding manner. Â  Over the years, the history, values, and integrity of New Balance have been the company’s major governance strength. This is because, with an early mission to holding on to responsible management practices, the company has not turned its back on such practices to date (Tyssen, 2001). In the midst of this major strength of unshaken organizational culture for integrity and values, the company has failed to pay particular attention to issues of transparency and accountability and this poses a major weakness to the company’ overall governance. This missing link of transparency and accountability has resulted in a situation whereby the company has not been able to identify its business risk and opportunities (Mustapha, 2008). Invariably, the company has not taken advantages of opportunities that could make it larger and more popular than it is today. Â  Consistency is always a term that customers cherish because it keeps them in line with what is happening within the company and avoids the need to change their ways of dealing with the company (Mustapha, 2008). As far as products and services are concerned, this has thus been a major strength of the company, where it has been able to be consistent with its line of sports brand of production.

The Importance of Entrepreneurship and Enterprise in the UK Essay - 1

The Importance of Entrepreneurship and Enterprise in the UK - Essay Example ameters which tend to change continuously, however when all appropriate preparation has been made, entrepreneurship can lead to a significant development of the commercial market involved. However, in order to ensure the success of their efforts, entrepreneurs should try to follow strictly the principles of the commercial market avoiding risk in cases that there are no limits for the achievement of a particular plan. The existence of alternative plan of action has to be considered as necessary in order for the entrepreneurship to survive on a long term basis. Entrepreneurship should be considered as a fundamental activity that helps the market to be developed. However, in order for this activity to lead to positive outcomes it is necessary that the participants (entrepreneurs) follow a specific plan of action which has to be characterized by the thorough analysis of the market, the appropriate design of strategic plan and the rapid reaction to the opportunities appeared. Of course in any case the existence of risk creates a series of uncertainties for any potential entrepreneurship. But if all appropriate steps of action are followed they are little chances for the entrepreneurship to end up to a failure. This paper examines the characteristics of entrepreneurship as a unique commercial activity and tries to identify all the appropriate ‘qualities’ of a good entrepreneur as they can be observed both in the field of theory but also in practice. For this reason, the relevant literature review has been followed with a few examp les of successful entrepreneurs in UK as they have been evaluated and awarded in a relevant awarding scheme involving entrepreneurial activities in UK. Entrepreneurship has been defined through a variety of terms in order to respond to the needs of the market as they have been observed by theorists throughout years. At a first level, Thornton (1999, 19) refers to entrepreneurship as ‘the creation of new organizations which occurs as a

Continuous devastation Essay Example for Free

Continuous devastation Essay The story of a jellyfish in Quinn’s book represents quite an original psycho-philosophical approach to the problem of evolution. The story is made up in a form of a dialogue. A person, telling a story argues, that man is a highpoint of evolution, and the opponent applies something like a doctrine of relativity, explaining, that the world has not always been made for man and it can be ascertained, that once the world will be made for someone else again. For the speaker, evolution has finished as man appeared, because there is no more way to evolve, thusly, he advocates a theory of extremity of evolution. And while man is a final product of evolution, he can be mentioned as ultimate and supreme creature and the whole world is made for him. To contest such a conclusion the opponent turns to a relativistic approach, trying to concretize the concerned time. A jellyfish serves as example of such relativity, because in case a researcher appeared on the shore of an ocean 500 million years ago, he would find nothing more perfect, than a jellyfish on earth. Therefore, a jellyfish could reasonably believe, that it is a supreme creature, because man was just to appear and has not yet become factual. The evolution ended with jellyfish and the world was made for jellyfish. For Quinn, the core difference between jellyfish and man in the matter of evolution is that a jellyfish does not tell stories, and a man does. Therefore, he invented a religious dogma to justify his superiority and to prove, that the evolution indeed ended with man. Nevertheless, religions remain human inventions and can serve as justification only for other humans. The conclusion is quite pessimistic for humanity: once there can appear a creature, which overpasses man just as we overpass a jellyfish. Question 2 It should first be pointed, that Ishmael sees agriculture as violation of natural laws. Humans do not listen to the voice of mother-nature which tells â€Å"take what you need and leave the rest†. In spite of doing so, man starts producing surpluses, taking more, than he needs. Production of surpluses leas to expansion of population in proportion to food supplies and is not limited by any cultural or technological barriers, finally resulting in environmental and natural phenomena, which limit population growth. Quinn compares such processes to a system of checks and balances. Women’s fertility in the regions with high surpluses production lessens year after year, until it falls below reproduction rate. Quinn suggests, that population still continues to grow globally, although population may fall locally, and this depends on the type of society. Industrial societies are much less reproductive, since people have less incentive for reproduction. Agrarian societies and their members need a lot of children, often just of economic reasons, because children are future working force. For Quinn there is one positive effect from present model of population growth. This is unsustainable pressure on nature and biosphere, leading to extension of about 200 species daily. The situation is especially dramatic in non-European countries, where industrialization, combined with traditionally high birth rates, would lead to catastrophic increase of pressure on nature. Question 3 The next link between food supplies and population growth, which is proposed by Quinn is embodied in term â€Å"food race†. He compares such a race with the arms race during the Cold war. For him, human population is determined by food supplies just as with any other animals. In case food supplies grow – population and civilization grow. Sometimes the inverse relationship is possible and food supplies grow as the population grows. Consequently, there are two variables: population and food supplies, which are mutually dependant. The primary difference with the Malthusian catastrophe concept is that fro Quinn, population can never exceed it’s food supplies. It will just not grow big enough to consume more food, than it produces. Quinn himself explained, that the problem of Malthus is that â€Å"How are we going to feed those people? †, and his problem is â€Å"How are we going to stop producing all those people? †. So, Quinn saw population growth as function of food supplies with direct correlation between them. Under his concept, a population merely can not overgrow it’s food supplies, because more people are going to produce more food. Nevertheless, it can be pointed, that Quinn does not consider secondary factors, for example, ability of the Planet itself to produce enough food. Quinn believes, that there can be two endings for food race – either abandonment, or catastrophe. It is therefore up to human discretion whether to sensually stop reproduction or face overpopulation and finally decline. Question 4 Quinn defined two major types of humans dependently on their attitude to nature – Takers and Peacekeepers. Takers are those, who are usually referred as civilized. Their culture came to the world with the beginning of agricultural revolution 10 000 years ago. Takers considered themselves the masters of nature, for whom the world has been created, and so man has a right to conquer the world. They think, that the world belongs to man. The reverse of their ideas is a belief, that there is something fundamentally wrong with people. Man does not know how to live properly because that knowledge is unobtainable and related to some divine revelation. Peacekeepers, named Leavers by Quinn represent a pretty different approach. They consider themselves just a part of Nature and try to limit their influence on it by taking nothing more than they need from their environment. They think, that a man belongs to world. Quinn uses an example of Cain and Abel. Cain symbolizes ancient tribes of farmers, who already acted as takers, and Abel presents prehistoric tribes of Semite herders. Undoubtedly, herders have much smaller influence on nature, since they do nothing to change it. Killing Able by Cain, therefore, is s Symbol of Taker’s victory over Leavers. Takers indeed easily overcome the Leavers in the process of evolution, because they enjoy much greater opportunities to increase their food supplies and consequently the population. However, in the remote prospective, their way leads to disaster due to overpressure on nature. The Leaver’s approach is more respective to nature and allows to retain it for longer time, so prospectively the Leaver’s idea seems to be preferential. Question 5 Quinn uses a figure of a pedaling airman and an aircraft as a civilization metaphor. He speaks, that humans in the last several thousands of years are Takers, â€Å"who are in the air, but not in the flight†. He compares a modern taking man to a person, who has brought some flying machine to a top of a cliff and attempts to fly. For some time he could really think, that he is able to fly, because his apparatus does not longer stand on the top of a cliff, and a man finds himself in the air. However, only a little time later a man discovers, that he flies down towards his death. Under Quinn, this happens, because man is not familiar with natural laws. He looks like an inventor, who attempts to fly without knowledge of laws of aerodynamics. Similarly, humanity, which is not aware of natural laws is likely to fall down. The basic mistake of a man is that he believes, that it is he, who pilots the aircraft, although it is piloted only by natural laws. Not having a sufficient instrument to make his machine fly, man looks like a pedaling pilot, who tries to move his plane by means of bicycle pedals. It is obvious, that pedals are not good enough to bring an aircraft into motion, so man falls down. Such fall is a direct result of Taker’ conviction, that the world is made for man. Many humans just ca not believe, that their effort to pilot such a strange aircraft would lead them only to death and annihilation. Question 6 The poster, which is observed by the character of a story puts forth one of the key questions of Quinn’s book. Gorilla here is likely to represent those other creations of nature, which share our planet with us, humans. It is impossible to say whether they should be reviewed separately from nature, Separation is human feature, and gorilla’s never tried to oppose natural processes. So, they can both be regarded as nature itself and as inhabitants of that nature. The first part of a slogan: â€Å"With Gorilla gone, will there be hope for man† is more or less clear. Quinn points, that continuous devastation of nature would lead to devastation of man, who can not survive without nature. The second part: â€Å"With man gone, will there be hope for Gorilla† is less obvious. It can seem, that in case humanity died out, natural balance would be restored. In other words, gorilla does not need man to survive. To answer the question we should consider, that finally a man is also a part of nature, same as gorilla is, so distinguishing of man would also violate natural balance. Therefore, destroying humanity to save nature appears to be an extreme, same as extreme of human’s supreme power over nature. So, humans need to find a third way – a way of clever cooperation with nature. They need to once again become part of the world and be in a way similar to gorillas.

Health Essays Alzheimer Dementia Disease Essay

Health Essays Alzheimer Dementia Disease Essay Alzheimer Dementia Closing in on Alzheimer’s â€Å"Soon, Alzheimer’s disease will touch everyone in this country in some form or another, so the need to redouble our research efforts greater than ever before. We must have better treatments, earlier detection, and effective strategies to prevent Alzheimer’s. Scientists have made tremendous strides in the last two decades, but the clock is ticking.† -Samuel Gandy, MD, PhD, chair of the Alzheimer’s Association’s Medical and Scientific Advisory Council. There is no cure, but there is hope, for the world’s most leading cause of dementiaALZHEIMERS. â€Å"AD† is a neurodegenerative disorder, the underlying cause still being unknown. The clinical features or the underlying pathology can only be discovered on autopsy and thus the signs and indications of AD are instigated only after years of accretion of the credible causes. Some of the signs include:- Cognitive deterioration. Visual spatial confusion. Loss of recognition of persons and objects. Reduced mobility. Deterioration of muscles. Inability to feed oneself. Language disorientation. The onus of the illness lies in the deposition of fibrillized plaques containing amyloid beta(AB). The AB proposition shows potential for the reason that, as seen in patients with trisomy 21(downs syndrome), who have an additional copy of the gene for AB precursor, almost universally exhibit AD like indications prior to age 40. These signs of AD can be accredited to the cytotoxic potential of the mature aggregated amyloid fibrils. Consequently, a great amount of the research work on lead breakthrough is focused on:- Inhibition of fibrillization. Inhibition of AB precursor to AB. A different supposition understood to elicit the disease cascade, is centered on the effects of aggregated tau proteins. This speculation is sustained by the long standing observation that aggregation of AB plaques does not correlate with neuron loss. Although a great deal is known a propos the disease prognosis, causative or risk factors, the acquaintance we encompass of, in the present day, concerning the fundamental pathological origin or the core cause of the disease is zilch. Nevertheless, ApoE4, the foremost genetic risk factor for AD has been allied with surplus of AB build-up. The risk factors for AD are:- Advancing age. Head injury. Aluminum intake. ApoE4. Poor CVS health. Smoking. AD is most often established based on clinical signs and symptoms, and the history of patient’s infirmity, as a definitive diagnosis is only achievable by performing an autopsy. Common diagnostic tests include:- Memory testing. Intellectual functioning. Neuropsychological screening tests. Blood tests to rule out presence of other diseases. Functional neuro-imaging techniques like SPECT ad PET. Once diagnosed, on an average, survival is 7 – 10 years, the extremes being 4 years to 21 years. Essentials, statistics and incidence of Alzheimer’s:- 24 million people affected with AD worldwide. Slated to become 81 million by 2040. 1 out of 8 people above the age of 65 have AD. Only 19% with AD have the diagnosis recorded in their medical records. 7th leading cause of death in the United States. From 2000-2004, death rate due to AD has increased by 32.8%, while that of breast cancer, prostate cancer, stroke and heart disease has decreased by 2.6, 6.3, 10.4, 8% respectively. Costs of AD and other dementias amount to $148 billion annually. Current drugs in the global market for treatment of Alzheimer’s:- [1]ARICEPT: Key essentials about aricept: Was permitted for the treatment of mild to moderate Alzheimers by the FDA in 1996, and for the treatment of severe Alzheimers in 2006 Is the #1 prescribed Alzheimer’s drug—worldwide, more than 3.8 million people have been treated with Aricept. Aricept is a drug branded as a cholinesterase inhibitor. It is one of a group of prescriptions that appear to improve the cognitive ability (thinking, perception, judgment and recognition) in people with Alzheimer’s disease. Aricept can reduce behavioral troubles that may be exhibited by people with this type of dementia. Known as a cholinesterase inhibitor, Aricept delays the breakdown of the neurotransmitter acetylcholine in the brain. Acetylcholine helps communication between the nerve cells and is vital for memory. Side effects are typically mild and tend to disappear as treatment progresses. Common side effects are nausea, vomiting, diarrhea, fatigue, insomnia, muscle cramps. Less common effects are headaches and dizziness. Rare side effects are anorexia, gastric or duodenal ulcers, gastro-intestinal hemorrhage, bladder overflow obstruction, liver damage, convulsions, heart problems and psychiatric disturbances. [2]EBIXA: Ebixa fine points: Ebixa is one of a group of drugs called NMDA (n-methyl-D-aspartate) receptor antagonists. These receptors, along with the neurotransmitter glutamate, are implicated in transmitting nerve signals in the brain that may be imperative for learning and memory. Ebixa, which acts on NMDA receptors, facilitates to normalize transmission of nerve signals, and perhaps slow the decline of some indications of Alzheimers disease. Ebixa is not a cure for Alzheimers disease as it does not affect the fundamental degenerative progression of the disease. Ebixa may cause some unwelcome reactions. These may include fatigue, dizziness, sleepiness, headache, hypertension (high blood pressure), constipation, vomiting, anxiety, confusion, hallucinations and sleep disturbance. [3]EXELON: Exelon particulars: Exelon is one of a group of drugs known as cholinesterase inhibitors which is intended to treat symptoms in people with mild to moderate Alzheimers disease. Exelon works by reducing the breakdown of acetylcholine and thus escalating the amount of the chemical in the brain, a chemical thought to be vital for learning and memory. The prescription augments the action of acetylcholine by making the receptors it interacts with in the brain more responsive. Exelon is not a cure for Alzheimers disease as it does not affect the fundamental degenerative progression of the disease. Familiar side effects, in addition to nausea, vomiting, loss of appetite and weight loss, comprise of diarrhea, heartburn, stomach pains, dizziness, headache, weakness, fatigue and difficulty sleeping. A small number of people also experienced fainting. [3]REMINYL: Key specifics on reminyl: Reminyl ER is one of a group of drugs called cholinesterase inhibitors which is used to treat symptoms in people with mild to moderate Alzheimers disease. As of June, 2006, Reminyl became available only in the extended release (ER) format. It means that if you were taking Reminyl tablets twice a day prior to June 2006, you would now take a Reminyl ER capsule once a day. It augments the action of acetylcholine by making the receptors it interacts with in the brain more responsive. In the area of the brain first affected by Alzheimers disease, that dealing with cognition and memory, too little acetylcholine is available at the junctions between nerve cells to get messages across to the next nerve cell, The condition is helped, consequently, not only by preserving the acetylcholine from being destroyed by cholinesterase, but by making the receptors more responsive to the inferior amounts of acetylcholine. Reminyl ER is not a cure for Alzheimers disease as it does not affect the fundamental degenerative progression of the disease. probable side effects include: abdominal pain, diarrhea, indigestion, decreased appetite, difficulty swallowing, bleeding in the digestive system, weight loss, low blood potassium, low blood pressure, dehydration, seizures, agitation, aggression, hallucinations, weakness, fever, malaise, leg cramps, tingling in the hands or feet, ringing in the ears, headache, dizziness, tiredness, sleeplessness, runny nose, urinary tract infection, fainting or fluttering of the heart. INTERNATIONAL MARKET STATISTICS FOR DRUGS USED IN THE TREATMENT OF ALZHEIMERS:   BRAND GENERIC CLASS SPONSOR SALES in (million $) 2004 MARKET SHARE(approx) 2004 2005 Aricept donepezil CI Pfizer 1,266 1,580 58.10% Reminyl galantamine CI JJ 256 343 12.60% Exelon rivastigimine CI Novartis 320 340 12.50% Namenda memantine NMDAA Forest 5 247 9.10% Ebixa memantine NMDAA Lundbeck 28 86 3.20% Axura memantine NMDAA Merz 6 15 0.60% Cognex tacrine CI FirstHorizon 1 1 0.00% Others 87 107 3.90% TOTAL 1,969 2,719 100.00% Total Sales Figures = $2.7B (2005) with Aricept ®having 58% market share. DRUGS IN PIPELINE:- Name of the drug sponsor phase About the drug Data from previous phases. FLURIZAN Myriad 3 It is a selective amyloid lowering agent (SALA) that reduces levels of the toxic peptide amyloid beta 42 (AÃŽ ²42). Reduces the levels of the toxic amyloid beta 42 peptide through the allosteric modulation of gamma-secretase. FLURIZAN has completed Phase2 human clinical trial in 207 patients with Alzheimers disease. Phase 1 safety trial of FLURIZAN in healthy older volunteers identified no serious drug-related side effects. In nonclinical studies, FLURIZAN reduced the levels of the toxic peptide AÃŽ ²42 by approximately 70%, by modulating the action of gamma-secretase. Flurizan reduces amyloid pathology in the brain and prevents memory defects in transgenic mice. ALZHEMED Neurochem Inc. 3 Alzhemed is an oral small organic molecule that has been designed to interfere with the association between glycosaminoglycans (GAGs) and AÃŽ ² amyloid protein. It is thus thought to prevent GAGs from promoting ÃŽ ²-sheet and amyloid formation. Designed to prevent amyloid formation and deposition in the brain, and thus modify the course of AD. Alzhemed is expected to act on two levels: firstly to prevent and stop the formation and deposition of amyloid fibrils in the brain as well as to bind to soluble AÃŽ ², and secondly to to inhibit the inflammatory response associated with amyloid build-up in AD. Inhibit AÃŽ ² fibrillization and binds and reduces soluble AÃŽ ². VP025 Vasogen 1 Mediated via the regulation of microglial cell activation. Treatment with VP025 reversed age-related decreases in CD200 levels in the brain, reduced levels of microglial cell activation, and restored memory and learning function. Considerable amount of preclinical work has demonstrated: the ability of VP025 to reduce inflammation in models of a number of neurodegenerative diseases. the ability of VP025 to reverse detrimental neurological effects of chronic beta-amyloid exposure the ability of VP025 to reverse age-related inflammation in the brain AAB-001 Elan Pharmaceuticals, Inc., Wyeth. 3 Designed to bind and remove the AÃŽ ² peptide that accumulates in the brain. Immunotherapy approaches to the treatment of Alzheimer disease is based on the ability of antibodies raised against AÃŽ ² peptides to bind to and clear AÃŽ ² from the brain, thus removing the peptide and inhibiting the damage to neurons that AÃŽ ² inflicts. Anti-AÃŽ ² antibodies have been shown to prevent the accumulation of AÃŽ ² peptides in the brains of transgenic mouse models of AD (Shenk et al., 1999; Bard et al., 2000; DeMattos et al., 2001). In one clinical trial, patients immunized with AÃŽ ² peptide who actively generated anti-AÃŽ ² antibodies showed a significantly slower rate of decline in cognitive functions (Hock et al., 2003). Long-term follow-up studies of the patients who were involved in the failed phase 2a clinical trial of AN-1792 has shown that NTB (quality of life) scores remained significantly improved in antibody responders. In addition, CSF tau was significantly decreased in antibody responders (Gilman et al., 2005). Closing In on Alzheimer’s:- Lastly, fresh drugs tender genuine hope for repealing the malady. Concluding test outcomes will be out, for a complete novel generation of drugs designed to assault the fundamental basis of Alzheimers disease—medicines that propose, what one specialist calls legitimate, substantial, irrefutable hope for those with mild to moderate forms of the illness. Within three years, its nearly assured, well have disease-modifying drugs that fundamentally amend the nature of Alzheimers. From drugs which facilitate alleviation of merely the symptoms of the disease, we are now moving towards an era which will comprise of drugs that not only slow down the disease, but encompass the potential to wholly reverse it. Scientists are certain that one of the more than four dozen drugs now in human trials will succeed. One of the most hopeful of those, Flurizan, from Myriad Genetics, should complete its tests in the next 18 months. Exceedingly few drugs make it to Phase III clinical trials, the final stride before a drug goes to the FDA for authorization. Today, conversely, nine new Alzheimers treatments are in Phase III trials to test their effectiveness on a large number of patients. And dozens more are in smaller Phase II trials. This subsequent generation of drugs is deliberated to avert, obliterate and clean out deposits of beta-amyloid plaque that exterminate the brains nerve cells, leading to the distressing loss of memory, reason and, eventually, life that typifies Alzheimers. This optimistic information comes as the world awaits an epidemic of Alzheimers, the traumatic variety of dementia that Americans tell pollsters they dread more than heart disease, stroke or diabetes. Today, 5.1 million people in the United States suffer from the disease, but the supreme risk factor is age—the longer a person lives, the greater the likelihood—and in just four years millions of boomers begin to turn 65. One in eight people age 65 and older now has Alzheimers; half of those 85 and older have it. Connoisseurs say still if Alzhemed or another of these premature anti-amyloid drugs fails, that doesnt mean the amyloid theory is incorrect. It merely may mean that the drug didnt eliminate sufficient plaque to appreciably slow or arrest the disease. Finally, with the advent of such promising drugs into the market in the near future, there is potential to mitigate the humanity of the exorbitant fiscal burden due to the disturbing tempo at which Alzheimer’s is making headway. Keeping our fingers crossed might just help. References: http://www.myriad.com/alzheimers/flurizan.php http://www.vasogen.com/sec/vp025 http://www.alzforum.org/ http://www.alz.org/national/documents/PR_FFfactsheet.pdf http://www.alz.org/national/documents/PR_FFquotesheet.pdf http://www.medicinenet.com http://www.pharmaceutical-business-review.com http://www.theracarb.com/documents/investor_%20presentation.pdf http: //www.wikipedia.com