Green Potatoes: Are Very Dangerous For Your Health, Strictly Avoid This!


Potatoes are widely used as a primary ingredient in many cuisines. But, do you know about the green potatoes? They are green because of the high amount of chlorophyll.But we are sorry to disappoint you, that green potatoes are very dangerous for your health.
The scientific researches are stating that green potatoes contain high amount of solanine,a poisonous chemical that can lead to diarrhea, vomiting, nausea, headaches and many other illnesses, if consumed by mistake.Green Potato Are Very Dangerous For Health, Strictly Avoid This
The high amount of chlorophyll is the main cause for the green colour of the green potato, and the chlorophyll is basically harmless for the health. But it is more like a signal that the amount of solanine, which is produced at the same time as the chlorophyll, has raised too.

Alexander Pavlista, a professor at the University of Nebraska-Lincon,stated that — a 100 pound man would have to consume approximately 16 ounces of green potato to feelsick.

He also added that the green potatoes were never sent to the market for sale. It is always suggested that potatoes should be stored in dim light and cool places to prevent the production of solanine, and to remove the green areas before its consumption.

If the green potato tastesbitter, throw it away and don’t consume it. This green diet has proved to be harmful so just stay away from it.

7 Powerful Herbs and Spices that Slow Aging, Boost Metabolism and Fight Disease


Spices can collectively help your skin look younger and softer. Many spices contain antioxidants which protect your skin from sun dent and help you overcome aging. Since they are rich in antioxidants they act as anti-aging agents .They firm up your skin by keeping it moisturised. They also remove some toxins. In fact, many herbs and spices rank even higher in antioxidant activity than fruits and vegetables, some spices such as cloves, turmeric, and cinnamon are having as much as 10 to 50 times more antioxidants compared to the blueberry.

image

The benefits of the antioxidants in these spices include protection against most serious degenerative diseases like cancer, heart disease, diabetes, arthritis, macular degeneration, Alzheimer’s, and overall aging.(i)

Herbs and Spices Health Benefits

 

  • Fat Burning and Boost Metabolism – Mostly herbs and spices are thermogenic, which means they naturally help to increase metabolism, partly because they have more nutrient.
  • Stabilize Blood Sugar – Some spices are also good at regulating blood sugar and controlling insulin–even as good as some diabetic drugs! When your blood sugar is well controlled, you are more likely to burn fat and not store calories as excess weight.
  • Anti-Inflammatory Properties –Studies show that herbs and spices can actually work as well or better than some medications at calming inflammation without the negative side effects of isolated drugs.
  • Anti-bacterial, anti-viral, anti-fungal – Herbs and spices contain properties that effectively kill dangerous pathogens like viruses, bacteria and stubborn fungi. The natural properties in these foods work against many microbes that are resistant to conventional medications.(ii)

7 Most Powerful anti-aging herbs and spices

Turmeric

Turmeric has yellow-orange pigment, curcumin, is the main active ingredient in the spice. Amazingly, curcumin’s anti-inflammatory benefits are comparable to drugs like hydrocortisone and over-the-counter anti-inflammatory medicines like Advil and Motrin. But, unlike the drugs, curcumin is not toxic at all, it does not have the dangerous side effects.

Curcumin is more effective at slowing down the development of Alzheimer’s disease than many medications, because it decreases inflammation and oxidation in the brain. This spice also speeds up the recovery time from strokes as well.

Turmeric and its active ingredient, curcumin, are  highly effective against diseases like irritable bowel disease, ulcerative colitis, Crohn’s, and arthritis. Turmeric also improves liver function, lowers homocysteine and prevents heart disease. Turmeric has anti-inflammatory property, it can help reduce joint pain and aid in healing joint problems over time.

Paprika

Paprika is one of the best spices to slow down ageing. It is rich in anti-oxidants like vitamin A and C. It absorbs the free radicals which cause damage to the collagen of the skin and helps in maintaining firmness. Applying of paprika on the skin makes you feel relaxed and fresh.

Spices are used in detox drinks and in regular diet. Thus consuming them orally or applying them on skin gives you a natural benefit.(iii)

Cinnamon

The superfood provided those cultures with an abundance of nutrients, and was also used for medicinal purposes, treating inflammation, infections, poisonous bites, and respiratory infections. It makes sense—two teaspoons of ground cinnamon provides you with 45.5% of your daily requirement of manganese, 11% of fiber DV, and 5.2% of your calcium. The superfood is also a beneficial source of iron, containing 8.3 mg per 100 g.

Cinnamon also has anti-inflammatory properties, such as relieves pain and stiffness in muscles and joints, including arthritis, reduces inflammation in blood vessels that leads to atherosclerosis and heart disease, as well as anti-fungal and antibacterial.

Cumin

Cumin is another spice that is especially high in antioxidants, but cumin is known for being especially good for digestion. It stimulates the gallbladder and pancreas to secrete enzymes and bile that break down food into usable nutrients your body can use.

Due to the high antioxidant content, Cumin can help fight inflammation throughout the body, and thereby helps in slowing down the aging process.

Cumin also helps detoxify the body, and is highly effective for respiratory disorders like asthma and bronchitis.

Ginger

ginger as an effective, low-cost treatment for motion sickness and nausea, and I’m sure many of you have used it for this purpose. I’ve also reported at length on its effectiveness in preventing migraine headaches, healing burns, and alleviating the pain and inflammation of rheumatoid arthritis.

A great everyday tea is a freshly made ginger tea. Simply steep several slice of ginger root in warm water with the juice of half a lemon to help with bloating, digestion, and inflammation. This tea is also an everyday detox and you will notice after several weeks an improvement in the clarity of your skin. It may also be effective in weight loss.

Ginger is also a wonderful food to cook with, giving your dishes a spicy flavor lessening the needs to use salt.(iv)

Fenugreek

Fenugreek is a cooling and soothing agent. You can soak them over night and can drink the water in the morning which may help you exhaust your body heat. Applying this water on the skin and over the eyes gives you a great cooling effect and a brighter, shiny look. It can be used as an eye drop which will cleanse your eyes.

Oregano

Oregano is herb that contains oil that has anti-bacterial , anti-fungal and anti-viral agent, rosmarinic acid (also found in rosemary) properties.  Oregano oil has been used to treat a wide range of conditions from bacterial and viral infections, to parasites and stubborn fungal infections. Although oil of oregano is most often used for medicinal purposes, the herb itself can provide many of the same benefits when consumed regularly.

Oregano also relieves inflammation, internal or external, and can offer relief from allergies, aches and pain, without side effects.  Oregano is very high in antioxidants, it helps fight radicals and quelling inflammation.

DNA CAN’T EXPLAIN ALL INHERITED BIOLOGICAL TRAITS, RESEARCH SHOWS


150402161751-large

Edinburgh scientists studied proteins found in cells, known as histones, which are not part of the genetic code, but act as spools around which DNA is wound.

Histones are known to control whether or not genes are switched on.

Researchers found that naturally occurring changes to these proteins, which affect how they control genes, can be sustained from one generation to the next and so influence which characteristics are passed on.

Research avenues

The finding demonstrates for the first time that DNA is not solely responsible for how characteristics are inherited.

It paves the way for research into how and when this method of inheritance occurs in nature, and if it is linked to particular traits or health conditions.

It may also inform research into whether changes to the histone proteins that are caused by environmental conditions – such as stress or diet – can influence the function of genes passed on to offspring.

Theory confirmed

The research confirms a long-held expectation among scientists that genes could be controlled across generations by such changes.

However, it remains to be seen how common the process is, researchers say.

Scientists tested the theory by carrying out experiments in a yeast with similar gene control mechanisms to human cells.

They introduced changes to a histone protein, mimicking those that occur naturally, causing it to switch off nearby genes.

The effect was inherited by subsequent generations of yeast cells.

ELEMENT OF SURPRISE HELPS BABIES LEARN


150402161501-large

Infants have innate knowledge about the world, and when their expectations are defied, they learn best, researchers at Johns Hopkins University found.

In a paper that will be published Friday in the journal Science, cognitive psychologistsAimee E. Stahl and Lisa Feigensondemonstrate for the first time that babies learn new things by leveraging the core information with which they are born. When something surprises a baby, like an object not behaving the way she expects it to, she not only focuses on that object but ultimately learns more about it than from a similar yet predictable object.

“For young learners, the world is an incredibly complex place filled with dynamic stimuli. How do learners know what to focus on and learn more about, and what to ignore? Our research suggests that infants use what they already know about the world to form predictions. When these predictions are shown to be wrong, infants use this as a special opportunity for learning,” says Feigenson, a professor of psychological and brain sciences in the university’s Krieger School of Arts and Sciences. “When babies are surprised, they learn much better, as though they are taking the occasion to try to figure something out about their world.”

The study involved four experiments with pre-verbal 11-month-old babies, designed to determine whether babies learned more effectively about objects that defied their expectations. If they did, researchers wondered if babies would also seek out more information about surprising objects and if this exploration meant babies were trying to find explanations for the objects’ strange behavior.

First the researchers showed the babies both surprising and predictable situations regarding an object. For instance, one group of infants saw a ball roll down a ramp and appear to be stopped by a wall in its path. Another group saw the ball roll down the ramp and appear to pass—as if by magic—right through the wall.

When the researchers gave the babies new information about the surprising ball, the babies learned significantly better. In fact, the infants showed no evidence of learning about the predictable ball. Furthermore, the researchers found that the babies chose to explore the ball that had defied their expectations, even more than toys that were brand new but had not done anything surprising.

The researchers found that the babies didn’t just learn more about surprising objects—they wanted to understand them. For instance, when the babies saw the surprising event in which the ball appeared to pass through the wall, they tested the ball’s solidity by banging it on the table. But when babies saw a different surprising event, in which the ball appeared to hover in midair, they tested the ball’s gravity by dropping it onto the floor. These results suggest that babies were testing specific hypotheses about the objects’ surprising behavior.

“The infants’ behaviors are not merely reflexive responses to the novelty of surprising outcomes but instead reflect deeper attempts to learn about aspects of the world that failed to accord with expectations,” said Stahl, the paper’s lead author and a doctoral student in the Department of Psychological and Brain Sciences.

“Infants are not only equipped with core knowledge about fundamental aspects of the world, but from early in their lives, they harness this knowledge to empower new learning.”

SMART PHONE DIAGNOSIS? BIOSENSING PLATFORM QUICKLY AND ACCURATELY DIAGNOSES DISEASE AND MONITORS TREATMENT REMOTELY


150402092042-large

In much the same way that glucometers and pregnancy tests have revolutionized in-home diagnostic testing, researchers from Florida Atlantic University and collaborators have identified a new biosensing platform that could be used to remotely detect and determine treatment options for HIV, E-coli, Staphylococcus aureas and other bacteria. Using a drop of blood from a fingerprick, this novel biosensing platform provides clinically relevant specificity, sensitivity and detection of pathogens from whole blood and plasma.

The thin, lightweight and flexible materials developed by these researchers can be fabricated and operated without the need for expensive infrastructure and skilled personnel, potentially solving real-world healthcare problems for both developed and developing countries. Using this technology, they also have developed a phone app that could detect bacteria and disease in the blood using images from a cellphone that could easily be analyzed from anywhere in the world.

Waseem Asghar, Ph.D., assistant professor of electrical engineering in the College of Engineering and Computer Science at FAU, co-first author on the study, along with Hadi Shafiee, Ph.D., instructor in medicine at the Division of Biomedical Engineering at Brigham and Women’s Hospital, Harvard Medical School; Fatih Inci, Ph.D.; and Utkan Demirci, Ph.D., Stanford School of Medicine, senior authors on the study, have published their findings inNature Scientific Reports in an article titled “Paper and Flexible Substrates as Materials for Biosensing Platforms to Detect Multiple Biotargets.” Other team members on the study include Mehmet Yuksekkaya, Ph.D.; Muntasir Jahangir; Michael H. Zhang; Naside Gozde Durmus, Ph.D.; Umut Atakan Gurkan, Ph.D., and Daniel R. Kuritzkes, M.D.

In the article, the researchers address the limitations of current paper and flexible material-based platforms and explain how they have integrated cellulose paper and flexible polyester films as new diagnostic tools to detect bioagents in whole blood, serum and peritoneal fluid. They employed three different paper and flexible material-based platforms incorporated with electrical and optical sensing modalities. They were able to demonstrate how these new materials can be widely applied to a variety of settings including medical diagnostic and biology laboratories.

Using paper and flexible substrates as materials for biosensors, Asghar and his colleagues have identified a new rapid and cost-effective way to diagnose diseases and monitor treatment in point-of-care settings. They have been able to show how their new platforms are uniquely able to isolate and detect multiple biotargets selectively, sensitively, and repeatedly from diverse biological mediums using antibodies.

“There is a dire need for robust, portable, disposable and inexpensive biosensing platforms for clinical care, especially in developing countries with limited resources,” said Asghar.

Existing paper and flexible material-based platforms use colorimetric, fluorometric and electrochemical approaches that require complex labeling steps to amplify their signal, are very costly to fabricate and also require expensive equipment and infrastructure.

“The future of diagnostics and health monitoring will have potentially cell-phone based or portable readers sipping saliva or blood and continuously monitoring human health taking it way beyond where we are with counting steps today,” said Demirci, who is the corresponding author.

Asghar notes that because their materials are easy to make, easy to use, and can easily and safely be disposed by burning, they provide appealing strategies for developing affordable tools that have broad applications such as drug development, food safety, environmental monitoring, veterinary medicine and diagnosing infectious diseases in developing countries.

“Our paper microchip technologies can potentially have a significant impact on infectious diseases management in low- and middle-income countries where there is limited laboratory infrastructure,” said Shafiee.

Demirci notes that these platforms could potentially be adapted and tailored to detect other pathogens and biotargets with well-known biomarkers.

ONE DOLLAR BLOOD TEST USING GOLD NANOPARTICLES OUTPERFORMS PSA SCREEN FOR PROSTATE CANCER, STUDY SUGGESTS


150403130826-large

A test that costs less than a $1 and yields results in minutes has been shown in newly published studies to be more sensitive and more exact than the current standard test for early-stage prostate cancer.

The simple test developed by University of Central Florida scientist Qun “Treen” Huo holds the promise of earlier detection of one of the deadliest cancers among men. It would also reduce the number of unnecessary and invasive biopsies stemming from the less precise PSA test that’s now used.

“It’s fantastic,” said Dr. Inoel Rivera, a urologic oncologist at Florida Hospital Cancer Institute, which collaborated with Huo on the recent pilot studies. “It’s a simple test. It’s much better than the test we have right now, which is the PSA, and it’s cost-effective.”

When a cancerous tumor begins to develop, the body mobilizes to produce antibodies. Huo’s test detects that immune response using gold nanoparticles about 10,000 times smaller than a freckle.

When a few drops of blood serum from a finger prick are mixed with the gold nanoparticles, certain cancer biomarkers cling to the surface of the tiny particles, increasing their size and causing them to clump together.

Among researchers, gold nanoparticles are known for their extraordinary efficiency at absorbing and scattering light. Huo and her team at UCF’s NanoScience Technology Center developed a technique known as nanoparticle-enabled dynamic light scattering assay (NanoDLSay) to measure the size of the particles by analyzing the light they throw off. That size reveals whether a patient has prostate cancer and how advanced it may be.

And although it uses gold, the test is cheap. A small bottle of nanoparticles suspended in water costs about $250, and contains enough for about 2,500 tests.

“What’s different and unique about our technique is it’s a very simple process, and the material required for the test is less than $1,” Huo said. “And because it’s low-cost, we’re hoping most people can have this test in their doctor’s office. If we can catch this cancer in its early stages, the impact is going to be big.”

After lung cancer, prostate cancer is the second-leading killer cancer among men, with more than 240,000 new diagnoses and 28,000 deaths every year. The most commonly used screening tool is the PSA, but it produces so many false-positive results – leading to painful biopsies and extreme treatments – that one of its discoverers recently called it “hardly more effective than a coin toss.”

Pilot studies found Huo’s technique is significantly more exact. The test determines with 90 to 95 percent confidence that the result is not false-positive. When it comes to false-negatives, there is 50 percent confidence – not ideal, but still significantly higher than the PSA’s 20 percent – and Huo is working to improve that number.

The results of the pilot studies were published recently in ACS Applied Materials & Interfaces. Huo is also scheduled to present her findings in June at the TechConnect World Innovation Summit & Expo in suburban Washington, D.C.

Huo’s team is pursuing more extensive clinical validation studies with Florida Hospital and others, including the VA Medical Center Orlando. She hopes to complete major clinical trials and see the test being used by physicians in two to three years.

Huo also is researching her technique’s effectiveness as a screening tool for other tumors.

“Potentially, we could have a universal screening test for cancer,” she said. “Our vision is to develop an array of blood tests for early detection and diagnosis of all major cancer types, and these blood tests are all based on the same technique and same procedure.”

NASA TESTS GREEN AVIATION TECHNOLOGY


NASA-Tests-Green-Aviation-Technology-1-640x426

Specially outfitted Boeing 757 airplane called the ecoDemonstrator, designed by NASA, will help reduce fuel consumption and emissions.

One experiment includes 31 small devices that will blow jets of air on the vertical tail and the other involves non-stick coatings to help repel bugs from the leading edge of wings.

NASA-Tests-Green-Aviation-Technology-2-640x832

Fay Collier, manager for the NASA Aeronautics Research Mission Directorate’s Environmentally Responsible Aviation (ERA) Project, said:

“Both are designed to improve the air flow over the surface and ultimately reduce drag. Increased drag means increased fuel consumption, which results in more pollutants in the atmosphere. The goal of our project is to develop aircraft concepts and technologies to reduce the impact of aviation on the environment over the next 30 years.”

The first technology to be tested is called the Active Flow Control Enhanced Vertical Tail Flight Experiment. NASA worked with Boeing to install 31 tiny jets called sweeping jet actuators that can manipulate, on demand, the air that flows over the ecoDemonstrator 757’s vertical tail and rudder surfaces. An aircraft’s vertical tail is primarily used to add stability and directional control during takeoff and landing, especially in the event of an engine failure. But when the aircraft is cruising at altitude the same large, heavy tail is not necessary.

Researchers at NASA’s Langley Research Center check results following preliminary NASA flight tests of nonstick coatings.   Credit: NASA Langley / David C. Bowman

Engineers theorized they could reduce the size of the vertical tail by using the sweeping jets to generate the same side force during takeoff and landing that a larger tail does.

In another set of flight tests a few weeks later near Shreveport, Louisiana, NASA’s ERA project will assess how well five different coatings repel insect residue in an experiment called Insect Accretion and Mitigation. Bug remains may be a nuisance on cars, but on some airplane designs they are also a drag, quite literally. Studies have shown that keeping the flow smooth, called laminar, over a wing can reduce fuel consumption as much as six percent. Even something as small as a bug on a leading edge can cause turbulent wedges that interrupt laminar flow. That results in an increase in drag and fuel consumption.

The Active Flow Control system tested on a full-sized tail in the National Full-Scale Aerodynamic Complex, a massive wind tunnel located at NASA’s Ames Research Center.  Credit: NASA / Dominic Hart

source NASA

HOW TO DETOX FROM FLUORIDE


28875646_m

In today’s world, fluoride is hard to avoid completely. Here’s how to detox your body. 

Adding fluoride to the water supplies has been called murder on a grand scale. But whether or not your town adds it to your drinking water, you’re probably ingesting this toxin every day.

You’re exposed to fluoride if you take prescription drugs like Prozac, swim in pools, or sit in hot tubs.  It’s in conventional produce like lettuce, and commercial bread and bakery products.  It may be in beverages like iced tea, wine, and beer made with municipal water, or in infant formula.  And of course it’s in toothpaste.  It may even sneak into your food from Teflon coated pots and pans.

In addition to increasing the risk of death, fluoride alsocalcifies the pineal gland and hardens the arteries.  And it increases the risk of hypothyroidism.

Minimizing your exposure to fluoride is important.  But in today’s world, this toxin is hard to avoid completely. That’s why it’s critical to detox your body from fluoride.

Iodine Flushes Out Fluoride

Cleansing your system of fluoride is not the same as getting rid of mercury or arsenic.  Fluoride is not a heavy metal.  It’s a halide in the same family as bromine and chlorine. Fluoride, bromine, chlorine, and perchlorate all bind to iodine receptors in the body and displace iodine.

Perchlorate is a man-made molecule combining oxygen and chlorine.  It’s used for rocket fuel and industrial processes and contaminates our water supplies.

According to Dr. Mark Sircus, the only effective way to detox from perchlorate, fluoride or other halides is with iodine.[1]  Chelation and other methods for heavy metal detox may not be as effective.

Loading the body with iodine displaces fluoride from cell receptors and flushes the fluoride out of the body in urine.

Your body can’t make iodine.  You have to get it from food or supplements.  And unfortunately it’s estimated that as many as 74% of Americans are deficient in this crucial element.

The best dietary source of iodine is seaweed.  Sea vegetables like wakame, nori, kombu (kelp), arame, and dulse are the richest edible sources of iodine.  Just one tablespoon of dried dulse flakes contains about 750 mcg of iodine.  The government’s daily recommended amount is about 150 mcg.

Other good iodine sources include seafood (salmon, lobster, scallops, cod and shrimp).  Cranberries, yogurt, potatoes, strawberries, and navy beans also contain iodine but in much lower amounts.

You can also find seaweed supplements like kelp tablets at most health food stores.

Iodine supplements are also widely available.  Iodoral® tablets contain 5 mg of iodine, and 7.5 mg of potassium iodide.  A typical dose is 6.25mg or 12.5 milligrams of combined iodine and iodide.

Detoxing from fluoride using iodine may trigger symptoms like headaches, agitation, and palpitations as fluoride is released.  To minimize those effects, it’s important to work with a natural health specialist.  According to Dr. David Brownstein in his book “Iodine: Why Your Need It, Why You Can’t Live Without It” an iodine detox should include a nutritional plan as well as unrefined sea salt, selenium, vitamin C, and a vitamin B complex.

At the same time, as with any cleanse, your liver will need additional support.  Liver cleansing foods include garlic, turmeric, flaxseeds, milk thistle, lemons, limes, and avocados.

And always drink plenty of water when detoxing.  Divide your weight by two and drink that number of ounces of fluoride-free water each day to help flush the toxins.

Even though iodine may be the best way to detox from fluoride, studies show that other methods may help reverse the damage done by fluoride in the body.

Curcumin Fights Fluoride Toxicity

In a study published in Pharmacognosy Magazine, curcumin was found to protect against the brain-damaging effects of fluoride.[2]

Other studies show curcumin, the active ingredient in the spice turmeric, also protects the kidneys against fluoride toxicity.[3]  And curcumin has been shown to prevent DNA damage from fluoride in human lymphocytes.[4]

Tamarind Moves Fluoride Out of Bones

Tamarind is an African spice commonly used in Ayurvedic medicine. In a recent randomized, diet control study, Indian researchers studied the effect of tamarind in 30 subjects living in an area with high natural fluoride levels.  After two weeks, the group supplementing with tamarind had a significant increase in fluoride excreted through their urine. The researchers concluded that tamarind mobilized fluoride from bone and carried it out in urine.

In another study, Indian schoolboys ate 10 grams of tamarind every day.  After 18 days, their excretion of fluoride was significantly increased.  The researchers concluded that tamarind could delay fluorosis by improving excretion of fluoride in the urine.

Tamarind is a tropical tree.  Its pulp, bark, and leaves can be used to make a tincture or tea.  Leaves, flowers, fruit, and seeds are used to make curries, lentils, salads, stews and soups.

 

Newsletter:

GreenMedInfo.com provides cutting-edge, evidence-based natural health information and has one of the internet’s most popular e-newsletters with over 100K subscribers.Register for free here.

 

Resources:

[1] http://drsircus.com/medicine/iodine/iodine-protects-fluoride-toxicity#_edn3

[2] Sharma C, Suhalka P, Sukhwal P, Jaiswal N, Bhatnagar M. Curcumin attenuates neurotoxicity induced by fluoride: An in vivo evidence. Pharmacognosy Magazine. 2014;10(37):61-65. doi:10.4103/0973-1296.126663.

[3] Seyed Fazel Nabavi et al, “Protective effects of curcumin against sodium fluoride-induced toxicity in rat kidneys.” Biol Trace Elem Res. 2012;145(3):369-74. Epub 2011 Sep 7. PMID: 21901432

[4] Hemlata Tiwari, Mandava V Rao, “Curcumin supplementation protects from genotoxic effects of arsenic and fluoride.” Food Chem Toxicol. 2010 Feb 17. Epub 2010 Feb 17. PMID: 20170701

Is CTA better than functional testing for diagnosing CAD?


Diagnosing new onset chest pain with computed tomographic angiograph (CTA) may be a better option for some patients with suspected coronary artery disease (CAD) than use of functional testing.

Results from the PROMISE trial (Prospective Multicenter Imaging Study for the Evaluation of Chest Pain) presented recently at the 2015 American College of Cardiology (ACC) Annual Scientific Sessions, showed no difference in outcomes for the composite of death, MI, hospitalization for unstable angina, or major procedural complications in patients receiving CTA vs functional testing (3.3 percent vs 3.0 percent with functional testing; hazard ratio [HR], 1.04). However, patients receiving CTA had fewer invasive procedures and less exposure to radiation than those receiving functional testing. [N Engl J Med 2015; e-pub 14 March, doi:10.1056/NEJMoa1415516]

This was the first-ever trial comparing these diagnostic options for CAD, which the authors hope will help to inform future clinical guidelines.

Current guidelines essentially leave the selection of tests for patients reporting symptoms of chest pain or shortness of breath up to the preferences of the physician and patient.

“Until this study, we have essentially be guessing on decisions about which initial test to use for this huge population of patients who need evaluation for cardiovascular symptoms,” said the study’s lead investigator, Pamela Douglas of the Duke University School of Medicine in Durham, NC, USA.

“Our study shows that the prognostic outcomes are excellent and are similar regardless of what type of test you use, but there are some indications that CTA might be the safer test with fewer catheterizations without obstructive disease and lower radiation exposure when compared to nuclear testing,” she explained.

The 3 percent event rate was lower than expected in PROMISE. Given this low event rate, Douglas said that in the future it may be feasible to offer a no-testing strategy to patients with the lowest risk of CAD.

The researchers thus plan to further investigate the outcomes in different subgroups of patients to identify patient subgroups that may benefit with different testing options.

PROMISE included 10,003 symptomatic patients with no previous history of CAD. They were randomized to receive CTA or functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography) and followed up for a median of 25 months.

The number of catheterizations showing no obstructive CAD occurred in 3.4 percent of patients with CTA vs 4.3 percent of patients with functional testing (p=0.002). However, more patients in the CTA group underwent catheterization within 90 days after randomization (12.2 percent vs 8.1 percent).

The mean cumulative radiation exposure per patient was 12.0 mSv with CTA vs 10.1 mSv with functional testing (p<0.001). However, the exposure to radiation differed by the type of stress test used. The majority of patients (67.3 percent) received nuclear stress testing, for which radiation exposure was significant higher vs CTA (12.0 mSv vs 14.1 mSv; p<0.001).

Commenting on the study, Dr. Valentin Fuster of the Mount Sinai Hospital Icahn School of Medicine in New York, NY, USA, noted that the study shows CTA is on par with functional testing in a low-risk CAD population.

“CTA offers advantages in its ability to detect lesions, but radiation exposure is a concern. That said, newer and newer systems are evolving into a low-radiation tool,” Fuster said. At the end of the day, the choice of testing will depend very much on the physician and patient, he added.

PCSK9 inhibition better than standard therapy for cholesterol-lowering


PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibition is showing significant promise in reducing cardiovascular (CV) events with effective cholesterol-lowering, based on impressive results from the OSLER-1 and -2 (Open-Label Study of Long-Term Evaluation Against LDL-C) trials.

OSLER-1 and -2 showed that the investigational PCSK9-inhibitor evolocumab (Repatha, Amgen) along with standard therapy, reduced LDL-cholesterol (LDL-C) by 61 percent vs standard therapy alone; from a median 120 mg/dL to 48 mg/dL after a median 11.1 month follow-up (p<0.001). [N Engl J Med 2015, e-pub 15 March, doi:10.1056/NEJMoa1500858]

In a prespecified exploratory analysis, evolocumab also reduced the incidence of CV events, defined as death, MI, unstable angina, coronary revascularization, stroke, transient ischemic attack, or heart failure, at 1 year (0.95 percent) vs standard therapy alone (2.18 percent) (p=0.003). This 53 percent reduction with evolocumab was consistent across each major CV event.

“The reduction in LDL-C was profound and that may be why we saw a marked reduction in CV events so quickly,” said Dr. Marc Sabatine of the Brigham and Women’s Hospital in Boston, MA, USA, a TIMI (Thrombolysis in Myocardial Infarction) Study Group investigator and lead author of OSLER-1 and -2.

“It suggests that if we can drive a patient’s LDL-C down a large amount to a very low level, we may start to see a benefit sooner than would be expected with a more modest intervention.”

These results follow similar results with the PCSK9-inhibitor alirocumab (Praluent, Sanofi/Regeneron), presented earlier at the 2015 European Society of Cardiology Congress, which showed a 61 percent reduction in LDL-C vs a 1 percent increase with placebo (p<0.0001). [N Engl J Med 2015, e-pub 15 March, doi:10.1056/NEJMoa501031]

“We now have many studies in a variety of different populations where we’ve seen the ability of these drugs to significantly reduce LDL-C,” said Sabatine. “And all the data we have point to the fact that the reduction in clinical events is tied to the reduction in LDL-C.”

In the open-label OSLER trials, 4,465 patients who had participated in 1 of 12 previous parent trials of evolocumab were randomized to receive intravenous evolocumab 140 mg every 2 weeks or 420 mg monthly plus standard therapy or standard therapy alone.

Adverse events occurred similarly between the two arms, however, evolocumab was associated with slightly more neurocognitive events.

An ongoing trial to study the effect of evolocumab on CV outcomes is expected to answer key questions regarding its clinical potential. The study, involving 27,500 patients, is not expected to see results until 2017.