I noticed that the line for cabs was about 200 cardiologists long, while there were hardly any cabs pulling up. I personally prefer taking public transportation in foreign cities as you get a better idea of the city and it is, well, cheaper and better for the environment. With the metro stop right next door it makes you wonder what lengths those cardiologists will go to to avoid mixing with the rabble.

Anyhoo upon passing the snaking line of cardiologists I was handed a card by a young lady as I entered the convention center. I thanked her and looked at the card as I walked in. Surprisingly it was for the El Cabaret Strippers Club in Barcelona. I immediately twittered the news and received various feedback including laughter and being accused of being a misogynist. As I continued following the signs to the hall where Mrs. Bremner was to lecture on Non-obstructive coronary artery disease in women, or Syndrome X, the signs routed me directly through the cavernous exhibit hall where drug and device manufacturers tout their wares. After freaking out about a 40 foot high model of a person with pulsating veins suspended from the ceiling, I tried to scuttle past the vendors averting their eyes and looking for the ephemeral lecture hall. I couldn’t help but be distracted, though, by the Medtronics booth, who I wrote about a while back in reference to their picking up the tab in the VIP room of the Platinum Club strippers place in Memphis for a bunch of surgeons who were brought in to learn more about Medtronics spinal devices. Inhibiting the urge to ask them if they were picking up the tab for the ESC meeting too, I continued on to the lecture, where we learned that 50% of women who undergo diagnostic catheterization do not have evidence of coronary artery obstruction, versus 20% of men.

As I left the convention center attractive young women were seen walking around holding signs over their heads saying ‘Novartis’ and ‘GSK’, followed by laughing groups of cardiologists.

As I reflected on my experiences I wondered who in fact were the hookers and the patrons. Were the physicians the patrons of prostitutes, or was it the other way around, were the physicians prostituting themselves to device and drug makers?

I tried to get a picture of the El Cabaret but got the following message when I searched for it on the internet.

La página que desea visualizar ha sido filtrada por el sistema, ya que su contenido ha sido clasificado dentro de las categorías no permitidas.
	permite limitar el acceso a páginas web con contenidos no apropiados, eliminar la publicidad y controlar la descarga de determinados archivos. Si considera que ha habido un error, por favor, seleccione su caso en el siguiente formulario, pulse el botón enviar y si nos indica un email le daremos una respuesta una vez hayamos analizado su petición:

Accompanied by a pair of happy Catalonian children surfing the net. I guess they were too prudish in my apartment here to let me look up El Cabaret. I think the cardiologists at ESC should pick up some pointers from them.

May 28, 2009 — Blood-pressure-lowering drugs should be offered to everyone, regardless of their blood pressure level, as a safeguard against coronary heart disease and stroke, researchers who conducted a meta-analysis of 147 randomized trials (comprising 958,000 people) conclude in the May 19 issue of BMJ.

I have heard of this before through Mrs. Bremner, as there was discussion at Emory and the CDC about creating a “polypill” that would be given to the entire population to prevent heart disease. When asked why interventions like diet and exercise couldn’t be tried first the response was “we tried that and it doesn’t work”.

Which just makes me wanna say…

Argggg!!!!!

Not the polypill! Please!

The authors of the BMJ meta analysis have previously advocated that everyone over age 55 should take the polypill, which would include a statin for lowering cholesterol, three anti hypertensive drugs at half dosage, aspirin, and folic acid. Given that questions have arisen about the capacity of statins and anti hypertensive drugs to induce depression, I think they should add Prozac to the polypill.

Anyhoo according to this meta-analysis of anti-hypertension trials, giving three antihypertensive drugs will lower risk of coronary heart disease (CHD) events by 22%. What’s more, it doesn’t matter if your blood pressure is “normal” down to 110/70, you still get the reduction in CHD events.

The CME goes on to quote the study authors:

“Guidelines on the use of blood-pressure-lowering drugs can be simplified so that drugs are offered to people with all levels of blood pressure,” write Drs Malcolm R Law and Nicholas Wald (Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, UK). “Our results indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some.”

“Whatever your blood pressure, you benefit from lowering it further,” Law told heartwire . “Everyone benefits from taking blood-pressure-lowering drugs. There is no one who does not benefit because their blood pressure is so-called normal.”

Ya gotta wonder about the logic of these guys. First of all aspirin has repeatedly been shown to be useless for the primary prevention of heart attacks in terms of its overall risk-benefit ratio. Second of all, statins do not reduce mortality in men without heart disease and are not beneficial at all for women without heart disease not to mention that they have side effects which can be pretty significant.

Hat tip to Rick Lippin MD

Don’t get me started on my father-in-law, who is becoming increasingly deaf at the age of 89, and who isn’t as perky as he used to be, and who ‘stopped working’, therefore his Italian physician has brilliantly put him several different psychotropic medications for a “pochino depression”.

Is that in the DSM? Should that be under consideration for the DSM Shadow Team?

Anyhoo now my brother-in-law has now been prescribed Cardura for high blood pressure (what is it with these Italian physicians and Cardura? They must be giving out some really great pens or maybe something even better. Hmmm…). He told his physician about what I had written about Cardura and his physician’s response was:

Those American physicians make a lot of mistakes.

Humph.

Another news item from Italy this week is related to the earthquake that flattened much of the city of Aquila and the region of Molise. BTW thanks guys who were asking about me. The Italians fearless leader, Silvio Berlusconi, after seeing the 28,000 people who were living in tents, made the brilliant comment:

They should try and enjoy themselves and pretend they are camping.

This from the guy who made a former topless model and “showgirl” a member of his cabinet, a woman he said he would marry instantly if he wasn’t already married. Which led to his wife demanding a public apology in one of his newspapers. Which he gave. Oh, he also said Obama had a “sun tan”.

Silvio Berlusconi relaxing with cabinet member Mara Carfagna

I swear I am not making this stuff up.

The interesting thing about his ‘camping’ comment is that although this idiotic comment made the front page of the London Times, there was not one word in the Italian papers. Maybe that is because he owns all three major TV networks and had influence over the newspapers and other media outlets as well. You know how Jon Stewart likes to lampoon government leaders? The last comedian to make fun of Berlusconi on TV ended her show with “see you next week… maybe.” That was back in 2003 and we haven’t seen her since. Berlusconi’s government replied that the Times should have written about how the earthquake victims clapped for Berlusconi. Maybe we should get Sarah Palin to clap into the microphone with them.

Anyhoo since presumably the majority of Italians voted for this clown (three times??), and since he is right wing presumably a majority of physicians, who are they to say that we make ‘alot of mistakes’?

In this paper the authors point out that many studies that are used to argue that salt reduction has no effect on hypertension or health are studies in which the salt reduction only occurred of the course of one week, or involved acute salt depletion. The authors point out that one week is not long enough to evaluate the effects of salt reduction, and that acute salt reduction leads to an activation of the sympathetic nervous system, which leads to an artificial increase in blood pressure. Sounds good to me so far, guys.

They listed 17 trials of people with hypertension and 11 trials of people with normal blood pressure that were conducted for four weeks or more and had adequate salt reduction (4.6 g per day) as measured by excretion in the urine. People with hypertension had a 5 mm Hg point drop in systolic and 3 point drop in diastolic. People with normal blood pressure also showed a drop to a lesser extent. The authors note that this amount of salt reduction would result in a 14% drop in strokes and a 9% drop in heart deaths.

Clinical trials of dietary salt reduction and high blood pressure

Unfortunately noone has done a randomized trial of low salt versus high salt diet and it is unlikely to happen now due to ethical issues. Mrs. Bremner points out that increases in salt in the diet lead to a craving for salty food that causes a vicious cycle, which is one way people may become addicted to salty junk foods and snack foods.

Dr B.’s comment: It looks like cutting down on salt does lower blood pressure although a 14% relative reduction in cardiac events may not be that big of a deal in terms of absolute reduction of risk for a single individual. Salt may be just part of the problem with junk food. There was a study showing that people who eat in fast food restaurants three times a week have a greater than 90% risk of getting diabetes or heart disease and I need to find that reference again.

Our daughter told me that she doesn’t like it when I call her mother Mrs. Bremner. She thinks it is demeaning. And sounds bad. For those readers who haven’t caught on (Duh!), my wife kept her own name when we married (she’s not REALLY Mrs. Bremner, SORRY!), which is entirely reasonable since we are academics and she already had a string of papers under her belt when we married that she would lose ‘credit’ for if she changed her name.

That is fine and good but I wasn’t prepared for the fact that she would give our first born the name ‘Vaccarino Bremner’ as a last name. I wasn’t around when they gave her the form to fill out the application for the birth certificate. I guess it serves us guys right for not being *around*. It was a little awkward though when we went to Mexico and had a hard time getting into the country cuz her passport didn’t match her plane ticket. That is when we had to break the news to our little cherubin that she wasn’t REALLY a Bremner!

Sob!

I named my son James Douglas Bremner III but when he actually popped out of Mrs Bremner’s (sic) belly he looked more Mexican than Scottish so I had to acknowledge that the Sicilian genes had wiped out the last trace of the brave Scottish freedom fighter from the family line. As do I. Mrs. Bremner suggested that we should ALL change our names to ‘Vaccarino Bremner’.

Doy!

Anyway/hoo back to salt. Excessive salt intake in the diet is the leading cause for increases in high blood pressure (hypertension). And increases in untreated hypertension are a leading cause for heart and kidney disease. Salt was originally introduced into the diet in China 5,000 years ago as a way to preserve food during the winter. Unfortunately we have a natural proclivity toward salt, and our current consumption of salt is 50 times what is was 10,000 years ago. Salt tends to result in a retention of water in the kidnies, which leads to high blood pressure. Countries who have taken a concerted effort to lower salt in the diet, like Japan and the United Kingdom, have seen a drop in hypertension and heart disease. Most salt in the US diet is from processed foods and from soft drinks. Salt improves the taste of tasteless food, prolongs the life of food, and retains the weight of processed foods, all of which are advantage to food companies, so they tend to put a lot of salt in food.

Multiple studies show a correlation between salt consumption and high blood pressure

Data above is from the INTERSALT trial. The data is conclusive that salt contributes to high blood pressure.

Several studies have shown that populations who migrate from countries where salt is not available to those where it is available have an increase in hypertension.

Stay away from processed foods, the “center of the grocery store”, and remember that canned foods are high in sodium. Eating out at fast foods restaurants will get you a high sodium hit. Cook your own meals whenever possible.