Prevention

Dementia could be prevented much better …

The human brain is very sensitive to lack of oxygen. The cause of lack of oxygen is local thrombosis and emboli originating from atherosclerosis, localized in carotid arteries, the ascending aorta and the aortic arch with its great vessels and intracerebral arteries. Further, atrial fibrillation and patent foramen ovale may cause repeated embolizations, further attacking the resources of the human brain.
Although dementia may be provoked by Alzheimer disease, mixed forms of vascular dementia are quite more common.
Local thrombosis and emboli can be prevented by two simple measurements: aspirin and statin. Aspirin reduces the risk of atherothrombosis, and statins reduce atherosclerosis risk by reducing stroke risk. Additionally, perfect control of blood pressure as well as absence of smoking and diabetes is required.
Current research about dementia prevention appears mislead. Instead, we should exploit the large opportunity to reduce atherosclerotic and atherothrombotic risk in daily clinical practice, a goal by far not yet achieved to avoid many cases of preventable dementia.

BMI as a surrogate marker for cholesterol

In this study we are working on the ability of BMI to predict coronary risk without knowing cholesterol values. The idea comes from the Framingham Study. Our test in 1’000 subjects showed excellent agreement. More…
Therefore, instead of involving laboratory findings like cholesterol, LDL, TG and HDL, a risk prediction model may be based solely on the following variables:
  • Age
  • Sex
  • BMI
  • Smoker
  • Blood Pressure untreated
  • Blood Pressure treated
  • Diabetes
  • TPA
This way of assessing risk is especially well suited for screening of populations. If coronary and stroke risk is relevant (e.g. coronary risk > 10% in 10 years) then the screened person should establish a meeting with his general practitionar.

Arterial Age as a Substitute for Chronological age

We have developed a formula based on 1500 subjects that allows to calculate arterial age based upon TPA for male and female subjects. When we substituted chronological age with arterial age and calculated 10 year coronary risk, we found that the AUC increased from 0.63 to 0.80 (p=0.03) to detect 13 subjects from the London cohort.