In the arena of drug development, cardiovascular medicine is no longer the favorite therapeutic area. This is according to a study published in the August issue of Nature, which analyzed the number of clinical trials registered at ClinicalTrials registery during the last two years, as reported by heartwire. Cardiology, which used to occupy the top priority position in research and development in the pharmaceutical industry, only now ranked 3^rd. The top two places are occupied by cancer oncolgy and neurodegenerative medicine, respectively. This is despite the fact that lipid regulators which brought in US$ 35.2 billion worth of drug sales in 2006. The complete list of the six highest-ranked therapeutic/disease areas is given below:

• Oncology
• CNS disorders
• Cardiology
• Infectious diseases
• Endocrinology
• Respiratory diseases

The Nature review paper which surveyed Phase II to IV interventional studies sponsored by pharmaceutical companies and registered with the clinical-trials registry between October 2005 and September 2007 showed the same trend.

Does this mean that the incidence of cardiovascular diseases has decreased significantly that they are no longer a major health threat? Unfortunately, this is not the case. Many pharmaceutical companies feel that the profitable days of statins and beta-blockers are coming to an end as one drug after another, including the blockblusters Coreg and Lipitor, lost or will soon be losing its patent. With each drug going off patent, generic versions are already waiting at the sidelines to grab the market.

An as example of the lack of enthusiasm for cardiology, I reported in an earlier post about an internal memo from Pfizer which some how leaked which stated

“…an Integrated Strategic Plan (ISP) that focuses and prioritizes our R&D investments. Alzheimer’s Disease, Diabetes, Inflammation/Immunology, Oncology, Pain and Psychoses (Schizophrenia) are confirmed as our higher priority areas.“

Several clinical phase drugs which showed blockbuster potential fell short of expectations and many are facing safety issues. Results from the ENHANCE trial which tested ezetimbe (Zetia) in combination simvastatin were disappointing as well as controversial. More recently, all clinical development programs of rimonabant (Acomplia), earlier thought to be the next bestseller, were halted when the European Medicines Agency (EMEA) announced that “it had asked the company [sanofi-aventis] to suspend marketing of the drug, on the grounds that its benefits no longer seemed to outweigh its risks.” The APPROACH study failed to show that rosiglitazone (Avandia) prevents atherosclerosis progression in diabetes patients, thus probably putting a stop to the drug’s use in cardiovascular medicine. Late last year, the US FDA added a black box warning to Avandia’s label due to increased heart attack risks.

As previously discussed in a previous post, maybe it’s time to look more towards lifestyle change strategies for prevention and treatment of cardiovascular treatment. And I think it’s worth repeating some practical tips here:

• Wellness and fitness in the workplace.
• Better nutrition and fitness in schools.
• Legislation regulating smoking.
• Better access to health care.
• Increased health awareness and education.

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Resource post for November

Background

Statin drugs or HMG-CoA reductase inhibitors play a very important role in the prevention of cardiovascular diseases. They are the first line treatment against high cholesterol levels. Statins have anti-inflammatory properties and interfere with the production of cholesterol thus slowing down the formation of plaques on the arterial walls.

According to the US FDA, statin medications

• work in the liver to prevent formation of cholesterol
• are effective in lowering bad cholesterol levels and raising good cholesterol
• are not recommended for pregnant patients or those with active or chronic liver disease
• can cause serious muscle problems

Statins are also said to be the bestselling drugs of all times, raking in billions of dollar in sales every year. Currently available statin drugs are:

• Lovastatin (Mevacor, Altoprev)
• Pravastatin (Pravachol)
• Simvastatin (Zocor)
• Fluvastatin (Lescol)
• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)

Research studies

Recent studies indicate that statins may play a major role in therapeutic areas outside cardiovascular medicine, thus may earn the title of “the aspirin of the 21st century“. Some of these studies are summarized below.

Statins associated with lower risk of death from pneumonia

Pneumonia is a major cause of mortality worldwide, even in developed countries. It has been reported that the incidence of pneumonia is increasing and hospitalization rates in the US and Europe have increased by 20 to 50% during the last 10 years. About 10 to 15% of pneumonia cases result in death.

Does statin use lower mortality rates due to pneumonia? Danish researchers report in the October 27 issue of Archives of Internal Medicine that “individuals who take cholesterol-lowering statins before being hospitalized with pneumonia appear less likely to die within 90 days afterward.”

The researchers studied data from 29,900 patients hospitalized with pneumonia between 1997 and 2004. 4.6% of these patients (1,371) were taking statins before and during hospitalization as anticholesterol treatment.

Death rates within 30 days among statin users were much lower (10.3%) were much lower than non-statin users (15.7%). The same trend was observed after 90 days, with 16.8% mortality rates among statin users compared to 22.4% among non-users.

The mechanism behind this effect of statins is not clear but the authors theorize that

“Statins change the immune response, beneficially affect processes associated with blood clotting and inflammation and inhibit dysfunction in blood vessels. These effects may especially benefit patients with sepsis and bacteremia, which are associated with early death from pneumonia.”

Statins block 1 cause of pregnancy loss in mice

What does statin have to do with pregnancy? Researchers at Cornell University observed that statins can actually prevent antiphospholipid syndrome (APS), an inflammatory condition that causes serious complications in pregnancy ranging from spontaneous abortion, fetal growth problems and even fetal death. The researchers demonstrated this beneficial effect of statins in laboratory mice.

Statins may protect against memory loss

Statins seem to also have protective properties against dementia and other neurodegenerative diseases. This is according to a study by researchers at the University of Michigan School of Public Health. The researchers observed that “if a person takes statins over a course of about 5-7 years, it reduces the risk of dementia by half.” The study studied tracked 1674 older Mexican-Americans did not have dementia for 5 years. Within the follow up period, 130 study participants developed some form of dementia or cognitive impairment. The incidence of dementia was lower among the 452 participants who took statins at some point in the study. This is an interesting development in view of stories about the popular statin drug Lipitor causing memory losses.

Statins lower blood marker for prostate cancer

Men who are taking statins to lower their cholesterol levels have lower prostate-specific antigen (PSA). PSA is a known biomarker for cancer risk. The PSA reduction seems to be related to statin use in a dose-dependent manner. The study followed up 1214 men who were on statins between 1990 and 2006 and monitored their PSA levels. Whether the effect of statins on the PSA levels translates into anticancer properties is not yet clear.

Are statins beneficial or harmful in multiple sclerosis?

A previous study in animals has shown that some statins may be beneficial against multiple sclerosis when combined with other drugs. This was demonstrated by University of California researchers in mice. In another study, Phoenix researchers showed that simvastatin may have some anti-inflammatory effect that counteracts inflammatory components of multiple sclerosis. However, another study indicates that certain doses of stains combined with beta interferon may actually increase the clinical disease activity in patients with multiple sclerosis. “Caution is [therefore] suggested in administering this combination.” The latter study was based on data of 26 study participants.

Statins lower risk of clots in cancer patients

Researchers at the Albert Einstein Medical Center in Philadelphia observed that cancer patients taking statins have lower incidence of blood clots than non-users. Thus, statins “may have a future in preventing blood clots in patients with breast, lung, colon and other solid-organ cancers.”

Caveat

The abovementioned studies show that there are other potential uses of statins aside from lowering cholesterol levels. However, all these results are preliminary. Further and larger studies are needed to further explore these beneficial effects as well as the risks that may be involved. Many people will claim that most of the positive reports about statins are propaganda from the pharmaceutical companies. Conspiracy theories abound. However, if statins can provide health benefits beyond cardiovascular medicine, who are we to say no?

We also have to be aware that like all drugs, statins come with side effects. Most side effects are mild but some can be serious. Myopathy is a potential fatal denegerative disease of the muscles possibly linked to statin use.

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Good day, everyone. Here is your heart news round up for this weekend.

CVD socioeconomic watch

Socioeconomic gap in BP management closed
Time was when management of hypertension was distinctly different between lower income and more affluent areas in the UK. It seems that with “the introduction of quality-of -care measures in general practices,” this socioeconomic gap has been successfully bridged and closed. This was partly achieved by “the so-called quality and outcomes framework (QOF), a pay-for-performance system” which give financial incentives to primary health care providers who reach certain outcome targets. The proportion of patients with up-to-date BP monitoring was 1.7% more in the higher income communities in 2005 but this advantage narrowed down to 0.2% in 2007.

CVD patient watch

British Teen Refuses Heart Transplant
“I’ll take my chances,” says 13-year old Hannah Jones after refusing a heart transplant. The British teen has been undergoing chemotherapy and other treatments against leukaemia since she was 4, which also damaged her heart in the process. It seems that Hannah has had enough of hospitals and would rather stay at home with her parents than undergo the rigorous process of heart transplantation.

CVD ethnicity watch

Differences in the incidence of congestive heart failure by ethnicity
Results from analysis of data from the Multi-Ethnic Study of Atherosclerosis (MESA) show that the risk for congestive heart failure is much higher among African Americans compared to other ethnic groups. The increased risk is related to prevalence of hypertension, diabetes mellitus, as well as socioeconomic status.

CVD gender watch

Gender matching aids long-term survival after heart transplants
Male and female hearts do differ and when it comes to heart transplants, gender matching is important. Except for size, heart differences are not so evident, yet survival rates in sexually matched transplantation are much higher. However, it boils down to a trade off between longer waiting time and sexual matching for organs.

CVD depression watch

Heart disease patients may not benefit from depression screening
Clinical guidelines by American Heart Association (AHA) and the American Psychiatric Association a few weeks ago recommended screening for depression among cardiac patients as reported in a previous post. This study, however, casts doubts on the necessity of the recommendation. According to Dr. James Coyne of the University of Pennsylvania School of Medicine, “there is no clear evidence that depression screening plays a conclusive role in improving cardiovascular patients’ health.”

CVD healthcare watch

New survey: More than half of US chronically ill adults skip needed care due to costs
The Commonwealth Fund surveyed 7500 chronically ill adults in eight industrialized countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, UK, and the US) with at least one of the following conditions: hypertension, heart disease, diabetes, arthritis, lung problems, cancer, or depression. The survey results

“finds that those in the U.S. are by far the most likely to forgo care because of the cost, as well as the most likely to experience medical errors, care coordination problems, and high out-of-pocket costs.”

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According to a study based on 2006 data from United Network of Organ Sharing in the US, 3,299 American children were on the heart transplant waiting list during an eight-year period up to 2006. Based on their ethnicity, the distribution is as follows:

• 58% white
• 20% black
• 16% Hispanic
• 3% Asian
• 3% others

Does this mean that more white children have heart problems and therefore need more heart transplantation? Actually no. The truth is actually sad and raises concerns about the role of race in health care.

“The most common reasons that children require heart transplants are serious congenital heart defects in children under the age of 1 and cardiomyopathy in those over the age of 10 years. These conditions tend to be equally distributed in children 1 to 10 years old [regardless of ethnicity]. Cardiomyopathy is a serious disease in which the heart muscle becomes inflamed and doesn’t work as well as it should.”

The reason why more white children are on the waiting list is because non-white children have a much higher likelihood of dying while waiting for a heart donor. If we look at the mortality figures, we see a completely different picture:

• Black children had a 60 percent greater chance of dying.
• Hispanics had a 50 percent higher mortality rate.
• Asians and others had a 100 percent to130 percent greater chance of dying.

If split between two ethnic groups white and non-whites, the non-white children clearly have a higher risk of dying before they can have a transplant.

I am mother to two kids who are partly of Asian ethnicity. It is heartbreaking to know that other kids like mine lose their chance for a heart transplant just because of the color of their skin.

However, the reasons for the disparity are many and complex and go beyond just the race issue. They include:

Socioeconomic factors. White children are more likely to belong to higher income families and better health insurance coverage. 58% of black children and 59% of Hispanic children have Medicaid insurance compared to 24% of white children. Those who have Medicaid have 20% higher mortality likelihood.

Cultural factors. Cultural and religious beliefs may play a role in the parents’ attitude towards treatments, including heart transplantation and “bridging therapies” while waiting for a heart donor.

Communication problems. Communications between healthcare providers and the patients (or parents of the patients) may play a big role. Language barriers as well as cultural and socioeconomic barrier can influence the efficiency of communications and therefore can cause delay in decision making.

Other unknown factors may play role and need to be addressed in future studies. However, this disparity due to race is very troubling and should be taken into account by health care providers when treating their young patients.

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You are what you eat. And this study indicates that diet can determine the risk of heart attacks - in a global scale.So what’s your typical diet?

Canadian researchers at McMaster University reported in the Circulation: Journal of the American Heart Association their results after studying the dietary patterns and heart attack rates in 52 countries. And it’s bad news for the Western diet.

The researchers could group dietary patterns in the world into three categories, namely:

• The oriental diet is characterized by higher intake of tofu, soy and other sauces;
• The prudent diet is characterized by higher intake of fruits and vegetables; and
• The Western diet is characterized by higher intake of fried foods, salty snacks, eggs and meat.

“The objective of this study was to understand the modifiable risk factors of heart attacks at a global level” according to lead researcher Salim Yusuf.

A long term study on diet and heart disease risks conducted on a global scale is not feasible in terms of costs and logistics. However, the researchers came up with a feasible alternative. It entailed interviewing heart attack patients in different countries using a questionnaire which included a dietary risk scores.

The data analyzed was part of the INTERHEART study. It documented the relationship of various risk factors and heart attack risks in more than 16,000 people in 52 countries. The Canadian study analyzed 5,761 cases of heart attack and compared them to 10,646 people without known heart disease used as study controls.

The results can be summarized as follows, after adjusting for known risk factors:

• People who consumed the Prudent diet of more fruits and vegetables had a 30 percent lower risk of heart attack compared to people who ate little or no fruits and vegetables.
• People who consumed the Western diet had a 35 percent greater risk of having a heart attack compared to people who consumed little or no fried foods and meat.
• The Oriental pattern showed no relationship with heart attack risk.

Now, you may ask, where does the so-called Mediterranean diet fit in?

Unfortunately, it seems that this diet, which complied with the World Health’s Organization’s (WHO) nutritional recommendations supposedly the most well-suited diet for cardiovascular health, is longer what it used to be, according to this report in the International Herald Tribune.

The traditional diet which is rich in vegetables, fruit, whole grains, olive oil and a bit of wine consumed on a daily basis is all but non-existent. It has been replaced by fast food rich in red meat, poultry, and trans fat.

“The fact is that the Mediterranean diet, which has been associated with longer life spans and lower rates of heart disease and cancer, is in retreat in its home region. Today it is more likely to be found in the upscale restaurants of London and New York than among the young generation in places like Greece, where two-thirds of children are now overweight and the health effects are mounting,” the report continues.

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What do rocket science and cardiology have in common? The quest for a total artificial heart. That’s how the Carmat heart was developed.

The French biomed company Carmat announced that they might just be 3 years away from completing the quest. Although the company is based in France, the project is actually a pan-European venture partly funded by the European Aeronautic Defense and Space Company (EADS). And it combines, of all things, tissue engineering and missile science to come up with a very promising heart prototype. The group is led by a star in cardiology, the renowned heart surgeon and inventor Dr Alain Carpentier of the Pierre & Marie Curie University, Paris, France.

“The device itself combines animal tissue, titanium, and technology borrowed from the missile-defense industry…A unique feature of the design is the sensor technology used in guided missiles, which senses the body’s activity level and adjusts accordingly.”

The Carmat heart is not the first of its kind but it may be the best (yet). There are already several US FDA-approved artificial hearts in the market.

• Jarvik 7 was developed by Dr Robert Jarvik in the early 1980s and was used in more than 350 patients. The average survival time was 10 months. A big limitation was the high complication rates.
• CardioWest is a modern version of Jarvik 7 and is used only in hospitalized end-stage heart failure patients as a bridging device while waiting for heart transplantation. It is manufactured by SynCardia System and was approved for marketing by the FDA in 2004.
• The AbioCor heart is the first fully implantable artificial heart. The devise is manufactured by Abiomed. It was cleared for marketing in 2006. It is used “for end-stage heart-failure patients who are not eligible for a heart transplant. It has an internal battery that lasts for just 30 minutes and a wearable external battery pack that lasts four hours.” The average survival rate of patients implanted with AbioCor is 5 months. A big limitation of the device is its bulky size which can only be accommodated by patients of a certain size. The manufacturer is developing a smaller version.

So what’s so special about the Carmat heart?

According to Business Week:

“The Carmat device can already claim to be the closest to mimicking a real heart’s anatomy, size, and function. A real heart, for instance, has two ventricles, the lower chambers that pump deoxygenated blood to the lungs and oxygenated blood out to the body. The Carmat heart similarly has two pumps that play the same role-a first for an artificial device.”

Other innovative features are:

• It combines polymer and biological tissues for the internal membranes
• It has a design that minimize blood turbulence
• It minimizes the formation of blood clots, a major limitation of other models
• It adjusts its own performance with state-of-the-art software and sensors

The great innovator himself, the late Dr. Michael DeBakey, who also dreamed of completing the quest, would have been impressed!

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The American Lung Association (ALA) is actively campaigning for a comprehensive smokefree legislation across the US - the so-called Smokefree Air 2010 Challenge.

According to ALA, there are currently only twenty-three states, plus Puerto Rico and the District of Columbia which have already passed comprehensive laws that protect people indoors -including workers and customers in restaurants and bars- from secondhand smoke. There is a still a lot to be done before the 2010 goal can be reached.

About the challenge

ALA launched the Smokefree Air 2010 Challenge in January 2006,

“calling on all states and local communities to pass comprehensive smokefree laws as soon as possible, but no later than 2010 to protect people across the U.S. from secondhand smoke.”

At that time, only 9 states have smokefree legislations in place. Also in the same year, a report from U.S. Surgeon General stated that “there is no safe level of exposure to secondhand smoke. The report also concludes that eliminating smoking in all indoor spaces is the only way to fully protect nonsmokers from secondhand smoke. We believe - as we know you do as well - that everyone should be able to work in a smokefree environment. People should not have to risk their health through exposure to tobacco smoke in order to make a living.”

Since then, 14 more states plus DC followed suit, reaching a total of 23. These states are as follows:

• Arizona
• California
• Colorado
• Connecticut
• Delaware
• Hawaii
• Illinois
• Iowa
• Maine
• Maryland
• Massachusetts
• Minnesota
• Montana
• Nebraska
• New Jersey
• New Mexico
• New York
• Ohio
• Oregon
• Rhode Island
• Utah
• Vermont
• Washington

Twenty-seven states more to go. Is your home state on the list?

About secondhand smoke

ALA gives some information about secondhand smoke:

• Secondhand smoke (also sometimes called passive smoking or environmental smoke) exposure is linked to almost 50,000 deaths annually.
• 90% of the adult population has detectable levels of chemical signature of secondhand smoke exposure in their blood.
• Secondhand smoke is linked to “low birth weight babies, asthma, respiratory infections and inner ear infections” in children.
• In adults, it has been linked to stroke and other cardiovascular disorders.

About the petition

ALA is collecting signatures for a US-wide petition to make US smokefree by 2010. At the time I am writing this post, they have already collected just over 13,200 signatures but still short of their 20,000 goal. If you are interested in signing up, then go for it and click here.

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CVD conference watch

AHA!
The best experts of the heart will be gathering in New Orleans, Louisiana this weekend. The 2008 Scientific Sessions of the American Heart Association run from November 8 to 12. Next week, I will try to bring you a review of the latest heart news from the conference.

CVD exercise watch

President-elect’s workout has predecessors gasping
He is not your typical American - at least as far as the Europeans are concerned. He’s black and he’s skinny. And he works out. Barack Obama is the first African-American to be elected US president. And the Obama fitness workout will probably become a legend.
“The main reason I do it is just to clear my head and relieve me of stress… My blood pressure is pretty low and I tend to be a healthy eater,” the UK Guardian quotes president-elect Obama.

CVD gender watch

Brown Named CEO of the American Heart Association
No, it’s not that kind of gender issue. Nancy Brown will be the next Chief Executive Officer of the American Heart Association, starting January 1, 2009. She will be the first woman to hold the position.

CVD drug watch

Sanofi-Aventis scraps ongoing rimonabant research
It was thought to be the next blockbuster - a drug that can be used to treat obesity as well as cardiovascular disorders. Unfortunately, rimonabant (Acomplia) fell short of these expectations and dealt a big blow to the big pharma Sanofi-Aventis, which announced that it is halting all clinical development programs associated with rimonabant. The downfall of the potential wonder drug is due to safety issues. In one trial, 5 suicides were reported in the rimonabant treatment group compared to 1 suicide in the placebo group. Two weeks ago, the European Medicines Agency (EMEA) announced that “it had asked the company to suspend marketing of the drug, on the grounds that its benefits no longer seemed to outweigh its risks.”

CVD obesity watch

Can Nintendo Wii Tackle Child Obesity?
Nintendo Wii, a program which simulates sports on the computer, is very popular among children and young people. The question is - is it effective against child obesity? This is the question that researchers at the University of Derby (UK) is tackling.
“This study aims to see if young children can lose weight or improve their health by using the Nintendo Wii. There is a lot of discussion that video games are bad for your health and we hope this research will determine if playing on this equipment could actually have physical benefits for children,” according to researcher Dr Michael Duncan.

CVD patient watch

Health of Ted Rogers stabilizes
Ted Rogers, head and founder of the Canadian company Rogers Communications was hospitalized Friday last week for an existing heart condition. The company announced that his condition has stabilized.

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Depression, poor quality of life, and now, increased risk for bone fractures. Is there no end to the problems facing heart failure patients? Unfortunately, a study by Canadian researchers found a link between heart failure and incidence of bone fractures.

“Patients who are newly diagnosed with heart failure in the emergency department are at least four times as likely to suffer serious bone fractures over the next year compared with patients presenting to the emergency department with other CV disorders.”

The analysis was based on hospital data from over 16,000 patients. 2041 of these patients were just newly diagnosed with heart failure. The remaining 14,253 had other cardiovascular conditions. The incidence of any orthopedic bone fracture among heart failure patients was more than 4 times higher (4.6% vs. 1%) than those without heart failure. The figures did not significantly change when corrected for age, sex, and medications. Of all types of fractures, hip fractures are the most common with more than 6% higher risk among heart failure patients. This is especially disturbing because hip fractures are difficult to heal, cause prolonged disability and increase the risk for thrombosis and lung infections.

The mechanism behind the heart failure - bone fracture link is not clear and requires bigger and more in-depth studies. A possible explanation might be the fact that long term heart failure can cause secondary parathyroidism. Parathyroidism is a condition wherein the parathyroid glands are enlarged. The glands are responsible for controlling the breakdown of calcium in the body. Dysfunction of the parathyroid glands can cause bone loss and high levels of blood calcium. Other factors which can further weaken the bones may be poor nutrition and lack of exercise among elderly depressed heart failure patients.

Heart failure is a chronic disease that worsens over time until the heart completes loses the capacity to pump. According to the American Heart Association, “more than 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year.” According to the study, heart failure is also a leading cause of hospitalizations and mortality in Canada. It occurs in 2.2% of the general population and 8.4% in adults older than 75.

The results of the study also highlight a possible link between heart failure and osteoporosis. The incidence of osteoporosis is about 25% in females and 12% in males among adults 50 years old and above.

The study continues to say that

“heart failure and osteoporosis also share common risk factors such as older age, female sex, smoking and type-2 diabetes.”

However, with the proper preventive measures, such as lifestyle changes and knowing the early signs, heart failure need not be a death sentence.

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The cold season is here and we can see what’s coming. No, I am not referring to winter and snow. I am talking about the holidays - Halloween, Thanksgiving, Christmas, New Year. Good food, calories and cholesterol. Good for the tummy, bad for the heart. Here are a few tips as what to pay attention to during this season of festivities and parties:

Eat slowly

The term “fast food” certainly has a double meaning, both not necessarily good for our health. This study by Japanese researchers indicates that the faster you eat, the more pounds you gain. People who eat faster than usual have the tendency to be overweight than those who eat at normal speed. Fast-eating men are 84% more likely to be overweight. Fast-eating women are 50% more likely to be overweight. The reason behind this is the signalling system in the between the tummy and the brain. Once the tummy is full, it sends a message to brain that says “Stop eating!” However, when you wolf down your food, the tummy gets filled too fast and even gilled overfilled before it can send the “stop” signal. The best strategy, therefore, is chew, enjoy, don’t rush and give the food a chance to settle in your tummy.

Do not eat till your tummy is full

The same study also observed that people who habitually eat till they feel fully satisfied also tend to be overweight. The same principle works here - there is usually a time delay between the signal sent by the tummy to the brain and the actual status of tummy content. Don’t overwork your tummy - give it a break and listen to what it says.

The study concludes that

“Eating until full and eating quickly are associated with being overweight in Japanese men and women, and these eating behaviours combined may have a substantial impact on being overweight.”

Weekend and holiday treats

Holidays and weekends are the times when you gain the most number of pounds. Experts therefore are warning to people to watch the portions you eat. Concentrate on the social part of the festivities to take your mind off the goodies. That doesn’t mean to say you have to drink more and eat less. On the contrary, drinking on an empty tummy is not good for your health. Yes, a little bit of alcohol may be good for your health. But never forget - alcohol contains a lot of sugar!

Yes, ‘tis the season to party and be jolly but also to keep healthy.

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