Author Archives: andybyun

Cholesterol’s role in heart disease

Causes of death pie chart (Image from http://www.sca-aware.org)

Causes of death pie chart (Image from http://www.sca-aware.org)

 

Heart disease is the leading cause of death in the world, and it has been long known that heart disease is highly associated with elevated levels of cholesterol.  Cholesterol is fatty substance which originates from dietary intake and liver production.  If you have thought of cholesterol merely as a measurement of obesity (which is not entirely wrong), you should keep in mind that an adequate level of cholesterol is vital to help your brain, skin, heart, and other organs grow and do their jobs in the body.

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Cholesterol can be divided into two groups: LDL (low density lipoprotein) and HDL (high density lipoprotein).  LDL is called “bad” cholesterol, because it is the LDL cholesterol that forms plaques and is associated with heart disease.  HDL is called the “good” cholesterol, because HDL cholesterol actually extracts LDL cholesterol from artery walls and moves them back into liver, preventing atherosclerosis.

HDL vs LDL (image from http://www.ellies-whole-grains.com/)

HDL vs LDL (image from http://www.ellies-whole-grains.com/)

 

The LDL cholesterol is unarguably one of the risk factors that often make heart diseases deadly, but it has not been clearly understood why. However, University of British Columbia researchers David Fedida and Jodene Eldstrom discovered that cholesterol disrupts the flow of the electrical currents that generate the heart beat, causing cardiac arrhythmias (irregular heartbeats).

 

We have countless ion channels present in the membranes of all cells in the body, and they are key components in a wide variety of biological processes. The type of protein channels that are involved in the mechanism by which the heart’s electrical activity occurs is voltage-gated Kv1.5 potassium channel.

250px-Potassium_channel1

The heart undergoes depolarization (positively charged) as positively charged potassium ions move into the cell through Kv1.5 potassium channel. Shortly after depolarization, the heart releases potassium ions and returns its membrane potential to a negative value (repolarization).  The ion exchanges are regulated by Kv1.5 potassium channel.   The continuous depolarization and repolarization create small electric current.

All the cells with Kv1.5 potassium channel contributes to this process like little batteries, and the generated electricity flows through the heart as an impulse and the heart beats.  One important thing about this ion channels is that they are synthesized inside the cell and transported to the cell’s surface. They stay at the surface for only a few hours, and then they internalize back into the cells to be degraded or remade again.  Dr. David Fedida found that cholesterol disrupts this whole recycling process and affects the number of cells that can act as “little batteries”, causing the heartbeat to quicken, and eventually fail.  David Fedida explains that cholesterol-lowering drugs may help normalize the heart’s electrical activity.

Arrythmia

Small amount of cholesterol is inevitable for normal function of body. However, excessive cholesterol can lead to sudden cardiac arrest: the number one cause of death in the world.  This discovery of additional danger of cholesterol on coronary heart disease sheds light on sudden death in people with high cholesterol and opens ways to potential anti-arrhythmic drugs.

Andy Byun

Prostate cancer screening harmful to men?

Would you be surprised to know that one in 7 men will develop prostate cancer during his lifetime? Prostate cancer is the most common cancer among Canadian men and, on average, 73 Canadian men will be diagnosed with prostate cancer every day. Imagine that you are just diagnosed with prostate cancer. Your life will flash before your eyes, and try to handle the verdict in the midst of the flashbacks. But don’t be scared yet, gentlemen. And let’s look at how prostate cancer is commonly tested and see if it is necessary as part of normal checkups.

Cancer
Image: http://healthydebate.ca/opinions/we-should-aggressively-screen-for-cancers-early-right

There are mainly two ways of testing for prostate cancer: PSA screening and digital rectal exam. PSA, also known as prostate specific antigen, is often used by doctors and healthcare practitioners to detect the presence of prostate tumor.  Because PSA level in the blood generally goes up with the presence of prostate tumors, it is generally thought that early detection can be achieved by PSA screening.

PSA testing no longer recommended
Image: http://alvinblin.blogspot.ca/2012/05/uspstf-recommends-against-psa-for.html

However, U.S. Preventive Services Task Force (PSTF) concluded that PSA screening for prostate cancer are unreliable and do not offer men any tangible benefit in lifespan or quality of life.  PSTF found that there are many more men who were injured by PSA tests than are helped by it. But, why?

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First of all, PSA blood levels can be increased by many other factors, meaning that the test has a high chance of producing false-positives.  Prostatitis, benign prostatic hyperplasia, and even rigorous physical activity can contribute to the increase in PSA blood levels.  According to the ten years’ worth of comprehensive data on PSA screening, PSTF determined that, while at least 100 will receive false positives, only one in 1,000 men will derive any potential benefit.

A: increased diagnose of prostate cancer
B: minimal reduction in deaths by prostate cancer
Image: http://www.nejm.org/doi/full/10.1056/NEJMoa0810696

Secondly, PSA screening has serious side effects, thus does more harm than good. According to the study, Mortality Results from a Randomized Prostate-Cancer Screening Trial: it was concluded that the rate of death from prostate cancer was very low and did not differ significantly between the two study groups with over 76000 men: one that had PSA screening for 6 years and the other that had usual care as the control. Why did the PSA screening test fail to reduce the death from prostate cancer? Despite the early detection of prostate cancer, PSA screening led to other medical complications such as infection, bleeding, clot formation, and urinary difficulties. Treatment-related complications, which are generally more serious, included infection, incontinence, impotence, and other disorders.

Most men develop prostate cancer if they live long enough. However, prostate cancers are very slow growing and usually do not kill the patient. Long before the prostate cancer becomes life-threatening, it is more likely that a man with prostate cancer generally dies of some other cause. It questions us whether PSA screening is really necessary for healthy men.  It is still a very controversial topic, but I cautiously  suggest avoiding PSA screening as part of normal checkups, and I recommend digital rectal examination which is sufficient to detect prostate cancer without any medical complication. PSA screening should be done on patients only when there is an enlarged prostate or other related symptoms.

Andy Byun