Arterial Disease

Some Topics

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Avoid Stimulant Drugs

Stimulant drugs increase the risk of stroke and sudden death. They must be used with caution or avoided. The drugs of concern are epinephrine, norepinephrine, ephedrine, pseudoephedrine, phenylpropanolamine, methyphenidate, ampthetamine, and methamphetamine

Cocaine decreases brain perfusion and increases the risk of ischemic stroke.

The intake of caffeine will increase the effect of sympathetic amines.

Multiple doses of caffeine are added to stimulant drugs found in weight loss products, cold remedies, cough syrups, energy drinks and prescription drugs. Sympathetic amines increase blood pressure, heart rate and decrease brain perfusion. 

Ephedra alkaloids

Haller and Benowitz warned that: “Dietary supplements that contain ephedra alkaloids (also known as ma huang) and guarana-derived caffeine are widely consumed in the United States for purposes of weight reduction and energy enhancement. A number of reports of adverse reactions to dietary supplements that contain ephedra alkaloids, some of which resulted in permanent injury or death, have appeared in the medical literature. In response to growing concern about the safety of ephedra alkaloids in dietary supplements, the Food and Drug Administration (FDA) requested an independent review of reports of adverse events related to the use of ephedra alkaloids to assess causation and determine the level of risk these products pose to consumers.”  See Reversible Stroke Caused by Ephedra

High Caffeine Intake

Caffeine is a stimulant drugs that is potentially harmful. High intakes may occur with the ingestion of coffee, teas, sodas, and over the counter "medicines and now high caffeine "Energy Drinks."  Emma Hitt wrote:" A lack of research and regulation associated with energy drinks, combined with reports of toxicity and high consumption, may result in  dangerous consequences." Sara M. Seifert et al reported that energy drinks are regularly consumed by 30% to 50% of children, adolescents, and young adults. They suggested that the use of energy drinks provide no benefit and can have serious adverse health effects.  Energy drinks are categorized in the US under the bizarre category "nutritional supplements" which includes many products that have nothing to do with nutrition. Under this category the drinks can have high caffeine content of 75 to 400 mg caffeine per container, avoiding the limit of 71 mg caffeine per 12 fluid ounces that the US FDA set for sodas. They cited  a New Zealand report that found that children, teenagers, and young men would exceed an adverse effect level of 3 mg/kg per day of caffeine after consuming a single retail unit of energy drink or energy shot in addition to dietary exposure. Germany, Australia, and New Zealand have reported numerous adverse outcomes associated with energy drink consumption. These include liver damage, kidney failure, respiratory disorders, agitation, confusion, seizures, psychotic conditions, nausea, vomiting, abdominal pain, rhabdomyolysis, tachycardia, cardiac :dysrhythmias, hypertension, myocardial infarction, heart failure, and death. Other ingredient in the drinks are also potentially harmful such as 5-hydroxy tryptophan, vinpocetine, yohimbine, and ginseng.

Ritalin and Amphetamines

In the US, a FDA advisory committee heard testimony indicating that 2.5 million children take stimulants for ADHD, including nearly 10 percent of all 10-year-old boys in the United States. The use of these agents is much less prevalent in European countries, where the diagnosis of ADHD is relatively uncommon. The popularity of the diagnosis, Adult ADHD is relatively recent leading to at least 1.5 million adults who take stimulants on a daily basis, with 10 percent of users older than 50 years of age. Drug-related events reviewed by the committee included 25 cases of sudden death in children or adults that included myocardial infarction, stroke, and serious heart arrhythmias. The committee concluded: “We rejected the notion that the administration of potent sympathomimetic agents to millions  of Americans is appropriate. We sought to emphasize more selective and restricted use, while increasing awareness of potential hazards. We argued that the FDA should act soon and decisively. “

May 26 2006 Canada's health ministry warned individuals with hypertension, heart disease or abnormalities, arthrosclerosis or hyperthyroidism not to take drugs used to manage attention deficit hyperactivity disorder (ADHD). All ADHD drugs stimulate the heart and blood vessels... in some patients this stimulation may result in cardiac arrests, strokes or death. 

The drugs mentioned by Health Canada include:

Adderall XR, made by Britain's Shire Pharmaceuticals Group Plc

* Concerta, made by Johnson & Johnson

* Ritalin and Ritalin SR, made by Novartis AG

* Dexedrine, made by GlaxoSmithKline Plc

* Strattera, made by Eli Lilly and Co.

Walter N. Kernan, et al. Phenylpropanolamine and the Risk of Hemorrhagic Stroke N Engl J Med 2000;343:1826-32

Nissen S. ADHD Drugs and Cardiovascular Risk. Published at www.nejm.org March 20, 2006

High Blood Pressure According to the Canadian Coalition for High Blood Pressure Prevention and Control, non-drug strategies should be the priority for hypertension control.

The Alpha Nutrition Program can be recommended, along with Alpha DMX, exercise and relaxation as a rational strategy of preventing and managing cerebrovascular disease.

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