New treatments mean aneurysms are no longer an automatic death sentence, specialists say.

Aneurysms are a weakening or bulging of blood vessels that can rupture and become life-threatening. They can occur anywhere in the body, but are most common in the brain, or in the main blood vessels that lead to the heart, legs and arms.

Fixing problem from inside

Aneurysms used to carry a high probability of death, but many can now be treated before they pose a serious threat.

“If detected early, there are new interventions like a minimally invasive catheter-based procedure to treat the condition,” said Dr Ali Azizzadeh. He is director of vascular surgery at Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles.

Doctors used to have to fix a blood vessel by hand, which meant open surgery and the risks that go along with it. “Today, we can fix the problem from the inside, without always having to open up the patient,” Azizzadeh said in a hospital news release.

Roxanne Hanks, 61, of Simi Valley, California, is living proof of that progress.

“I was healthy, I exercised and still worked full-time,” she said in the release. “But I often felt lightheaded and short of breath from minor exertion, like walking a flight of stairs. I was insistent that my doctors keep searching for the answer.”

After months of tests and doctor visits, she was diagnosed with an aortic aneurysm and sought treatment at Smidt Heart Institute.

Early detection key

Hanks’ case was complex. First, she needed open heart surgery to repair the front part of her aorta. Two months later, she had her final, minimally invasive surgery.

Hanks said she is “back to work, back to exercising and living a fulfilling, great life.”

Early detection is key to successful treatment of an aneurysm, Azizzadeh said. If you have unexplained pain, coupled with any risk factor, it’s important to talk to your doctor and mention aneurysms, he advised.

Risk factors include family history, smoking, high blood pressure and elevated cholesterol. Some aneurysms can cause pain, but most cause no symptoms.

Thoracic (chest-area) aortic aneurysms affect about 15 000 Americans each year and are the 13th leading cause of death, according to the Cleveland Clinic.

“Listen to your body,” Hanks said. “I knew something was wrong, but I kept searching and ultimately ended up with the best doctors and care team who saved my life.”

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Men who abuse hormones such as testosterone or steroids for bodybuilding can have declines in sperm and testosterone production, researchers say.

The good news: these changes seem to reverse once men stop hormone overuse.

Effect on men’s reproductive function

While the use of non-prescribed male hormones (androgens) has surged in many wealthy countries, there has been little research into their effect on men’s reproductive function, including sperm production, testosterone and fertility, according to lead researcher Nandini Shankara Narayana. She’s an endocrinologist at the University of Sydney and Concord Repatriation General Hospital in Australia.

The study of 93 men included 41 who were currently using testosterone or steroids; 31 who had used them three or more months before the study; and 21 healthy men who exercised regularly and did not use androgens.

Compared with men who had stopped using the hormones or who had never taken them, current users had significantly smaller testicles, on average, and lower sperm output, the study found.

Current users also had lower levels of luteinizing hormone, which is involved in testosterone production, and of follicle-stimulating hormone, which is involved in sperm production, the findings showed.

Little prognostic info available

Former users did not differ from men who had never taken the supplements in terms of sperm production and hormone levels, indicating complete recovery, according to the study presented Monday at the Endocrine Society’s annual meeting, in New Orleans.

On average, luteinizing hormone levels recovered within nine months after men stopped taking the supplements. Sperm output returned to normal in about 14 months and follicle-stimulating hormone levels normalized in nearly 19 months, the findings showed.

“These results will help endocrinologists involved in care of men who are using typically non-prescribed, high doses of androgens for bodybuilding, a practice that is increasingly recognised but for which virtually no prognostic information has been available to support medical care during recovery from androgen abuse,” Shankara Narayana said in an Endocrine Society news release.

Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

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Sleep disorders expert

Dr Alison Bentley is a general practitioner who has consulted in sleep medicine and sleep disorders, in both adults and children of all ages, for almost 30 years. She also researches and publishes on a number of sleep-related topics both in formal research journals and lay publications including as editor of Sleep Matters, an educational newsletter on sleep disorders for doctors.

Snake antivenoms have been around for 125 years, are effective and can be produced cheaply at scale. Yet Africa, with its abundance of deadly snakes, has an alarming shortage of the life-saving medicine.

Experts and campaigners blame a combination of weak production capacity, feeble policy and oversight, high prices and a general lack of concern for the plight of people in poor, remote areas of the world.

Dangerous manoeuvre

The method of antivenom production has changed very little since it was first developed by French immunologist Albert Calmette in the late 19th century. It remains a painstaking, time-consuming process, although researchers are working to develop synthetic alternatives.

First, a technician has to milk a snake’s venom in a dangerous manoeuvre that sees it holding the animal’s head still while it bites a cup covered in plastic film, releasing its poison – a small amount each time – into the container.

Small venom doses are then injected into a large domestic animal, usually a horse, to trigger an immune response and the production of toxin-attacking antibodies.

After several doses over a period of about a year, the horse produces so many antibodies that it becomes immune to the venom, at which point blood can be taken from the animal.

In a lab, antibodies are then separated from the blood, to be given to snakebite victims – who may need several doses.

An antivenom usually works only for a specific species, or small group of species of snake.

Prohibitive price

A key challenge, especially in poor, remote areas of the world where most snakebites occur, is that most antivenoms need to be refrigerated.

Already patchy, availability of antivenoms in Africa was thrown into disarray when French laboratory SANOFI stopped production in 2014 of its FAV-Afrique drug, which was effective against a number of species, including some of the most dangerous on the continent.

The last available doses expired mid-2016.

SANOFI was moved mainly by financial considerations. The prohibitive price of a single dose – more than $100 (±R1 410) – rendered sales in Africa unprofitable.

The failure to use antivenom “to save tens of millions of lives… is a shameful failure. Nowhere in the world is this more confronting than in Africa,” says the Global Snakebite Initiative, adding in a report on its website that the “collapse of the snake antivenom market in Africa” was a “medical tragedy”.

Lower demand and falling sales

The cause is multifold.

In a vicious circle, unaffordability leads to lower demand and falling sales, which result in reduced production, higher costs, and raised prices for consumers.

Even an antivenom produced on the continent and effective against multiple snake species, is nigh impossible to find further north than South Africa, where it is made, a 2018 study by the Liverpool School of Tropical Medicine found.

“The market remains volatile because they are small producers and the African antivenom market is limited,” said Julien Potet, an expert in neglected tropical diseases with aid group Doctors Without Borders.

Inconsistent quality standards and lacking oversight have also seen an infiltration of counterfeit and “inappropriate” antivenoms developed for different snake types in other countries. Using the wrong antivenom can be dangerous, even deadly.

Doctors Without Borders, which describes Africa’s antivenom shortage as a public health crisis, has launched its own survey of available antivenoms.

Antivenom should be free

Most were brought to the market “without any clinical information, without any data on their efficacy or safety in humans,” said Potet.

A further problem: even if antivenoms were available, people most likely to be bitten by a venomous snake live prohibitively far from a clinic or hospital, some of which have no refrigeration capacity, and with medical staff that have never been trained in treating snakebites.

“We are losing around 1 000 people in Kenya each year from snakebites,” said Royjan Taylor, director of the Bio-Ken snake farm and research centre on the country’s east coast.

This is out of 81 000–138 000 worldwide.

Africa alone sees about half a million snakebites that need treatment every year, according to the World Health Organization (WHO).

“Governments and the international community therefore should really pick that up… What I would like to see over the next five to 10 years, maybe even 15 years, is for an antivenom to be produced for each area of the world that has a problem and that antivenom should be provided to those people free of charge,” Royjan said.

The WHO has launched a massive review of the availability, efficacy and safety of snakebite serum available in Africa, where the majority of countries have no effective or affordable antivenom at all.

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Patients who have high triglycerides and take cholesterol-lowering statins to lower their risk for heart attack or stroke can cut that risk by another 30% by adding a high-dose omega-3 fatty acid pill, investigators report.

The prescription drug, called Vascepa, is not to be confused with over-the-counter dietary omega-3 (often fish oil) supplements. Such supplements typically contain far lower doses of the critical omega-3 fatty acid called EPA and have not undergone a rigorous safety and effectiveness review by the US Food and Drug Administration.

Large degree of clinical benefit

Since 2012, the FDA has approved Vascepa (icosapent ethyl) for patients whose triglyceride fat levels exceed 500 milligrams per decilitre of blood.

Now, an updated analysis of research first released last September suggests Vascepa markedly reduces a patient’s lifetime risk of dying from heart disease; experiencing a nonlethal heart attack or stroke, or needing heart surgery or hospitalisation for a heart complication.

“We found a 30% reduction in total ischaemic events,” said lead author Dr Deepak Bhatt, referring to any number of serious heart problems caused by restricted blood flow. “That is a very large degree of clinical benefit.”

Among 1 000 patients who take Vascepa for five years, nearly 160 serious heart problems would be prevented, he noted. That includes 12 cardiovascular-related deaths, 42 heart attacks, 14 strokes, 76 coronary artery bypasses and 16 hospitalisations for unstable angina (chest pain or heaviness) while at rest or during moderate activity.

Bhatt is executive director of international cardiovascular programmes at Brigham and Women’s Hospital in Boston.

Problematic saturated fat

He and his colleagues are slated to present their research – which was funded by the New Jersey-based drug manufacturer Amarin Pharma, Inc. – this week at a meeting of the American College of Cardiology, in New Orleans.

Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

The study team likened the high dose of EPA contained in Vascepa to eating more than 20 servings of fish a week, minus the problematic saturated fat.

The updated findings concern the “REDUCE-IT” study, which involved nearly 8 200 patients. All had high cholesterol and were taking statins to control it.

This, investigators said, meant patients were receiving a good standard of care. But that care did not mean they were out of the cardiac woods.

Subsequent events

All also had high triglycerides, and about 70% had a heart disease diagnosis. The other 30% were diabetic and were thought to be at risk for future heart complications.

For the trial, half took 2g of Vascepa twice a day for an average of about five years. Half took a placebo.

Initial results suggested a 25% reduction in the risk for experiencing a first cardiac event, such as a heart attack or stroke.

Now, researchers have also examined subsequent events as well – for example, a fatal stroke after an initial heart attack.

And that new analysis showed a 30% lower lifetime risk for heart attack, stroke and the like.

Supplements unregulated

Eileen Handberg is research professor of medicine, and programme director of the Cardiovascular Clinical Trials Program at the University of Florida. She was not involved with the study.

Handberg said the findings are important, because even when heart patients receive the very best of care, some risk remains. And patients with a risk for heart disease tend to experience more than one event – meaning multiple heart attacks, or a heart attack and then a stroke, she added.

“But here, the data shows that this drug reduces that risk, whether it’s a first, second or third event,” Handberg said. “That is very important information for patients to have, because it means there is a way to reduce risk over the long term.”

She underscored the research team’s warning that consumers should not look to over-the-counter fish-oil supplements for the same protection.

“Supplements are not manufactured to consistent standards and are unregulated,” Handberg said. “So you have no real idea of what you’re taking.”

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