Plant-Based Doesn’t Always Mean Healthy

Some plant-based foods are high in calories and sodium content. Photo by Shutterstock

You may want to reconsider a plant-based diet if your motivation is health. When it comes to resolutions, many opt for getting healthy, cutting out drinking or starting a new hobby. These days, vegan magazines and organizations are pushing plant-based diets — calling it the “ultimate new year’s resolution.”

But plant-based meats are often high in sodium, ultra-processed and not any healthier than the meat they imitate. Meanwhile, nearly half of the consumers think they are more nutritious. So if your resolution is related to health, you may want to reconsider switching to a plant-based diet.

The Impossible Burger, for example, is an impressive meat-free mix of soy, potato proteins, coconut and sunflower oils. It even bleeds like the real thing. At the same time its calorie count and saturated fat levels mirror a McDonald’s quarter-pounder, and it has six times more sodium.

The global market for plant-based meat is projected to explode to US$85 billion in 2030. And grocery stores are taking note, featuring an array of burgers, sausages, nuggets, ground meat and seafood options all without any trace of animal products.

What’s the Nutritional Benefit?

According to one recent study, the nutritional benefit of plant-based foods is minimal. Researchers from the Singapore Institute for Food and Biotechnology Innovation modelled the outcome of replacing bacon, chicken, beef burgers and ice cream with animal-free versions.

Diets that substituted animal products with the plant-based alternative were below the daily recommendations for vitamin B12, calcium, potassium, zinc and magnesium, and higher in sodium, sugar and saturated fat.

Even with added vitamins and minerals, these products are not nutritionally interchangeable, says Stephan van Vliet, a postdoctoral associate at the Duke Molecular Physiology Institute. “Meat made from plants isn’t meat made from cows and meat made from cows isn’t meat made from plants,” he says.

Animal sources like meat, milk and eggs are complete proteins, meaning they contain enough of the nine essential amino acids we must get from our diets every day. Plant-based foods like fruits, vegetables, nuts, seeds and grains often lack one or more of these amino acids and need to be eaten in combination.

Plant-based meat manufacturers argue their products contain similar amounts of protein that are comparable in quality to animal protein. But focusing on protein is too “simplistic,” says van Vliet. “Foods contain hundreds to thousands of compounds that are capable of impacting human metabolism and health.”

Van Vliet and colleagues compared 190 molecules in plant-based meat alternatives with grass-fed ground beef and found that 90 per cent of them were different. Plant-based meat alternatives lacked certain amino acids and derivatives, like creatine, taurine and anserine, “which can all have an impact on our health and potentially brain function as well as muscle function,” he says.

Other metabolites like polyphenols and antioxidants were found in greater quantities or exclusively in plant-based meats. He sees plant and animal source foods as complementary in our diet, where some nutrients are better obtained from animal sources and others from plants.

The Term “Plant-Based”

“People opt for a plant-based burger for a variety of reasons,” says Rosie Schwartz, a Toronto-based consulting dietitian, “including reducing meat intake.” But she argues that consumers should rethink their reasoning if it’s because of health.

“To substitute something plant-based as a substitute because it’s called plant-based is really steering us in the wrong direction,” says Schwartz.

According to nutrition scientists and Canada’s Food Guide, plant-based is the recommended way we should be eating. Fill half your plate with vegetables and fruits, and the other half with whole grains and proteins.

But “plant-based” also refers to anything from meat to paint to pillowcases, as long as they were made mostly or completely of plants, according to the Merriam-Webster dictionary.

Just because it’s made from plants, doesn’t mean it’s healthy. “I do think it’s very confusing for the consumer,” says van Vliet. “It’s probably not the chicken, but everything else that comes with the chicken nugget that is probably detrimental to our health.”

The Future of Plant-Based Meats

Up until this point, plant-based meat companies focused on the taste, texture and appearance of its products. These companies targeted meat eaters by creating plant-based marvels meant to look, taste and feel like the real thing.

Impossible Foods, the creator of the Impossible Burger, says 90 per cent of their customers are still meat eaters. It isn’t in the business of converting salad and tempeh-eating veggie lovers into fake meat consumers.

“The whole mission of Impossible Foods is to create plant-based products that compete directly against animal meat,” said Esther Cohn, communications manager at Impossible Foods. “If you eat five beef burgers a week, we want you to swap, even just try swapping one out for an Impossible Burger.”

With a booming market and new animal-free proteins made from cells in a lab or fungi in fermentation tanks, the options are endless. Can they be adapted to be healthier as well? We’ll have to wait and see.

By: Meghan McGee, The Conversation

Meghan McGee is a nutrition scientist and Dalla Lana Fellow at the University of Toronto.

Source: Plant-Based Doesn’t Always Mean Healthy

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Related contents:

Definition of a plant-based diet and overview of this special issue”. Journal of Geriatric Cardiology. Wolfram T (1 October 2018).

Vegetarianism: The basic facts”. Academy of Nutrition and Dietetics. Retrieved 21 April 2019.

Plant-based diet”. British Dietetic Association. September 2017.Hemler EC, Hu FB (November 2019).

Plant-Based Diets for Personal, Population, and Planetary Health”. Advances in Nutrition. 10 (Suppl_4): S275–S283.

PLANT-BASED English Definition and Meaning | Lexico.com”. Lexico Dictionaries

What is a plant-based diet and why should you try it?”. Harvard Health. Retrieved 11 February 2022.

Plant-based diets and cardiovascular health”. Trends in Cardiovascular Medicine. 28 (7): 437–441.

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If Cancer Can’t Survive In An Alkaline Environment, Why Don’t We Use That As A Treatment?

If no disease, including cancer, can survive in an alkaline environment, then why aren’t doctors using this method to heal their patients? originally appeared on Quora: the place to gain and share knowledge, empowering people to learn from others and better understand the world.

Answer by Mike Condron, M.D. Medicine, Meharry Medical College, on Quora: If no disease, including cancer, can survive in an alkaline environment, then why aren’t doctors using this method to heal their patients?

This is a great question.

First of all, let’s be clear about this: human blood is in fact “alkaline”. Our blood pH is very (and I mean VERY) tightly regulated to be almost exactly 7.4 (maybe 7.35, but let’s use 7.4 so I don’t have to type more), which is in fact slightly alkaline. There are multiple systems in place to keep our blood pH at or very near this level.

So, right away, the premise of the question is off: Lots of diseases—or actually, all human diseases, can survive just fine in an alkaline environment, since our blood is alkaline. But it is also true that if you make the environment alkaline enough, nothing can survive. You could pour, say, lye (sodium hydroxide, with a pH of about 13), onto tumor cells in a laboratory dish, or bacteria, or yeast, and you would kill them in an instant.

But is this a useful therapeutic method? If your blood were infused with sodium hydroxide you would be dead long before it got to a pH of 13. I don’t think experiments have been done to test exactly what blood pH is lethal, but I can assure you it is nowhere near 13. Probably about 7.8.

We cannot survive with a blood pH much different from 7.40. The “normal” range is 7.35 to 7.45. Any significant deviation will cause major problems, and is in fact a sign of major derangements of the systems that are designed to keep our blood pH in that range. There are buffers in the blood that chemically limit the pH, and then there are mechanisms in both the lungs and the kidneys to change the way acidity (which is just hydrogen ions) is managed, just to keep the blood pH in that range.

A deviation to either more acidic or more alkaline will cause severe physiologic disturbances, like enzymes not working properly, chemical reactions in cells not working right, and so on. That is the reason we have evolved so many multi-layered backup systems and emergency plans to keep our blood pH in that range.

The question does not say what kind of range of alkalinity is being considered as a treatment for diseases, but we are already slightly alkaline, and we cannot survive any deviation from the very precise level of alkalinity that we need. So, one major idea here is that you can kill a tumor, or micro-organism, or whatever else may be causing a disease, by putting it in a sufficiently alkaline environment.

But you can do the same with acidity — pouring hydrochloric acid on tumor cells in a laboratory dish will kill them too. You can also do the same with heat—nothing can survive being heated to 250 F (about 120 C). We would kill all cancers, infections, and every other disease known, by heating them to that temperature. That works great in a laboratory test dish, but we can’t subject living patients to such a treatment, obviously, just like we can’t infuse lye or hydrochloric acid into patients’ blood to kill their cancer.

You can kill cancer by depriving it of oxygen, too…but that is also not a useful treatment, because it would also kill the patient. Same for glucose — cancer cells need glucose (although some bacteria could maybe make it from things they can absorb from your body, perhaps) but your body’s cells need glucose too, so inducing a hypoglycemic state is not a useful treatment for cancer. You could make the same argument for vitamins and minerals, since cancer cells (and micro-organisms) need them too.

So, to summarize before I go on: We are alkaline to begin with, so the idea that an alkaline environment is bad for diseases is simply wrong. Making the body more alkaline will kill the patient. Lots of other things can kill cancer or other diseases, but they will all kill the patient, too, like acidity, or heat, or deprivation of oxygen, or glucose, etc.

Now let me turn to a different perspective on this question. I have a feeling — and forgive me if I am jumping to conclusions here but I have a feeling that this question is about one of the latest trends in marketing … “alkaline” water, and “alkaline” diets. I described earlier that our blood pH is very (and I emphasized VERY) tightly regulated. One part of that is that there is almost nothing you can eat or drink that will affect your pH. Certainly not the “alkaline water” that is being sold everywhere now.

Think about this. It’s true that pure water is at a pH of 7.0, which is neutral. But does that really matter? We eat fruits, most of which are acidic. Are we saying that fruits are bad? Or what about meat? It has a pH, like most tissues, around the same as our body, so why drink alkaline water, when you can just eat meat? Does the idea that the pH of our food affects our blood pH even make sense? No, it does not.

Bear in mind that the acidity of our stomach is impressive — the cells lining the stomach secrete acid with a pH of around 1. That is somewhere between vinegar and battery acid. And that is regardless of what you eat. So if you eat or drink something slightly alkaline (say, 7.5 or 8.0) it will be immediately overwhelmed by the gastric acid, and what enters your duodenum (the first part of the small intestine after your stomach) is going to be at the pH of your gastric secretions, more or less. Maybe around pH 3 or 4.

Is a slightly alkaline water going to stand a chance against the wildly acidic environment of the stomach? Then bear in mind this: Immediately after the stomach contents goes into the duodenum, it is met with a huge load of bicarbonate ions secreted by the pancreas, which immediately neutralizes any acidity. And this all happens before anything is actually absorbed into the body.

Another aspect of this is the concept of “alkaline foods”. This is an unfortunate misunderstanding of an almost irrelevant idea from old food physiology research, which looked at the pH not of foods, but of the ash left over after foods were burned. The vague idea that burning something and looking at the residue left over applied to our physiology of digestion has led to the concept that certain foods are “acidic” and others are “alkaline”.

This was not the intent of the original research, but for some reason has been taken on by alternative medicine as a way of directing dietary choices, and then there was the birth of alkaline water. Wikipedia has a good article on this: Alkaline diet – Wikipedia…And now let me take a more general perspective on this question. It is in a broad category of questions: “I read somewhere [or heard, or saw in an advertisement] that doing X will cure diseases. So why don’t doctors do X?”

The answer to that is: Because X does not work in the real world, and X is being sold to people, hoping that the customer is too ignorant to know better. I know what I am about to say implies something that you have not stated, but maybe I can speak to others reading this answer who might think this: Please, if you read about something that someone is selling, and they are trying to say doctors are keeping a miracle cure from you, don’t believe them.

I am glad you asked this question, and I hope this answer gives some insight into why we don’t treat cancer or any other disease with alkalinity… or any other non-scientific method.

Quora

Quora: the place to gain and share knowledge, empowering people to learn from others and better understand the world.

Source: If Cancer Can’t Survive In An Alkaline Environment, Why Don’t We Use That As A Treatment?

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Hydration Linked With Lower Disease Risk, study finds

You may know that being adequately hydrated is important for day-to-day bodily functions such as regulating temperature and maintaining skin health. But drinking enough water is also associated with a significantly lower risk of developing chronic diseases, a lower risk of dying early or lower risk of being biologically older than your chronological age, according to a National Institutes of Health study published Monday in the journal eBioMedicine.

“The results suggest that proper hydration may slow down aging and prolong a disease-free life,” said study author Natalia Dmitrieva, a researcher in the Laboratory of Cardiovascular Regenerative Medicine at the National Heart, Lung and Blood Institute, a division of NIH, in a news release.

Learning what preventive measures can slow down the aging process is “a major challenge of preventive medicine,” the authors said in the study. That’s because an epidemic of “age-dependent chronic diseases” is emerging as the world’s population rapidly ages. And extending a healthy life span can help improve quality of life and decrease health care costs more than just treating diseases can.

The authors thought optimal hydration might slow down the aging process, based on previous similar research in mice. In those studies, lifelong water restriction increased the serum sodium of mice by 5 millimoles per liter and shortened their life span by six months, which equals about 15 years of human life, according to the new study. Serum sodium can be measured in the blood and increases when we drink less fluids.

Using health data collected over 30 years from 11,255 Black and White adults from the Atherosclerosis Risk in Communities study, or ARIC, the research team found adults with serum sodium levels at the higher end of the normal range — which is 135 to 146 milliequivalents per liter (mEq/L) — had worse health outcomes than those at the lower end of the range. Data collection began in 1987 when participants were in their 40s or 50s, and the average age of participants at the final assessment during the study period was 76.

Adults with levels above 142 mEq/L had a 10% to 15% higher chance of being biologically older than their chronological age compared with participants in the 137 to 142 mEq/L range. The participants with higher faster-aging risk also had a 64% higher risk for developing chronic diseases such as heart failure, stroke, atrial fibrillation, peripheral artery disease, chronic lung disease, diabetes and dementia.

And people with levels above 144 mEq/L had a 50% higher risk of being biologically older and a 21% higher risk of dying early. Adults with serum sodium levels between 138 and 140 mEq/L, on the other hand, had the lowest risk of developing chronic disease. The study didn’t have information on how much water participants drank.

“This study adds observational evidence that reinforces the potential long-term benefits of improved hydration on reductions in long-term health outcomes, including mortality,” said Dr. Howard Sesso, an associate professor of medicine at Harvard Medical School and associate epidemiologist at Brigham and Women’s Hospital in Boston, via email. Sesso was not involved in the study.

However, “it would have been nice to combine their definition of hydration, based on serum sodium levels only, with actual fluid intake data from the ARIC cohort,” Sesso added.

Biological age was determined by biomarkers that measure the performance of different organ systems and processes, including cardiovascular, renal (relating to the kidneys), respiratory, metabolic, immune and inflammatory biomarkers.

High serum sodium levels weren’t the only factor associated with disease, early death and faster aging risk — risk was also higher among people with low serum sodium levels. This finding is consistent with previous reports of increased mortality and cardiovascular disease in people with low regular sodium levels, which has been attributed to diseases causing electrolyte issues, the authors said.

The study analyzed participants over a long period of time, but the findings don’t prove a causal relationship between serum sodium levels and these health outcomes, the authors said. Further studies are needed, they added, but the findings can help doctors identify and guide patients at risk.

“People whose serum sodium is 142 mEq/L or higher would benefit from evaluation of their fluid intake,” Dmitrieva said. Sesso noted that the study did not strongly address accelerated aging, “which is a complicated concept that we are just starting to understand.”

“Two key reasons underlie this,” Sesso said. The study authors “relied on a combination of 15 measures for accelerated aging, but this is one of many definitions out there for which there is no consensus. Second, their data on hydration and accelerated aging were a ‘snapshot’ in time, so we have no way to understand cause and effect.”

Drink enough fluids every day

About half of people worldwide don’t meet recommendations for daily total water intake, according to several studies the authors of the new research cited.

“On the global level, this can have a big impact,” Dmitrieva said in a news release. “Decreased body water content is the most common factor that increases serum sodium, which is why the results suggest that staying well hydrated may slow down the aging process and prevent or delay chronic disease.”

Our serum sodium levels are influenced by liquid intake from water, other liquids, and fruits and vegetables with high water content.

“The most impressive finding is that this risk (for chronic diseases and aging) is apparent even in individuals who have serum sodium levels that are on the upper end of the ‘normal range,’” said Dr. Richard Johnson, professor at the University of Colorado School of Medicine, via email. He was not involved in the study.

“This challenges the question of what is really normal, and supports the concept that as a population we are probably not drinking enough water.”

More than 50% of your body is made of water, which is also needed for multiple functions, including digesting food, creating hormones and neurotransmitters, and delivering oxygen throughout your body, according to the Cleveland Clinic.

The National Academy of Medicine (formerly known as the Institute of Medicine) recommends women consume 2.7 liters (91 ounces) of fluids daily, and that men have 3.7 liters (125 ounces) daily. This recommendation includes all fluids and water-rich foods such as fruits, vegetables and soups. Since the average water intake ratio of fluids to foods is around 80:20, that amounts to a daily amount of 9 cups for women and 12 ½ cups for men.

People with health conditions should talk with their doctor about how much fluid intake is right for them.

“The goal is to ensure patients are taking in enough fluids, while assessing factors, like medications, that may lead to fluid loss,” said study coauthor Dr. Manfred Boehm, director of the Laboratory of Cardiovascular Regenerative Medicine, in a news release. “Doctors may also need to defer to a patient’s current treatment plan, such as limiting fluid intake for heart failure.”

If you’re having trouble staying hydrated, you might need help working the habit into your usual routine. Try leaving a glass of water at your bedside to drink when you wake up, or drink water while your morning coffee is brewing. Anchor your hydration habit to a location you’re in a few times per day, behavioral science expert Dr. B.J. Fogg, founder and director of the Stanford University Behavior Design Lab, previously told CNN.

Source: Hydration linked with lower disease risk, study finds | CNN

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Related contents:

The Impact of Hydration on Disease and Longevity Runners’ World

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Taming The World’s Leading Killer: High Blood Pressure

An article published recent in in the New England Journal of Medicine reports some astounding research findings which could save millions of lives. Why did you miss it? Because there was zero media coverage (apart from a few specialty medical blogs). Zero. That tells you something. Tells you a lot, actually. So, here are the details.

High blood pressure is the world’s leading killer — and will kill more people, including more young people, than Covid-19 (and, in usual years, more than all other infectious diseases combined). High blood pressure can be prevented, mostly by reducing dietary sodium, and is effectively treated with safe, low-cost medications.

But globally, we’re doing terribly on blood pressure control. Less than 1 in 7 people with high blood pressure, an abysmal 14%, have it controlled. This is, frankly, pathetic — and is killing millions of people a year. It’s the most important health care intervention for adults to save lives, and we get it right less than 1 in 7 times (and, in the United States, with a $4 trillion dollar health care system, we get this right less than half the time, despite it being the intervention that can save more lives than any other health care intervention in the US!)

Elegant studies by University of Oxford scientists prove that, for every 20-point increase in systolic blood pressure (the larger “top” number), the death rate from cardiovascular disease doubles. What’s more, this starts at a blood pressure of 115/75 — way below the usual level at which we treat, or toward which we aim treatment. Adapted from “Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies” in The Lancet. But showing that lower is better didn’t prove that lowering more is better. That’s where the incredibly important Systolic Blood Pressure Intervention Trial (SPRINT) study, begun in 2010, comes in.

It’s one thing to prove (as Oxford’s Dr. Sarah Lewington did) that lower blood pressure correlates with lower risk of death, but quite another to prove that lowering blood pressure more saves more lives. Lower blood pressure reduces the risk of death, but how low do we need to go? That’s what’s big news about the results from the SPRINT study that were just released. They prove that lower IS better — and that setting a blood pressure goal lower than the standard treatment goal prevented many more deaths.

The SPRINT study also showed that, despite more side effects (far less dangerous than heart attack or stroke), intensive blood pressure treatment to reach the lower blood pressure goal is safe — even for older people. More intensive treatment prevented more heart attacks, strokes and deaths.Based on the SPRINT study, many guidelines now recommend that certain high-risk patients with high blood pressure aim for a systolic blood pressure below 130 rather than the standard target of 140. (SPRINT aimed for an even lower target of 120/80.)

But the bigger implication: We need to do much better at getting people to under 140/90. For years, doctors were afraid to lower their patients’ blood pressures to levels they thought would be too low, and potentially dangerous. Now, it’s proven that “overshooting” the goal of 140/90 isn’t just something that won’t hurt the patient — it could well save their life.

The death rate among people treated with a blood pressure goal of under 120/80 was 27% lower than the death rate of people treated to the usual target of 140/90. And for every death prevented, about two heart attacks are prevented in addition to strokes, kidney failure, dementia, and more. Now, it’s also true that interventions other than medication can be important. Reducing sodium, in particular, can reduce blood pressure and other health harms from our overly salty diet. Getting regular physical activity, eating a healthier diet overall, reducing air pollution, and more can make a big difference. But these interventions are best done on a societal, community-wide basis.

That’s why, although we should empower and inform patients, we shouldn’t expect them to be able to withstand the obesogenic, salty, sedentary, polluted environment we live in. And even if we could magically improve our food and overall environment, there would still be a billion people in the world in need of medications to treat their hypertension. Why are we failing to control high blood pressure? One reason is that we’ve made treatment too complicated — far more complicated than it needs to be for optimal results. For the past four years, Resolve to Save Lives has worked with our global partners to identify characteristics of high-performing hypertension control programs throughout the world.

The WHO HEARTS technical package for improving cardiovascular health simplifies hypertension treatment: standard treatment protocols that any health worker can implement, reliable supply of quality-assured medicines, team-based health care, patient-centered services and a strong health information system. This makes it more likely that patients will achieve and maintain blood pressure control. Think about it. A study came out last week that could save millions of lives. There was not a single news article about it. Though this was “just” the final report from a study whose key results had previously been released in advance (because the findings are so important), we have been slow to implement these recommendations. It shows that we still have a lot to learn about what we need to focus on to save the most lives.

Resolve To Save Lives partners with countries which implement WHO’s HEARTS package to lower blood pressure. Sodium reduction and hypertension treatment can prevent 3 million early deaths — every year. Lowering blood pressure can save millions of lives. We know what we need to do, now let’s make it happen.

By: Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention during the Obama administration, when he oversaw responses to the H1N1 influenza, Ebola and Zika epidemics, is President and CEO of Resolve to Save Lives, an initiative of Vital Strategies and Senior Fellow for Global Health at the Council on Foreign Relations. Twitter: @DrTomFrieden.

Source: Taming the world’s leading killer: high blood pressure – CNN

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Hypertension or high blood pressure is a chronic medical condition in which the blood pressure in the arteries is higher than it should be. This involves the heart working harder than normal to circulate blood through the blood vessels.

The pressure in the arteries changes depending on what the heart is doing. When the heart squeezes, pumping blood into the arteries, the pressure increases. When the heart relaxes, the pressure decreases. When blood pressure is measured, the highest pressure (when the heart is squeezing) is called the systolic blood pressure. The lowest pressure (when the heart is relaxing) is called the diastolic blood pressure.

Blood pressure is written as two numbers. For example, in the picture at the right, the person’s systolic blood pressure was 158. Their diastolic blood pressure was 99. This blood pressure is written as 158/99. It is said “158 over 99.”

Hypertension Types

There are two types of hypertension, called “primary” and “secondary.” Primary hypertension means that the hypertension is not caused by any other disease or condition and it gradually develops over time with age. Secondary hypertension means that the hypertension is caused by another disease or conditions. Secondary hypertension tend to result in higher blood pressure than primary hypertension. In most cases (90-95%), hypertension is primary. Only a small amount of hypertension (5-10%) is secondary.

There are various health conditions that leads to secondary hypertension which includes: Obstructive sleep apnea, Kidney problems, Adrenal gland tumors, Thyroid problems, Certain defects you’re born with (congenital) in blood vessels, Certain medications (birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs), Illegal drugs (cocaine and amphetamines)

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References

  • “High blood pressure (hypertension) – Symptoms and causes”. Mayo Clinic. Retrieved 2019-10-28.
  • Arguedas, JA (Jul 8, 2009). Arguedas, Jose Agustin (ed.). “Treatment blood pressure targets for hypertension”. Cochrane Database of Systematic Reviews (3): CD004349. doi:10.1002/14651858.CD004349.pub2. PMID 19588353. Unknown parameter |coauthors= ignored (|author= suggested) (help)
  • Williams, B; Poulter, NR, Brown, MJ, Davis, M, McInnes, GT, Potter, JF, Sever, PS, McG society (March 2004). “Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV”. Journal of Human Hypertension 18 (3): 139–85. doi:10.1038/sj.jhh.1001683. PMID 14973512 Law M, Wald N, Morris J (2003). “Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy”. Health Technol Assess 7 (31): 1–94. PMID 14604498.
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