Mayo Clinic Proceedings: November highlights

The November issue of Mayo Clinic Proceedings includes three articles with leading research, highlighted below. Khat Chewing Increases Risk of Stroke and Death in Patients With Acute Coronary Syndrome

ROCHESTER, Minn. -- Researchers found that people who chew khat and present with acute coronary syndrome had significantly higher rates of death, cardiogenic stroke, and stroke complications, despite having lower cardiovascular risk profiles.

"The leaves of khat, a leafy green shrub, are chewed habitually for euphoric and stimulating effects. The main ingredients, cathinone and cathine, are structurally related to amphetamine and ecstasy," says lead author Waleed Ali, M.D., from Hamad General Hospital in Doha, Qatar. An estimated 5 million to 10 million people worldwide chew khat, predominantly those living in the horn of Africa and the Arabian Peninsula, according to an editorial written by Farrah Mateen, from Johns Hopkins University in Baltimore, and Gregory Cascino, M.D., from the Department of Neurology at Mayo Clinic. They further state that Khat is illegal in the United States, and is not currently an accepted form of medical treatment.

Dr. Ali says, "Patients of Eastern African and Yemeni origins should be evaluated and counseled about khat chewing, even when living in Western countries."

Are Energy Beverages Safe to Drink When Exercising?

ROCHESTER, Minn. -- The resurgence of exercise has been accompanied by multiple supplements, sports drinks, and energy beverages that promise to enhance performance, muscle growth, and recovery. But the question remains: Are energy beverages safe?

"One can of an energy beverage during one session of exercise is safe for most healthy individuals," says John Higgins, M.D., lead author from The University of Texas Medical School in Houston. However, he states, "excess consumption and consumption with other caffeine-containing beverages or alcohol may lead to adverse effects and possibly death."

The United States is the world's largest consumer of energy beverages by volume, and consumption is primarily among people ages 11 to 35 years. The most common ingredient is caffeine, which ranges from 50 milligrams (mg) to 505 mg per 16-ounce serving.

Perspectives on Withdrawing Pacemakers and Implantable Cardioverter-Defibrillators at End of Life Vary Substantially

ROCHESTER, Minn. -- Mayo Clinic researchers found that the majority of medical professionals and patients feel implantable cardiac device (ICD) therapy should be withdrawn based on the patient's right to refuse continued life-sustaining therapy at the end of life.

"Almost one-third of medical professionals surveyed considered withdrawal of a pacemaker in a pacemaker-dependent patient as physician-assisted suicide or euthanasia, but only a very small percentage believed the same about an ICD," says Samuel Asirvatham, M.D., lead author and cardiologist, Mayo Clinic. The article noted that legal professionals tend to view all devices as similar and saw little difference between withdrawal of an ICD and withdrawal of a pacemaker.

"Education and discussion of managing devices at the end of life are important when making end-of-life decisions to better understand patients' perceptions and expectations," says Dr. Asirvatham.

Source: Mayo Clinic