Drivers of mortality come in many forms, and a potentially significant one will come in June in the form of an FDA ban on trans fats in packaged foods. We are familiar with improvements in cardiovascular mortality in the population due to less smoking, improved diet/exercise and improved treatments and technology. We should see another reduction coming from wholesale reduction of trans fats in US pre-packaged foods.
Trans fats are partially hydrogenated oils that were developed for shelf life and the creamy texture. However, studies have shown that they raise LDL (bad) cholesterol and contribute to the development of cardiovascular disease. US companies have been moving away from using trans fats since 2006, when labelling requirements were initiated.
As of June 18, 2018 the FDA will no longer recognize partially hydrogenated oils as “generally recognized as safe” and will ban them from being added to manufactured foods. When Denmark instituted a ban on trans fats, one study showed a reduction of 14.2 deaths per 100,000 people due to cardiovascular disease over the next three years.
And in a study comparing jurisdictions restricting trans fats with those without restrictions in New York, it was found that hospital admissions for myocardial infarction and stroke were reduced 6.2% in those areas with restrictions.
The World Health Organization on May 14 released a plan to eliminate industrially produced trans-fatty acids from the world food supply. Estimates are that, if fully implemented, the plan may eliminate 10 million cardiovascular deaths per year worldwide. Fortunately, trans fats can be replaced without an increase in cost or a loss of taste.
Implementation of these preventative dietary measures should continue to improve mortality.
In this issue Dr. Kadouch presents a case of paraganglioma. This is an unusual tumor in that histology, histochemistry and biomarkers do not predict the risk of recurrence or metastases. The tumor is only determined to be malignant when metastases are found in tissues that do not normally contain the underlying cell type (chromaffin cells). For this reason, surveillance for recurrence is often maintained for years.
And Dr. Rooney presents a case of erythromelalgia. This disorder is diagnosed clinically as there is no definitive test that defines the disease. And finally, a Puzzler is included for your perusal and interpretation.