This month is going to be a bit of a mixed bag of preventive medicine information. Fortunately, we continue to advance and refine our knowledge of what interventions are effective in promoting and sustaining good health. Recently, some good studies have looked at two important areas: your heart and your brain. Let's start with our brains.

Regrettably, we understand that advancing age usually brings with it a decline in cognitive functioning, especially in the areas of memory and information processing speed. In addition, these changes are linked to the development of dementia, such as Alzheimer's. Anything that might lessen the impact of such impairment would be welcomed by all of us. Previously in this space, we have considered the positive effects of statins (lipid- lowering drugs) in this regard, as well as such simple things as reading and other avenues of mental stimulation (crossword puzzles, computer gaming, writing medical columns).

Now we have some encouraging information from the UCLA School of Medicine, published in a recent edition of the Lancet. These researchers looked at the impact of lowering levels of homocysteine (a naturally occurring chemical, previously linked with the development of heart disease) by the use of oral folic acid (a common and safe vitamin). Their results indicated that those people who took 800mcg a day of folic acid had significantly better memory and information processing speed testing at the end of 3 years, compared with those who didn't take the supplement. The importance of this study it that is was well constructed and spanned a significant amount of time (3 years). This research will generate more studies, and additional clarity will be forthcoming. In the meantime, taking 800mcg a day of folic acid is safe, inexpensive, and probably good for you.

Now let's talk about our hearts, and the usefulness of aspirin. Just last evening, as I was thinking about this column, a news story reported that aspirin has been proven to help prevent heart attacks in women. Not much new there. We have long known that aspirin is effective in preventing second heart attacks, and maybe even the first one. It has also been demonstrated to reduce the instance of colon polyps and recently, the development of asthma in adults. This last study was from the Physicians Health Study, an ongoing study of 22,040 physicians, from which a lot a good data has been derived. The interesting thing for me from this study was that instead of using one baby aspirin a day, these researchers used one aspirin (325 mg) every other day. This is important, in that regular aspirin is readily available and is much less expensive than baby aspirin (think of all those Bayer commercials– somebody's got to pay for them). And if you take your folic acid, maybe you can remember to take your aspirin every other day rather than every day. Just another reason to be taking aspirin if you're other the age of 40. Check with your doctor first, though.

And lastly, what if we could reverse the effects of coronary artery disease, the building up of yellowish plaques in our important blood vessels? I will always remember one of the cadavers in our gross anatomy class in Charleston. I had just started medical school, and was 22 years old. One of the bodies was that of a 25 year old man, who had died of a brain hemorrhage. As his aorta was being dissected, one of our anatomy professors called us over to take a look at the discoloration of the inner lining of this large vessel. Instead of being smooth and glistening, there were streaks of yellow, gritty material. "Cholesterol build-up," we were informed. "You guys probably have some by now too."

My chest started hurting, and I laid off bacon. At least for two weeks, I think.

Unfortunately, we all have some plaque build-up, some more than others. And when that amount gets excessive, and the lumen of the vessels get too small, we start having problems. But there's good news here as well. An article in one of this year's editions of JAMA reports that those patients who significantly reduce their bad cholesterol (LDL) levels, or elevate their good cholesterol (HDL) levels can actually reduce the size of their plaque build-up in their coronary vessels. This would be a huge development - the reversal of heart disease. They accomplished this with the use of aggressive statin therapy. Of course, life-style factors are also important, including exercise, smoking cessation, weight loss, and proper diet. As an aside (all of you dieticians should close your eyes) we have been most successful with combining statins with the low-carb diet approach in substantially elevating HDL levels.

So, there are some things to consider. Take your folic acid and your aspirin, and ask your doctor if you should be on a statin.