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Friday, April 8, 2011

 

Fish Oil Boosts Responses to Breast Cancer Drug Tamoxifen, Researchers Find

ScienceDaily

Friday, April 8, 2011

ScienceDaily (Apr. 8, 2011) — Breast cancer is the second most common cancer among women, with more than 200,000 women diagnosed each year. Being exposed to estrogen over a long period of time is one factor that can increase a woman's risk of developing the disease. One way a woman can combat this risk factor is by taking the breast cancer drug tamoxifen, which interferes with the activity of estrogen. Now, researchers at Fox Chase Cancer Center have found that omega-3 fatty acids -- abundant in fish -- could be a safe and beneficial booster for tamoxifen therapy.

Jose Russo, MD, director of the Breast Cancer Research Laboratory at Fox Chase, is presenting the new findings at the AACR 102nd Annual Meeting 2011 on April 6.

To investigate how fish oil intensifies the effects of tamoxifen, Russo, in collaboration with a team led by Andrea Manni, MD, from Pennsylvania State University, induced mammary tumors in rats and then divided the animals into four groups. They fed the groups either a 17 percent fish oil diet, with or without tamoxifen, or a 20 percent corn oil diet, with or without tamoxifen, for eight weeks. They then analyzed gene expression patterns in the tumors. Omega-3 fatty acids produced a greater expression of genes related to cellular specialization, or differentiation -- a sign of lower cancer severity -- compared to corn oil. The combination of fish oil and tamoxifen reduced the expression of genes linked to tumor growth and spreading.

"If a tumor was being treated with tamoxifen, the addition of an omega-3 fatty acid diet seemed to make the tumor, at least at the molecular level, more benign and less aggressive and responsive to tamoxifen," says Russo.

The fish oil diet also boosted the expression of genes related to immune defenses against tumors, more so than did the corn oil diet. But omega-3 fatty acids simultaneously increased the expression of genes that trigger counterproductive immune responses, such as inflammation and allergic reactions, which curtail the ability of cells to fight cancer and can even promote the migration of tumor cells.

More studies are needed to fully understand the effects of fish oil on the immune system, Russo says. Meanwhile, his team is examining whether omega-3 fatty acids can prevent breast cancer in animals and testing the influence of diet on breast cancer risk in women.

Co-authors on the study include Bidinotto, L.T.; Vanegas, J.E.; Vanden Heuvel, J.P.; Lopez, R.; Santucci-Pereira, J.; Washington, S., Xu; H., Russo I.H.; El-Bayoumy, K.; and Manni, A. from Fox Chase.

The work was supported by a grant from Susan G. Komen for the Cure.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

More evidence painkillers lower colon cancer risk

By Kerry Grens

Reuters Health

Friday, April 8, 2011

NEW YORK (Reuters Health) – A new study adds to growing evidence that regular use of painkillers like aspirin or ibuprofen may reduce a person's risk of developing colon or rectal cancers - sometimes by as much as 50 percent.

This latest report also shows that people with a family history of colon cancer - who are therefore at higher risk for the disease - also benefit from the pain relievers.

"The (risk) reductions that we saw here are not inconsequential," said Dr. Elizabeth Ruder of the National Cancer Institute, the study's lead author.

"But we're not at the point that one could make a public health recommendation" based on the findings, she added.

Colon and rectal cancers are diagnosed in about 48 out of every 100,000 people in the U.S., according to the National Cancer Institute.

Together, these "colorectal" cancers are the third-leading cause of deaths from cancer.

Previous studies have found that aspirin is tied to a smaller risk of colon cancer (see Reuters Health story of October 22, 2010).

The current study expanded on earlier research by including larger numbers of people and assessing where in the colon cancers occurred.

Using questionnaire data from more than 300,000 adults, Ruder's group analyzed how often people took any of 19 non-steroidal anti-inflammatory (NSAID) pain medications, which include aspirin, ibuprofen (Advil), naproxen sodium (Aleve), sulindil (Clinoril), and others.

The observed drop in cancer risk varied depending on how often people took the painkillers and the type of cancer in question.

Overall, taking any of the NSAID drugs was associated with a 20 percent drop in the risk of colorectal cancer over 10 years.

And the more frequently people took a drug, the less likely they were to be diagnosed with colon or rectal cancer.

Daily use of an NSAID was associated with a 28 percent drop in colon cancer risk, for instance, whereas monthly use was associated with only a 14 percent reduction in risk.

A similar pattern was seen among people with immediate family members who had been diagnosed with colon cancer: Daily users of NSAIDs saw a 28 percent drop in their risk of colon or rectal cancer, and weekly users had an 11 percent decline.

When the researchers looked at the site in the colon where cancers appeared, the drugs' effects were more pronounced, but distinctly different for aspirin versus non-aspirin NSAIDs.

Those who took aspirin daily, for example, had a 62 percent drop in rectal cancer risk, but their risk of colon cancer did not change.

In contrast, non-aspirin NSAIDs, taken daily, were linked to a 56 percent drop in risk of colon cancers farthest from the rectum (a region called the proximal colon), whereas the risk of rectal cancer was unaffected.

Ruder said it's unclear why there's a difference between the type of drug and the risk of developing a particular type of colorectal cancer.

One of the limitations of the study, the authors note, is that they didn't monitor how long people took the drugs.

The researchers also caution that they did not weigh the potential benefits of the drugs against their drawbacks.

"There's an elevated risk of gastrointestinal ulcers and bleeds" from taking aspirin, said Amanda Cross, an investigator at the National Cancer Institute and another of the study's authors.

"We're certainly not advocating that people take aspirin to reduce the risk of colon cancer," she told Reuters Health.

The research, funded by the National Institutes of Health, is published in the American Journal of Gastroenterology.

Dr. Andrew Chan, a gastroenterologist at Massachusetts General Hospital who was not involved in the study, said it would be premature to offer any recommendations.

"I think what remains to be addressed," Chan said, "is, 'are there specific types of colon cancer that may be most likely to benefit from aspirin use, and who are the best patients to take aspirin?'"

Fewer studies supporting the use of non-aspirin NSAIDS in reducing colon cancer risk have been done, he added.

"This is an area of a lot of controversy," Chan told Reuters Health.

But the study is useful in backing up what doctors are beginning to realize, he said. "These are compelling data, which support (the idea) that aspirin use reduces the risk of colorectal cancer."

Source: http://bit.ly/gXOuZQ

The American Journal of Gastroenterology, online March 15, 2011.

Atherosclerotic Plaques Form During a Late and Limited Time Period in Life, Atom Bomb Residues Reveal

ScienceDaily

Friday, April 8, 2011

ScienceDaily (Apr. 8, 2011) — In a new study performed in humans, researchers from Sweden's Karolinska Institutet have determined the age of atherosclerotic plaques by taking advantage of Carbon-14 (14C) residues in the atmosphere, prevailing after the extensive atomic bomb tests in the 1950s and 60s. The findings, published in the scientific online journal PLoS ONE, suggest that in most people plaque formation occurs during a relatively short and late time period in life of 3-5 years.

The investigators collected carotid plaques during carotid stenosis surgery at the Stockholm South General Hospital (Södersjukhuset). The patients were admitted for surgery since their carotid lesions partly obstructed the blood flow to the brain, causing symptoms of insufficient oxygen called Trans Ischemic Attacks (TIA) that in some cases also had lead to strokes.

The plaques were carbon dated at Uppsala University, by using Accelerator Mass Spectrometry (AMS). As a result of the extensive atomic bomb test in the 1950s and 60s, the atmospheric concentration of 14C rapidly increased. Since then the concentration of 14C is declining, which now can be used to determine the time of synthesis of any biological sample.

"We suspected that the plaque would be substantially younger than the patients, who were on average were 68 years old at surgery, but we were surprised when we found that the average age of these plaques was less than 10 years," says Associate Professor Johan Björkegren, who lead the study at the Department of Medical Biochemistry and Biophysics.

Another striking finding was that the variation of plaque age was low, suggesting that in most people plaque formation occurs during a relative short and late time span in life (3-5 years). If proven true, the growth of atherosclerotic lesions may be interrupted to prevent clinical manifestation, like TIA and stroke, even in late stages of life, at 60 years of age or possibly later.

During the last years, a number of 14C dating studies have been performed at Karolinska Institutet, revealing new perspectives on common diseases involving, fat cells, neurons and cardiomyopathies. However, unlike previous studies, the current study did not date DNA reflecting cell turn over, but instead the entire atherosclerotic lesion.

The age of plaques was also found to be associated to blood levels of insulin, and plaques with lower age (formed more recently) were found to be more unstable than older plaques and therefore more likely to cause clinical complications.

"The correlation between low plaque age, higher insulin levels and instability is also consistent with our findings of gene activity where younger plaques were characterized with higher activity of genes related to immune responses and oxidative phosphorylation," says Dr Björkegren. "However, our study is small and need to be replicated in future, larger clinical studies before we can determine the exact roles of biological age for plaque stability and associated clinical events."

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

Sara Hägg, Mehran Salehpour, Peri Noori, Jesper Lundström, Göran Possnert, Rabbe Takolander, Peter Konrad, Stefan Rosfors, Arno Ruusalepp, Josefin Skogsberg, Jesper Tegnér, Johan Björkegren. Carotid Plaque Age Is a Feature of Plaque Stability Inversely Related to Levels of Plasma Insulin. PLoS ONE, 2011; 6 (4): e18248 DOI: 10.1371/journal.pone.0018248

Nearly 20% of Lung Cancer Patients Keep Smoking

By John Leighty
HealthDay Reporter

HealthDay News

Friday, April 8, 2011

FRIDAY, April 8 (HealthDay News) -- Many patients diagnosed with lung cancer -- as well as their family caregivers -- continue to smoke even though doing so may jeopardize their recovery and long-term health outcome, says a study sponsored by the U.S. National Cancer Institute.

Researchers report that nearly one in five recently diagnosed lung cancer patients continues to light up, which can make them feel guilty or socially stigmatized.

"The biggest obstacle is fatalism, the belief that it is too late to quit smoking so why bother," said Kathryn E. Weaver, study lead author and assistant professor of social sciences and health policy at Wake Forest Baptist Medical Center in Winston-Salem, N.C.

"There are benefits to be gained by quitting that have important implications for survival, response to treatments, and quality of life," she said.

The findings point to the need for family support, counseling and medication to help patients and/or family caregivers overcome their addiction and adopt healthy lifestyle choices, said Weaver.

The study was recently published in Cancer Epidemiology, Biomarkers & Prevention.

The researchers looked at 742 cancer patients and caregivers at multiple sites and found that 18 percent of smokers with lung cancer failed to quit after their diagnosis. Smoking is the leading cause of lung cancer.

Among a subset of smokers with colorectal cancer, which is not strongly associated with tobacco use, 12 percent of the patients continued smoking.

An even higher proportion of the patients' family caregivers also kept on smoking -- 25 percent of those caring for lung cancer patients and 20 percent of those caring for colorectal cancer patients, the researchers found.

Most of the caregivers were middle-aged females and were often spouses of the patients. In some cases, both the patient and the caregiver continued smoking.

If family caregivers see the cancer patient quit, they're more likely to quit themselves, Weaver said. But if either the patient or caregiver continues to smoke, it can trigger issues of guilt, stigma or blame, she added.

Continued smoking increases the likelihood of developing a secondary cancer and can interfere with treatment, the researchers say.

Another clinical reason to stop smoking, said Dr. Norman H. Edelman, chief medical officer of the American Lung Association, is that chronic obstructive pulmonary disorder (COPD) usually accompanies lung cancer, making it more difficult to breathe. Continued smoking exacerbates COPD, he said.

Also, research has suggested that nicotine may be a co-promoter in generating lung cancer, so continual exposure to nicotine might work against chemotherapy treatments, Edelman said.

Given that more than 80 percent of some 200,000 lung cancer cases diagnosed annually in the United States are smoking-related, he said the complex dynamics of why so many smokers don't quit needs to be better understood.

Even patients highly motivated to stop for good often need substantial support, he added.

Weaver said the stressful period following diagnosis of lung cancer can create a "teachable moment" for physicians, nurses and other health care professionals to discuss smoking cessation with the patient and family members, and offer encouragement and resources to quit.

"My long term goal is to develop more effective interventions that can be delivered in the oncology setting, said Weaver.

Janine Cataldo, an assistant professor and researcher in physiological nursing and gerontology at the University of California San Francisco, is developing tools that measure the quality of life and impact of social stigma on lung cancer patients who continue smoking.

"For a smoker to have lung cancer and be unable to quit speaks to the power of nicotine addiction," said Cataldo. The average lung cancer patient is 55 years old and typically has tried and failed to quit smoking several times, she added.

Continued smoking has serious repercussions for lung cancer patients, she said. Patients may develop appetite loss, fatigue, cough or coughing up of blood, pain and poor sleep, said Cataldo. Self-esteem suffers too, and anxiety and depression may also develop, she said.

Cataldo is developing a six-month intervention that focuses on three key components: nicotine replacement therapy to ease withdrawal symptoms; a computerized calling system for monthly phone counseling and weekly follow-up; and creation of a smoke-free home environment.

"The immediate benefits of quitting smoking are easier breathing, increased circulation and improved efficacy of cancer treatments," said Cataldo. "People find that once they quit, they have an increased joy of life, no matter how much they believed in the myth that they would miss cigarettes."

Vegetarian diet linked to lower cataract risk

By Leigh Krietsch Boerner

Reuters Health

Friday, April 8, 2011

NEW YORK (Reuters Health) – Eating less meat and more vegetables is tied to a lower risk of cataracts, a British study says.

In a large dietary survey that followed people for as long as 15 years, researchers found that about three in 50 meat eaters had cataracts, compared to about two in 50 vegans and vegetarians.

The results translated to a 30 to 40 percent lower cataract risk among vegetarians and vegans compared with the biggest meat eaters.

"People who don't eat meat have a significantly lower risk of developing cataracts," said Naomi Allen, an epidemiologist at the UK's University of Oxford who coauthored the study.

A cataract occurs when the lens of the eye becomes cloudy, blurring vision. They're more common in older people, and more than half of Americans either have cataracts by the time they're 80 or have had surgery for them, according to the National Eye Institute.

The British findings do not mean that people should necessarily become vegetarians to avoid getting cataracts, Allen told Reuters Health.

The study does not prove that eating meat promotes cataracts. Eating a lot of vegetables might be protective, for instance - some past research has linked certain nutrients in plant foods to a lowered risk of cataracts. A vegetarian diet may also simply be a sign of other healthy behaviors that contribute to the lowered risk.

Smoking, diabetes, and exposure to bright sunlight are also linked to an increased risk for cataracts.

The new findings actually contradict a study done in India, where a vegetarian diet was associated with high numbers of cataracts, said Dr. Jack Dodick, who chairs the department of ophthalmology at New York University Langone Medical Center.

"It means that still to this day we don't know what influences cataracts. It may be more lifestyle. There may be other factors in causing cataract other than diet," Dodick, who did not work on the current study, told Reuters Health.

The British researchers asked more than 27,600 people older than 40 to fill out dietary surveys between 1993 and 1999, then monitored the participants' medical records between 2008 and 2009 to see if they developed cataracts. Almost 1,500 had cataracts during the follow-up period.

The highest risk was seen among the heaviest meat-eaters - those who consumed more than 100 grams (3.5 ounces) of meat daily. Moderate meat eaters were only slightly less likely to develop cataracts. Fish eaters' risk was 15 percent lower than that of the heavy meat eaters, vegetarians' 30 percent lower and vegans' 40 percent lower.

This study, published in the American Journal of Clinical Nutrition, was well done, Dodick said, but there are "still a lot of questions that need to be answered."

Whether nutrition really plays a role in cataract risk is still not clear cut, he said.

It's generally accepted that if you live long enough everyone will develop a cataract, Dodick added.

Cataracts are treated by surgery. Operations typically performed in the U.S. can cost between $1,500 and $3,000.

"It's the most performed operation in the U.S.," Dodick said. "Approximately 3.5 million cataract surgeries are performed a year."

To decrease the probability of early onset cataracts, "the top of my list would be always protect eyes against ultraviolet rays when outdoors (by wearing sunglasses)," Dodick said.

"The moral of the story is, live life in moderation," Dodick added. "A healthy active lifestyle with exercise might decrease the risk of cataracts."

Source: http://bit.ly/eMiI0R

The American Journal of Clinical Nutrition, online March 23, 2011.

Short Bursts of Exercise Good for the Heart: Study

HealthDay News

Friday, April 8, 2011

FRIDAY, April 8 (HealthDay News) -- All exercise is the same, right? Not so fast, suggests a small study of teens out of Scotland that found that high-intensity exercise may be better than endurance training for preventing cardiovascular disease because it can be done in less time.

The study included 57 adolescent schoolchildren (47 boys and 10 girls) who were randomly assigned to high-intensity or moderate-intensity exercise groups.

Both groups did three exercise sessions a week for seven weeks. The high-intensity group's program consisted of a series of 20-meter sprints over 30 seconds, while the children in the moderate-intensity group ran steadily for 20 minutes.

By the end of the seven weeks, teens in the moderate-intensity group had completed a total of 420 minutes of exercise, compared to 63 minutes for those in the high-intensity group. Estimated total energy expenditures per child were 4,410 kcal for those in the moderate-intensity group and 907.2 kcal for those in the high-intensity group.

Both groups of children showed significant improvements in cardio-respiratory fitness, blood pressure, body composition and insulin resistance. But the teens in the high-intensity group achieved those health benefits with only 15 percent of the exercise time put in by those in the moderate-intensity group.

The findings, published April 5 in the American Journal of Human Biology, suggest that brief, intense workouts offer a time-efficient way to reduce cardiovascular disease risk factors in teens, said study author Duncan Buchan, of the University of the West of Scotland, and his colleagues.

However, further research is needed, they added.

More information

The U.S. Centers for Disease Control and Prevention outlines recommended amounts of exercise for children and teens.

Very high caffeine intake linked to leaky bladder

By Amy Norton

Reuters Health

Friday, April 8, 2011

NEW YORK (Reuters Health) – Women who down a lot of caffeinated drinks each day may have a slightly increased risk of developing urinary incontinence, a new study suggests. The results add to conflicting evidence on whether caffeine worsens a common condition.

Researchers found that of more than 65,000 U.S. women, those with the highest caffeine intake -- roughly equivalent to four or more cups of coffee per day or 10 cans of soda -- were more likely than the less-caffeinated to develop urinary incontinence over 4 years.

Compared with women who got the least caffeine, those with the highest intake were 19 percent more likely to develop frequent problems with bladder control (at least once a week).

The study found no increased risk among women consuming 299 milligrams of caffeine - the equivalent of about three cups of coffee - or less per day.

In the most highly caffeinated group that downed 450 mg or more per day, however, caffeine was particularly related to urge incontinence, or urgency, a type of incontinence where leakage happens after a sudden, strong urge to urinate.

The findings, reported in the Journal of Urology, do not prove that caffeine caused the women's bladder-control problems.

And if caffeine is to blame, it may only be at very high amounts.

"We only observed an increased risk of urinary incontinence among women with the highest intakes of caffeine -- that is, women who consumed about four or more cups of coffee per day," Dr. Mary K. Townsend, one of the researchers on the work, told Reuters Health in an email.

"We found no increase in risk among women with lower caffeine intakes," said Townsend, of Harvard Medical School in Boston.

She said it is too early to give women specific advice on caffeine intake. More studies are needed to confirm the current results.

Another study published in March looked at 14,000 Swedish women and found no increased risk of incontinence among coffee drinkers when age was taken into account (see Reuters Health story of April 6, 2011). That analysis did not factor in the amounts of caffeine individual women consumed, however.

Women who already have urinary incontinence are commonly told to limit their caffeine intake, Townsend noted.

"Our study suggests that avoiding higher caffeine intake might also be useful advice for women who do not have urinary incontinence, but are concerned about developing (it)," she said.

The findings are based on data from two large long-term studies of U.S. nurses who were between the ages of 37 and 79 at the outset. Of 65,176 women who were initially incontinence-free, half fell into the lowest caffeine intake group -- less than 150 mg of caffeine a day. That's roughly equivalent to less than a cup of coffee per day.

Another 9 percent reported downing more than 450 mg of caffeine or more per day. That equates to about four or more cups of coffee each day, or 10 cups of tea or cans of caffeinated soda.

Of the women in that high-caffeine group, 2.7 percent developed frequent urinary incontinence each year over the next 4 years. That compared with 1.9 percent in the lowest-intake group.

The researchers then factored in a number of other variables -- like women's age, weight and smoking habits. They found that a very high caffeine intake, itself, was tied to a 19 percent increase in the risk of frequent incontinence.

According to Townsend, caffeine might promote incontinence because it is a diuretic - it promotes flushing of water from the body -- and people who already have an overactive bladder may be more susceptible to those effects.

There's also evidence, she said, that even low doses of caffeine can speed muscle contractions in the bladder.

Urinary incontinence is about twice as common in women than men, and its likelihood rises with age. One large U.S. study found that almost one-quarter of women in their 60s and 70s said they had urine leakage at least once a month; the rate rose to one-third among women in their 80s.

Risk factors for urinary incontinence include obesity and past pregnancies with vaginal births.

Source: http://bit.ly/gKhAVP

Journal of Urology, online March 18, 2011.

Blood Protein Levels May Predict Risk of a Cardiovascular Event

ScienceDaily

Friday, April 8, 2011

ScienceDaily (Apr. 8, 2011) — Increased levels of a protein that helps regulate the body's blood pressure may also predict a major cardiovascular event in high-risk patients, according to a study led by St. Michael's Hospital's cardiovascular surgeon Subodh Verma. Measuring the amount of the protein, known as plasma renin activity (PRA), in the blood stream may give doctors another tool to assess a patient's risk and help prevent a heart attack or stroke.

"Conventional factors like genetics and environment do not always provide a complete patient story and an understanding of cardiovascular risk," says Dr. Subodh Verma, senior author, researcher and cardiovascular surgeon at St. Michael's Hospital. "The plasma renin activity blood marker allows us to identify people at a higher risk and that gives us the opportunity to introduce therapies that would work to lower a patient's PRA levels."

Published in March in the European Heart Journal, the paper was based on 2,913 Canadian HOPE (Heart Outcomes Prevention Evaluation) study patients. Patients in the study had stable chronic vascular disease and/or diabetes and one cardiovascular risk factor.

"This study makes a strong case for further study of PRA and its association with cardiovascular death," explains Dr. Verma. "The next step will be to move into larger trials with PRA therapies and study whether or not this impacts the cardiovascular death rate. This could be a big step forward in our battle against heart disease."

The Heart & Stroke Foundation estimates that heart disease and stroke costs the Canadian economy more than $22.2 billion every year in physician services, hospital costs, lost wages and decreased productivity.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

S. Verma, M. Gupta, D. T. Holmes, L. Xu, H. Teoh, S. Gupta, S. Yusuf, E. M. Lonn. Plasma renin activity predicts cardiovascular mortality in the Heart Outcomes Prevention Evaluation (HOPE) study. European Heart Journal, 2011; DOI: 10.1093/eurheartj/ehr066 

Thursday, April 7, 2011

Caffeine and Diabetes: Helpful or Harmful?

ScienceDaily

Thursday, April 7, 2011

ScienceDaily (Apr. 7, 2011) — A growing body of research suggests that caffeine disrupts glucose metabolism and may contribute to the development and poor control of type 2 diabetes, a major public health problem. A review article in the inaugural issue of Journal of Caffeine Research: The International Multidisciplinary Journal of Caffeine Science, a quarterly peer-reviewed journal from Mary Ann Liebert, Inc. publishers, examines the latest evidence, contradicting earlier studies suggesting a protective effect of caffeine.

James Lane, PhD, Duke University, describes numerous studies that have demonstrated caffeine's potential for increasing insulin resistance (impaired glucose tolerance) in adults that do not have diabetes, an effect that could make susceptible individuals more likely to develop the disease. In adults with type 2 diabetes, studies have shown that the increase in blood glucose levels that occurs after they eat carbohydrates is exaggerated if they also consume a caffeinated beverage such as coffee. This effect could contribute to higher glucose levels in people with diabetes and could compromise treatment aimed at controlling their blood glucose.

"More than 220 million people worldwide have diabetes, says Editor-in-Chief Jack E. James, PhD, School of Psychology, National University of Ireland, Galway, Ireland. "The links that have been revealed between diabetes and the consumption of caffeine beverages (especially coffee) are of monumental importance when it is acknowledged that more than 80% of the world's population consumes caffeine daily. Dr. Lane's review of the topic gives the clearest account to date of what we know, what we don't know, and what needs to be done -- urgently!"

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

James D. Lane. Caffeine, Glucose Metabolism, and Type 2 Diabetes. Journal of Caffeine Research, March 2011, 1(1): 23-28 DOI: 10.1089/jcr.2010.0007

Stent studies don't reflect "real world" patients

By Kerry Grens

Reuters Health

Thursday, April 7, 2011

NEW YORK (Reuters Health) – Stroke-preventing devices are not being tested in people who resemble the patients most likely to receive them, a new study shows.

The researchers looked at tests being done as part of "post-market surveillance studies," which test products that are already approved and in general use by the public.

They found that patients who had small mesh tubes, called stents, placed into their neck in these studies were healthier than other patients in a broader nationwide registry of people who received stents.

"We were surprised," said Dr. Robert Yeh, the lead author of the study and a cardiologist at Massachusetts General Hospital and Harvard Medical School.

"The intention and presumption of most post-marketing studies is that they represent the group of patients that we see in clinical practice."

Yet the patients in the larger registry database who weren't in the post-marketing studies were 50 percent more likely to have had a stroke in the past, and were four times as likely to die in the hospital, Yeh said.

"When we look at these results (from post-marketing surveillance) we should be a little bit careful in applying them to the patient in front of us," Yeh told Reuters Health.

People in the study were having a stent put into a major blood vessel in the neck that had become narrowed, to widen it and prevent plaque from moving into the brain and causing a stroke.

The blood vessel is known as the carotid artery. When carotid artery stents were first approved, the Food and Drug Administration required that companies monitor their safety and effectiveness after they came on the market.

Like stents that are placed in heart arteries, carotid artery stents are implanted through an incision in the skin - usually in the groin -- without surgery.

Yeh and his colleagues looked at the health characteristics before and after stenting for 7,115 patients in the national registry; roughly half of them participated in surveillance studies.

They found that four of every 10 patients in the surveillance studies had experienced a stroke or mini-stroke before they had the stent.

In contrast, six of every 10 patients who were not involved in any studies had had a stroke or mini-stroke (also called a transient ischemic attack, or a TIA).

Surveillance study participants were also less likely to have had any symptoms of stroke at the time of their stent procedure.

"There's a reasonable explanation for that," said Dr. William Gray, a cardiologist at Columbia University Medical Center and New York-Presbyterian Hospital, who has conducted post-market studies of stents. He was not involved in this study.

Gray said it all comes down to insurance; Medicare, in particular.

Medicare, the federally-funded health insurance for people over age 65, pays for stenting when people have symptoms.

When people don't have stroke symptoms, they are more likely to enroll in studies - such as post-marketing surveillance -- that will cover the costs of the procedure, Gray told Reuters Health.

Yeh agreed that insurance could partially explain the differences, but he thinks it doesn't explain them all.

The risk of dying 2 years after stenting was also 20 percent lower among patients in the post-marketing studies than among people in the larger registry who didn't enroll in a study.

Yeh said that difference might be explained by the skills of the physicians performing the stenting procedures for post-marketing studies.

"Maybe physicians are paying more attention," Yeh told Reuters Health.

Or, it could be that studies exclude sicker patients, because people need to be well enough to sign and read papers and consent to joining the study, Yeh said.

The authors write that post-marketing surveillance studies "may be insufficient for monitoring long-term, community-based outcomes," and that nationwide registries might be better able to fill that role.

The study, published in the journal Circulation, was funded by the American College of Cardiology Foundation, which developed the national database, or registry, of carotid artery stent procedures.

The Food and Drug Administration and Boston Scientific - a company that makes carotid artery stents -- did not respond to requests for comment.

Another stent maker, Abbott, said in an email to Reuters Health, "the company is supportive of clinical registries as they contribute to the overall body of data on product use and provide additional data that help physicians treat their patients," but would not comment on the study.

When the carotid artery becomes clogged, another option for widening it is to have surgery to remove the plaque. Doctors have debated the benefits of carotid artery stents versus surgery.

Neither procedure is ideal. People who have surgery are more likely to later have a heart attack, while those who undergo stenting are more likely to suffer a stroke later on (see Reuters report, October 11, 2010).

Source: http://bit.ly/ex4z8D

Circulation, online March 21, 2011.

Study Finds Strong Smoking-Asthma Link

HealthDay News

ScienceDaily

Thursday, April 7, 2011

THURSDAY, April 7 (HealthDay News) -- The link between smoking and asthma may be even stronger than previously suspected, a new study finds.

Researchers analyzed data from a large, epidemiological survey of American adults (the National Comorbidity Survey-Replication) and found that people who were diagnosed with asthma were 1.26 times more likely to have been a smoker and about twice as likely to have been nicotine dependent at some point in their lives, compared to those without asthma.

The link between asthma and smoking was even stronger among adults who said they'd been nicotine dependent in the previous 12 months.

"Individuals with asthma were nearly three times as likely as those without asthma to have reported nicotine dependence in the past 12 months after controlling for demographic and drug abuse/dependence variables," Alison McLeish, an assistant professor of psychology at the University of Cincinnati, and her colleagues wrote in the study.

About half of the smokers with asthma said they started smoking before they were diagnosed with asthma. These adults were diagnosed with asthma at a much later age than those who began smoking after they were diagnosed with asthma.

The proportion of people who had been nicotine dependent at some point in their lives was similar among those who started smoking before (29.3 percent) or after (25.7) they were diagnosed with asthma.

The study appears online in the Journal of Health Psychology.

More information

The U.S. National Heart, Lung, and Blood Institute has more about asthma. 

Wednesday, April 6, 2011

Coffee, tea may not affect leaky bladder much

By Leigh Krietsch Boerner

Reuters Health

Wednesday, April 6, 2011

NEW YORK (Reuters Health) – Despite international guidelines that suggest cutting caffeine to counter urinary incontinence, a new study finds that coffee or tea may not have much effect on the condition.

In a study of more than 14,000 Swedish twins, researchers found that drinking tea did not significantly increase the odds of having a leaky bladder. When age was taken into account, coffee drinkers had a somewhat decreased risk of the urinary disorder.

There have been plenty of studies about incontinence and caffeine, but the results have been inconsistent, according to lead author Giorgio Tettamanti, a doctoral student in epidemiology at the Karolinska Institutet in Stockholm, Sweden.

"What we found is not really surprising, but it goes against current knowledge," Tettamanti told Reuters Health by email.

Doctors sometimes tell women with urinary incontinence to try reducing caffeine intake, said Nancy Nairi Maserejian, an epidemiologist at New England Research Institutes, Inc., in Watertown, Massachusetts.

"It's actually part of the guidelines," Maserejian, who was not part of the study, told Reuters Health. Practice recommendations for doctors from the National Collaborating Center for Women's and Children's Health in the U.K. are used as international guidelines, she said.

But the new finding doesn't mean that women with leaky bladders should start downing lattes.

"I don't think we can make a blanket statement from this study," Maserejian said. "Moderation is key and women have to talk to their physicians and decide what works for them."

Tettamanti and co-workers ran an online survey of sets of female twins, asking about caffeine-consumption habits as well as urinary incontinence symptoms. In all age groups, slightly more than 900 of the women reported having at least one leaky bladder symptom.

Initially, the researchers found that about nine out of 100 coffee drinkers had urinary incontinence, compared to about six out of 100 non-coffee-drinkers.

However, when they adjusted their analysis to take into account other potential contributing factors -- including age, body mass index (a ratio of weight to height), smoking and whether the women had given birth - there was actually a decreased risk of incontinence, by about 22 percent, among coffee drinkers.

It turns out the coffee drinkers tended to be older and their age explained most of the original higher rate of incontinence, the report notes.

The researchers did not have sufficient information, though, to determine whether the seeming protective effect of coffee drinking came from the fact that women with incontinence might be avoiding coffee -- so women without incontinence would be more likely to be among the coffee drinkers.

Tettamanti's group did find a link between drinking tea and overactive bladder -- the sudden need to urinate, usually several times a day. Again, however, when they compared members of both identical and fraternal twin pairs, the association went away.

Comparing twins to each other allows researchers to tease apart inherent predispositions, like a family tendency to develop incontinence, from learned behaviors and other outside influences.

The study was published in the obstetrics and gynecology journal, BJOG.

In the U.S., between one and two out of 10 women report weekly bladder leakage, according to the Centers for Disease Control and Prevention.

Even though the current study didn't find an increased risk of urinary incontinence in people who drink coffee or tea, Tettamanti suggested that limiting these beverages may reduce total fluid intake and consequently how full the bladder becomes.

Drinking less fluid does not seem to help women avoid developing incontinence, another large study of women recently concluded (See Reuters Health story of March 11, 2011). Decreasing fluids can improve leaky bladder symptoms among women who are already incontinent, though, Tettamanti said.

"However, keep in mind that fluid restriction may cause troublesome constipation among elderly patients, and elderly subjects are more likely to experience urinary incontinence," he said.

More people have urinary incontinence as they get older, Maserejian agreed. "The bladder is muscle and the ability to hold the urine in weakens."

Genetic factors, childbearing, and greater body weight, especially around the waist, can also increase the risk of leaky bladder. Weight reduction can improve urinary incontinence, she said.

Women with incontinence should "ask about their specific situation and what their provider would suggest for them," Maserejian said.

Source: http://bit.ly/e3ulhx

BJOG, online March 15, 2011.

Simple treatment cuts preterm births by 45 percent

By Julie Steenhuysen

Reuters

Wednesday, April 6, 2011

CHICAGO (Reuters) – Treating high-risk pregnant women with the hormone progesterone cut their rate of premature delivery by 45 percent and helped lower the risk of breathing complications in their babies, U.S. researchers said on Wednesday.

The late-stage study of the vaginal gel made by Columbia Laboratories Inc and Watson Pharmaceuticals Inc raises hopes for a simple way to prevent premature birth in women with a short cervix.

"The study published today offers hope to women, families and children," Dr. Roberto Romero, chief of the perinatology research branch of the National Institutes of Health, said in a statement.

"Worldwide, more than 12 million premature babies - 500,000 of them in this country - are born each year, and the results are often tragic. Our clinical study clearly shows that it is possible to identify women at risk and reduce the rate of preterm delivery by nearly half, simply by treating women who have a short cervix with a natural hormone - progesterone," Romero said.

Babies born too early -- before the 33rd week of pregnancy -- have a higher risk of early death and long-term health and developmental problems.

In the United States, 12.8 percent of babies were born preterm in 2008, raising their risk of dying in their first year and having breathing difficulties, cerebral palsy, learning disabilities, blindness and deafness.

Hormone Gel

The findings, published online in the journal Ultrasound in Obstetrics and Gynecology, will be used to support the companies' application for marketing approval of the hormone gel, known by the brand Prochieve.

The companies said they plan to file for U.S. approval in the second quarter of this year.

In the study, researchers at the NIH and 44 medical centers around the world looked at effects of giving progesterone to women with a short cervix, which is the part of the uterus that opens and shortens during labor.

Researchers suspect that women with a short cervix may not have enough of this hormone, and giving it during pregnancy in a gel form might help prolong their pregnancies.

The team studied 458 women with a short cervix who got either a vaginal gel containing progesterone or a placebo between the 19th and 23rd week of pregnancy.

Only 8.9 percent of women who got the gel delivered before the 33rd week of pregnancy, compared with 16.1 percent who were in the placebo group.

The treatment also helped babies. Only 3 percent of babies born to women treated with progesterone had respiratory distress syndrome compared with 7.6 percent of babies in the placebo group.

"We have for a long time known that short cervix is associated with an increased risk of preterm birth," said Dr. Ashley Roman of New York University's Langone Medical Center, who was not involved with the research.

Roman said other studies have shown that progesterone can cut the risk of premature birth in women with this problem. She said the NIH study is important because it shows that the treatment also reduces respiratory problems in newborn babies.

"Not only are fewer babies being delivered preterm, fewer babies have medical problems associated with prematurity," she said in a statement.

Watson's shares were up about 1 percent in afternoon trading on the New York Stock Exchange, while shares of Columbia fell about 2 percent after touching an earlier 52-week high on Nasdaq.

(Editing by Vicki Allen)

PFCs linked to earlier menopause

By Amy Norton

Reuters Health

Wednesday, April 6, 2011

NEW YORK (Reuters Health) – Women exposed to high levels of certain household-product chemicals may go through menopause at a younger age than other women, a new study finds.

The chemicals in question are called perfluorocarbons, or PFCs, and they have historically been widely used in products ranging from furniture and carpeting to non-stick pans, plastic food containers and clothing. Their use in the U.S. is set to be phased out by 2015.

But PFCs persist in the environment, and the chemicals are found in water, soil, plants, animals and people. A 2004 U.S. government study detected PFCs in 98 percent of blood samples taken from a large pool of Americans.

Animal research suggests that PFCs act as endocrine disruptors -- meaning they interfere with normal hormone function.

"But up until now, basically nothing has been known about the effects in women," said Dr. Sarah S. Knox, a professor at the West Virginia University School of Medicine in Morgantown and lead researcher on the new study.

Knox and her colleagues found that among women older than 42, those with relatively higher blood levels of PFCs were more likely to have gone through menopause. They also tended to have lower estrogen levels than other women.

Whether PFCs were the cause is not known, Knox said.

"It's a correlation, and correlation is not causation," she told Reuters Health in an interview. "We can't say that PFCs cause early menopause."

"But we think that these findings are a red flag, and this warrants further investigation," Knox said.

The main concern with earlier menopause and waning estrogen levels is that they could raise a woman's risk of conditions such as heart disease and osteoporosis.

The findings, published in the Journal of Clinical Endocrinology & Metabolism, are based on 26,000 West Virginia women whose drinking-water supplies had been contaminated with PFCs from a nearby DuPont plant in 2005 and 2006. The blood testing was performed as part of a lawsuit over the water contamination.

On average, area residents' levels of one type of PFC, called PFOA, were very high -- 500 percent higher than the average American's. However, their average level of another PFC, called PFOS, was similar to the U.S. norm.

The researchers found that among women older than 42, those with relatively higher levels of PFOS were more likely to have already gone through menopause.

Of women between the ages of 42 and 51, those in the top 20 percent for PFOS levels were 40 percent more likely to have gone through menopause, versus women in the bottom 20 percent.

The odds were even greater among women older than 51. Those with the top PFOS levels were twice as likely to have gone through menopause as those with the lowest levels of the chemical.

In addition, the women's blood levels of estrogen generally dipped as their PFOS levels rose.

Since the study group was similar to the U.S. average when it came to PFOS levels, Knox said the findings could be widely relevant.

There was also a correlation between PFOA levels and menopause among women older than 51, though it was not as strong.

More studies are needed to find out whether PFCs themselves alter women's hormonal function, according to Knox.

In the meantime, she said there are steps people can take that may curb their PFC exposure. That includes avoiding fabrics with stain- or water-resistant treatments; non-stick cookware; and food in containers designed to be grease-resistant -- french fries, pizza and microwave popcorn being common examples.

Source: http://bit.ly/hZwGpM

Journal of Clinical Endocrinology & Metabolism, online March 16, 2011.

Overall Health May Be Key to Beating Breast Cancer

HealthDay News

Wednesday, April 6, 2011

WEDNESDAY, April 6 (HealthDay News) -- Poor overall health seems to be associated with worse outcomes for breast cancer survivors, according to the results of a new study.

Researchers analyzed data from almost 9,400 early stage breast cancer survivors participating in the After Breast Cancer Pooling Project. The patients completed a health assessment survey shortly after diagnosis, and follow-up occurred an average of seven years after diagnosis.

The survey results showed that about half the women were in poor physical health. Higher body mass index (a measurement that takes into account a person's height and weight) was strongly associated with low physical health scores, said the team at the University of California San Diego Moores Cancer Center.

Women with poor physical health scores had a 27 percent increased risk of experiencing either a recurrence of their breast cancer or a new breast cancer, and a 65 percent increased risk of death from any cause, the researchers said.

The researchers also found that breast cancer survivors with low health scores were less physically active, more likely to have sleep problems, had 50 percent higher rates of high blood pressure and diabetes, and were twice as likely to have arthritis.

The study was slated for presentation Wednesday at the annual meeting of the American Association for Cancer Research (AACR), in Orlando, Fla. Experts note that research presented at meetings has not been subjected to the same type of rigorous scrutiny given to research published in peer-reviewed medical journals.

Taking care of health problems in breast cancer survivors can improve their well-being and help them avoid associated breast cancer risks, said John P. Pierce, a professor of cancer prevention and associate director for population sciences at Moores Cancer Center.

"Instead of looking at breast cancer survivors as a whole, we need to focus on the women with low physical health scores, those most at risk," he said in an AACR news release. "An increase of 5 percent in their physical health scores can reduce their risk. We can empower them to take charge of their health and thereby improve their chance of survival as well as their quality of life."

More information

The U.S. National Cancer Institute has more about breast cancer.

Young female athletes at risk for stress fractures

Genevra Pittman

Reuters Health

Wednesday, April 6, 2011

NEW YORK (Reuters Health) – Girls who spend lots of time playing high-impact sports including gymnastics and basketball are twice as likely to suffer a small crack in their bones than girls who spend less time exercising, or those who play low-impact sports, says a new study.

Stress fractures are especially worrisome in adolescent girls because puberty is an important time for bones to strengthen, which wards off osteoporosis later in life.

"I certainly don't want to be discouraging any girls from becoming active," Alison Field, the article's lead author who studies adolescent medicine at Children's Hospital Boston, told Reuters Health.

"The problem is there are some girls that are too active," she said. When that's the case, "your body's just not getting the time it needs to heal. And that's particularly true for stress fractures."

The small cracks generally occur in weight-bearing bones in the leg and foot and develop over time when bones don't have a chance to repair themselves during ongoing physical activity.

In the current study, published in Archives of Pediatrics & Adolescent Medicine, Field and her colleagues surveyed almost 7,000 girls ages 9 to 15 over a period of 7 years. Every 1 or 2 years, girls recorded how many hours a week they spent participating in a variety of sports and other physical activities.

At the end of the 7 years, girls' mothers were asked if their daughters had been diagnosed with a stress fracture during the study period. All mothers were registered nurses who were participating in another long-term health study.

A total of 267 girls, or about 4 percent, were diagnosed with a stress fracture. Spending 1 to 2 hours a day playing any sport meant that girls were twice as likely to get a stress fracture compared to those that spent about 30 minutes or less being active every day.

When the authors examined stress fracture risk by sport, they found that only participating in high-impact activities - basketball, cheerleading, gymnastics and running - made girls more likely to get a stress fracture. The researchers calculated that each extra hour spent playing a high-impact sport every week increased a girl's risk of getting a stress fracture by about 8 percent.

Girls who played sports considered "medium-impact," such as baseball or hockey did not have an extra risk of stress fracture, nor did those who participated in non-impact activities such as biking and swimming.

Field said that the findings were especially troubling given that more young athletes are specializing in one sport and putting strain on the same muscles and bones every season.

The authors did not find that having low body weight or symptoms of an eating disorder were linked to stress fracture risk, which was a surprise, Field said. But they did find that girls who got their period at a later age were more likely to suffer a stress fracture - and first periods are often delayed in girls who are very thin.

For girls especially, variety is an important part of athletic training, Field said. Runners, for example, can spend some of their time cross-training on a bike or elliptical trainer to use different muscles and avoid damage to their bones, she said.

While some weight-bearing activity is good for bones, the message for young athletes with high-intensity training plans and their coaches is: "can we bring that down a level?" Field said.

"What we're seeing is that some kids are spending a phenomenal amount of time engaged in sports," she added. "As with most things, you can do too much of a good thing."

Source: http://bit.ly/eJxzDm

Archives of Pediatrics & Adolescent Medicine, online April 4, 2011.

Older Age Memory Loss Tied to Stress Hormone Receptor in Brain

ScienceDaily

Wednesday, April 6, 2011

ScienceDaily (Apr. 6, 2011) — Scientists have shed new light on how older people may lose their memory. The development could aid research into treatments for age-related memory disorders.

Stress and memory

Many believe that stress is bad for our brains especially as we get older. Now University researchers have shown how two receptors in older brains react to a stress hormone called cortisol. This has been linked to increasing forgetfulness as we age.

"While we know that stress hormones affect memory, this research explains how the receptors they engage with can switch good memory to poorly-functioning memory in old age," according to Dr Joyce Yau of the University's Centre of Cardiovascular Science.

Stress hormone receptors

The study, by the University of Edinburgh, found that one receptor was activated by low levels of cortisol, which helped memory. However, once levels of this stress hormone were too high they spilled over onto a second receptor. This activates brain processes that contribute to memory impairment.

The study found that high levels of the stress hormone in aged mice made them less able to remember how to navigate a maze. The memory recall problem was reversed when the receptor linked to poor memory was blocked.

The research helps explain why too much stress over a prolonged period interferes with the normal processes in storing everyday memories.

This is despite the fact that a little bit of stress can help us better remember emotional memories.

Dr Joyce Yau said: "We now know that lowering the levels of these stress hormones will prevent them from activating a receptor in the brain that is bad for memory. Understanding the mechanisms in the brain, which affect memory as we age, will help us to find ways to combat conditions linked to memory loss."

Potential drug treatment

The researchers are currently investigating a new chemical compound which blocks an enzyme -- 11beta-HSD1 -- that is involved in producing stress hormones within cells.

They hope this could be used to develop a drug treatment to slow the normal decline in memory associated with aging or even improve memory in the already very old.

The study was funded by the Medical Research Council. This research is also supported by a Seeding Drug Discovery Award from the Wellcome Trust.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

J. L. W. Yau, J. Noble, J. R. Seckl. 11 -Hydroxysteroid Dehydrogenase Type 1 Deficiency Prevents Memory Deficits with Aging by Switching from Glucocorticoid Receptor to Mineralocorticoid Receptor-Mediated Cognitive Control. Journal of Neuroscience, 2011; 31 (11): 4188 DOI: 10.1523/JNEUROSCI.6145-10.2011

Tuesday, April 5, 2011

Study finds blood marker can't predict Alzheimer's

By Kate Kelland

Reuters

Tuesday, April 5, 2011

LONDON (Reuters) – Scientists searching for clues to Alzheimer's have found that higher blood levels of a protein called clusterin are closely linked with the presence and severity of the brain disease, but not with the risk of developing it.

The research, published in the Journal of the American Medical Association, helps scientists confirm the importance of clusterin as an Alzheimer's signal, but also shows it is unlikely to be useful in predicting who might fall prey to the fatal mind-robbing disease later in life.

Alzheimer's affects around 26 million people across the world and, in 2010 alone, cost $604 billion to treat. The number of sufferers is expected to triple by 2050 as populations age.

It is diagnosed by symptoms and can only be confirmed by examining the brain in an autopsy after a patient has died.

Despite decades of research, scientists and drugmakers have so far failed to develop any treatments that can halt or reverse the progression of the disease, which robs its victims of their mental faculties, affecting memory, thinking, behavior and the ability to handle daily activities.

Bapineuzumab, an experimental drug being developed by Pfizer and Johnson & Johnson, is among the most advanced in the search for effective treatments but recent attempts by Eli Lilly and Medivation to develop a meaningful treatment have largely failed.

A separate study published on Sunday identified five new gene variants linked to Alzheimer's and scientists say they are starting to piece together the puzzle, getting closer to the possible development of treatments.

Monique Breteler of the Erasmus MC University Medical Center in the Netherlands, who conducted this study with colleagues, said it showed that clusterin has a clear role in the disease.

"Clusterin levels cannot be used as a predictor of the disease but it seems that clusterin levels get elevated during the disease course," she said in a telephone interview.

The team analyzed data on blood levels of clusterin measured between 1997 and 1999 in 60 people who had Alzheimer's disease, a random sub-group of 926 other study participants who had no disease, and another 156 people who were diagnosed during the period of the study up until January 2007.

They found that the likelihood of a patient having Alzheimer's disease increased in line with increasing blood levels of clusterin. And among patients with Alzheimer's, higher clusterin levels were linked with more severe disease.

"Our data from the general population show that increased plasma clusterin levels are associated with prevalent Alzheimer's disease (AD) and are higher in more severe cases." they wrote. "However, increased levels of clusterin do not precede development of AD and therefore are not a potential early marker of subclinical disease."

(Editing by Greg Mahlich)

Soy Foods OK After Breast Cancer: Study

By Kathleen Doheny
HealthDay Reporter

HealthDay News

Tuesday, April 5, 2011

TUESDAY, April 5 (HealthDay News) -- Some breast cancer survivors fear that eating foods containing soy will increase the risk of a cancer recurrence, but new research suggests that those worries appear to be unfounded.

"We did not see any evidence that soy intake after breast cancer increases the risk of recurrence or deaths [from breast cancer]," said Dr. Xiao Ou Shu, a professor of epidemiology and medicine at Vanderbilt University Medical Center in Nashville.

"Our study indicated that soy food intake among breast cancer survivors is safe and may reduce the risk of recurrence," she said.

She emphasized she is talking about soy foods, such as tofu and soybeans, not soy supplements.

The research is to be presented Tuesday at the American Association for Cancer Research's annual meeting in Orlando, Fla. Results of studies presented at meetings are considered preliminary until published in a peer-reviewed journal.

For the study, Shu evaluated data on 9,515 women who had participated in one of three studies of breast cancer survivors: Life After Cancer Epidemiology, Women's Healthy Eating and Living and the Shanghai Breast Cancer Survival studies.

Shu reviewed information from food questionnaires on the women's soy food intake. The average time between breast cancer diagnosis and soy food evaluation was about 14 months.

After a follow-up that averaged 7.4 years, Shu found 1,348 breast cancer recurrences and 1,171 deaths from breast cancer and other causes.

Compared to the women who ate the least soy, women in the upper 10th percentile group for soy food intake had a 35 percent reduced risk of recurrence.

Those who ate the most soy also had a 17 percent reduced risk of death from all causes during the follow-up, but that finding did not reach statistical significance, Shu said.

Soy food consumption was considerably higher in the Shanghai group than among the U.S. participants.

How much soy might be protective? "Women can get the level of soy isoflavones that is similar to the top 10 percent consumption level found in our U.S. study population by consuming a cup of [soy] milk or half serving of tofu (2 oz.) per day," she said.

In the past, women who survived breast cancer tended to avoid soy foods, said Dr. Marian Neuhouser, associate member of the Fred Hutchinson Cancer Research Center in Seattle.

The worry, she said, was that some soy foods can act as a weak phytoestrogen, and most breast cancers are estrogen-receptor positive, needing estrogen to grow.

"I think this study and a previous study support the idea that soy foods are safe for women with breast cancer," she said.

She, too, emphasized that the study is on soy foods, not supplements. Soy foods are a good source of low-fat protein, she said.

Soy contributes to an overall healthy diet pattern, and healthy diet patterns are linked with lower recurrence, she said.

"If someone has a latte with soy milk, it means they aren't having a latte with whole milk, which has a lot more fat in it," Neuhouser said.

More information

To learn more about soy, visit the Soyfoods Association of North America.

Stroke risks fade when women stop taking estrogen

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, April 5, 2011

CHICAGO – Strokes and other health problems linked with estrogen pills appear to fade when women quit taking them after menopause, the first long-term follow-up of a landmark study found. It's reassuring news for women who take the hormone in their 50s when menopause usually begins.

The latest study bolsters previous evidence that concerns about breast cancer and heart attacks are largely unfounded for those who take the hormone for a short period of time to relieve hot flashes and other menopause symptoms.

Estrogen-only pills are recommended just for women who have had a hysterectomy, and the study focused only on that group. About 25 percent of women in menopause have had hysterectomies. Other women are prescribed a combination pill of estrogen and progestin because for them, estrogen alone can raise the risk for cancer of the uterus.

The study results don't really change the advice doctors have been giving for several years now: Take hormones to relieve menopause symptoms in the lowest possible dose for the shortest possible time.

The women in the study took estrogen for about six years and were evaluated for about four years after stopping. Slightly increased risks for strokes and blood clots that were found while they took the pills disappeared during the follow-up. Unfortunately, the bone-strengthening benefit of estrogen disappeared, too. Once women ended it, they had just as many hip fractures during the follow-up as women who'd taken dummy pills.

The research also found that women who started taking estrogen-only pills in their 50s fared better after stopping than women who'd started in their 70s — an age when hormones are generally no longer recommended.

"Our results emphasize the need to counsel women about hormone therapy differently depending on their age and hysterectomy status," the researchers said in reporting the study to be published in Wednesday's Journal of the American Medical Association.

The new results are from 10,739 participants in the estrogen-only part of the federal government's Women's Health Initiative study — research which shook up conventional wisdom about health benefits of hormones for menopausal women. Study of the estrogen-progestin group was halted in 2002 when risks for heart attacks and breast cancer were linked with the combination hormone pills. The estrogen-only study was halted in 2004 after stroke risks were seen in that group.

The troubling findings prompted many doctors to stop prescribing the pills to prevent chronic health problems and led millions of women to quit taking them.

Doctors now generally recommend hormones only to relieve hot flashes, night sweats that disrupt sleep and vaginal dryness in the lowest possible dose for the shortest possible time. Dr. Jacques Rossouw, who directed the initial research at the National Institutes of Health, said the estrogen follow-up results reinforce guidance "that women can use it shortly after the menopause for a limited period of time and then stop."

When the research began in the 1990s, doctors were still prescribing hormones after menopause, based on the belief the pills were good for bones, the heart and had other benefits beyond relieving menopause symptoms. So the women in the WHI study were taking hormones after menopause, rather than using them to relieve symptoms.

The women in the new study were in their 60s on average, nearly a decade past the age when most women enter menopause. So the overall results don't necessarily apply to the average U.S. woman now weighing the pros and cons of taking hormones.

One surprising twist in the results: The younger estrogen-takers actually had a lower risk for heart problems, breast cancer and death than those taking dummy pills. Researchers don't know why and say women should not use that as a reason to take hormones. They hope answers may be found in further research.

The results suggest that for every 10,000 women in their 50s taking estrogen for a year, there would be 12 fewer heart attacks and 13 fewer deaths than among women not on estrogen, said Dr. JoAnn Manson, a study co-author and chief of preventive medicine at Harvard's Brigham and Women's Hospital.

However, using the same comparison for women in their 70s, there would be 16 extra heart attacks and 19 extra deaths for those on estrogen versus those not taking the pills, she said.

"It's really powerful and compelling evidence," Manson said.

Breast cancer also appeared to be less common in women who'd taken estrogen than among those on dummy pills. An editorial accompanying the study notes that those findings contrast with many studies linking estrogen pills with an increased breast cancer risk.

Andrea LaCroix, the study's lead author and a researcher at the Fred Hutchinson Cancer Research Center in Seattle, said it's possible that estrogen didn't have a harmful effect on breast tissue in women studied because they were taken well after menopause when women's naturally occurring estrogen levels have declined.

Dr. Graham Colditz, a Washington University researcher who co-wrote the editorial, noted that duration of estrogen use as directed was pretty short during the study, averaging about 3 1/2 years, and most women started taking the hormone years after a hysterectomy or after menstrual periods ended.

"The results really don't directly translate to how we see women getting hormone therapy in the real world of current American medicine," Colditz said.

Online:

JAMA: http://jama.ama-assn.org

Women's Health Initiative: http://www.nhlbi.nih.gov/whi/

Patients on Higher Doses of Prescription Painkillers More Apt to Overdose

HealthDay News

Tuesday, April 5, 2011

TUESDAY, April 5 (HealthDay News) -- Patients who are prescribed higher doses of opioid painkiller drugs (such as Oxycontin or Vicodin) are at increased risk of death from overdose than those given lower doses, a new study finds.

In fact, the study, published in the April 6 issue of the Journal of the American Medical Association, found no increased risk for patients who take opioid painkillers both as-needed and as regularly scheduled doses.

"Between 1999 and 2007, the rate of unintentional overdose death in the United States increased by 124 percent, largely because of increases in prescription opioid overdoses," wrote Amy S.B. Bohnert of the Department of Veterans Affairs, Ann Arbor, Mich., and colleagues in a journal news release.

"Achieving a better understanding of the factors contributing to prescription opioid overdose death is an essential step toward addressing this troubling and dramatic increase in overdose mortality," they added.

For this study the researchers examined VA data on 750 accidental opioid overdose deaths that occurred from 2004 to 2008 and a random sample of almost 155,000 patients who received opioids to treat pain in 2004 or 2005.

The overdose rate among patients treated with opioids was 0.04 percent. Patients who died of an opioid overdose were much more likely to be middle-aged and white; more likely to have chronic or acute pain, more likely to have substance use disorders or other psychiatric diagnoses; and less likely to have cancer.

Patients who received a higher maximum daily dose (100 milligrams/day or more) were more likely to overdose than those who received a lower maximum daily dose (between 1 and 20 mg/day).

"The present findings highlight the importance of implementing strategies for reducing opioid overdose among patients being treated for pain," the researchers wrote.

"This study documents a relationship between opioid prescribing and opioid overdose in a large, national, prospective cohort of individuals receiving opioid therapy for a variety of medical conditions," they continued. "The risk of opioid overdose should continue to be evaluated relative to the need to reduce pain and suffering and be considered along with other risk factors."

More information

The U.S. Food and Drug Administration has more about opioids and other pain medicines.

Vitamin A Derivative Can Inhibit Early Forms of Breast Cancer, Researchers Show

ScienceDaily

Tuesday, April 5, 2011

ScienceDaily (Apr. 5, 2011) — A nutrient found in carrots and sweet potatoes may prove key to fighting breast cancer at early stages, according to a new study by researchers at Fox Chase Cancer Center. Sandra Fernandez, PhD, an assistant research professor at Fox Chase, is presenting the findings at the AACR 102nd Annual Meeting 2011 on Tuesday, April 5.

Retinoic acid, a derivative of vitamin A, could be a promising cancer therapy because it affects cell growth, proliferation, and survival. Although it is being tested in a number of clinical trials, so far its success at combating cancer has been inconsistent. However, Fernandez and her colleagues have now pinpointed critical aspects of retinoic acid's mode of action -- a potentially important step toward developing successful treatments for patients.

Retinoic acid binds to retinoic acid receptor beta (RAR-β), and it may be through this action that it can suppress tumors. A decrease in RAR- β levels in tumors is associated with cancer progression, and an increase is linked to positive responses to certain clinical interventions. It is thought that the activated receptor limits cell growth by regulating gene expression, but its underlying mechanisms are not completely understood.

To identify the specific conditions under which retinoic acid inhibits and even reverses the growth of abnormal masses in the breast, however, Fernandez developed a culture system consisting of four cell lines representing different phases of cancer: normal-like human breast cells; transformed cells (which give rise to solid masses upon exposure to carcinogens); invasive cells (which are capable of breaking through breast tissue barriers and spreading to other parts of the body); and tumor cells (which form when invasive cells are injected into the mammary fat pad of mice and show all of the characteristics of fully malignant breast cancer cells).

"We found that the RAR-β gene was active in the two earliest stages of cancer, but silenced in the final two stages," says Fernandez. "These changes in gene activation were caused by a type of chemical modification called methylation, which involves the addition of a methyl group to DNA."

In three-dimensional cultures containing a collagen matrix, normal-like cells formed tubules resembling a normal mammary gland, while the transformed cells also gave rise to solid masses. The cells that produced solid masses in collagen produced tubules when they received retinoic acid for 15 days. By contrast, invasive and tumor cells did not generate tubules in response to treatment with retinoic acid, even in combination with a drug that activates RAR-β by inhibiting DNA methylation.

The results suggest that retinoic acid can stop tumor progression early on, but not at later timepoints because the genetic changes related to cancer have become too severe. "There appears to be no way to revert the tumors with retinoic acid when they become too advanced," Fernandez says.

The study also shows that the methylation status of RAR-β can act as a biomarker for the early detection of breast cancer. In addition, drugs that reactivate this receptor by decreasing DNA methylation may help breast cancer patients. These medications are already being used to manage a certain type of leukemia, offering hope that it will also be approved to treat other diseases.

Co-authors on the study include Rebecca A. Starker, Maria F. Arisi, and Ishara Lareef -- all students who studied at Fox Chase.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Monday, April 4, 2011 

Avoiding or Controlling Diabetes May Reduce Cancer Risk and Mortality

ScienceDaily

Monday, April 4, 2011

ScienceDaily (Apr. 4, 2011) — Results of the NIH-AARP Diet and Health Study revealed that diabetes is associated with lower risk of prostate cancer in men but with higher risk of other cancers in both men and women. The data, presented at the AACR 102nd Annual Meeting 2011, held in Orlando, Florida April 2-6, also showed an association between diabetes and higher cancer mortality rates.

Previous epidemiologic studies have shown an association between diabetes and an increased risk for cancers including colorectal, liver and pancreas, according to Gabriel Lai, Ph.D., a cancer prevention fellow at the National Cancer Institute.

"Our results provide further evidence that abnormal insulin and glucose signaling may contribute to cancer initiation and development," he said. "There are myriad benefits from avoiding diabetes through exercise, diet and maintaining a healthy body weight. Our study confirms additional benefits in the form of reduced morbidity and mortality from certain cancers."

Lai and colleagues conducted a prospective study using data from more than 500,000 predominantly white, non-Hispanic men and women aged 50 to 71 years. From 1995 to 1996, the participants completed questionnaires about diet, lifestyle and whether or not they had diabetes. Researchers followed the patients for 11 years.

Results showed that diabetes was associated with an 8 percent increased risk for cancer among women and a 4 percent decreased risk for men. In previous research, a decreased risk for prostate cancer was associated with diabetes, which researchers believe might be due to the lower testosterone levels associated with diabetes. After excluding prostate cancer from their evaluation, Lai and colleagues found that diabetes was associated with a 9 percent increased risk for cancer in men.

As for mortality, diabetes was associated with an 11 percent increased risk in women and a 17 percent increased risk in men.

"These risks appeared independent from other cancer risk factors, such as obesity and cigarette smoking," Lai said.

After evaluating by cancer site, the researchers found diabetes was associated with a significant increase in risk for colon, rectal and liver cancers among men and women. In men, diabetes was associated with an increased risk for pancreatic and bladder cancers; in women, it was associated with an increased risk for stomach, anal and endometrial cancers. No association was found between diabetes and lung, skin or other cancers.

"Follow-up studies to identify the biologic mechanisms involved should be performed to build upon confirmed findings," Lai said.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Breast Milk Cells May Someday Help Predict Cancer

By Kathleen Doheny
HealthDay Reporter

HealthDay News

Monday, April 4, 2011

MONDAY, April 4 (HealthDay News) -- Examining cells from a woman's breast milk may help evaluate future breast health, new research suggests.

"It looks as if we can use the cells from breast milk to assess breast cancer risk," said Dr. Kathleen Arcaro, an associate professor of veterinary and animal sciences at the University of Massachusetts in Amherst.

She is to present her findings Monday at the annual meeting of the American Association for Cancer Research in Orlando, Fla.

For the study, she collected breast milk from 271 women in the United States.

Most of the women had registered with the Love/Avon Army of Women, indicating they were willing to engage in breast cancer research. Others were recruited from doctors' offices or cancer clinics. All had either undergone a biopsy of the breast to check for cancer, or were scheduled for one.

Arcaro evaluated breast milk samples from the biopsied and non-biopsied breasts. She isolated potentially cancerous cells, known as epithelial cells. Next, she isolated DNA to look for signals that regulate tumor suppressor genes.

She analyzed three genes among the many known to undergo a process called methylation in breast cancer. Methylation in a specific region of a gene can inhibit or suppress the expression of a gene, Arcaro said, "so it's turned off."

For one gene, SFRP1, the average methylation was higher in the biopsied breast, she found.

Among the women whose biopsies detected cancer, average methylation of the RASSF1 gene in the biopsied breast was considerably higher compared to the non-biopsied breast.

The researchers presented results for 182 women whose biopsy reports were complete and who had the DNA analysis.

Previous studies of these methylation patterns in breast cells used fine nipple aspiration or a technique called ductal lavage to retrieve the cells. Obtaining the cells from breast milk is noninvasive and inexpensive, Arcaro noted.

It's too soon, however, to assess the cancer detection rate associated with breast milk cell examination, she said, but research is continuing.

"We can't say at this point for two reasons," she said. "One is, we need long-term follow-up. And the second really important reason is, we need to sample a larger panel of genes."

Eventually, the hope is to use the breast milk screening on older mothers soon after they give birth. The test could supplement other breast cancer predictor tools, such as the Gail model, which takes factors such as age into account, Arcaro said.

The research has merit, said Dr. Priscilla A. Furth, a professor of oncology and medicine at Georgetown Lombardi Comprehensive Cancer Center.

Obtaining the cells seems to be the easy part, Furth said. "The question is, how good will this be? And I think this study does not yet answer that."

Using it on a large scale for screening will only be valuable if its predictive value is high, she said. And that number is still being researched.

The findings should be viewed as preliminary as they are presented at a medical conference in advance of any publication in a peer-reviewed medical journal.

Arcaro is continuing the research and will accept milk samples from any nursing mother who learns she needs a breast biopsy. If interested, contact her at the university, and she will arrange to have the sample picked up.

More information

To learn more about breast cancer, visit the U.S. National Cancer Institute.

Working long hours? Watch out for your heart

Reuters

Monday, April 4, 2011

LONDON (Reuters) – People who regularly work long hours may be significantly increasing their risk of developing heart disease, the world's biggest killer, British scientists said Monday.

Researchers said a long-term study showed that working more than 11 hours a day increased the risk of heart disease by 67 percent, compared with working a standard 7 to 8 hours a day.

They said the findings suggest that information on working hours -- used alongside other factors like blood pressure, diabetes and smoking habits -- could help doctors work out a patient's risk of heart disease.

However, they also said it was not yet clear whether long working hours themselves contribute to heart disease risk, or whether they act as a "marker" of other factors that can harm heart health -- like unhealthy eating habits, a lack of exercise or depression.

"This study might make us think twice about the old adage 'hard work won't kill you'," said Stephen Holgate, chair of the population and systems medicine board at Britain's Medical Research Council, which part-funded the study.

The study, published in the Annals of Internal Medicine journal, followed nearly 7,100 British workers for 11 years.

"Working long days is associated with a remarkable increase in risk of heart disease," said Mika Kivimaki of Britain's University College London, who led the research. He said it may be a "wake-up call for people who overwork themselves."

"Considering that including a measurement of working hours in a (doctor's) interview is so simple and useful, our research presents a strong case that it should become standard practice," he said.

Cardiovascular diseases such as heart attacks and strokes are the world's largest killers, claiming around 17.1 million lives a year, according to the World Health Organization (WHO). Billions of dollars are spent every year on medical devices and drugs to treat them.

The findings of this study support previous research showing a link between working hours and heart disease.

But the scientists said hard workers should not necessarily be alarmed about their heart health.

"Current evidence on (heart disease) prevention emphasizes the importance of focusing on the total risk, rather than single risk factors," Kivimaki told Reuters Health in an email.

"People who work long hours should be particularly careful in following healthy diets, exercising sufficiently and keeping their blood pressure, cholesterol levels, and blood (sugar) within healthy limits."

The research used data from a study called Whitehall II which has followed the health and wellbeing of more than 10,000 civil service workers in Britain since 1985.

For this study, men and women who worked full time and had no heart disease were selected, giving 7,095 participants.

The researchers collected data on heart risk factors like age, blood pressure, cholesterol, smoking and diabetes and also asked participants how many hours they worked -- including work during the day and work brought home -- on an average weekday.

During the 11-year study, 192 participants had heart attacks. Those who worked 11 hours or more a day were 67 percent more likely to have a heart attack than those with fewer hours.

(Additional reporting by Amy Norton of Reuters Health in New York, editing by Susan Fenton)

Monthly Aspirin Use Linked to Lower Pancreatic Cancer Risk

HealthDay News

Monday, April 4, 2011

MONDAY, April 4 (HealthDay News) -- Taking aspirin even once per month, whether low-dose or full strength, appears to be associated with a marked drop in the risk of developing pancreatic cancer, new research reveals.

Specifically, taking full-strength aspirin once monthly was linked to a 26 percent reduction in the risk of pancreatic cancer. Taking low-dose aspirin, to reduce the risk of heart disease, was associated with an even greater drop (35 percent lower) in pancreatic cancer risk.

The findings, from a team led by Dr. Xiang-Lin Tan, a research fellow at the Mayo Clinic in Rochester, Minn., are slated for presentation Monday at the annual meeting of the American Association for Cancer Research, in Orlando, Fla.

"This provides additional evidence that aspirin may have chemoprevention activity against pancreatic cancer," Tan said in a news release from the association.

But, he cautioned, "the results are not meant to suggest everyone should start taking aspirin once monthly to reduce their risk of pancreatic cancer. Individuals should discuss use of aspirin with their physicians because the drug carries some side effects."

To explore the protective potential of aspirin, the investigators focused on 904 pancreatic cancer patients and just over 1,220 healthy individuals, all of whom were seen at the Mayo Clinic between 2004 and 2010.

All of the study participants were at least 55. Questionnaires were completed to assess aspirin use between the ages of 41 and 60, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.

Using aspirin at least once per month was linked to a significant drop in pancreatic cancer risk, the research team concluded, even after accounting for other factors that might affect the finding, such as body-mass index and smoking history.

Those who had once smoked but kicked the habit seemed to experience an even stronger protective effect with respect to aspirin use than those who had never smoked or those who continued to smoke, the study authors noted.

NSAID and acetaminophen use did not, however, have any noticeable impact on pancreatic cancer risk, the authors added.

Dr. Michael Choti, a professor of surgery and oncology with the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, expressed little surprise with the findings.

"There have been other preclinical findings suggesting that there may be some role for aspirin in inhibiting carcinogenesis, including pancreatic carcinogenesis," Choti noted. "And in other cancers, such as colon cancer, aspirin use has been associated with a reduction in cancer risk."

However, "studies that are not randomized trials are fraught with biases," he cautioned. "Those taking aspirin for a variety of reasons, say for cardiac or other cancer-protective effects, may generally have a better lifestyle, smoke less, eat better, exercise more. So one cannot purely conclude from this kind of study as to whether they are finding a general association between people who take aspirin, or in fact a true causative effect," Choti pointed out.

"But it's very interesting," he added. "And certainly the cost and risk of aspirin use is quite low. And this is compelling evidence to suggest there is some benefit, and it's perhaps another reason to advocate the use of aspirin."

Because the study was presented at a medical meeting, the findings should be viewed as preliminary until they are published in a peer-reviewed journal.

More information

For more on pancreatic cancer, visit the American Cancer Society.

Studies question heart bypass, angioplasty method

By Marilynn Marchione

AP Medical Writer

The Associated Press

Monday, April 4, 2011

NEW ORLEANS – Two new studies could change care for hundreds of thousands of heart patients each year. One finds that bypass surgery has been overrated for many people with very weak hearts from clogged arteries and previous heart attacks. The other challenges the way artery-opening procedures have been done for decades.

It was the first big test of doing balloon angioplasty to clear heart arteries through an arm instead of a leg. Complications were fewer with the arm method and at hospitals that did this more often, deaths, heart attacks and other big problems were lower, too.

The arm method is common in India, Israel, Europe and Canada, but less than 5 percent of U.S. cases are done this way.

"This is the way we should be heading," and more doctors should be trained to do it, said Dr. Edward McNulty of the University of California, San Francisco.

He is a leader of the American College of Cardiology conference in New Orleans where the studies were presented on Monday.

The bypass study's surprising result is "a blockbuster," McNulty said. The operation did not improve survival for heart failure patients who already were taking medicines to control risks like high cholesterol and high blood pressure.

Clogged arteries cause about two-thirds of the 6 million cases of heart failure in the United States. The heart isn't getting enough blood and enlarges as it grows weaker from working too hard. Doctors often advise bypass to improve blood flow, but the new study calls that into question.

"Even if surgery is better, it's not better by much," said Dr. Byron Lee, a heart specialist at UCSF.

The study involved 1,200 heart failure patients in 22 countries, mostly men around 60 years old. Most had suffered a heart attack in the past. All were taking medicines they should for heart risks, and half were assigned to also get bypass surgery.

Doctors assumed bypass would cut deaths by 25 percent. But after nearly five years, about the same number in each group had died, said study leader Dr. Eric Velazquez of Duke University Medical Center.

One hundred people in the drug-alone group wound up having a bypass; 55 who were supposed to get the operation never did. Results on only those who had the treatment they were initially assigned suggested that bypass surgery did improve survival.

But its risks were evident, too. For the first two years, there were more deaths among those given surgery versus the others.

"If you don't have an expectation to outlive that two-year window," surgery is not a good idea, Velazquez said.

The National Heart, Lung and Blood Institute paid for the study, and Abbott Laboratories provided some medicines. Results were published online by the New England Journal of Medicine.

The other study involved more than 7,000 people in 32 countries getting an angiogram — a diagnostic test to look for blockages — followed by angioplasty to open any clogs found.

It usually involves poking a tube through a leg artery near the groin up to the heart, inflating a tiny balloon to flatten a blockage in a heart artery and placing a mesh tube called a stent to prop the artery open. But patients can suffer major bleeding requiring transfusions or surgery, so doctors are trying this through an artery in the wrist instead.

It's harder on doctors to do but easier on patients, who spend just a couple hours wearing a wrist band to control bleeding afterward instead of a day or more off their feet in a hospital.

The study assigned patients to get one method or the other. Survival and success rates were similar — about 4 percent of each group died or had a heart attack, stroke or major bleeding in the following month.

But significantly fewer of these problems occurred in people treated with the arm method after major heart attacks, and in hospitals that did the arm method more often.

"The more you do the better you get," and the better patients fare, said the study's leader, Dr. Sanjit Jolly of McMaster University in Hamilton, Ontario.

The study was funded by the Canadian government, a Canadian nonprofit, and Sanofi-Aventis SA and Bristol-Myers Squibb Co. (It was part of a larger study testing different doses of an anti-clotting drug used after angioplasty.) Results were published online by the journal Lancet.

The cardiology college's president, Dr. Ralph Brindis, said the study should be "a tipping point" to boost the arm method in the U.S.

"Every study that's ever been done shows it's safer," said Duke University's Dr. Sunil Rao, who led one of them.

Dr. Gary Idelchik is the only one of the 30 or so cardiologists at Trinity Mother Francis Hospital in Tyler, Texas, who does the arm method regularly.

"People have said 'I don't want it any other way'" after having it, he said.

Online:

Heart meeting: http://www.acc.org

New England Journal: http://www.nejm.org

Lancet study: http://tinyurl.com/42sd9me

Evidence Weak to Support Many Medications for Autism: Study

By Jenifer Goodwin
HealthDay Reporter

HealthDay News

Monday, April 4, 2011

MONDAY, April 4 (HealthDay News) -- Little evidence supports the use of most medications for treating autism in children, with the exception of the anti-psychotic drugs risperidone and aripiprazole that have shown success in controlling severely disruptive, hyperactive and repetitive behaviors, a new study shows.

However, anti-psychotics can have significant side effects, including substantial weight gain, sedation and tremors or rigidity, and should only be used when absolutely necessary, the researchers added.

"The medications are efficacious, but they have significant side effects that should limit their use to patients with severe impairment or at risk of injury," said study author Melissa McPheeters, co-director of the Vanderbilt Evidence-Based Practice Center in Nashville.

Other medications sometimes prescribed for children with autism -- including selective serotonin reuptake inhibitors (SSRIs) to treat repetitive behaviors and stimulants used to treat hyperactivity and impulsive behavior -- have scant evidence supporting their use, according to the study. It was published online April 4 in the journal Pediatrics.

A randomized, controlled trial on SSRIs showed no benefit in controlling repetitive behaviors, according to the study. And while one study did show that stimulants may help with hyperactivity, far more research is needed.

A second study in the same issue of the journal analyzed seven randomized controlled trials on secretin, which is used to treat peptic ulcers, and the study found no benefit in treating autism symptoms and that it wasn't even worth further study. (Animals studies have showed secretin affects the central nervous system, which sparked the interest in using the drug for children with autism, but those hopes have not been borne out, the researchers said.)

A third study in the journal looked at 34 studies on behavioral interventions in preschoolers. The research generally shows such interventions help children improve their language and social skills, but most studies were poorly designed, and more research is needed, the authors of the new study said.

"We see a real variability in response, with some subgroups having dramatically positive effects and some children remaining very impaired," McPheeters said.

An estimated one in 110 U.S. children have an autism spectrum disorder, which is often marked by problems with language, social and communication skills, and repetitive behaviors.

But the condition can vary widely among individuals, with some people never developing the ability to speak and others going on to college.

"This trio of review articles is important in that they remind parents and professionals how difficult it is to effectively treat children with autism, how little research there is to support some of our medical and developmental interventions and how daunting it is to conduct well-designed clinical research effectively," said Dr. Andrew Adesman, chief of developmental and behavioral Pediatrics at Steven and Alexandra Cohen Children's Medical Center of New York.

Children with autism also often have other conditions, such as aggressive or disruptive behaviors, seizure disorders and hyperactivity. No medications target the communication issues or problems with social functioning that define autism itself, experts said. Instead, physicians prescribe drugs to try to ease those other conditions.

"The drugs are used to treat co-morbid symptoms, not the core autism symptoms," McPheeters explained.

In the review, the researchers looked at studies conducted between 2000 and 2010 on the use of various drugs in children aged 12 and under with an autism spectrum disorder. The study on medications included nine studies on anti-psychotics, five on SSRIs and four on stimulants.

While the evidence for anti-psychotics is strong, far more research is needed on newer anti-psychotic drugs that may have fewer side effects, McPheeters said.

As for the early behavioral interventions, "we have a small number of studies that suggest positive outcomes, but we are in critical need of replication, extension and controlled studies," McPheeters said.

She added: "Even though the paper says there is low and insufficient strength of evidence, that should not be interpreted as the interventions are not effective, but as encouragement for additional research."

The three studies were part of an 18-month long project done in conjunction with the Agency for Healthcare Research and Policy to review all of the evidence on treatments for autism spectrum disorders for children 12 and under published after 2000, said McPheeters, the senior author of the report that will be published soon on the AHRQ Web site.

That report started with more than 4,000 abstracts and was narrowed down to 183 studies in all

For the medication study, studies had to include at least 30 people, while for the behavioral study, studies had to include at least 10 people.

"The report includes studies that are very rigorous and also studies that we rated to have poor quality," McPheeters said. "We felt like it was important to make sure we covered the waterfront so that people could see what all was out there."

Another challenge for physicians is determining which children will respond best to which treatment, said Dr. Eric Hollander, director of the Compulsive, Impulsive and Autism Spectrum Disorders Program at Montefiore Medical Center in New York City.

"There is no single treatment that works for all patients," Hollander said.

More information

To learn more, visit Autism Speaks.

Magnesium Deficiency: Not Always a Nutritional Problem

ScienceDaily

Monday, April 4, 2011

ScienceDaily (Apr. 4, 2011) — Researchers and scientists of the Charité -- Universitätsmedizin Berlin, in cooperation with the Max Delbrück Center for Molecular Medicine, and colleagues from the Netherlands, Belgium, Switzerland and the Czech Republic have succeeded in identifying a genetic cause of magnesium deficiency.

The study from Dr. Dominik Müller of the Department of Pediatric Nephrology, ascertained changes in a gene which is involved in the regulation of magnesium processes. This research, which is published in the current issue of the American Journal of Human Genetics, opens the way for possible future medicinal treatment of genetically caused magnesium deficiencies.

A magnesium deficiency, with symptoms ranging from fatigue and muscle weakness to severe seizures and heart rhythm disturbances, may also be associated with diabetes and high blood pressure. Up until now it has been mostly explained by dietary insufficiencies.

Dr. Müller and his team have now shown that an altered gene may be the cause for this deficiency. Changes in a gene (Cnnm2), entail changes in the human blueprint and thus in the structure and function of protein sequence. In this case, the change affects a protein that is anchored in the membrane of kidney cells and intestinal cells and is responsible for the absorption of magnesium in the blood stream. Since this process no longer works in the defective protein, the magnesium is not put into the blood stream but excreted through the intestine and the urine, and therefore forfeited.

Dr. Mueller commented on his research results as follows: "Our results provide us with a number of new insights into magnesium metabolism in the body. In the end, following further research and development, we see the possibility to deal with such deficiencies medicinally."

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

Marchel Stuiver, Sergio Lainez, Constanze Will, Sara Terryn, Dorothee Günzel, Huguette Debaix, Kerstin Sommer, Kathrin Kopplin, Julia Thumfart, Nicole B. Kampik. CNNM2, Encoding a Basolateral Protein Required for Renal Mg2 Handling, Is Mutated in Dominant Hypomagnesemia. The American Journal of Human Genetics, 2011; 88 (3): 333 DOI: 10.1016/j.ajhg.2011.02.005

Sunday, April 3, 2011

Vitamin D Levels Linked With Health of Blood Vessels

ScienceDaily

Sunday, April 3, 2011

ScienceDaily (Apr. 3, 2011) — A lack of vitamin D, even in generally healthy people, is linked with stiffer arteries and an inability of blood vessels to relax, research from the Emory/Georgia Tech Predictive Health Institute has found.

The results add to evidence that lack of vitamin D can lead to impaired vascular health, contributing to high blood pressure and the risk of cardiovascular disease. Study participants who increased their vitamin D levels were able to improve vascular health and lower their blood pressure.

The data was presented by Ibhar Al Mheid, MD, a cardiovascular researcher at Emory University School of Medicine, at the annual American College of Cardiology meeting in New Orleans. Al Mheid is one of five finalists for the ACC's Young Investigators Award competition in physiology, pharmacology and pathology. He is working with Arshed Quyyumi, MD, professor of medicine and director of the Emory Cardiovascular Research Institute.

The 554 participants in the study were Emory or Georgia Tech employees -average age 47 and generally healthy -- who are taking part in the Center for Health Discovery and Well Being, part of the Emory/Georgia Tech Predictive Health Institute.

The average level of 25-hydroxyvitamin D (a stable form of the vitamin reflecting diet as well as production in the skin) in participants' blood was 31.8 nanograms per milliliter. In this group, 14 percent had 25-hydroxyvitamin D levels considered deficient, or less than 20 nanograms per milliliter, and 33 percent had levels considered insufficient, less than 30 nanograms per milliliter.

The researchers monitored the ability of participants' blood vessels to relax by inflating and then removing a blood pressure cuff on their arms. To allow blood to flow back into the arm, blood vessels must relax and enlarge -- a change that can be measured by ultrasound. The researchers also made other measurements of smaller blood vessels and examined the resistance to blood flow imposed by the arteries.

Even after controlling for factors such as age, weight and cholesterol, people with lower vitamin D levels still had stiffer arteries and impaired vascular function, Al Mheid says.

"We found that people with vitamin D deficiency had vascular dysfunction comparable to those with diabetes or hypertension," he says.

Throughout the body, a layer of endothelial cells lines the blood vessels, controlling whether the blood vessels constrict or relax and helping to prevent clots that lead to strokes and heart attacks.

"There is already a lot known about how vitamin D could be acting here," Al Mheid says. "It could be strengthening endothelial cells and the muscles surrounding the blood vessels. It could also be reducing the level of angiotensin, a hormone that drives increased blood pressure, or regulating inflammation."

Most Americans generally get the majority of their vitamin D from exposure to sunlight or from dietary supplements; fortified foods such as milk or cereals are a minor source. A few foods, such as oily fish, naturally contain substantial amounts of vitamin D.

Participants whose vitamin D levels increased over the next six months, either from dietary supplements or ample sun exposure, tended to improve their measures of vascular health and had lower blood pressure. Forty-two study participants with vitamin D insufficiency whose levels later went back to normal had an average drop in blood pressure of 4.6 millimeters mercury.

"This was an observational study, rather than an interventional one, and it was difficult to tease out how the people who restored their vitamin D levels got there," Al Mheid says. "We are hoping to conduct a study where we have participants take a defined regimen of vitamin D."

"With his findings showing the relationship between vitamin D deficiency and vascular dysfunction, Dr. Mheid has helped advance our understanding of the importance of Vitamin D in preventing a common health problem in aging adults," says Kenneth Brigham, MD, medical director of the Emory/Georgia Tech Center for Health Discovery and Well Being. "Additionally, ongoing health studies based on the Center's collection of health information from participants will yield more discovery as the Center continues to develop."

The Emory-Georgia Tech Predictive Health Institute is a national leader in moving the practice of medicine from a reactive, disease-focused system to a proactive health-focused system. The initiative integrates research, scholarship and education in an innovative effort aimed at revolutionizing care of people to define, preserve and prolong the health of individuals and of society.

Key areas of the Initiative include defining and measuring health using optimal biomarkers of health and understand their interrelationships, determining the best interventions to optimize health throughout an individual's or a population's lifetime.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Saturday, April 2, 2011 

Exercise preserves, builds heart muscle

By Ransdell Pierson

Reuters

Saturday, April 2, 2011

NEW ORLEANS (Reuters) – Consistent lifelong exercise preserves heart muscle in the elderly to levels that match or even exceed that of healthy young sedentary people, a surprising finding that underscores the value of regular exercise training, according to a new study.

The first study to evaluate the effects of varying levels of lifelong exercise on heart mass was presented on Saturday at the annual scientific meeting of the American College of Cardiology in New Orleans.

It suggested that physical activity preserves the heart's youthful elasticity, showing that when people were sedentary, the mass of their hearts shrunk with each passing decade.

By contrast, elderly people with a documented history of exercising six to seven times a week throughout adulthood not only kept their heart mass, but built upon it -- having heart masses greater than sedentary healthy adults aged 25 to 34.

"One thing that characterizes the aging process by itself is the loss of muscle mass, particularly skeletal muscle," said Dr. Paul Bhella, a researcher from John Peter Smith Hospital in Fort Worth, Texas who presented the study at the conference.

"But we are showing that this process is not unique to skeletal muscle, it also happens in cardiac muscle," he said. "A heart muscle that atrophies is weaker."

The study enrolled 121 healthy people with no history of heart disease. Fifty nine were sedentary subjects recruited from the Dallas Heart Study, a large multiethnic sample of Dallas County residents.

Some 62 lifelong exercisers, all over age 65, were recruited mainly from the Aerobics Center Longitudinal Study, which had documented their exercise habits over a period of 25 years.

In the new study, exercise was assessed by the number of aerobic exercise sessions per week, rather than intensity or duration. Subjects were broken down into four groups: non-exercisers; casual exercisers (two to three times a week); committed exercisers (four to five times a week) and master athletes (six to seven times a week).

Heart mass measurements, taken using MRIs, showed that sedentary subjects had diminished heart mass as they aged, while lifelong exercisers had heart mass expansion with increasing frequency of exercise.

"The data suggest that if we can identify people in middle age, in the 45 to 60 year range, and get them to exercise four to five times a week, this may go a very long way in preventing some of the major heart conditions of old age, including heart failure," said Benjamin Levine of the University of Texas Southwestern Medical Center, who headed the study.

(Reporting by Ransdell Pierson and Bill Berkrot; Editing by Paul Simao)