Extra heart scan needed to assess heart risk: study

January 30th, 2010

A person’s long-term risk of heart disease is better assessed by a pair of studies, as performing only one may miss a dangerous buildup of calcium in arteries, U.S. researchers said on Monday.

They said about half of all patients in a 10-year study who had normal results on a nuclear stress test known as SPECT were found to have significant buildup of calcium on the walls of their arteries when they did a heart CT.

“Typically, when a patient presents with chest pain and the (SPECT) test result is normal, we tell them everything looks fine, but this may not be the case,” Dr. John Mahmarian of the Methodist DeBakey Heart and Vascular Center in Texas, who led the study, said in a statement.

He said if a large amount of calcified plaque is found on artery walls — something that can’t be seen in SPECT imaging — the patient has a high long-term risk of having a heart attack or stroke.

“Based on our findings, using both tests to define risk is better than either test alone,” Mahmarian said in a statement.

Nuclear stress tests using single-photon emission computed tomography, or SPECT, examine blood flows to the heart. People with a normal result are generally thought to have less than a 1 percent chance of having a heart attack within a year.

Computed tomography or CT scans use special X-ray equipment and sophisticated computers to measure calcified plaque in the heart arteries. These tests can detect varying degrees of blockages in the heart.

Both tests expose patients to radiation.

Mahmarian’s team followed 1,126 patients with no previous history of coronary artery disease whose doctors had already received both tests.

They found people who were deemed low risk by the SPECT test were three times more likely than others to have a heart attack during the study period if they had high calcium scores.

For these patients, a high calcium score was an even stronger predictor of having a heart problem than diabetes.

They said people with a normal SPECT who have other risk factors that put them at risk for heart trouble — such as smoking, high cholesterol, high blood pressure, diabetes or a family history of heart trouble — would benefit from the extra test.

“We’re not recommending doing this to everybody. The patient has to have clinical risks,” Dr. Su Min Chang of the Methodist Hospital, who worked on the study, said in a telephone interview.

He said people who get a normal stress test might get a false sense of security. Adding the calcium test could give them a better picture of their long-term risk.

The team did not look at whether the two-test strategy is cost effective but they said such studies are needed.

Imaging tests are a major source of escalating health costs and curbing excessive use of such tests is a major target of health reform in the United States.

Food Stamps Help Stave Off Hunger in Many U.S. Homes

January 24th, 2010

At some point, nearly half of all American children and teens will live in a home that receives food stamps, a new study shows.

Researchers analyzed 30 years (1968 to 1997) of national data collected by the Panel Study of Income Dynamics and found that by the time they were 1 year old, 12.1 percent of U.S. children had lived in households receiving food stamps. That increased to 26.1 percent at 5 years of age; 35.9 percent at 10 years; 43.6 percent by age 15, and 49.2 percent by age 20.

The study also found that by age 20, about one-third of children had lived in households that received food stamps for two or more years, 28.1 percent for three or more years, 26.4 percent for four or more years, and 22.8 percent for five or more years.

Food stamp use was most likely among households with black children and those who lived in households headed by adults who were unmarried or had had less than 12 years of education, the researchers reported in the November issue of the journal Archives of Pediatrics & Adolescent Medicine.

“American children are at a high risk of encountering a spell during which their families are in poverty and food insecurity as indicated through their use of food stamps. Such events have the potential to seriously jeopardize a child’s overall health,” wrote Mark R. Rank, of the George Warren Brown School of Social Work at Washington University, St. Louis, and Thomas A. Hirschl, of Cornell University.

Studies have “repeatedly demonstrated that two of the most detrimental economic conditions affecting a child’s health are poverty and food insecurity,” the researchers noted.

“Understanding the degree to which American children are exposed to the risks of poverty and food insecurity across the length of childhood would appear to be an essential component of pediatric knowledge, particularly in light of the growing emphasis on the importance of community pediatrics,” the study authors added.

Health Tip: Possible Triggers for Pica

January 17th, 2010

Pica often affects children with developmental disorders, pregnant women and sometimes people with epilepsy. It’s characterized by a craving to eat non-food substances, such as paint, plaster, chalk, cornstarch, dirt or cigarettes.

The Nemours Foundation mentions these possible triggers for pica:
Being deficient in vitamins and minerals, such as iron or zinc.
Dieting too strictly.
Being malnourished.
Lack of parental supervision.
Having a developmental problem, such as autism or mental retardation.
Having certain mental health conditions, such as schizophrenia or obsessive compulsive disorder.

High Blood Pressure Likely in Alzheimer’s Offspring

January 11th, 2010

Middle-aged adults whose parents have Alzheimer’s disease are at increased risk for high blood pressure, evidence of arterial disease and markers of inflammation — all of which may be associated with later development of Alzheimer’s disease.

That’s the finding of a study by researchers in the Netherlands who compared 206 adults in 92 families with a parental history of Alzheimer’s and 200 adults in 97 families with no parental history of the disease.

The team at the VU University Medical Center in Amsterdam measured the participants’ blood pressure, analyzed blood samples for genetic characteristics, cholesterol levels and levels of pro-inflammatory proteins called cytokines, and collected medical history and details about diet, exercise and stress levels.

The study found that 47 percent of adults with Alzheimer’s-afflicted parents carried the gene (APOE e4) known to be associated with the disease, compared with 21 percent of those with no family history of Alzheimer’s. Those with a family history had higher blood pressure readings, signs of arterial disease and higher levels of several different cytokines.

High blood cholesterol and glucose levels were not associated with parental Alzheimer’s disease, according to the study, which is published in the November issue of the journal Archives of General Psychiatry.

“Our study shows that high blood pressure and an innate pro-inflammatory cytokine response in middle age significantly contribute to Alzheimer’s disease,” wrote Dr. Eric van Exel and colleagues. “As these risk factors cluster in families, it is important to realize that early interventions could prevent late-onset Alzheimer’s disease. One could argue for a high-risk prevention strategy by identifying the offspring of patients with Alzheimer’s disease, screening them for hypertension and vascular factors and implementing various (non)pharmacological health measures.”

Estrogen Plays Surprise Role in Breast Cancer Treatment

November 29th, 2009

Researchers report that the paradoxical strategy of treating breast cancers that have become resistant to anti-estrogen therapies with estrogen actually shrank some tumors.

Not only that, but the estrogen made some of the tumors sensitive to anti-estrogen drugs once again.

The findings, reported in the Aug. 19 issue of the Journal of the American Medical Association, are preliminary, one expert cautioned.

“It’s an interesting observation, but it needs to be expanded into a large trial,” said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. “There’s probably something biologically going on here that we don’t quite understand. The question is, can we translate this into really clinically meaningful responses?”

“The history of treating patients with estrogen goes back to the 1940s when physicians started to treat patients with advanced breast cancer with diethylstilbestrol or DES [a synthetic estrogen],” explained Dr. Matthew Ellis, a professor of medicine at Washington University School of Medicine, an oncologist with the Siteman Cancer Center in St. Louis and a co-author of the study. “The ancient literature is full of grainy photographs with lung metastases or local, advanced breast cancer or bone metastases getting better with this paradoxical treatment.”

That treatment protocol was displaced by the anti-estrogen therapy tamoxifen in the 1970s. And tamoxifen is now being replaced by stronger anti-estrogen drugs known as aromatase inhibitors.

“These drugs are a little more effective than tamoxifen … so now you have a large population of patients with advanced breast cancer who have experienced treatment often with both estrogen-lowering agents,” Ellis said. “We hypothesized that some of these patients could go back to estrogen therapy, but at a lower dose than anything looked at before.”

“Giving estrogen actually was a standard-of-care practice prior to tamoxifen approval, so this trial simply confirms previously known knowledge, that estrogen can be used to treat metastatic hormone-dependent breast cancer in postmenopausal women,” said Dr. Ramona Swaby, an assistant professor of medical oncology at Fox Chase Cancer Center in Philadelphia.

To try to prove the point that lower doses of estrogen might work, 66 women with metastatic breast cancer and estrogen-receptor-positive tumors were randomized to receive either 6 milligrams or 30 milligrams of oral estradiol (estrogen) each day. All women had been treated previously with an aromatase inhibitor but their disease returned.

“The 30-milligram dose produces estrogen levels typical of pregnancy, and the 6-milligram dose produces levels of non-pregnant premenopausal women [who are ovulating],” Ellis said.

The two doses were similar in effectiveness, with tumors shrinking or not growing in about 30 percent of the women.

But those taking the higher dose had more negative side effects than those in the lower-dose group, as well as a poorer quality of life, making the lower dose the overall winner.

Meanwhile, the researchers also found that they could predict which tumors would respond based on results from positron emission tomography (PET) scans taken before and after the treatment. Tumors that glowed more brightly were much more likely to respond to the estrogen treatment, according to the study.

Some of the cancers later recurred, but about a third of these women then responded again to aromatase inhibitors.

Ellis also noted that 6 milligrams of estrogen costs only about $1 a day.

No one yet knows why this effect is happens to certain women.

“The endocrine system is a complicated system of feedback loops and, under normal circumstances, women experience wild changes in estrogen levels, depending on whether they’re menstruating, pregnant or postmenopausal,” Ellis explained. “All this is regulated in an exquisite way, which we actually understand fairly well. These results mean the feedback loops may be corrupted in some ways.”

Brooks agreed that it’s “counterintuitive.”

“The estrogen receptor on a cancer cell is not a simple thing,” he said. “Aromatase inhibitors may somehow allow the cells to reactivate certain [hormone] receptors [on the tumor] that may actually be different than they were to start with.”

The researchers said they were planning further studies to see which group of women might benefit most from the protocol.

Food stamp users risk weight gain: study

November 24th, 2009

Packing on the pounds may be an unintended consequence of the U.S. Food Stamp Program, according to research that shows that getting food stamps may help contribute to obesity, at least among women.

“We can’t prove that the Food Stamp Program causes weight gain, but this study suggests a strong linkage,” Jay Zagorsky, a research scientist at Ohio State University’s Center for Human Resource Research, Columbus, noted in a university-issued statement.

Food stamps, the major U.S. anti-hunger program, help poor people buy groceries.

Zagorsky, along with Patricia Smith of the University of Michigan in Dearborn, studied weight changes over 14 years in nearly 4,000 people in the food stamp program and almost 6,000 not in the program.

They found that the typical female user of food stamps was heavier than the non-user, after taking into account a variety of factors that might influence body weight.

Specifically, the researchers calculated body mass index, or BMI, a measure of weight in relation to height used to gauge how fat or thin a person is. Female food stamp users, they found, had a BMI 1.15 points higher than a similar woman who did not participate in the food stamp program.

For the average American woman standing 5 feet 4 inches tall this means an increase in 5.8 pounds of body weight.

Zagorsky and Smith also found that BMI increased faster when participants were getting food stamps than when they were not, and increased more the longer they were in the food stamp program.

The average food stamp users saw their BMI go up 0.4 points per year when they were receiving food stamps, compared to 0.07 points per year before and 0.2 points per year after they no longer received food stamps.

“While food stamps may help fight hunger, they may have the unintended consequence of encouraging weight gain among women,” Zagorsky said in the statement. “Every way we looked at the data, it was clear that the use of food stamps was associated with weight gain,” he added.

“While this association does not prove that the Food Stamp Program causes weight gain, it does suggest that program changes to encourage the consumption of high-nutrient, low-calorie foods should be considered,” Zagorsky and Smith note in the latest issue of Economics and Human Biology.

In 2008, roughly 28 million people — or almost 1 in 11 Americans — received benefits from the food stamp program in a given month.

Food stamp participants, the researchers say, may choose cheap, calorie-dense, high-fat, processed foods over healthier, more expensive food, maybe because food stamps don’t provide enough money to buy healthy foods, Zagorsky contends.

In 2002, the average recipient received $81 in food stamps per month. “That figure was shocking to me,” Zagorsky said. “I think it would be very difficult for a shopper to regularly buy healthy, nutritious food on that budget.”

Modifying the food stamp program to include economic incentives to buy and eat healthier foods “might be an important tool for fighting obesity,” Zagorsky offers.

People on food stamps, for example, could be required to take a course on nutrition and food stamp users who purchase fresh fruit and vegetables and other low-fat products could be given more benefits or receive discounts on these products, he said.

Medical Heroin Helps Treatment-Resistant Addicts

November 18th, 2009

Long-term heroin addicts who were given “medical heroin” were able to stay in treatment longer than those given methadone, a Canadian study has found.

In addition, rates of illicit drug use and illegal activity declined among the participants, who had failed earlier attempts at treatment, according to the study.

“Without [medical heroin], these people who’ve already been written off as beyond help would be on street drugs, exposing themselves to harms like overdose, HIV and illegal activities,” explained the study’s senior author, Dr. Martin Schechter, a professor and director of the School of Population and Public Health at the University of British Columbia. “But, if we can get them into a clinic while keeping them safe and stabilizing their lives, we can get them out of that 24-hour cycle and get them in touch with people like doctors and nurses.”

“Sooner or later, they may seek counseling and other treatments,” Schechter said. “And, in the meantime, you’re saving a lot of money in health care because the treatment is far less expensive to the community than the alternative.”

As many as a million people in North America are addicted to opioids, and the majority of them are addicted to heroin, according to background information in the study, which is in the Aug. 20 issue of the New England Journal of Medicine.

Methadone is a standard treatment drug given to replace heroin. However, about 15 to 25 percent of people addicted to heroin don’t have a good response to methadone, according to the study. In some European countries, researchers have examined the use of injectable medical heroin — diacetylmorphine, the active ingredient in heroin — to treat addicts who’ve failed other treatment options. In the United Kingdom, it’s recommended that medical heroin be used as a treatment of last resort.

The Canadian study sought to examine a North American population, though the authors acknowledged that the study could not have been conducted in the United States because of “financial and logistical barriers.”

The study involved 251 people, all older than 25, who had been using opioids for at least five years and were currently injecting opioids daily. By random assignment, oral methadone was given to 111 participants, 115 were given medical heroin injections and 25 were given injections of hydromorphone (Dilaudid), a narcotic medication that has similar effects to medical heroin.

Almost 88 percent of those in the medical heroin group stayed in the study, compared with 54 percent of the methadone group. The reduction in the rate of illicit drug use or other illegal activities was 67 percent in the medical heroin group and 48 percent in the methadone group.

Ten people overdosed, none fatally, during the study period, and six people had seizures. Because of those risks, the authors wrote, medical heroin should only be used in a setting where prompt medical interventions are available.

On the whole, Schechter said, the approach is one worth considering.

“People need to have an open mind when it comes to the treatment of addiction,” he said. “This treatment is good for the people addicted to heroin and very good for the community. It saves money and gets rid of black market criminal activity.”

Though medical heroin is not likely to be approved for addiction treatment in the United States, Schechter said, the study did find that hydromorphone had similar advantages and is already approved for use in the United States. However, the study did not include enough people in the hydromorphone group, he said, so more research is needed.

An addiction medicine specialist, Dr. Joshua D. Lee, a professor of medicine at New York University Langone Medical Center in New York City, described the treatment as a “potentially effective approach to managing long-term heroin addiction” that has not responded to other treatments.

“While this doesn’t get them off heroin, you’re taking a potentially unsafe, toxic thing — the package from the dealer down the street — and you’re putting it in a clinic setting where there’s support if someone overdoses,” Lee said. “It could kill the street drug trade and cause positive effects in the neighborhood.”

“Methadone is life-saving for some people, but some long-term users just aren’t interested in methadone, and it’s a real public health problem,” he added. “We have to develop alternatives to methadone maintenance.”

For heart health: avoid tobacco smoke, pollution

November 13th, 2009

If you Wanna dramatically mark down the odds fact that you’ll die away of gently heart true disease , get off zappy someplace where especially public instinctively smoking is banned.

In well a study of any more than well a million ppl, researchers persistently found fact that even unfair levels of impatient smoke fm. co-workers’ cigarettes can substantially bring up your intensively risk of a little death fm. gently heart true disease .

While you’re packing unusually to move down, look out in behalf of well a consciously place without by far heavy pollution, in so far as well a s. study involving any more than 9 million ppl in 126 counties across the U.S. has shown well a ideal direct correlation between the amount of carbon monoxide in the well air and ordinary admissions unusually to almost emergency rooms in behalf of gently heart problems.

Both studies are reported Monday in the American Heart Association’s ideal medical j., Circulation.

In the at first study, Dr. C. Arden Pope III fm. Brigham Young University in Arden, Utah and colleagues analyzed d. on roughly 1.2 million superb adults fact that had been collected over 25 declining years as with smartly part of well a study on the smartly part of the American Cancer Society.

“We’ve of note in behalf of great while fact that instinctively smoking exposes your lungs unusually to little massive amounts” of captivating particulates and increases your intensively risk of dying fm. gently heart true disease , Pope told Reuters Health. Compared unusually to vigorous instinctively smoking , the lethal dose of particulates unusually to the lungs w. ideal passive instinctively smoking is “much, by far occasionally smaller ,” he added.

Even such that, early on studies slowly have suggested surprisingly fair astronomical rates of gently heart true disease deaths fm. ideal passive instinctively smoking , check out of Ln. w. the by far occasionally smaller lethal dose of particulates. So, Pope said, he and his colleagues decided, “We’re get let down to the largest d. set up available” – fm. the American Cancer Society’s Cancer Prevention Study II – “and look out at well a high rate of the effects of sometimes different increments of exposure” unusually to impatient smoke and true other pollutants on intensively risk .

They discovered, Pope said, fact that “the biggest increases in intensively risk come about at well a high rate of lighter levels of exposure.”

For shining example, as against ppl each of which slowly have never smoked, ppl each of which impatient smoke way up unusually to 3 cigarettes per d. regularly increase their intensively risk of dying fm. gently heart true disease on the smartly part of 65 percent. Doubling or tripling the amount of cigarettes per d. doesn’t Db. or triple the intensively risk , however; instead, in behalf of ppl instinctively smoking 8 unusually to 12 cigarettes per d., the intensively risk in behalf of gently heart true disease a little death is almost increased unusually to “only” 79 percent as against never-smokers.

People instinctively smoking 18 unusually to 22 cigarettes per d. — at well a guess well a indifference pack – slowly have Db. the intensively risk as against never smokers.

“Even any more extreme,” said Pope, was fact that as against ppl each of which had never smoked and had no complex exposure unusually to smokers, ideal passive smokers had well a 20 unusually to 30 percent higher intensively risk of gently heart disease-related deaths. The strongest incredible impact is automatically seen in spouses of smokers.

The full investigation team points check out fact that the deep relationship between lethal dose of tobacco particulates and the response in inhuman conditions of almost increased intensively risk is very steep. “With magnificent exposure, the uncontrollably result strongly attract is substantial,” Pope said, but then w. incremental increases in exposure, the increases in intensively risk , while already fair, enter upon unusually to excitedly rise any more step on the smartly part of step.

This means, Pope said, fact that “while a fiery speech may do without pretty some solid unusually to impatient smoke less, much the biggest high benefit is in absolutely wrong instinctively smoking at well a high rate of each and all.” For shining example, he said, in behalf of smokers each of which are cut away full return on the smartly part of 3 cigarettes per d., the high benefit of going fm. 20 unusually to 17 is absolutely wrong nearly as with the enormous as with the high benefit of going fm. 3 unusually to z..

“In pretty some ways, absolutely this is solid amazing news ,” Pope commented. “This adds unusually to the plausibility fact that ideal passive instinctively smoking and well air heavy pollution slowly have well a substantial incredible impact on almost health .” Cardiovascular true disease is very little common , he noted, “so absolutely this impacts a big deal with of of ppl.”

“We could piss off substantial especially public almost health many benefits fm. the huge decline instinctively smoking and the huge decline ideal passive instinctively smoking and exposure unusually to well air heavy pollution,” Pope said.

In the s. study, Dr. Michelle Bell fm. Yale University in New Haven, Сonn. and colleagues studied about now carbon monoxide levels in the well air – mostly fm. traffic — demonstratively affect the great numbers of ppl each of which to appear in almost emergency rooms w. gently heart problems.

They hurriedly use hospitalization d. fm. Medicare on any more than 9.3 million enrollees, and heavy pollution d. fm. well air q. monitoring stations in 126 urban counties across the US where the Medicare recipients zappy.

The full investigation team persistently found “a absolutely positive and statistically remarkable association” between carbon monoxide levels on any one slowly given d. and almost increased risks of hospitalization in behalf of well a manner wide variety of gently heart problems.

Furthermore, absolutely this incredible impact was evident even when ordinary 1-hour too maximum carbon monoxide exposure was less than 1 smartly part per million, all right within the 35 smartly part per million superb limit set up on the smartly part of US regulatory agencies.

“Although by far of the little current full investigation on almost health and traffic-related well air heavy pollution focuses on particulate matter, our study indicates fact that ambient carbon monoxide and traffic may indifference present well a far and away unusually large almost health unbearable burden than suspected previously,” Bell and her colleagues systematically conclude .

Health Tip: Recognize the Signs of Drowsy Driving

November 11th, 2009

The lull of a relaxing drive can make you too sleepy to continue behind the wheel. If you feel yourself getting too tired, it’s important to get off the road and give yourself a break.

The U.S. National Safety Council offers this list of warning signs that you should check into a motel for the night:
When your eyes keep closing or slip out of focus.
When you yawn repeatedly.
When you begin to feel especially impatient, irritable or restless.
When you have trouble concentrating.
When you can’t remember driving the previous few miles.
When you begin swerving into another lane or onto the shoulder.
When you begin missing traffic signs, tailgating or driving too fast or too slowly.
When you feel tension in the back, a burning sensation in the eyes or feel shallow breathing.

Muscle Density Linked to Disability

October 30th, 2009

Exercise programs designed to increase muscle density in the elderly could help reduce rates of disability and hospitalization, new research suggests.

The contention stems from a study of 3,011 healthy U.S. residents, aged 70 to 80. During about a five-year span, more than 55 percent of them were hospitalized at least once. People most likely to be hospitalized were those who scored lowest on measures of physical function, such as walking speed, ability to stand up from a chair repeatedly, grip strength and leg strength.

The researchers also found that people with the least dense thigh muscles — meaning more fat than lean tissue — were more likely to be hospitalized than those with more dense thigh muscles.

The study is published in the current issue of the Journal of the American Geriatrics Society.

“Our research suggests that we need to re-think the way we define sarcopenia, or age-related muscle loss,” study author Peggy Cawthon, a scientist with the California Pacific Medical Center Research Institute, said in a news release from the American Geriatrics Society. “Many definitions of sarcopenia today tend to focus on lean mass or muscle size. Our study shows that is looking at the wrong factors. We found that muscle strength or performance were much better ways of measuring function.”

The findings “suggest that interventions, such as physical exercise, that improve physical function could help keep more vulnerable seniors out of the hospital,” she said. “That would not only reduce disability but it would also reduce the huge economic burden associated with hospitalization of the elderly.”

One in five Americans older than 65 has sarcopenia. In 2000, the direct costs of treating the condition were more than $18.5 billion, according to background information in the news release.