WF- News July 2003

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Blood Pressure and Kidney Disease (July 29, 2003)

(Ivanhoe Newswire)

Kidney disease is a relatively common complication in patients with diabetes. However, in patients with type 2 diabetes, studies have not looked at the effects of lowering blood pressure on end-stage renal disease or death. A new study explores that issue.

Researchers examined more than 1,500 type 2 diabetes patients with kidney disease and high blood pressure. Doctors looked at the impact of reducing systolic blood pressure (SBP), pulse pressure, and decreasing diastolic blood pressure (DBP). It was a randomized study looking at the medication losartan compared to placebo and a few other medications designed to lower blood pressure.

They found a baseline SBP range of 140 to 159 increased the risk of end stage renal disease or death by 38 percent, compared with those below 130. Every increase of 10 points increased the risk by 6.7 percent. The same rise in DBP decreased the risk by 10.9 percent.

Researchers conclude, “Baseline SBP is a stronger predictor than DBP of renal outcomes in those with nephropathy resulting from type 2 diabetes.” Those with the highest pulse pressure have the highest risk for progression of kidney disease. This same group also benefits the most from lowering their SBP. They say the goal can be achieved by giving patients common medications known as beta-blockers and calcium channel blockers. They write, “Hopefully, these data will better equip physicians to slow the epidemic of ESRD.”

SOURCE: Archives of Internal Medicine, 2003;163:1555-1565

Fish Protects Against Alzheimer’s (July 29, 2003)

(Ivanhoe Newswire)

Eating fish just one time a week appears to be good for your health. A new study finds people who eat a fish meal once a week or more have a 60-percent lower risk of developing Alzheimer’s disease. Previous studies have shown the fatty acids in fish offer a protective effect against Alzheimer’s in animals. Now, the study has been replicated in people.

Researchers from the Rush Institute for Healthy Aging in Chicago studied the dietary habits of 815 people between the ages of 65 and 94. They were asked about their consumption of four seafood items: tuna fish sandwich, fish sticks/fish cakes/fish sandwich, fresh fish as a main dish and shrimp/lobster/crab. During the length of the study, 131 people went on to develop Alzheimer’s disease.

Those who ate a fish item once a week or more had a 60-percent lower risk of developing Alzheimer’s compared with those who rarely or never ate fish. The polyunsaturated fatty acids are thought to offer the protective effect. In an accompanying editorial, Robert P. Friedland, M.D., writes there is now considerable evidence pointing to the importance of diet and its influence on Alzheimer risk. He writes: “These recommendations have not yet been evaluated with a double-blind, multi-site clinical trial. However, this dietary advice is fully in accordance with recommendations for lowering the risk of cardiovascular disease and diabetes.”

Friedland also says fish consumption is believed to reduce the risk of prostate, gastrointestinal tract and several other cancers. There are still some questions surrounding the subject. Specifically, doctors want to compare the risk of eating fish (exposure to toxins) to the benefits.

SOURCE: Archives of Neurology, 2003;60:940-946

Anemia may Lead to Physical Decline (July 29, 2003)

(Ivanhoe Newswire)

A new study shows anemia may double the risk of an older person developing serious physical declines that can erode the ability to live independently. Researchers say seniors who do not have anemia, but whose blood tests are just above the traditional cut-off point for the condition's diagnosis, are 1.5-times more likely to develop physical declines than those who have normal blood hemoglobin levels.

Investigators followed 1,146 people, ages 71 and older, for more than four years. Researchers assessed participants' standing balance, a timed eight-foot walk, and the ability to rise from a chair. Each activity was scored on a scale (a zero equaled inability to do a test; a four equaled a top performance). Points were then added together for a cumulative score.

Results of the study show two-thirds of participants had at least modest declines in physical performance scores. Those who did not have anemia averaged a 1.4-point decline on the overall 12-point scale. Those who had borderline anemia dipped an average of 1.8 points and those with anemia dropped an average of 2.3 points.

Anemia is a blood condition that affects at least 3.4 million Americans and about 13 percent of older Americans. It is the most common blood disorder in the United States. The condition occurs when the body doesn't produce enough red blood cells or red blood cells are prematurely destroyed.

SOURCE: American Journal of Medicine, 2003;115:104-110

Obesity Linked to Alzheimer’s (July 28, 2003)

(Ivanhoe Newswire)

Obese individuals have a greater risk of developing certain cardiovascular conditions, but could being overweight also increase your risk of Alzheimer’s? Researchers in Sweden say yes, if you are a woman.

A new study shows women who are obese have a greater risk of developing dementia and Alzheimer’s disease. Researchers studied nearly 400 patients between ages 70 and 88. The participants were given physical exams that included an electrocardiogram, a chest X-ray, several blood tests, and a neuropsychiatric evaluation. Participants also had their body mass index recorded.

Results of the study show nearly 100 of the 400 participants were diagnosed with a form of dementia. Women who developed dementia between 79 and 88 years of age had a higher BMI at age 70 and 79 than those who did not develop dementia. Women who developed Alzheimer’s disease also had higher BMIs at ages 70 and 75 years. For every one-point increase in BMI at age 70, the risk for Alzheimer’s increased by nearly 40 percent.

These results, however, were not found in men. In fact, no link was found between the BMI of men and the risk of dementia. Authors of the study write, “The association between large body size and dementia was found only in women. This may be due to selective survival, a true metabolic phenomenon in women, sex differences in body fat distribution, or the low number of men in our sample.”

More than 50 percent of adults in the United States and Europe are obese. The highest prevalence of obesity is found in adults who are 50 or older.

SOURCE: Archives of Internal Medicine, 2003;163:1524-1528

Cholesterol is the Key (July 28, 2003)

(Ivanhoe Newswire)

A new study finds the majority of the public still does not know cholesterol can lead to early death. In order to save lives, the American Heart Association believes the public has to know high cholesterol is dangerous. Their new study finds physicians, overall, need to improve the educational process.

Heart disease is the leading cause of death in the United States. While death rates from heart disease have dropped in the last 20 years, the AHA says more needs to be done. This study by doctors at Mt. Sinai Medical Center was a survey of more than 1,100 adults. They found while 91.2 percent said it was “important to them personally to have a healthy cholesterol level”, only half knew their cholesterol level. Only 40 percent knew the national guidelines on cholesterol management.

A little more than half of those surveyed knew what numbers were desirable when it comes to cholesterol. The authors of the study say these findings point to the need for further education. Specifically, they say more needs to be done to advise people of the modifiable risk factors such as smoking, exercise, a healthy diet, and high blood pressure.

The study also revealed patients rely on their physicians to educate them more than any other source. The authors of the study write, “Physicians and other health care providers have a tremendous opportunity to improve their education of patients and lower the morbidity and mortality of atherosclerotic disease.”

SOURCE: Archives of Internal Medicine, 2003;163:1597-1600

Breast Implant Risks Increase with Implant Age (July 25, 2003)

(Ivanhoe Newswire)

New research shows the risk of silicone breast implant rupture increases with implant age. The study, supported by the International Epidemiology Institute, performed a set of two MRIs on 271 women whose breast implants were at least three years old.

Silicone breast implants are the preferred implants in Europe, but their use has been restricted in the United States since 1992. This restriction is partly due to the risk of ruptures that “often remain unnoticed by both patient and physician because the leaking silicone is kept in place by the surrounding fibrous scar tissue,” researchers explain.

Participants in this study were given a baseline MRI to scan for possible ruptures, then given a second MRI two years later to again check for ruptures. Within this two-year period 10 percent of the implants showed definite ruptures and 7 percent of the implants showed possible ruptures, leading researchers to conclude, “A minimum of 15 percent of modern implants can be expected to rupture between the third and tenth year after implantation.”

Some plastic surgeons suggest routine exchange of implants “exceeding 10 years of age,” but this advice may provide false security. Further investigation of untreated silicone breast implant ruptures and their changes over time is needed.

SOURCE: Archives of Surgery 2003;138:801-806

How to Improve Life Expectancy (July 25, 2003)

(Ivanhoe Newswire)

Eat better, exercise more, stop smoking -- they all sound simple, but can they really impact health? A new study shows removing some of these factors can significantly improve life expectancy worldwide.

Researchers from several international centers combined efforts to determine the potential health gains of reducing risk factors for disease. They looked at 20 risk factors. Some of those include unsafe sex, alcohol use, unsafe water, sanitation and hygiene, indoor smoke, childhood sexual abuse, and vitamin deficiencies.

They found 47 percent of premature deaths and 39 percent of total diseases around the world in 2000 resulted from a combination of risk factors. Some of the health problems that resulted were diarrhea, lower respiratory infections, lung cancer, chronic obstructive pulmonary disease, heart disease and stroke. Researchers say removing the risks would increase life expectancy by an average of nine years, depending on the location. The researchers write, “The analysis showed that even populations with high life expectancy at present, such as developed regions of the western Pacific and western Europe, could benefit considerably from risk reduction.”

Study investigators believe this information can lead people to make improvements in their health. They say, “The implementation of affordable and effective prevention strategy should incorporate the interaction of major risks to health.”

SOURCE: The Lancet, 2003;362:271-280

Bone Strength After Menopause (July 24, 2003)

(Ivanhoe Newswire)

Menopause can wreak havoc on a woman’s bones and a new study reveals a good way to determine the risk of a fracture. Researchers know bone loss occurs after menopause, increasing chances of a fracture. However, not much is known about bone size and strength.

The Swedish study involved 146 women who were followed through menopause. Every other year they had bone scans done to determine bone size and density. All fractures related to a fall were recorded during the length of the study. Bone mineral density decreased annually by around 1.9 percent and bone mineral content decreased by around 1.3 percent. At the same time, the size of the bones increased significantly while strength decreased.

The researchers say after menopause, bone size increases at the same time bone density decreases. They suspect the loss of estrogen plays a part in the growth of bones, since the hormone is known to inhibit bone formation in rats.

While a woman’s risk of a fracture increases with the loss of bone, the researchers believe the increase in bone size can offer more protection. They say bone density alone should no longer be the only predictor of fracture. It should be considered along with size to determine the true strength.

SOURCE: New England Journal of Medicine, 2003;349:327-334

FDA Approves Enbrel to Treat Ankylosing Spondylitis (July 24, 2003)

FDA today approved an application for etanercept (trade-name Enbrel), a genetically engineered protein, for a new indication for treatment of patients with active ankylosing spondylitis (AS), a chronic inflammatory disease affecting primarily the lower back and joints. The product is manufactured by Immunex Corporation, Thousand Oaks, Calif. and marketed by Amgen and Wyeth Pharmaceuticals. Etanercept is also licensed for treatment of patients with rheumatoid arthritis, juvenile rheumatoid arthritis, and psoriatic arthritis.

Approximately 350,000 patients in the United States have AS. The disease affects men more often than women. Symptoms of the disease may start in adolescence and are usually present by age 30. Patients often have lower back pain and stiffness, chest pain, joint pain and swelling, and tenderness due to the inflammation. In some patients the disease can cause significant pain and disability for many years.

Currently approved drugs for AS include some non-steroidal anti-inflammatory drugs (NSAIDS) which are approved to treat the symptoms of AS. Disease Modifying Anti-Rheumatic Drugs (DMARDS) that are approved for use in other inflammatory joint diseases are sometimes used when NSAIDS are ineffective, but none is FDA approved for use in the treatment of AS.

Etanercept binds to tumor necrosis factor (TNF), a naturally occurring protein in the body, and inhibits its action. TNF, which promotes inflammation in the body, is found at elevated levels in the blood and certain tissues of patients with AS. It is believed that interference with TNF plays a role in the beneficial effects of etanercept for AS.

The major efficacy trial of etanercept for AS was a randomized, double-blind, placebo-controlled study of 277 patients. The study excluded patients with the most severe forms of AS. After six months of twice-weekly treatments, 58% of patients who received etanercept showed significant improvement on a scale that measured pain, function, and inflammation compared to 23% who received a placebo.

The main side effects of etanercept in the study were similar to those previously seen for this drug for other indications, including injection site reactions and upper respiratory infections. The approved labeling warns physicians about post-marketing reports of serious infections. The labeling says that Enbrel should not be given to patients with any active infection, including chronic or localized infections. It also recommends that patients who develop a new infection while being treated with Enbrel should be monitored closely.

Amgen will continue to follow patients in the trial to evaluate the long-term safety of etanercept in patients with AS.

Dad’s Age Affects Baby (July 23, 2003)

(Ivanhoe Newswire) -- The age of your father when you are born may affect your risk of schizophrenia. Researchers in Denmark found an increased risk of schizophrenia associated with advanced paternal age, particularly in females.

Investigators studied data from 7,704 patients diagnosed with schizophrenia. They found an increased risk for the mental disorder in females born to fathers ages 50 or older and an increased risk for males born to fathers ages 55 or older. Researchers found the same link whether the offspring had a family history of schizophrenia or not.

These findings lend support to the theory that de novo mutations, possibly linked to the X chromosome and associated with increased parental age, may be responsible for some cases of schizophrenia. The X chromosome contains many genes expressed in the central nervous system and the gene for many diseases with cognitive impairment. Another possible explanation for the link is the adverse psychological effects of losing a parent due to the parent's increased age.

Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality and relates to others. It is a life-long disease that cannot be cured, but usually can be controlled with proper treatment.

SOURCE: Archives of General Psychiatry, 2003;60:673-678

Heat to Treat Cervical Cancer (July 21, 2003)

(Ivanhoe Newswire)

A new study shows a promising new idea in the treatment of advanced cervical cancer. The research shows radiotherapy followed by chemotherapy and hyperthermia could be beneficial. Hyperthermia is heating up the area to a higher-than-normal body temperature.

Advanced cervical cancer remains one of the most common cancers in women worldwide. While there have been many advances in treating this disease, researchers from Duke University Medical Center say a triple combination treatment could be the next step in treating patients with advanced cervical cancer.

Researchers conducted a small study to see if the triple treatment would be effective. Twelve patients were included in the study. Each underwent radiotherapy, chemotherapy and hyperthermia to treat their cervical cancer. The study reports 10 of the patients had a complete response to the treatment and their cancer did not spread. In two of the patients, the cancer continued to progress and spread to areas outside the pelvis. They both died within six months.

Five previous studies have shown the combination of chemotherapy and radiotherapy is beneficial to patients with cervical cancer. Researchers say this study shows adding hyperthermia to that treatment resulted in an excellent clinical response. They also say the treatment was well tolerated by the patients. Study authors feel this triple treatment warrants larger studies to confirm its efficacy.

SOURCE: Cancer, 2003;98:277-282

How Much Should Athletes Drink? (July 21, 2003)

(Ivanhoe Newswire)

If you’re going to exercise today, be careful how much fluid you drink. Too much fluid before, during or after exercise can have a potentially fatal outcome.

The warning follows reports of several deaths from a severe lack of salt in the blood due to excessive drinking known as hyponatremic encephalopathy. Since the cause of the condition is now known, Timothy Noakes, from the Sports Science Institute of South Africa, says it is preventable.

Noakes says there is no evidence athletes must drink the maximum amount of fluids tolerable to optimize performance and prevent medical consequences. He adds there is also a misconception that a feeling of thirst underestimates fluid requirements.

Drinking according to the personal dictates of thirst seems to be safe and effective, he says. Such fluid intake typically ranges between 400 milliliters and 800 milliliters per hour in most forms of recreational and competitive exercise.

Noakes concludes, “The recent adoption of these guidelines by USA Track and Field provides the hope that this sad aberration has finally run its tragic course.”

SOURCE: British Medical Journal, 2003;327:113-114

Depression Risk in the Genes (July 21, 2003)

(Ivanhoe Newswire)

Why do some people become depressed after a stressful event while others don’t? New research suggests it could be a specific version of a gene.

Researchers from Wisconsin and London followed more than 800 participants from birth into adulthood. Seventeen percent of the participants carried two copies of a short version of the serotonin transporter gene, about 30 percent carried two copies of a long version of the gene, and about 50 percent carried one copy of each version of the gene.

Results of the study show more than 40 percent of the participants carrying two short genes suffered from depression following a traumatic life event. Less than 20 percent of those with long genes developed depression after a stressful event. Researchers define a “stressful event” as losing a job, having a loved-one die, being diagnosed with a serious illness, or experiencing a break-up or divorce.

Terrie Moffitt, Ph.D., from the University of Wisconsin and King’s College in London, says, “We found the connection [between the gene version and depression] because we looked at the study members’ stress history.”

Everyone inherits two copies of the serotonin transporter gene, one copy from each parent. Each version of the gene functions differently. The short version makes less protein, resulting in increased levels of serotonin. Researchers say this may be why it appears less efficient at stopping unwanted messages.

Participants with the short genes who had experienced four or more life stresses accounted for nearly one quarter of the cases of depression. Among those with four or more life stresses who developed depression, more than 40 percent had two copies of the short gene compared to 17 percent with two copies of the long version of the gene.

Researchers say more research is needed to confirm their findings.

SOURCE: Science, 2003;301:386-389

Racial Differences in Diabetics (July 18, 2003)

(Ivanhoe Newswire)

Type 2 diabetes affects nearly 20 percent of adults over the age of 75 in the United States. The prevalence of this disease is higher among blacks and Hispanics than Caucasians. Blacks and Hispanics with diabetes also often have poorer glycemic control leading to increased death and complications. Why is there this racial difference in this group of diabetics? A new study tries to pinpoint the factors that cause this difference.

Researchers from the National Institute on Aging undertook the study. While study authors hypothesized glycemic control would be worse among blacks than whites, they thought it would be explained by differences in disease severity, health status, health care indicators and social, psychological or behavioral factors. They also assumed those patients with poorer glycemic control would be limited to those with lower education and lower income.

For the study, 468 diabetics between age 70 and 79 years were involved. Each participant had their blood levels measured and answered questions about their lifestyle. Fifty-eight percent of the participants were black.

Researchers found glycemic control was poor in all the participants. However, they say blacks had worse glycemic control than whites. After adjusting for insulin therapy, cardiovascular disease, cholesterol levels and other factors that affect blood concentrations, researchers still observed racial differences when it came to glycemic control. Race also remained an important factor, even after adjusting for education and income level.

Study authors say race plays a role in the health of older type 2 diabetics. While differences in glycemic control were associated with disease severity, health status and poorer quality of care, these factors did not fully explain why blacks have poorer control of their disease. They say racial difference in glycemic control should be further studied to identify factors that could lead to intervention. Researchers comment in the study, “Efforts in this direction are likely to benefit all older individuals with diabetes.”

SOURCE: Diabetes Care, 2003;26:1986-1992

Age to Begin Breast Screening Questioned (July 18, 2003)

(Ivanhoe Newswire)

Two leading experts in the United Kingdom are calling for the age a woman starts receiving mammograms to be lowered. The experts say the entry age for mammographic screening should be lowered from 50 to 47 years old.

In the United Kingdom, women aged 50 to 64 years are invited to have a mammogram screening every three years. There has been much debate on what age women should enter mammogram screening programs. There is an ongoing clinical trial that could recommend lowering the age, however the trial will not be complete until the end of 2004.

Two leading scientists at the Cancer Research UK say there is no reason to wait for the study results to lower the age. The scientists feel there is sufficient evidence now to lower the age. The authors point out that, at age 40, the annual rate of breast cancer is 79 per 100,000. But they say that number rises substantially to 148 per 100,000 women at the age of 47 years old and continues to increase at 48 years old.

Researcher Peter Sasieni says, “Between 48 and 54 years, the rates of breast cancer plateau before again increasing more slowly reaching 221 per 100,000 women by age 64 years. Thus, the incidence of breast cancer at age 48 to 49 years is as great as that as age 50 to 54 years, and the number of life-years that could be saved is potentially greater among these younger women.”

While the authors say it is not justifiable at this point to screen women in their early 40s, they feel there is a strong case to reduce the age to 47 with mammogram screenings every three years thereafter.

SOURCE: The Lancet, 2003;362:246-247

Smoking and Oral Contraceptives: A Deadly Combination (July 18, 2003)

(Ivanhoe Newswire)

A new study shows oral contraceptives are safe for non-smokers but can be deadly for women who smoke. The study began 35 years ago and included 17,000 women.

Oral contraceptives were widely used in the 1970s and 1980s. There has long been a question of whether being on the birth control pill could increase your chance for cancer or other fatal diseases. As part of the Oxford Family Planning Association study, researchers from the Institute of Health Sciences in England looked at the deaths associated with oral contraceptives use and cigarette smoking.

The women in the study were between 25 and 39 years old. They either used oral contraceptives, a contraceptive diaphragm or an intrauterine device. Follow-up information was available on the women up until 2000. By that time, researchers report 889 of the 17,000 women had died. Researchers looked at the cause of death and which contraceptive they used.

The study reports there was no increased risk of death among the women who used the birth control pill compared to the women who never used oral contraceptives. In fact, the numbers suggest the death rate was lower among those who were on birth control pills. However, there was an increased risk of death from heart disease in women who used the oral contraceptive and smoked. Specifically, there was a 25-percent increased risk of death for light smokers. The study also found women who smoked more than 15 cigarettes a day and were taking oral contraceptives were twice as likely to die than non-smokers.

Researchers say this study confirms what three other studies have found in that there is no adverse effect from oral contraceptive use in non-smokers. Study authors say this should be a reassuring finding for many older women today. However, the study also confirms that smoking and oral contraceptive use can be a deadly combination.

SOURCE: The Lancet, 2003;362:185-191

Sticking it to Osteoarthritis (July 18, 2003)

BALTIMORE (Ivanhoe Newswire)

About one-third of adults over age 50 have osteoarthritis -- a condition where bones and joints become achy and painful. While treatments are available, they don’t always alleviate the pain. Now an ancient treatment offers an alternative to modern-day arthritis care.

Every two weeks, Joy Berman takes this walk to a place she didn’t need until last year. “I was getting more uncomfortable and more difficult walking up and down the stairs, and so I wanted to try something and see if it would help me,” she tells Ivanhoe.

Berman has osteoarthritis. She turned to acupuncturist Lixing Lao, Ph.D., to ease the pain in her knees. “According to Chinese medical theory, acupuncture balances the energy in the body,” Lao, of University of Maryland in Baltimore, tells Ivanhoe.

According to a recent study, it also decreases pain from osteoarthritis. Rheumatologist Marc Hochberg, M.D., says it could help patients who don’t respond to standard treatments.

“I think it gives patients another avenue for treatment,” says Dr. Hochberg, also of University of Maryland.

That avenue could be the right path for many. “They may indeed notice an improvement in their symptoms and improvement in their functional capacity, and that’s really what we want out of the treatment,” says Dr. Hochberg.

The study shows more than 70 percent of patients had a 50-percent improvement in their pain.

Lao says, “We had very remarkable improvement in terms of pain, stiffness, function, and change. Quite remarkable compared to the non-treatment patients.”

In traditional acupuncture, needles are manipulated by hand to elicit a response. Now, doctors use electrical stimulation to enhance the effectiveness of the treatment.

Berman says, “I have less pain. I don’t have that much pain when I’m walking. Sometimes I feel almost normal.” Patients like her keep Lao inspired. “My favorite part is that the patient come back, say ‘I feel better.’ This make me very happy,” Lao says.

Lao says acupuncture can boost the immune system and decrease inflammation. It is meant to be used in combination with standard treatments and not in place of them.

If you would like more information, please contact:

Brian Berman, M.D.
University of Maryland School of Medicine
Kernan Hospital
2200 Kernan Dr.
Baltimore, MD 21207
(410) 448-6871
bberman@compmed.umm.edu

FDA Clears New Lab Test to Help Predict Those at Risk of Coronary Heart Disease (July 18, 2003)

The Food and Drug Administration (FDA) today cleared for marketing a new laboratory blood test that will increase the ability of doctors to predict the risk of coronary heart disease (CHD).

The test, called PLAC, works by measuring an enzyme called lipoprotein-associated phospholipase A2. This enzyme is made by a type of white blood cell called a macrophage. Macrophages make more of this enzyme and release it into the blood when a person has CHD.

FDA cleared the test based on results of a study of more than 1,348 patients. The study was a part of a large multi-center epidemiologic study sponsored by the National Heart, Lung, and Blood Institute. Patients were free from CHD at the start of the study and were followed for the development of disease for nine years. The greatest increased risk was found in subjects with the highest PLAC test results and LDL cholesterol levels lower than 130mg/dL.

The PLAC test is not a stand-alone test for predicting CHD. The test provides supportive information when used with clinical evaluation and other tools for patient risk assessment. An elevated PLAC test result with an LDL-cholesterol level of less than 130 mg/dL gives doctors increased confidence that patients have two to three times the risk of having coronary heart disease when compared with patients having lower PLAC test results.

Some 7 million Americans suffer from CHD, the most common form of heart disease. This type of heart disease is caused by a narrowing of the coronary arteries that feed the heart. CHD is the number one killer of both men and women in the U.S. Each year, more than 500,000 Americans die of heart attacks caused by CHD.

The PLAC test is manufactured by diaDexus, Inc. of San Francisco, Calif.

Fat Intake Associated with Breast Cancer (July 17, 2003)

(Ivanhoe Newswire)

There is yet another reason for young women to aim for a low fat diet; it could reduce their risk of breast cancer. A new study finds a high intake of animal fat is associated with a higher risk of developing breast cancer.

The current research was done in premenopausal women. Included in the study were more than 90,000 women who were part of the Nurses’ Health Study II. The women completed questionnaires about how frequently they consumed certain foods and were followed for eight years. Researchers at Harvard Medical School and Brigham and Women’s Hospital in Boston conducted the study.

During the eight-year follow-up, 714 women developed breast cancer. Researchers say when they looked at fat intake, they found women who consumed the highest amounts of fat (21 percent to 46 percent of calories from animal fat) had a slightly higher risk of breast cancer than those who consumed the smallest amounts of fat (less than 14 percent of calories from animal fat). Specifically researchers say animal fat, which includes red meat and high-fat dairy foods, was associated with this increased risk. The study found an increased intake of vegetable fat is not associated with an increased risk of breast cancer.

Researchers comment the prevention of coronary heart disease is a good reason to eat a diet low in animal fat. However, they say for young women prevention of heart disease is not a high priority. Therefore they hope this study may encourage younger women to eat a healthier diet if they know it could help prevent their risk of breast cancer as well.

SOURCE: Journal of the National Cancer Institute, 2003;95:1079-1085

Memory Impairments in Diabetics (July 16, 2003)

(Ivanhoe Newswire)

A new study shows eating high glycemic index carbohydrates contributes to memory problems among people with diabetes. Researchers say the degree of glycemic control is related to cognitive performance in adults with type 2 diabetes.

Experts say the risk of dementia is nearly doubled in adults with type 2 diabetes. This is why studies focusing on memory tests in diabetics are important. Researchers from the University of Toronto conducted a study to determine if carbohydrate consumption contributes to or exacerbates memory dysfunction.

The study included 19 adults with type 2 diabetes. Each participant was tested after being fed one half bagel and white grape juice and also when he or she had not eaten anything. The tests focused on memory, specifically recalling word lists and information from a story. The tests were done 15 minutes after eating and again 30 minutes after eating.

Researchers found, under fasting conditions, high blood sugar levels were associated with poor results on memory tests. Eating the carbohydrates improved the participants’ scores 15 minutes after eating, but impairments were seen again 30 minutes after eating.

Study authors conclude poorer glycemic control in type 2 diabetics is associated with lower performance on memory tests. They add, “Acute ingestion of high glycemic index carbohydrate foods further contributes to the underlying memory impairment.”

SOURCE: Diabetes Care, 2003;26:1961-1966

Better Blood Medication (July 16, 2003)

NEW YORK (Ivanhoe Newswire)

An irregular heartbeat, also known as atrial fibrillation, can lead to stroke or the formation of potentially life threatening clots. While the drug warfarin has been used for decades to reduce the risk of clots and stroke, difficulties with the drug often keep patients from taking it and doctors from prescribing it. This new research could mean a drug that offers the same benefits with fewer concerns.

It’s time for Camille Engelbert's regular visit to the doctor. Six months ago, she became one of the millions of Americans on the blood thinner warfarin. While the drug can prevent potentially fatal blood clots from forming, it’s a complex medication.

“Not only do a zillion factors affect it, but in fact, you have to control it within a very narrow range,” says cardiologist Jonathan L. Halperin, M.D., of Mount Sinai Medical Center in New York.

Not enough and clots can form. Too much can cause bleeding. This means monthly blood tests and a close watch on diet and other drugs.

Engelbert says, “I don’t take anything without checking with Dr. Halperin or the office.”

Now Dr. Halperin is studying a new drug called ximelagatran that he hopes will do the job of warfarin without all the worries.

“It acts in a different place in the body’s biochemistry of clotting to allow it to be used as a single dose for all people,” Dr. Halperin says.

A study in more than 3,000 patients had encouraging results. “Ximelagatran was at least effective as adjusted dose warfarin in preventing strokes and actually caused less bleeding than warfarin without the need for blood test monitoring or dose adjustment,” says Dr. Halperin. He hopes that means more patients will get the treatment the need and thousands of strokes can be prevented.

Also, unlike warfarin, ximelagatran is not affected by other drugs or foods. Dr. Halperin and his colleagues are currently analyzing the results of a second study, which compares the drug to standard treatments.

If you would like more information, please contact:

Jonathan L. Halperin, M.D.
Mount Sinai Medical Center
Fifth Avenue at 100th Street
New York, N.Y. 10029-6574
(212) 427 1540
Jonathan.halperin@msnyuhealth.org

Special Bedding not Effective for Asthma Control (July 16, 2003)

(Ivanhoe Newswire)

A new study finds allergen-impermeable bed covers are not effective at helping adults with asthma avoid mite allergens.

Conflicting data exists on the effectiveness of reducing mite allergen as a way to control asthma in patients. In recent years, special impermeable bed covers have been marketed that claim to substantially reduce the level of exposure to the allergen in bed. Researchers from the University of Manchester tested the hypothesis that these bed covers improve asthma control.

For the study, researchers included 1,122 adults who were diagnosed with asthma. The study focused on the breathing ability or expiratory flow rate over four weeks, at six months and at 12 months. The allergen levels were also measured in 10 percent of the homes at six months and 12 months.

Researchers report the prevalence of dust-mite allergen was 65.4 percent in the group supplied with the special bed covers and 65.1 percent in the group supplied with non-impermeable bed covers. Researchers also report the lung capacity improved in both groups with no significant difference between those with the special bedding and those without it.

In a perspective on the study, Thomas Platts-Mills, M.D., from the University of Virginia, comments on the latest research. He points no one currently understands what is necessary to make patients with asthma well. He also says dust mites are not the only agent that can influence lung function. He says it is clear that some changes in diet, lifestyle, cleanliness or housing have led to an increase in the prevalence and severity of asthma. He adds the challenge is to figure out what has caused this and how to prevent or cure the disease.

SOURCE: The New England Journal of Medicine, 2003;349:225-236,349

Gene Mutation Causes Ovarian Failure (July 14, 2003)

(Ivanhoe Newswire)

Researchers have discovered a gene mutation that may cause premature ovarian failure, or early menopause. The findings may be useful for further study into, what researchers say, is a poorly understood condition.

Premature ovarian failure is a form of infertility that affects about 250,000 women in the United States. It is diagnosed in one out of every 100 women ages 30 to 39.

Investigators from Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston created mice that lack both copies of a gene called FOXO3a, which belongs to the forkhead gene family. These genes are believed to control processes related to aging, cancer and diabetes. As the gene-altered mice aged, the females had fewer and smaller litters. By 15 weeks, which is comparable to early adulthood in a woman, they were sterile.

In addition, in the ovaries of the gene-altered mice, the follicles that contain eggs were activated earlier and more widely than in the normal mice. Lead study author Ronald DePinho, M.D., from Dana-Farber, explains: "There is a finite number of grains of sand that are released in a metered way. Similarly, a woman's eggs are gradually released over her reproductive lifespan. Menopause occurs when all the grains of sand have fallen. In mice lacking the FOXO3a gene, all of the grains of sand fall out very quickly, resulting in early menopause."

Researchers say it might be possible in the future to develop a contraceptive that would delay follicular activation. Current oral contraceptives prevent ovulation but do not slow the rate of activation.

SOURCE: Science, 2003;301:215-217

Effects of Alcohol in Diabetic Women (July 14, 2003)

(Ivanhoe Newswire)

Alcohol consumption may have a beneficial effect in women with insulin resistance, according to new research. The study shows one to two drinks a few days a week is particularly beneficial in overweight women.

Past studies have reported a beneficial effect of moderate alcohol consumption for people with type 2 diabetes. However, the studies also found an opposite effect if there is a heavy consumption of alcohol. Researchers from Harvard School of Public Health conducted a study to determine the association of drinking alcohol on glycemic control among women.

The study included 459 normal weight and overweight female nurses between 33 and 50 years old. The women provided blood samples and detailed information about their dietary and lifestyle factors. Researchers evaluated alcohol consumption and measurements that looked at insulin resistance and glycemic control.

Researchers report, after adjusting for other factors such as age, physical activity and weight, alcohol intake had a beneficial effect on several markers of glycemic control. They also found insulin levels were improved specifically for overweight women. They did not find a difference in the results if the alcohol was consumed with meals and it did not matter which type of alcoholic beverage was consumed.

Researchers conclude alcohol in a limited amount may have beneficial effects on insulin resistance in women, especially overweight women.

SOURCE: Diabetes Care, 2003;26:1971-1978

Better Information on Mammography Needed (July 14, 2003)

(Ivanhoe Newswire)

Having a mammogram may be a well-established practice for women, but a new article finds information about mammography needs to be improved. Researchers say there are many misconceptions about mammography and that women need to be informed about the benefits and the potential harms of the procedure in order to make an informed choice.

Study authors from the University of Leicester in the United Kingdom comment in an article in the British Medical Journal on the controversy surrounding mammography. They say there are many misconceptions about breast screening that should be cleared up. For example, study authors say the five common misconceptions about mammography screening include:

Screening tests are meant for patients with known symptoms
Screening reduces the incidence of breast cancer
Early detection implies reduced mortality
All breast cancers progress
Early detection is always a benefit
In the article, the authors point out that screening for cancer actually increases the incidence of the disease. They also say many health care providers ignore the harm that can come with mammography. Some women may suffer physical, emotional, social, financial or psychological harm from having a mammogram. Researchers say it is important for women to understand and be prepared for possible harm that may come from this screening. Furthermore, the authors say the data that is presented on mammography needs to be presented to women in terms that they can understand. They point out even the estimates on how mammography affects death from breast cancer varies greatly and this needs to be explained clearly to women.

In conclusion, researchers feel women must be enabled to make true informed choices about their decision to have a breast screening. Authors state, “It is unacceptable that women taking tests continue to suffer morbidity and regret because they found out the harms of screening from experience.”

SOURCE: British Medical Journal, 2003;327:101-103

Gene Mutation Causes Ovarian Failure (July 14, 2003)

(Ivanhoe Newswire)

Carnitine: Right Supplement, Wrong Reason? (July 14, 2003)

By Jim Brown, Ph.D., Ivanhoe Health Correspondent
(Ivanhoe Newswire)

Researchers keep trying and manufacturers keep hoping. They both want to prove that carnitine supplements make their way into muscle tissue to burn fat, enhance performance, and improve body composition. They may be looking may be looking in the wrong place.

Jeff Volek, Ph.D., William Kraemer, Ph.D., and a group of exercise scientists at the University of Connecticut conducted a study to find out if carnitine supplements could reduce the stressful effects of exercise and speed up the recovery process. They found the answer in blood flow, not in muscle tissue.

"Ninety-nine percent of the research with carnitine has focused on it as a supplement fat burner and performance enhancer," says Volek. "Theoretically, if you can burn fat, you conserve glycogen and enhance performance. But most of the studies never really showed that it burned more fat. Unlike taking creatine and increasing its presence in muscles by 20 percent or 30 percent, study after study has shown that it is difficult to increase muscle carnitine level by taking supplements."

Carnitine is a protein-like substance found in red meat and other foods. Although we take in up to 300 milligrams a day, the body can produce its own supply. There is no dietary requirement for carnitine. Its primary function is to transport fatty acids into cells to be burned as energy.

First to Look Outside the Box

"We were the first to look outside the box on how carnitine might work apart from the fat burning theory," explains Volek. "We knew there was research showing that carnitine also plays a role in vasodilation (expanding the size of blood vessels) and controlling blood flow. So we decided to find out what would happen if you were to have better blood flow due to carnitine supplements and how that would affect exercise recovery."

Volek's team recruited ten participants who were similar in background, health status, body size, and eating habits. All had participated in a weight training program for at least one year. For three weeks they were given two grams of L-carnitine a day. Then they were put through an exercise routine of five sets of squats with 15 to 20 repetitions each. Immediately after and at regular intervals up to three hours following the workout, blood samples were taken and magnetic tests were conducted to measure the amount of muscle damage and tissue repair. After a "wash out" period to rid the body of the added carnitine, the participants were given a placebo and put through the same exercise program and follow-up tests. Here is what they found.

"We discovered that some of the markers of the stress response caused by exercise were diminished," says Volek. "The MRI exams showed that the percent of muscle disruption was significantly greater when they took the placebo -- less when they took carnitine supplements. Also, soreness ratings were significantly higher after taking the placebo than after taking carnitine. We think this happened because the carnitine accumulated in the cells that line blood vessels, made them expand, and increased the blood flow and the delivery of oxygen."

Implications for Exercisers

The UConn research was reported in the Journal of Physiology. If it holds up to further investigations of different groups and with a variety of exercises, the implications for exercisers and athletes could be profound.

"Two grams of carnitine supplementation a day might be useful as a substance to aid recovery between bouts of exercise," concludes Volek. "If there is less tissue damage and muscle soreness, athletes can resume strenuous training sooner than they have been able to in the past. That capacity, not fat burning, could lead to better performance."

Computerized Leg (July 14, 2003)

WORCESTER, Mass. (Ivanhoe Newswire)

The earliest prosthetic limbs were essentially just wooden legs. From there, science has made them more comfortable, more functional, and lighter. Now the next phase of prosthetic legs is here, and it’s giving people the confidence to do activities they never thought possible. Here's one man who found he could even do his favorite wintertime activity.

Fifteen years ago, Chris Culross met his wife, Andrea, and found a new hobby. “I was over at her house one day, and her mother pulled some out and said, ‘Here, have some pancakes and maple syrup that I made,’ and I thought that was the best idea.”

But, tapping trees for syrup took on a new challenge when Chris lost his leg in a car accident. His first prosthetic was not what he expected.

“A wire came up, and that’s how I had to pull it to bend it,” he says. Even walking on smooth surfaces required total concentration. “Even in a building, if there was a little bump on the floor, I’d hit it and tumble.”

Determined to find something better, Chris went to Prosthetist Harvey Sosnoff, CPO. He fitted Chris with a new leg called a C-leg, short for computerized leg.

“This is a live, animated thing that actually senses in real time where his knee is,” says Sosnoff, of Hanger Prosthetics & Orthotics in Worcester, Mass.

Fifty times a second, a computer chip reads the amount of pressure on his foot and the position of his knee. Real time adjustments inside the knee keep Chris steady on his feet. For Chris, the benefits are more than he could have imagined. “I’ve never been able to hold my son and walk. Now, I can,” he says.

Hydraulics in the knee also make it possible for a person to keep weight on the prosthesis and sit slowly without crashing down as happens with other prosthetic knees.

If you would like more information, please contact:

Hanger Prosthetics and Orthotics
(877)-4-HANGER
http://www.hanger.com

Prevent Sudden Death (July 14, 2003)

ORLANDO, Fla. (Ivanhoe Newswire)

Each year, sudden cardiac death claims the lives of 300,000 Americans. Currently, people at risk of sudden cardiac death were not candidates for a lifesaving device unless they’d had a heart attack. New research reveals more people may be able to benefit from an ICD or implanted cardiac defibrillator.

Cycling is J. Brannen Murphy's passion. "I’ve bicycled literally all over the world," he tells Ivanhoe. But one Sunday morning, his cycling trip was cut short. “I just could not get my breath,” he says.

Cardio electrophysiologist Scott Pollak’s tests showed Murphy's weak heart put him at risk of sudden death. Since Murphy had not had a heart attack, in the past he would not have been a candidate for an implantable defibrillator -- the device that automatically shocks a quivering heart out of a deadly rhythm.

"We didn't have information or data to say we ought to just put a defibrillator in him,” says Dr. Pollack, of the Florida Heart Institute in Orlando.

Now, Dr. Pollak says studies show using an ICD as a preventive tool reduces deaths in high-risk patients by 30 percent.

This test shows how it works. Murphy’s heart is wired to a defibrillator and a pacemaker. Technicians use the pacemaker to induce a natural, but deadly rhythm. Without the defibrillator, doctors told Murphy he would die. Watch as it delivers a lifesaving shock. His rhythm is temporarily back to normal. Now, his survival depends on a pacemaker and the ICD in his chest.

Dr. Pollak says, “Should a dangerous rhythm result, the defibrillator would deliver a shock to his heart.”

Now, all Murphy has to worry about is his next bike ride. "Whenever Dr. Pollak tells me I can go, I'm gonna go," he says.

The cost of getting an ICD is approximately $85,000 over three years. A report by the American Heart Association found while the cost is high, it’s more cost-effective than prescribing medication for the prevention of sudden cardiac death.

If you would like more information, please contact:

The American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
(800) 242-8721
http://www.americanheart.org

New Sperm-Sorting Technique (July 11, 2003)

(Ivanhoe Newswire)

A new sperm-sorting technique could improve infertility treatment for men with inadequate sperm, according to new research. Researchers say the technique is an improvement over the method currently used to sort sperm because it doesn’t damage any viable sperm.

About 40 percent of infertility issues are caused by male problems including low motility or movement of sperm. While current methods help men with borderline cases of a low sperm count, researchers from the University of Michigan say this new method could help men with extremely low sperm numbers.

The method involves a new area of biomedical engineering that deals with microscopic flow of fluids. It’s the same idea used with gene sequencing and sorting cell cultures. A device about the size of a penny has two channels that flow together and eventually separate. The sperm and a saline solution are sent through the device. The motile or healthy sperm cross to one side while the unhealthy sperm stayed in the other side. Study co-author Shuichi Takayama, Ph.D., says, “Everything is pushed downstream because of fluid flow being generated by gravity and surface tension. The motile sperm exit a different outlet than non-motile components because motile sperm can swim and cross streamlines.”

Before passing through the device, only 44 percent of the sperm sample was healthy. After the sperm went through the device, the motile sperm increased to 98 percent. Testing showed the process did not affect the sperm quality. This is a big advantage because the current method used for sorting sperm can damage healthy sperm. The current method involves spinning the sperm at high speeds wherein dead sperm can release free oxygen radicals that can damage good sperm.

The current research only focused on separating the sperm and researchers did not attempt fertilization. However, study authors say they are encouraged by their findings. They add it will take several years of perfecting the procedure before this sperm-sorting technique could be used in a clinical setting.

SOURCE: Reproductive Biomedicine Online, 2003;7:73-79

Physical Activity Helps Preemies (July 11, 2003)

(Ivanhoe Newswire)

Exercise may be the key to better bones in premature babies. A new study shows physical activity in infants with low birth weights can help improve bone strength.

Infants who are born prematurely and weigh just a few pounds are at an increased risk of osteopenia. Osteopenia is having a low bone density and often happens in low birth weight infants because of a lack of bone nutrients. Researchers from Meir General Hospital in Israel conducted a study to determine if physical activity could improve bone density.

The study included 24 infants who were born prematurely, weighing about three pounds each. Half of the infants started an exercise routine at the first week of life and the other half did not exercise. The exercise routine included range of motion exercises with the infants’ arms and legs. The routine was done five minutes per day, five days a week for four weeks. Ultrasound was used to measure the bone strength in all of the infants.

Researchers report the bone strength decreased significantly in the group that did not exercise. However, the bone strength in the infants in the exercise group remained stable. Study authors conclude a simple range of motion exercise program could benefit low birth weight infants by stabilizing their bone strength and it could decrease the risk of osteopenia.

SOURCE: Pediatrics, 2003;112:15-19

High Blood Pressure Increasing (July 9, 2003)

(Ivanhoe Newswire)

New research shows the number of Americans diagnosed with hypertension has increased in recent years.

Nearly one-third of the adult population, or 58 million people, in the United States have hypertension. Hypertension is a major risk factor for cardiovascular disease and even death.

Researchers from the University of South Carolina and the Medical College of Wisconsin studied the most recent National Health and Nutrition Examination Survey to examine hypertension trends. In their study, hypertension was defined as having a blood pressure reading of 140/90 mm Hg or greater or being on antihypertensive drugs. They found the number of reported hypertension cases increased by nearly 4 percent between 1991 and 2000. Prior to 1991, however, hypertension prevalence had decreased over the last three decades.

Symptoms of hypertension are often overlooked, causing many cases to go undiagnosed. Between 1999 and 2000, nearly 30 percent of individuals with hypertension were unaware of their illness. In more than 60 percent of these cases, the patients’ hypertension was not under control at the time their blood pressure was measured.

Authors of the study say, overall, hypertension control rates have improved since 1988, but they are still unacceptably low. “If the increase in hypertension control rates remains at the current pace, the 50 percent target for hypertension control by 2010 will not be met,” they write. Programs targeting awareness and treatment options are underway to improve the current statistics.

SOURCE: Journal of the American Medical Association, 2003;290:199-206

Time of Day Affects Diabetes Treatment (July 9, 2003)

(Ivanhoe Newswire)

New research shows the time of day patients take insulin for type 2 diabetes can have a positive effect on their disease. The study shows medication taken in the morning is more effective than in the evening alone. Doctors from Germany tested their research on 695 patients with type 2 diabetes who were already taking oral antidiabetic medication.

Increasingly, type 2 diabetes is becoming a serious medical issue around the world. It is known that good glycemic control will lessen the long-term complications of the disease. Therefore, researchers are always looking for medications offering better glycemic control overnight.

This study looked at patients taking either morning doses of Lantus (glargine), bedtime doses of NPH (Neutral Protamine Hagedorn), or bedtime doses of Lantus and an oral medication called Amaryl. The study lasted 28 weeks. Researchers found, “Insulin glargine injected in the morning resulted in better glycemic control than did bedtime NPH insulin.” They say glargine lasts longer and therefore offers better glycemic control over 24 hours.

The investigators were surprised that there was better glycemic control when taken in the morning compared with the evening and do not fully understand the reason behind this. In conclusion, they say one injection of Lantus insulin, one oral medication, and one self-monitored blood glucose measurement per day is effective for type 2 patients. Furthermore, a pre-breakfast injection of Lantus appears to offer better glycemic control and fewer drops in blood sugar at night than an evening injection of NPH insulin. Further studies are underway to confirm these findings.

SOURCE: Archives of Internal Medicine, 2003;138:952-959

HHS TO REQUIRE FOOD LABELS TO INCLUDE TRANS FAT CONTE