New Help for Smokers (January 13, 2003)
What makes a smoker want to light up even in the face of obvious health risks? Researchers now believe cigarette smoke triggers a complex chemical reaction in the brain that’s hard to resist. But what if you could achieve the same sensation without smoking?

Terry Boatright has a problem -- two pack a week problem. He tells Ivanhoe, “I wish I wasn’t smoking at all.”

Jesse Baginski has an even bigger problem. He smokes a pack and a half a day. His lungs have already suffered serious damage. “I’ve tried the nicotine gum, a couple of different kinds of patches, I even tried hypnosis once,” he says.

Researchers at the VA West Los Angeles Healthcare Center say they now better understand people like Boatright and Baginski’s need to smoke. They say smoking releases chemicals in some of the pleasure-producing parts of the brain.

Psychologist Nicholas Caskey, Ph.D., of the VA West Los Angeles Healthcare Center, tells Ivanhoe, “Drugs like nicotine, the primary active ingredient of cigarette smoke, cocaine, and amphetamines, cause an increase in dopamine in those regions when those drugs are administered.”

In a study done at the VA center, 20 smokers took a dopamine-increasing drug called bromocriptine and then studied their smoking over a five-hour period. The smoking slowed considerably. A drug that impedes dopamine had the opposite effect.

Caskey says, “It may be possible in the future to develop a drug treatment for smoking that works directly on the brain chemical dopamine to help smokers quit smoking.”

That’s good news for the 47 million smokers in the United States.

Dopamine is believed to play a role in regulating the addictive effects of other stimulating drugs such as cocaine and amphetamines. Bromocriptine is not currently FDA approved for smoking cessation.

If you would like more information, please contact:
Department of Veterans Affairs, Los Angeles
Psychopharmacology Unit
(310) 268-3255
http://www.va.gov

New Hope for Lupus Patients (January 13, 2003)
  BALTIMORE (Ivanhoe Newswire) -- With positive results from high dose treatments of the anti-cancer drug cyclophosphamide, researchers have brought new hope to patients suffering from moderate to severe forms of lupus.

Lupus is an autoimmune disease in which the immune system attacks tissues and organs. Out of every 100,000 people, 40 to 50 of those individuals suffer from lupus. It is most prevalent among women in their 30s and African-Americans. Michelle Petri, M.D., professor of rheumatology at Johns Hopkins, says, "Living with long-term severe lupus is devastating as the body's immune system attacks itself." Dr. Petri and colleagues believe changing the immune system by "reprogramming it" could be beneficial in the treatment of the chronic, and sometimes deadly, disease.

In a study conducted by Dr. Petri at Johns Hopkins' Lupus Center and Kimmel Cancer Center, 14 lupus patients, who had not responded to standard lupus treatments and had considerable organ failure, received high-dose cyclophosphamide intravenously for four days. Dr. Petri says, "The idea with this treatment is to blast the lupus once and wipe out the abnormal immune system, and allow the body to relearn and function normally without further therapy."

After two and a half years, Dr. Petri and colleagues found five participants had positive immune responses from the treatment and three of those participants remained disease-free. Another six participants showed partial response and continue treatment with immune-suppressing drugs.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

SOURCE: Arthritis and Rheumatism, 2003;48:166-173

Milk Consumption Beneficial to Women (January 10, 2003)
 CINCINNATI (Ivanhoe Newswire) -- New research shows women who consumed little calcium or milk during childhood and adolescences have significant bone loss as adults and are at greatest risk for fractures.

Researchers from the University of Cincinnati used information previously gathered from the third National Health and Nutrition Examination Survey to evaluate if low milk intake during childhood and adolescences was linked to bone mineral density and the frequency of fracture later in life. Previous fractures to a participant's hip, spine, or forearm were assessed along with the rate of milk consumption during childhood and adolescence. 

Women ages 20 to 49 who consumed less than one serving of milk a week during childhood had 5.6-percent lower hip bone mineral content than those who consumed more than one serving a week during childhood. Those women who consumed less than one serving of milk per week during adolescence were linked to a 3-percent reduction in hip bone mineral content and bone mineral density as compared to women who drank more than one serving of milk during adolescence. Researchers also found 4.7 percent of women in this group reported having a fracture of the hip, spine or forearm after age 13.

Women over 50 who consumed less than one serving of milk a week during childhood had 2-percent lower hip bone mineral content and 2.1-percent lower bone mineral density than those who drank more that one serving of milk per week during childhood. Those women who consumed less than one serving of milk per week during adolescence were linked to a 2.4-percent reduction in hip bone mineral content and a 2.2-percent reduction in bone mineral density compared to women who drank more than one serving of milk during adolescence. Of this age group, 12.9 percent reported having a fracture of the hip, spine or forearm after age 13 and 8.4 percent reported having a fracture after age 50. 

The authors conclude, “Women with low milk intake during childhood and adolescence have less bone mass in adulthood and greater risk of fracture.”

FDA Approves New Labels for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women Following Review of Women's Health Initiative Data

The Food and Drug Administration (FDA) today is advising women and health care professionals about important new safety changes to labeling of all estrogen and estrogen with progestin products for use by postmenopausal women. These changes reflect FDA's analysis of data from the Women's Health Initiative study (WHI), a landmark study sponsored by the National Institutes of Health that raised concern about risks of using these products. 

FDA's labeling revisions are part of a series of actions to provide risk management information to women and advice to health care providers who prescribe these estrogen and estrogen with progestin-containing drug products for postmenopausal women. FDA will also be issuing updated guidances for manufacturers of estrogen and estrogen with progestin products regarding labeling of those products and development of new products for use in postmenopausal women. FDA's new labeling changes include a new boxed warning that reflects new risk information and changes to the approved indications to emphasize individualized decisions that appropriately balance the benefits and the potential risks of these products. 

FDA Commissioner Mark McClellan, M.D, Ph.D., said, "The Women's Health Initiative Study provided valuable information about the use of estrogen and progestin therapies for postmenopausal women. A woman who is using or considering estrogens or estrogen-progestin treatment should consult with her health care provider about the implications of the new information on risks and benefits in her case. 

He added, "In many cases, women will still want to rely on these products to deal with the effects of menopause. In other cases, alternative treatments will be appropriate. FDA's actions today will help inform health care providers and their patients so that they can appropriately balance the benefits and risks to make the best possible decisions about use of these drugs." 

The WHI study has several components, one of which was designed to assess the effects of Prempro, a combination of estrogens plus a progestin, on the risk of developing heart disease. The Prempro arm of the WHI was halted early in July 2002 because the overall health risks, particularly the risks of invasive breast cancer and cardiovascular disease, exceeded the benefits of the drug. Estrogen and progestin hormones have never been approved by FDA for prevention of heart disease, although physicians could prescribe them "off-label" for this use. 

FDA's approval for new physician prescribing information and patient information leaflets for Prempro and Premphase (containing estrogens with a progestin) and Premarin (containing estrogens) highlight this important new safety information. 

FDA has also requested that all other manufacturers of estrogen and estrogen with progestin drug products for use in postmenopausal women make similar changes to the labeling for their products.

It is estimated that about ten million postmenopausal women in the United States currently use estrogen and combination estrogen with progestin products for relief of menopausal symptoms and prevention of postmenopausal osteoporosis. Estrogen products are approved for use in relieving vasomotor symptoms of menopause such as "hot flashes" and night sweats; symptoms of vulvar and vaginal atrophy such as dryness, itching, and burning; and prevention of postmenopausal osteoporosis. Because there are few alternatives for the relief of severe vasomotor symptoms and severe symptoms of vulvar vaginal atrophy, estrogens and estrogens with progestins have an important role in women's health.

The revisions for the Premarin, Prempro, and Premphase labeling build on revisions to the labeling that Wyeth Pharmaceuticals (the products' manufacturer) made in August 2002, shortly after the release of the findings from WHI. Since August, FDA has carefully reviewed the data from the WHI study and has worked with Wyeth to develop the new labeling approved today for these products. 

The new boxed warning, the highest level of warning information in labeling, highlights the increased risks for heart disease, heart attacks, strokes, and breast cancer. This warning also emphasizes that these products are not approved for heart disease prevention. FDA has also modified the approved indications for Premarin, Prempro, and Premphase to clarify that these drugs should only be used when the benefits clearly outweigh risks. Of the three indications, two have been revised to include consideration of other therapies: 

Treatment of moderate to severe vasomotor symptoms (such as "hot flashes") associated with the menopause. (This indication has not changed.) 
Treatment of moderate to severe symptoms of vulvar and vaginal atrophy (dryness and irritation) associated with the menopause. When these products are being prescribed solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered. 
Prevention of postmenopausal osteoporosis (weak bones). When these products are being prescribed solely for the prevention of postmenopausal osteoporosis, approved non-estrogen treatments should be carefully considered, and estrogens and combined estrogen-progestin products should only be considered for women with significant risk of osteoporosis that outweighs the risks of the drug. 
To minimize the potential risks and to accomplish the desired treatment goals, the new labeling also advises 
health care providers to prescribe estrogen and combined estrogen with progestin drug products at the lowest dose and for the shortest duration for the individual woman. Women who choose to take estrogens or combined estrogen and progestin therapies after discussing their treatment with their doctor should have yearly breast exams by a health care provider, perform monthly breast self-examinations, and receive periodic mammography examinations scheduled based on their age and risk factors. Women should also talk to their health care provider about other ways to reduce their risk factors for heart disease (e.g., high blood pressure, poor diet, tobacco use) and osteoporosis (e.g., an appropriate diet, use of Vitamin D and Calcium supplements, weight-bearing exercise).

FDA will update guidances to provide advice on studies needed to demonstrate safety and effectiveness of new products for these indications and provide recommendations on labeling for estrogen and estrogen with progestin products used in postmenopausal women. 

FDA's review of the WHI findings leads to some important research questions for the medical community. These questions include whether lower doses of estrogen and progestin will have lower risks, if other types of estrogens and progestins or other ways of administering these drugs, such as through patches, have different risks, and how best to stop taking estrogens and progestins. FDA intends to work with researchers, sponsors and product manufacturers to encourage this further research. 

Wyeth Pharmaceuticals, a division of Wyeth of St. Davids, Pa., manufactures Premarin (conjugated estrogens), and Prempro and Premphase (conjugated estrogens/medroxyprogesterone). 
Further information is available online at:
www.fda.gov/cder/drug/infopage/estrogens_progestins/default.htm

Tamoxifen Boosts Fertility in Women With Breast Cancer (January 8, 2003)
 Tamoxifen may be a safe and effective ovarian stimulant for fertility preservation in women with breast cancer, according to a report in the January issue of Human Reproduction.

"Sometimes the best ideas are the obvious ones and tamoxifen seemed the obvious choice of drug to test, although, to my knowledge, no one has tried it before in breast cancer patients," lead author Kutluk Oktay, from Cornell University in New York, N.Y., says in a news release. "We hypothesized that tamoxifen stimulation would result in higher numbers of embryos compared with natural cycle in-vitro fertilization (IVF), while theoretically shielding breast cancer cells against estrogen." 

Dr. Oktay's group treated 12 breast cancer patients with tamoxifen, 40 to 60 mg for approximately seven days beginning on day 2 to 3 of their menstrual cycle (15 cycles), and IVF with either fresh embryo transfer (six cycles) or cryopreservation (nine cycles). A retrospective control group consisted of five women who had natural-cycle IVF.

Cycle cancellation occurred in 1 of 15 women in the tamoxifen group and in 4 of 9 women in the control group (P < .05). The tamoxifen-treated patients produced a greater number of mature oocytes than did the controls (1.6 ± 0.3 vs. 0.7 ± 0.2; P = .03) and embryos (1.6 ± 0.3 vs. 0.6 ± 0.2; P = .02) per initiated cycle. All 12 patients treated with tamoxifen generated embryos compared with three of five controls. 

Two of six patients in the tamoxifen group and two of five controls conceived. One patient treated with tamoxifen who had two fresh embryos transferred gave birth to twins, and another patient conceived on her second attempt although she miscarried. None of the patients has yet attempted pregnancy with the frozen embryos.

After a mean follow-up of 15 ± 3.6 months, all of the tamoxifen-treated patients remained cancer-free.

Study limitations include short follow-up and small, retrospective control group. A larger study is planned with modifications to include adding low amounts of follicle-stimulating hormone to tamoxifen. 

"I am optimistic," Dr. Oktay says. "Many of my patients tell me that just doing something to address the issue of loss of reproductive function makes it easier for them to deal with breast cancer. It connects them to their future and underlines that because they have breast cancer it does not mean they have a terminal illness.... It would be especially fitting if a drug that has saved so many women's lives should also turn out to be a means of preserving their fertility." 

Hum Reprod. 2003;18(1):90-95
Reviewed by Gary D. Vogin, MD

Obesity Can Reduce Lifespan by up to 20 Years (January 7, 2003)
  NEW YORK (Reuters Health) Jan 07 - Obesity can, on average, cut more than a decade from a person's life; for black men it can shorten life by up to 20 years, the results of a new US study indicate.

The findings, which are published in the January 8th issue of the Journal of the American Medical Association, support the idea that excess body weight is a health problem, and may spur physicians and public health officials to redouble efforts to address the growing obesity epidemic.

"Excess weight has not received the same attention from clinicians and policymakers as have other threats to health such as tobacco use, hypertension, or (high cholesterol)," Drs. JoAnn E. Manson and Shari S. Bassuk, from Brigham and Women's Hospital in Boston, write in an accompanying editorial. "It is not surprising that obesity rates continue to climb."

The findings show that "obesity has a profound effect on life span," study author Dr. David B. Allison, from the University of Alabama in Birmingham, and colleagues state.

According to the report, obesity is particularly dangerous for younger adults. Severely obese white men, 20 to 30 years of age, live about 13 fewer years than others in the general population. Severely obese white women can expect to live eight fewer years than their non-obese counterparts.

Obesity also had a profound effect on the lifespan of younger blacks. Obese black men, 20 to 30 years of age, lose about 20 years and obese black women lose about 5 years of life, even after adjusting the data for smoking.

In the study based on national survey data, white adults with a body mass index (BMI) of 23 to 25 and black adults with a BMI of 23 to 30 lived the longest.

The findings quantify the health risks associated with obesity, especially for young and middle-aged adults. Because about two thirds of the US adult population is overweight or obese, the findings portend an ongoing health crisis, the researchers warn.

The authors call for more research, particularly into the apparent racial differences observed. Nonetheless, the findings "confirm that obesity is a major public health problem that appears to lessen life expectancy markedly, especially among individuals in younger age groups," Dr. Allison and colleagues conclude.

JAMA 2003;289:187-193.

Bone Loss Rate Predicts Cognitive Decline in Older Women (January 6, 2003)
 (Reuters Health) Jan 06 - Older women who experience rapid hip bone loss are more likely to develop cognitive decline than their peers with slower rates of loss, according to a report published in the January issue of the Journal of the American Geriatrics Society.

Furthermore, the association is independent of baseline bone mass and is not explained by the apolipoprotein E (ApoE) genotype, lead author Li-Yung Lui, from the University of California at San Francisco, and colleagues note.

The current findings are based on a study of 4462 women, 70 years of age and older. Bone mineral density at the hip was measured 2 and 6 years after study enrollment. Cognitive function was assessed with a modified Mini-Mental State Examination at 6 and 10 years.

The percentage of women who developed cognitive decline was directly related to the amount of bone loss experienced. Twenty percent of women in the greatest bone loss group developed cognitive decline, compared with 12% in the group with the least bone loss. On multivariate analysis, the odds ratio cognitive decline was 1.4 for women in the greatest loss group versus the least loss group.

ApoE genotype information was available for 883 of the women studied. Analysis of the data revealed that the occurrence of the e4 allele of ApoE could not explain the link between bone loss and cognitive decline.

"Bone loss is unlikely to affect cognition directly," Dr. Lui and colleagues note, "but it may be a marker of an increased rate of aging or other processes, such as inflammation, that contribute to cognitive decline."
J Am Geriatr Soc 2002;51:000-000

Hormone Replacement Therapy May Reduce Diabetes Risk (January 6, 2003)
 Hormonal replacement therapy (HRT) reduced the incidence of diabetes by 35% in postmenopausal women with heart disease, according to the results of a randomized, double-blind, placebo-controlled trial reported in the Jan. 7 issue of the Annals of Internal Medicine.

"No randomized, controlled trial has evaluated the long-term effect of hormone therapy on diabetes incidence," write Alka M. Kanaya, MD, from the University of California at San Francisco, and colleagues.

The Heart and Estrogen/Progestin Replacement Study (HERS) was funded by Wyeth-Ayerst Research. At 20 U.S. clinical centers, 2,763 postmenopausal women with coronary heart disease were followed for 4.1 years. These subjects included 734 women with diabetes, 218 with impaired fasting glucose, and 1,811 who were normoglycemic at baseline.

During follow-up, fasting glucose levels increased significantly in the placebo group but not in the group receiving 0.625 mg conjugated estrogen plus 2.5 mg medroxyprogesterone acetate daily. The incidence of diabetes, defined by self-report of the disease or its complications, fasting glucose of at least 126 mg/dL, or initiation of glucose-lowering agents, was 6.2% in the HRT group and 9.5% in the placebo group (relative hazard, 0.65; 95% confidence interval [CI], 0.48 - 0.89; P = .006).

"This observation provides important insights into the metabolic effects of postmenopausal hormones but is insufficient to recommend the use of hormones for secondary prevention of heart disease," the authors write.

The number needed to treat with HRT to prevent one case of diabetes was 30 (95% CI, 18 - 103). This effect was independent of change in weight and waist circumference.

In an accompanying editorial, Peter W. F. Wilson, MD, from Boston University School of Medicine in Massachusetts, notes that these results are "not definitive" and require corroboration in a clinical trial with predetermined hyperglycemic endpoints.

"We may have thought that the curtain had fallen on HRT-related clinical trials, but only an estrogen encore will provide the necessary data to adequately assess the advantages and disadvantages of HRT and glycemic control," he writes.
Ann Intern Med. 2003;138:1-9

Counseling Improves Diet (January 6, 2003)
 (Ivanhoe Newswire) -- The U.S. Department of Health and Human Services announced that extended behavioral counseling can help patients who are at high risk for heart disease and other chronic illnesses.

After reviewing studies spanning 35 years, the Preventive Services Task Force concludes intensive diet counseling can help at-risk adults eat less fat and more fruits and vegetables. Studies of average-risk patients showed mixed results. In cases where counseling did improve the patients' diets, the study did not reveal sufficient evidence of greater health benefits.

Researchers analyzed 21 studies where adult patients were counseled to eat less saturated fat or overall fat, eat more fruits or vegetables, or eat more fiber each day. They found patients who received multiple types of counseling, such as a personal evaluation of their diet or group counseling, made bigger changes to their diet than less intensively counseled individuals. A combination of interactive materials and brief face-to-face advice also helped patients make large changes to their diets.

The health task force cautions that most of the evidence on the effectiveness of counseling comes from patients' reports of how their eating habits have changed, which, researchers say, may not be the most reliable measure of diet change. They add that there is insufficient evidence to gauge the effectiveness of brief, routine counseling among healthy adults.

SOURCE: American Journal of Preventive Medicine, 2003;24:75-92

Diabetic Father Impacts Baby (January 6, 2003)
 (Ivanhoe Newswire) -- According to a study in this week's British Medical Journal, diabetic men father lower-birthweight babies.

Researchers enrolled adult participants, who were previously part of a study of British births during 1958. In all, 34 diabetic men who had children and 24 women who became diabetic after parenting a child participated in the study. Researchers evaluated participants in order determine if diabetic fathers, or mothers with diabetes that developed after childbirth, could be connected to the low birth weight of their children.

Researchers found children born to diabetic fathers weighed an average .41 pounds less than children born to non-diabetic fathers. The height or social class of the diabetic father did not relate to the association of the father's diabetes nor to his child's birthweight. Researchers also found a child's birth order did not alter the effect of a father's diabetes on his child's birthweight.

However, researchers say they were surprised to find that diabetes in the mother increased the birth weight of her children. Researchers say, "Our findings support the hypothesis that common genetic factors contribute both to the risk of non-insulin dependent diabetes and decreased prenatal growth."

SOURCE: British Medical Journal, 2003;326:19-20

Teens and Extreme Dieting (January 3, 2003)
 (Ivanhoe Newswire) -- A new study shows adolescents who use extreme dieting methods are more likely to smoke, drink, use marijuana and attempt suicide.

Extreme dieting methods include the use of diet pills and vomiting to control weight. Previous studies have found that extreme dieting may contribute to risky behavior, like smoking or drinking, in teens. However, in the current study, researchers wanted to determine if all dieting methods were associated with risky behaviors, not just extreme dieting. Researchers from Cleveland State University used information from the 1999 South Carolina Youth Risk Behavior Survey to evaluate the link between extreme dieting and healthy diet behaviors to risky behavior.

Researchers found 19 percent of the 4,187 teens surveyed in the study were extreme dieters and 43 percent were moderate dieters. Moderate dieters were teens who ate less and exercised more to control their weight, and when compared to extreme dieters, moderate dieters were less likely to smoke cigarettes and use marijuana. Drug use, alcohol use, smoking and suicide were more prevalent for extreme dieters, but there was no difference between the two groups when it came to unprotected sex. Fruit and vegetable intake was also similar between the two groups.

Researchers found white females were more prone to both extreme and moderate dieting. However, they note that teenage boys should not be overlooked when it comes to weight issues because, "Men are increasingly becoming dissatisfied with their body image." Researchers also conclude that the link between risky behavior and extreme dieting may represent unseen problems relating to self-esteem or peer influence.

SOURCE: American Journal of Health Behavior, 2003;27:3-14

Improving Diet and Disease (January 3, 2003)
 (Ivanhoe Newswire) -- A new study shows multiple approaches to changing eating habits can play a significant role in reducing chronic disease risk.

Authors of the study say little is known about the ideal combination of dietary factors or the best way to assess adherence to dietary recommendations. In an attempt to educate people on reducing the risk of chronic disease through healthy eating, several agencies have created eating plans. Researchers looked at which of these plans is best at reducing chronic disease risk.

Researchers evaluated the Alternate Healthy Eating Index (AHEI) and the Recommended Food Score (RFS). Nearly 40,000 men and nearly 70,000 women were given dietary questionnaires. The AHEI predicted chronic disease risk better than the RFS for heart disease. The researchers say overall dietary guidelines can be improved by providing more specific and comprehensive advice.

Only about half of the AHEI recommendations have been shown to reduce cancer. Those include fruit intake, vegetable intake, white meat and dark meat intake and multivitamin use.

SOURCE: The American Journal of Clinical Nutrition, 2002;76:1261-1271

Iron and Risk for Cardiovascular Disease (January 2, 2003)
 (Ivanhoe Newswire) -- Women with high iron levels could find themselves at risk for cardiovascular disease, according to the findings of a new study.

Due to the growing percentage of iron levels among people living in heavily industrialized nations and the potential risk of cardiovascular disease among men with high iron levels, researchers have raised questions as to the possible link between high iron levels in women and the risk for CVD. Therefore, researchers from Emory University set out to determine the association, if any, between high iron levels and the possible risk for CVD among women. 

In their study, researchers used information from the National Health and Nutrition Examination Survey as a guide to examine iron levels and CVD risk factors such as body mass index, total cholesterol, triacylglycerol, HDL cholesterol, plasma glucose, and blood pressure. Among the 3,346 women evaluated, 1,178 were non-Hispanic white, 1,093 were non-Hispanic black, and 1,075 were Mexican-American. 

Researchers found iron levels were linked to CVD risk factors among non-Hispanic black women and, especially, Mexican-American women. The strongest link was found for Mexican-American women whose higher iron levels were associated with higher levels of body mass index, total cholesterol, triacylglycerol, glucose and diastolic blood pressure. 

Overall, researchers say, "These findings suggest that CVD risk factors, especially those relating to glucose and lipid metabolism, are positively associated with iron status in women."

SOURCE: American Journal of Clinical Nutrition, 2002;76:1256-1260

Black tea may lower heart disease risks (January 2, 2003)
 (Reuters Health) - That tea bag soaking in your cup could be brewing up a longer, healthier life, researchers report.

A study of over 3,400 adults in Saudi Arabia--a country of tea-lovers--found that those who drank more than 6 cups per day of the brown beverage had a more than 50% lower risk of coronary heart disease compared to tea abstainers, even after adjusting for other factors such as smoking, diet and obesity. 

Antioxidants called flavonoids, found in both green and black teas, are thought to be potent weapons in the fight against heart disease. "Tea, the most widely consumed beverage in the world, is a rich source of (these) antioxidants," explain researchers led by Dr. Iman A. Hakim of the University of Arizona in Tucson.

They published their findings in the January issue of the journal Preventive Medicine. 

Numerous studies have trumpeted the cardiovascular benefits of green tea, which is the beverage of choice in much of the Far East. But elsewhere in the world black tea reigns supreme, and fewer studies have examined its heart- healthy properties.

The researchers interviewed 3,430 Saudis ranging in age from 30 to 70. Study participants were quizzed on their dietary habits, history of smoking, coffee drinking, exercise and other factors. Just over 6% were diagnosed with coronary heart disease.

Tea- drinking is a very social event in Saudi Arabia, and about 90% of those interviewed drank the beverage daily. Comparing heavy drinkers to non-drinkers, the researchers found that those who consumed more than 6 cups of tea per day (about 20% of those interviewed) had a 50% lower risk of heart disease than those who did not drink tea. Those findings held even after the researchers adjusted for other cardiovascular risk factors such as smoking, obesity, fat intake, blood cholesterol levels or sedentary lifestyle.

In general, individuals with heart disease tended to drink less tea than healthier individuals--3.5 cups/day versus 4.5 cups/days, respectively. 

How might tea drinking boost heart health? Studies have suggested that flavonoids in tea may lower blood pressure and reduce stroke risk by about 12% for those drinking 3 cups of tea per day. Flavonoids may also lower clotting risks and "hardening of the arteries," and reduce levels of LDL or "bad" cholesterol, the researchers suggest. 

Whatever the reason, tea for two--or more--may be just the ticket for healthy tickers, the researchers conclude. "These findings support a potential protective effect of tea consumption in relation to coronary heart disease," they say.

SOURCE: Preventive Medicine: 2002;36:64-70.

Wider waistlines, more diabetes in US each year (January 2, 2003)
 (Reuters Health) - A national survey reveals that each year, Americans are becoming more obese and developing more related health problems.

From 2000 to 2001, obesity among US adults increased by almost 6%, to 21% of the population. Diabetes, a condition often related to excess body weight, affected 8% of the population in 2001- an 8% increase from the year before.

"Our study, the largest telephone survey of adults in the United States, shows a continuing increase of obesity and diabetes in both sexes, all ages, all races, all educational levels, and all smoking levels," write Dr. Ali H. Mokdad and colleagues at the Centers for Disease Control and Prevention (CDC) in Atlanta. 

"Because of the strong association between overweight and obesity and several well-established risk factors for morbidity and mortality, reversing the obesity epidemic is an urgent priority," they add.

The authors base their findings on surveys conducted over the telephone with 195,005 randomly selected adults. Participants reported their heights and weights, and whether they had certain health problems.

Mokdad and colleagues determined whether a participant was overweight by calculating his body mass index (BMI), which factors a person's height into his weight. People are considered overweight if their BMI falls between 25 and 29.9, and obese if it is 30 or above.

The authors report their findings in the January 1 issue of the Journal of the American Medical Association.

Based on the percentage of participants who were obese, Mokdad and colleagues estimate that the US is home to more than 21 million obese men and 23 million obese women. 

The rate of obesity among US adults has increased by 74% since 1991, according to the CDC.

People who were extremely obese also had a several-fold higher risk of related health conditions, the authors note. For instance, people with BMIs of at least 40 were more than 7 times as likely to be diagnosed with diabetes, more than 6 times more likely to have high blood pressure and 4 times as likely to have arthritis, compared to people with normal body weights.

However, the authors caution that the current estimates of obesity are "no doubt substantial underestimates." People without telephones are excluded from the survey, they note. Such individuals are more likely to be poor, a condition that has been linked to obesity and diabetes. Furthermore, people who are overweight tend to underestimate how much they weigh, and many overestimate their heights.

The authors also could not include cases of diabetes that had not been diagnosed.

Obesity and the form of diabetes linked to excess body weight are preventable, the authors point out. Currently, the CDC recommends that people wishing to maintain good health schedule 30 minutes of moderate physical activity each day, and 60 minutes each day if they want to lose weight.

SOURCE: Journal of the American Medical Association 2003;289:76-79.

FDA Approves New Therapy for Rheumatoid Arthritis (January 2, 2003)
 FDA has approved adalimumab (marketed by Abbott Laboratories as HUMIRA) to treat rheumatoid arthritis (RA). This is the second treatment of its kind and may significantly increase the availability of these therapeutics to patients. 

HUMIRA is produced by recombinant DNA technology. It is a human-derived antibody that binds to human tumor necrosis factor alpha (TNF alpha). TNF is naturally produced by the body and is involved with normal inflammatory and immune responses. Individuals with rheumatoid arthritis, a disease that affects more than 2 million Americans, have high levels of TNF in the synovial fluid (lubricating fluid in joints). The extra TNF plays an important role in both the pathologic inflammation and the joint destruction that are hallmarks of RA. 

By working against the inflammatory process, HUMIRA, like other TNF blockers has been shown to be effective in controlling symptoms of the disease. HUMIRA is indicated for reducing signs and symptoms and inhibiting the progression of structural damage in adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more disease-modifying anti-rheumatic drugs (DMARDs). HUMIRA can be used alone or in combination with methotrexate or other DMARDs.

The efficacy and safety of HUMIRA were assessed in four randomized, double-blind studies in adult patients. HUMIRA was found to reduce signs and symptoms of rheumatoid arthritis in over half the patients. In one of the four studies, patients were treated for a year and then evaluated radiographically. Patients treated with HUMIRA plus methotrexate (MTX) demonstrated less joint deterioration than patients receiving MTX alone.

HUMIRA is administered as a single subcutaneous injection every other week. The package insert carries a bolded warning stating that serious, sometimes fatal, infections (including cases of tuberculosis and sepsis) have been reported with the use of TNF-blocking agents including HUMIRA. The most serious adverse events associated with HUMIRA are, as with other TNF blockers, serious infections, neurologic effects, and certain malignancies of the lymphoid system. A higher rate of lymphomas was observed than the expected rate in the general population, but RA patients, particularly those with active disease, may be at a higher risk for development of lymphoma. Patients with rheumatoid arthritis should discuss therapy options with their healthcare providers. HUMIRA is administered as a single subcutaneous injection every other week.

The FDA’s Center for Biologics Evaluation and Research was able to approve this treatment ahead of deadline, reviewing the product within nine months (standard review is a ten-month cycle).

No Link Between Diet and Dementia (December 24, 2002)
(Ivanhoe Newswire) -- High dietary intake of fat has long been associated with risk for heart disease, obesity, diabetes, and several forms of cancer. However, a new study shows dementia is likely not a result of a diet high in fat.

Researchers from Erasmus Medical Center in Rotterdam studied more than 5,000 people from the Rotterdam Study, in which risk factors for different diseases in the elderly were examined. Participants had normal cognition, lived independently and had reliable dietary assessments.

Results of the study counter previous studies that suggest fat may be involved in the development of dementia. After six years, researchers found the intake of total fat, saturated and trans fats and cholesterol, was not linked to an increased risk of dementia. They also found no association between an intake of specific fatty acids and/or cholesterol-lowering medications and a reduced risk.

Smaller animal studies have linked cholesterol to the risk of dementia and the development of Alzheimer's disease. Cholesterol-lowering medications have been linked to a lower prevalence of Alzheimer's in humans. Specific fatty acids, such as those found in olive oil, vegetable oils and fatty fish, were previously linked to a reduced risk of dementia.

Lead researcher Monique Breteler, M.D., Ph.D., says while there are several validating features of the study, relative to previous ones, more research needs to be done. She says, "We feel it is premature to conclude with certainty that fat intake is in no way associated with dementia."

SOURCE: Neurology, 2002;59:1915-1921

BMI Increases Stroke Risk (December 24, 2002)
(Ivanhoe Newswire) -- In the first large scale study of its kind, Harvard researchers have found a definite link between body mass index (BMI) and increased risk of stroke.

Based on more than 21,000 male physicians in the United States, the study shows a 6-percent increased risk of overall stroke for every one-point increase in BMI.

Stroke is currently the leading cause of long-term disability in the United States and the third leading cause of death. Few effective therapies exist to treat people after stroke, so preventing the condition is important. Doctors know excess weight puts people at risk for high blood pressure and diabetes, which, in turn, increase stroke risk. That excess weight has also been firmly linked to heart disease. However, studies directly linking weight to stroke have produced conflicting results.

In this study, researchers looked at stroke incidence and BMI in physicians taking part in the Physicians’ Health Study. Over a 12-year period, there were 747 strokes among the more than 21,000 participants, 631 ischemic (the most common type of stroke), 104 hemmorrhagic, and 12 unidentified. When compared with participants whose BMI was less than 23, those with a BMI of 30 or greater had a significant increase in the risk for stroke.

The link between BMI and stroke declined somewhat for ischemic stroke when researchers accounted for high blood pressure, dropping to a 4 percent increase per each additional point of BMI, but not for hemorrhagic stroke.

The authors write, “These results suggest that individuals and their physicians should consider increased risk of stroke another hazard of obesity. Prevention of obesity should help prevent risk of stroke in men.”

SOURCE: Archives of Internal Medicine, 2002;162:2557-2562

New Benefits of Breastfeeding (December 24, 2002)
(Ivanhoe Newswire) -- If you're a new mom, no doubt you'll be flooded by people telling you the benefits and drawbacks of breastfeeding. Now doctors now have one more reason to support the age-old tradition. 

After three children, Melody Possinger says she knows the benefits of breastfeeding. "I've noticed that they're not often sick and, out of three children in four years, we've had one ear infection," she tells Ivanhoe.

Possinger knows there are some health benefits for her, too.

Research shows breastfeeding helps women lose their pregnancy weight. They are using an extra 500 to 1,000 calories daily. It also protects against osteoporosis. Now there's one more new finding.

"Even breastfeeding just a couple of children, by breastfeeding them for an additional six months or 12 months, women can reduce their risk of breast cancer probably on the order of 5 percent to 10 percent," says Anne McTiernan, M.D., Ph.D., director of the Prevention Center at Fred Hutchinson Cancer Research Center in Seattle.

That means 10,000 to 20,000 cases per year in the United States. Dr. McTiernan says this study may affect how society views breastfeeding. "Maybe it will help companies with choosing whether to provide rooms for breastfeeding or times for breastfeeding," she says.

Possinger says, "Whether it's one day or three months or six months or two years, every day that a mother chooses to breastfeed her baby, she is giving that child a precious gift."

The study that reveals the importance of breastfeeding to reduce the risk of breast cancer involved 200 researchers worldwide and 150,000 women. Researchers found breastfeeding can influence the risk of developing breast cancer, even more than genetic factors.

If you would like more information, please contact:

American Cancer Society
1599 Clifton Road NE
Atlanta, GA 30329
(800) 227-2345
http://www.cancer.org

Heart Attacks and Sports (December 23, 2002)
(Ivanhoe Newswire) -- Getting worked up about something emotional or a sporting event could be dangerous when it comes to heart attacks. New research shows heart attacks went up in England when the country's soccer team lost to Argentina in the world cup, telling researchers attacks can be triggered by emotional events.

The scientists used World Cup soccer as their study parameters. They analyzed hospital admissions for heart attack, stroke, and road traffic injuries for the day of or five days after England's World Cup matches. Previous research shows heart attacks often occur right after waking up, but up to half of patients report a triggering activity, most commonly emotional upset and physical exertion.

They report a 25 percent increase in admissions for heart attack on the day and two days after England lost to Argentina. They did not note an increase in stroke, or road traffic injuries. The authors write, "Some women and men may have translated their feelings of distress and disappointment at defeat by Argentina into physical symptoms."

While it is not significant that the number of heart attacks went up for a specific sporting event, the researchers say the findings can be applied widely. They write, "Major environmental events, whether physical catastrophes or cultural disappointments, are capable of triggering myocardial infarctions." Lastly, they suggest perhaps the lottery of the penalty shoot-out in soccer should be abandoned on public health grounds.

SOURCE: British Medical Journal, 2002;325:1439-1442

Eating Disorders Linked to Autoimmune Problems (December 23, 2002)
(Ivanhoe Newswire) -- Eating disorders such as anorexia nervosa and bulimia nervosa may have more in common with autoimmune disorders like arthritis and multiple sclerosis than doctors ever thought.

According to Swedish investigators, patients with these disorders have antibodies that attach to areas in the brain responsible for secreting chemicals that interfere with brain signals, similar to the process in typical autoimmune diseases. In the case of these eating disorders, the interference occurs in signals that regulate food intake and body weight.

Anorexia nervosa and bulimia nervosa affect about 3 percent of women during their lifetimes, and both illnesses usually begin at a young age. Anorexia is associated with an aversion to food while bulimia is characterized by binging and purging. In both diseases, sufferers experience exaggerated concerns about body image and shape. Past research has suggested the conditions may result from a neurobiological source.

These researchers tested this theory by isolating antibodies found in blood samples of anorexia and bulimia patients and then seeing if they would attach to key cells in rat brain samples. Forty-two out of 57 patients studied had antibodies that attached to the cells.

While researchers are not sure how these attachments may lead to the eating disorders, they speculate the antibodies may interfere with important brain signals aimed at regulating eating behavior or even destroying them. However, they note, a small number of people without eating disorders in their study also had these antibodies, suggesting antibodies alone do not doom someone to an eating disorder.

SOURCE: To be published in the Proceedings of the National Academy of Science


Heart Rates After Transplant (December 23, 2002)
(Ivanhoe Newswire) -- A new study in this month's Mayo Clinic Proceedings finds heart transplant patients can develop a more normal heart rate after surgery than previously believed.

Heart transplant surgery leads to loss of nerve function in the myocardium. This loss of the autonomic nervous system results in an abnormal heart rate response as seen in exercise testing. Resting heart rates are elevated, and generally only a minimal increase in the rate is seen during the first few minutes of exercise. Unlike in healthy people, the heart rate in transplant patients reaches maximum levels in the recovery period after exercise rather than at peak exercise. Until recently, the loss of nerve function leading to this scenario has been considered permanent. New studies, however, have suggested the possibility of recovery.

Researchers from the Mayo Clinic tested 95 heart transplant patients with a standard cardiopulmonary exercise test one year after transplant to gauge their heart rate response after exercise. All had received standard immunosuppressant medications after surgery and had participated in a supervised six- to eight-week exercise program within one month after their operations. All also received a prescription for independent exercise following the supervised program.

Results showed about a third of the patients achieved a partially normalized heart rate response to the exercise test. The results were similar for men and women and did not differ due to age, body mass index, or how much the patients exercised on a regular basis. The partial normalization, however, did not lead to better aerobic exercise capacity in the subjects.

SOURCE: Mayo Clinical Proceedings, 2002;77:1295-1300

Exercise an excellent way to control diabetes (December 16, 2002)
Source: Daily Herald - Chicago

There's no cure for diabetes - not yet, anyway. But folks at Edward Health and Fitness Centers in Naperville and Woodridge are introducing a new treatment - call it gym therapy - to help diabetes patients manage their disease. 

Today, as the disease reaches almost epidemic proportions, more people are struggling to understand and control it. The number of Americans with diabetes jumped 50 percent from 1990 to 2000. 

"Business is exploding. And frankly, we'd love to be out of the diabetes business," said Dr. W. Patrick Zeller, director of Edward Hospital's Diabetes Education Center. 

"We teach our patients to control lipids, blood sugar, blood pressure, monitor their eyes and kidneys. But we're also realizing more and more the importance of exercise in managing the disease," he said. If patients can manage the disease, "they can stave off some of the awful consequences." 

Diabetes educators like Jackque McKernan tell patients that exercise is one of the easier pills to swallow as they live with their disease. Exercise often is overlooked as a diabetes treatment, yet it improves blood glucose control, helps circulation, reduces insulin resistance and improves cardiovascular health. Exercise also keeps weight off - eliminating one complicating factor for diabetes - and builds muscle, which processes sugar better than fat tissue does. 

And, very important for people managing a chronic disease, exercise improves mood and boosts energy. 

"With exercise many patients don't always need as much insulin or medication," said nurse McKernan, coordinator of Edward's Diabetes Center. "We tell patients, 'Never expect anyone else to treat your diabetes except you. It's not your spouse's disease, not your kids', not your parents'. It's yours and yours to manage.' " 

Diabetes is the fifth-deadliest disease in the United States. More than 210,000 people will die from diabetes and its complications this year, the American Diabetes Association estimates. The risk of diabetes increases with age - half of all diabetes cases are diagnosed in people over age 55, and more than 20 percent of people over age 65 have the disease. 

Diabetes' devastating complications are well known. The disease is the leading cause of blindness in people ages 20 to 74. At least 60 percent of patients have at least some nerve damage, raising the risk of leg amputation 15 to 40 times higher than for a nondiabetic. Diabetics over age 65 are twice as likely to be hospitalized for kidney infections than those without diabetes. 

But it's heart disease that seems to be diabetes' most diabolical partner. High blood pressure often accompanies diabetes, damaging the heart and blood vessels. Diabetics have the same cardiovascular risk as someone who's already had a heart attack. They are two to four times more likely than nondiabetics to have heart disease or a stroke. 

Exercise can reduce those risks, a study appearing in the October Journal of the American Medical Association revealed. It works by: 

- Improving the function of endothelial cells, which line blood vessels and help the vessels expand to increase blood flow during periods of stress. 

- Strengthening the left ventricle of the heart to improve the heart's pumping ability. 

- Reducing blood vessel stiffening, a sure sign of early heart disease. 

- Reducing total and abdominal fat to improve insulin sensitivity and lower blood pressure. 

"The benefits of exercise go way beyond controlling blood sugar," said Kerry J. Stewart, director of clinical exercise physiology at Johns Hopkins Medical Institutions and author of the study. "Physicians should urge their patients to become more active." 

Edward Hospital's program, conducted by fitness specialists trained in diabetes care, will meet from 5:30 to 6:30 p.m. Tuesdays and Thursdays at Edward Health and Fitness Center in Naperville and at 1 p.m. Mondays and Wednesdays at the Seven Bridges Health and Fitness Center in Woodridge. 

Each session will include a warm up, 25 to 30 minutes of walking or biking, strength training and stretches. Topics such as nutrition, glucose monitoring and proper shoe and foot care also will be discussed. A physician's referral is required. Classes begin the week of Jan. 6. Members pay a $37 fee and nonmembers pay $63 for the eight-week program. 

"We have a well-educated, demanding clientele here in Naperville," Zeller said. "They're fun to work with because they take responsibility for their health. This is one way to help them do that." 

- For information or to register for the program, call Edward Health and Fitness Center at (630) 646-7910 or the Seven Bridges center at (630) 646-7911.

Exercise for Fibromyalgia (December 16, 2002)
(Ivanhoe Newswire) -- An exercise program can lead to significant improvements in well being for people who suffer from the musculoskeletal disease Fibromyalgia.

Fibromyalgia is a chronic disease characterized by pain of the muscles and skeleton, along with tender points at various places on the body. Patients with Fibromyalgia also complain of fatigue and stiffness as well. Standard treatment for the condition often produces poor results. Previous research has been conducted to determine if exercise could help, but studies have involved only limited numbers of patients and outcomes have been conflicting.

In a recent study, 136 patients with Fibromyalgia were placed in either a 12-week exercise program or a 12-week program of relaxation and flexibility training. Both groups met twice a week in classes of consisting of 18 participants each and all participants were given educational materials on Fibromyalgia. The exercise program centered on cardiovascular equipment such as treadmills or exercise bicycles. Participants were encouraged to work up from two six-minute exercise periods during each class to two 25-minute sessions over the course of the program.

Twelve people dropped out of both groups during the study, but attendance was better in the exercise group. By the end of the study, 35 percent of the exercise group reported improvements, compared to only 18 percent of the relaxation group. There were no adverse events reported due to the exercise.

In a review of the study, Stephen D. Persell, M.D., writes, "Twice weekly low-intensity aerobic exercise leads to subjective improvement for some patients with Fibromyalgia. When the level of activity is slowly increased, exercise appears to be well tolerated. Exercise therapy should be offered as part of a multifaceted approach for patients with Fibromyalgia."

SOURCE: Journal of Clinical Outcome Management, 2002;9:604-605

Stress and Breast Cancer Progression (December 14, 2002)
(Ivanhoe Newswire) -- Stress from the diagnosis of breast cancer may make the disease harder for patients to handle, according to researchers who compared previous studies on stress and cancer progression.

Anxiety and depression afflict 30 percent to 40 percent of women when they are first diagnosed with breast cancer, and post-traumatic stress disorder affects 3 percent to 10 percent of these women.

Linda J. Luecken, Ph.D., of Arizona State University and Bruce E. Compas, Ph.D., of Vanderbilt University, say, "Interventions focused on improving women's ability to cope with breast cancer diagnosis, treatment and recovery may have beneficial effects on emotional adjustment and potentially on physiological processes." Dr. Luecken and Dr. Compas obtained information from numerous studies to show that stress, mental state and coping style all work collectively to influence immune function and hormone levels that are imperative to cancer progression. They also say that healthy coping, which has been shown to help stress, depression, anxiety and post-traumatic stress disorder, could potentially affect cancer outcomes.

Dr. Luecken and Dr. Compas characterize coping as "conscious, volitional efforts to regulate one's cognitive, behavioral, emotional and physiological responses to stress and stressful aspects of the environment." They also explain that "active coping" means to abide by an honest and reasonable methodology for dealing stress and "passive coping" implies the rough tactics such as evasion, withdrawal and self-delusion. Previous studies have shown that individuals who assume an active coping style have healthier immune function. However, the opposite occurs for people who use passive coping strategies.

Dr. Luecken and Dr. Compas say, "There is clear evidence that interventions can have positive effects on emotional adjustment, functional adjustment and treatment of disease-related symptoms." They also say active coping and effective emotional management can help aid women in their course of cancer therapy.

SOURCE: Annals of Behavioral Medicine, 2002;24:336-344

Personality Impacts Arthritis (December 14, 2002)
(Ivanhoe Newswire) -- The personality of a patient can have a major impact on how susceptible they are to long-term problems from rheumatoid arthritis, according to new research. The published study explains doctors need to pay attention to factors not related to the disease when they screen at-risk patients.

There is no doubt being diagnosed with a chronic, disabling disease, such as rheumatoid arthritis, can have a significant impact on a person's life. Patients have to deal with a potentially uncontrollable, unpredictable, long-term condition that can have a physical, psychological and social impact on their life. While many patients adjust to this change, it's estimated 20 percent suffer heightened levels of anxiety and depression. Researchers from The Netherlands looked at the role of personality characteristics to determine who is best able to cope with a diagnosis.

Researchers studied 78 patients who were diagnosed with rheumatoid arthritis. The patients were assessed for anxiety and depressed mood at the time of the diagnosis and again after three and five years. Researchers looked at the role of neuroticism (a person who is overanxious, oversensitive and obsessive), clinical status, disease influence on daily life, and major life events. They also looked at coping and social support at the time of diagnosis.

The study finds a worse clinical status, more neuroticism, and lower education level at the time of diagnosis were significantly related to an increased psychological distress at the three- and five-year follow-up. However, the personality characteristics of neuroticism proved to be the most consistent and effective predictor of anxiety and depression after three and five years.

Researchers feel the study shows the importance of paying close attention to factors other than the disease when studying risk factors for heightened distress over time. Authors write, "In addition, screening patients with lower education levels and higher levels of neuroticism may be highly recommended in clinical practice, since these patients are known to report physical symptoms that do not stem purely from rheumatoid arthritis disease activity."

SOURCE: The Journal of Rheumatology, 2002;29:2327-2336

Strict Blood Pressure Control Important (December 13, 2002)
(Ivanhoe Newswire) -- A major new study finds lower blood pressure decreases the risk of death from cardiovascular causes, even among those with blood pressure readings that fall within the normal range.

The finding comes from the first large-scale report directly linking lower normal blood pressures with reduced mortality risks.

According to British investigators, each difference in blood pressure of 20 mm Hg systolic or 10 mm Hg diastolic can produce more than twice the difference in stroke death, death from ischemic heart disease, and other vascular diseases in those ages 40 to 69 years. Lower blood pressure readings were also associated with lower rates of deaths from all other causes. The link between lower blood pressure readings and reduced risk of death continued down to a reading of 115/75 mm Hg. The findings were more significant for younger people, but the benefits of lower blood pressure persisted even into very old age. The results were about the same for men and women.

Investigators write, "Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg."

The study is considered significant because it included data from 61 previous studies on 1 million people from Europe, North America, Australia, China, and Japan. The large number of participants allowed researchers to control their results for differences in the studies as well as random error.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

SOURCE: The Lancet, 2002;360:1903-1913

Music Improves Fitness (December 10, 2002)
(Ivanhoe Newswire) -- Based on the results of a new study, listening to music may help patients with severe respiratory disease boost their fitness levels.

In the study, researchers divided 24 patients with serious lung disease into two groups of 12 patients. Three months prior to the study, each patient participated in a six- to eight-week pulmonary rehabilitation program. Gerene Bauldoff, a study co-author and an assistant professor of nursing at Ohio State University says, "The first three months following pulmonary rehabilitation are critical -- this is when patients are most likely to drop an exercise routine."

Participants in the study kept journals of how frequently they walked and the duration of their walks for the eight-week study, and were asked to attempt to walk for at least 20 minutes, two- to five-times a week. The music group participants were given portable audiocassette players and two audiocassette tapes with country/western, classical, pop/Motown and big band music. The participants were also given an electronic pedometer to measure their walking distance.

The group who listened to music while walking traveled over 19 total miles during the course of the study as compared to the group who didn't listen to music. The non-music group walked 21-percent less, a total of 15 miles. The difference of four-miles is momentous, says Bauldoff. It implies that participants who listened to music may have felt less hindered by shortness of breath, the main physical symptom of serious lung disease.

Bauldoff says, "The positive effects of increased exercise spilled over into other areas of the participants' lives. They were better able to handle routine daily activities and, in turn, retain a good degree of independence." Participants in both groups said they felt a decrease in depression. However, the group who listened to music said they had fewer episodes of depression by the end of the study.

SOURCE: CHEST, 2002:122;948-954

Infection Linked to Miscarriages (December 10, 2002)
(Ivanhoe Newswire) -- Researchers at St. George's Hospital Medical School in London, England, have found miscarriages occurring during the second trimester of pregnancy could be caused by the genital infection, bacterial vaginosis.

Bacterial vaginosis (BV) is caused by an imbalance of organisms in the vagina and is common during pregnancy because of hormone changes throughout pregnancy. The symptoms differ between women, but, 50 percent of women with BV have no symptoms. Having an excessive amount of grayish white vaginal discharge, unlike normal vaginal discharge, is the most prominent symptom of BV. Those women with symptoms of BV are traditionally treated with medication and non-pregnant women without symptoms usually do not receive treatment. BV tends to recede without medication. However, a pregnant woman could have complications during her pregnancy if she has BV.

For the study, researchers gathered 1,216 pregnant women who were less than 10 weeks pregnant. The women were asked to submit a self-administered vaginal swab, and then complete a questionnaire at 16 weeks of their pregnancy. The questionnaire examined personal characteristics, medical history, and pregnancy outcome. 

Researchers found 174 women had BV. Out of all the participants, 121 women had miscarriages before their 16th week of pregnancy. Those participants who had BV were found to have a greater risk of miscarriage during their 13th through 15th week, compared to women who did not have BV.

The authors conclude, BV is not a good predictor for early miscarriage, however, it is linked to miscarriages occurring in the second trimester of pregnancy. The study also shows that checking for genital infections through self-administered vaginal swabs was practical for pregnant women.

SOURCE: British Medical Journal, 2002;325:1334-1336

Coffee, Caffeine and Cardiovascular Disease (December 9, 2002)
(Ivanhoe Newswire) -- Could your cup of coffee in the morning be doing more than waking you up? New research shows it might also increase your risk for cardiovascular disease.

A high plasma total homocysteine concentration is associated with an increased risk of cardiovascular disease. Research has shown drinking unfiltered or filtered coffee raises total homocysteine concentrations in healthy volunteers. Researchers in the Netherlands conducted a study to determine whether caffeine is to blame for this increase in homocysteine levels.

For the study, 48 participants aged 19 to 65 years old were recruited. The participants were randomly assigned to one of three treatment groups for two weeks. One group received capsules that provided 870 mg of caffeine, the second group drank coffee that had 870 mg of caffeine and the last group took placebo capsules. Blood samples were drawn from the participants to compare homocysteine concentration levels.

The study shows the caffeine capsules increased the level by 5 percent and the coffee increased the level by 11 percent. Therefore, caffeine had a much weaker effect on the levels than coffee. Researchers did find the effect of caffeine was stronger in women than in men, but the effect of coffee did not differ significantly between men and women.

Researchers say caffeine is only partly to blame for the homocysteine-raising effect of coffee. They also say coffee, but not caffeine, affects homocysteine metabolism within hours after intake, although the effect is still substantial after an overnight fast. Authors write, "The public health implications of the homocysteine-raising effects of caffeine and coffee will remain unclear until we know with certainty that a causal relation between high homocysteine concentrations and cardiovascular disease exists."

SOURCE: The American Journal of Clinical Nutrition, 2002;76:1244-1248

Protein in Eye Fights Diseases (December 9, 2002)
(Ivanhoe Newswire) -- A protein in the eye has prevented and stopped autoimmune eye disease in animal studies. Now, researchers say this could lead to promising treatments for other autoimmune diseases such as multiple sclerosis and type 1 diabetes.

Scientists from the Schepens Eye Research Institute in Boston found the factor alpha-MSH can be harnessed and used as a therapeutic drug. The drug can then prevent the onset of and stop the progression of uveitis in mice. Uveitis is a sight-stealing autoimmune disease.

"The results of our study are exciting and significant because they confirm for the first time that this factor can be successful in the treatment of an autoimmune disease, something that we have been suspecting since we first found alpha-MSH in the eye," says Andrew W. Taylor, Ph.D., from Schepens Eye Research Institute and senior author of the study.

Taylor and his colleagues discovered that the alpha-MSH plays a significant role with the T cells. In autoimmune diseases, the conventional T cells perceive a part of the body as foreign and attack it. When the MSH protein was injected into the mice, the T cells changed and did not attack the body.

"This technique was extremely effective in the mouse model, and we believe that it has great potential to work in other autoimmune diseases by changing the immune response responsible for multiple sclerosis or for the onset of type 1 diabetes," says Taylor.

Based on this study, the Schepens Eye Research Institute team was awarded a $330,000 grant by the Wadsworth Foundation to explore new therapies for multiple sclerosis.

SOURCE: Journal of Leukocyte Biology, 2002;72:946-952

Study suggests vegetarian cheese cuts cholesterol (December 9, 2002)
(Reuters Health) - Eating cheese made from vegetable oils rather than milk fat can reduce cholesterol levels in some people, a study from Finland shows.

After 4 weeks of eating a daily portion of vegetarian cheese, volunteers with moderately increased cholesterol saw levels drop by 5%, according to research carried out by the University of Kuopio and Oy Foodfiles Ltd, a private research body for the food industry. The research was sponsored by a producer of vegetable oils.

The cheese appears to work mainly by reducing levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol associated with increased risk of cardiovascular disease.

The results, published in the European Journal of Clinical Nutrition, suggest cheeses made from rapeseed oil could be a healthy alternative for those with slightly raised cholesterol levels.

Research leader Dr. Essi Sarkkinen and colleagues said in a report that rapeseed oil-based cheese might help people get their cholesterol levels down without losing out on the nutritional value of cheese in their diet.

"Our results have major practical implications," they write. "This single dietary modification has a clinically significant effect on serum, total and LDL cholesterol concentrations."

Cheese consumption in developed nations has been steadily increasing over the past 20 years. In the US, average annual consumption per head is 12.7 kilogrammes a year, while in Europe it's 17 kilos.

Although cheese provides valuable calcium, it is also high in saturated fat, which increases cholesterol levels.

Commenting on the report, Dr. Frankie Robinson of the British Nutrition Foundation said it was feasible that cutting out cheese rich in saturated fats could help lower cholesterol levels.

"By substituting it with polyunsaturated fats you might expect to see that kind of difference," said Robinson, who was not involved in the study. "But I very much doubt it contains any of the milk product that provides the calcium in cheese--there's not much calcium in rapeseed oil."

The Finnish researchers recruited 31 adults ages 25 to 65 with mild to moderately raised levels of cholesterol but no history of heart disease or other major illnesses.

All the volunteers were instructed to keep their alcohol consumption, smoking habits and medication the same throughout the study so as not to skew the findings. The same applied to their physical activity and consumption of vitamins and nutrients.

Half the group ate a daily portion of 65 grams of rapeseed-oil cheese, the other half a portion of ordinary cheese. After 4 weeks, the groups swapped over.

Laboratory tests on blood samples revealed that after 2 weeks of eating vegetarian cheese, total cholesterol levels were 6.7% lower than when they ate milk fat-based cheese. After 4 weeks, they were 5% lower.

Meanwhile, levels of LDL cholesterol in the same period were down 7% after 2 weeks and 6.4% after 4.

"Interestingly," the researchers note, "this single change in dietary habit resulted in a decline in total cholesterol concentration similar to reduction achieved by general dietary advice at population level."

SOURCE: European Journal of Clinical Nutrition 2002;56:1094- 1101

Metabolic Syndrome and Heart Disease (December 9, 2002)
(Ivanhoe Newswire) -- A new study finds middle-aged men with the metabolic syndrome are at an increased risk for cardiovascular disease and death.

Metabolic syndrome is characterized as having high blood pressure, blood lipid abnormalities, obesity, increased abdominal fat, high blood sugar levels, and insulin resistance. Researchers of the study used current definitions of the metabolic syndrome from the National Cholesterol Education Program (NCEP) and the World Health Organization (WHO) to evaluate the possible connection of heart disease and death from the metabolic syndrome. Researchers say, "To our knowledge, this is the first prospective population-based cohort study reporting the association of the metabolic syndrome using recently proposed definitions with cardiovascular and overall mortality."

In the study, researchers followed 1,209 men ages 42 to 60, free from heart disease, cancer or diabetes, for more than 11 years to assess the link between the metabolic syndrome and heart disease and death. Depending on the NCEP or WHO definitions of the metabolic syndrome, 8 percent to 14 percent of participants had the metabolic syndrome. During the study there were 109 deaths. Of those, 46 deaths were caused by cardiovascular disease and 27 were caused by coronary heart disease.

Researchers found that men with the metabolic syndrome, as defined by the WHO, were 2.9 to 3.3 times more likely to die from coronary heart disease. Men with the metabolic syndrome, as defined by the NCEP, were 2.9 to 4.2 times more likely to die from coronary heart disease. They also found that the metabolic syndrome as defined by the WHO, was linked to a 2.6 to 3.0 greater risk for death from cardiovascular disease.

Researchers say, "The threat to public health posed by the metabolic syndrome will continue to grow as the metabolic syndrome becomes more common. Early identification, treatment, and prevention of the metabolic syndrome presents a major challenge for physicians and public health policy makers facing an epidemic of overweight and sedentary lifestyle."

SOURCE: Journal of the American Medical Association, 2002;288:2709-2716