02.24.09
Posted in Uncategorized at 1:00 am by Luis
WASHINGTON (AP) -- How the heart handles anger seems to predict who's at risk for a life-threatening irregular heartbeat. Negative emotions like hostility and depression have long been considered risks for developing heart disease, and deaths from cardiac arrest rise after disasters such as earthquakes.
But research released Monday goes a step farther, uncovering a telltale pattern in the EKGs of certain heart patients when they merely recall a maddening event - an anger spike that foretold bad news.
In already vulnerable people, "anger causes electrical changes in the heart," said Dr. Rachel Lampert, a Yale University cardiologist who led the work. When that happens even in the doctor's office, "that means they're more likely to have arrhythmias when they go out in real life."
At issue is cardiac arrest, when the heart's electrical system goes haywire and heartbeat abruptly stops. Survival requires a fast electrical shock from a device called a defibrillator.
To track anger's effect, Lampert gave EKGs to 62 patients who had defibrillators implanted in their chests because of preexisting heart disease. When they recounted something that had made them angry, some patients experienced beat-to-beat EKG alterations that were similar to irregular heartbeat-predicting alterations that doctors can spot during treadmill testing.
In other words, the emotional stress was producing a red flag like physical stress can. But it did so without causing the jump in heart rate that exercise does, suggesting anger's Adrenalin rush may act directly on heart cells.
The result: People whose EKGs showed a big anger spike were 10 times more likely to have their defibrillators fire a lifesaving shock in the next three years than similarly ill patients whose hearts didn't react to anger, Lampert reported in the Journal of the American College of Cardiology.
Next she's studying whether anger-reducing techniques might help those high-risk patients avoid irregular heartbeats.
Don't race out for an EKG. Nobody knows if anger has a similar electrical effect in people whose hearts aren't already diseased.
But that question should be studied, said Dr. Nieca Goldberg, a spokeswoman for the American Heart Association who wasn't involved with the research.
There's a clear connection between the heart and the head, that chronic negative emotions are somehow heart-damaging. "But we haven't been able to explain why that happens," said Goldberg, a cardiologist at New York University School of Medicine. "This is a step in the right direction."
The question of the still-healthy aside, this is a small study and researchers must test the anger spike's predictive ability in many more heart patients to be sure of its value.
But if it pans out, the finding could affect a huge population: About 100,000 defibrillators are implanted each year in people at risk of irregular heartbeats because of damage from a survived heart attack, genetic disorders and other conditions. Scientists are searching for ways to tell which patients most need the implants, and the anger spike may offer help.
© 2009 The Associated Press.
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Posted in Uncategorized at 1:00 am by Luis
CHICAGO (AP) -- Taking B vitamins can prevent a common type of vision loss in older women, according to the first rigorous study of its kind. It's a slight redemption for vitamin supplements, which have suffered recent blows from research finding them powerless at preventing disease.
Age-related macular degeneration is the leading cause of blindness in people 65 and older, with nearly 2 million Americans in the advanced stage of the condition. It causes a layer of the eye to deteriorate, blurring the center of the field of vision and making it difficult to recognize faces, read and drive. There's no cure, but treatment, including laser therapy in some cases, can slow it down.
Preventing it has been more elusive.
"Other than avoiding cigarette smoking, this is the first suggestion from a randomized trial of a possible way to reduce early stage AMD," said William Christen of Harvard-affiliated Brigham and Women's Hospital in Boston, who led the research. He said the findings should apply to men as well.
The women in the study who took a combination of B vitamins - B-6, folic acid and B-12 - reduced their risk of macular degeneration by more than one-third after seven years compared to women taking dummy pills.
The study, involving more than 5,000 women ages 40 and older at risk for cardiovascular disease, appears in Monday's Archives of Internal Medicine.
Allen Taylor, director of the Laboratory for Nutrition and Vision Research at Tufts University in Boston, said the study was strong because patients were assigned at random and followed for a long time. But because the findings were teased out of a larger experiment for heart disease, there wasn't strict categorization of the type and severity of the eye disease, said Taylor, who does similar research but was not involved in the new study.
Among women taking the B vitamins there were 55 cases of AMD. In the placebo group, there were 82 cases. More serious cases, causing significant vision loss, totaled 26 in women taking B vitamins and 44 in those taking dummy pills.
There were too few cases of the most advanced AMD to make claims about vitamins' potential benefits, Christen said.
B vitamins lower homocysteine, a blood substance once thought to raise heart disease risk, but the nutrients weren't helpful for that in the larger study on cardiovascular disease.
The eye's small blood vessels may respond better to B vitamins' effect on homocysteine than the body's large vessels, Christen said.
It's too soon to recommend B vitamins to people who want to prevent age-related vision loss, he said. But people who already have the disease should talk to their doctors about over-the-counter eye-protecting supplements, including vitamins C and E and zinc, which prior studies have shown slow the disease.
Christen and others recommended food sources of B vitamins and folic acid such as meat, poultry, fortified cereals, beans, nuts, leafy vegetables, spinach and peas.
The study was funded by the National Institutes of Health. Vitamins and placebos were provided by chemical maker BASF Corp., which did not participate in the study otherwise. Some of the researchers reported past funding from pharmaceutical and nutritional supplement makers.
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On the Net:
Archives: http://www.archinternmed.com
© 2009 The Associated Press.
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Posted in Uncategorized at 1:00 am by Luis
CHICAGO (AP) -- A study in nearly half a million older men and women bolsters evidence that diets rich in calcium may help protect against some cancers. The benefits were mostly associated with foods high in calcium, rather than calcium tablets.
Previous studies have produced conflicting results. The new research involved food questionnaires from participants and a follow-up check of records for cancer cases during the subsequent seven years. This research method is less rigorous than some previous but smaller studies.
But because of its huge size - 492,810 people and more than 50,000 cancers - the new study presents powerful evidence favoring the idea that calcium may somehow keep cells from becoming cancerous, said University of North Carolina nutrition expert John Anderson, who was not involved in the study.
The study was run jointly by the National Institutes of Health and AARP. The results appear in Monday's Archives of Internal Medicine.
National Cancer Institute researcher Yikyung Park, the study's lead author, called the results strong but said more studies are needed to confirm the findings.
Duke University nutrition researcher Denise Snyder said the results support the idea that food rather than supplements is the best source for nutrients.
Participants were AARP members aged 50 to 71 who began the study in the mid-1990s. A total of 36,965 men and 16,605 women were later diagnosed with cancer. There were more than 10 different kinds of cancer, the most common being prostate, breast, lung and colorectal.
Compared with people who got little calcium, those who consumed the most had the lowest chances of getting colon cancer. Those in that highest category got on average 1,530 milligrams a day among men and 1,881 milligrams daily among women. The recommended amount for older people is 1,200 milligrams, and getting much more than that didn't result in any greater protection. Adults can get that amount from four cups of milk or calcium-fortified orange juice.
Men who got the most calcium from food were about 30 percent less likely to get cancer of the esophagus, about 20 percent less likely to get head and neck cancer and 16 percent less likely to get colon cancer, when compared to men who got low amounts of calcium.
Among women, those who got the most food-based calcium were 28 percent less likely to get colon cancer than low-calcium women.
In men, calcium supplements only seemed to help protect against colon cancer; for women, supplements meant a lower risk for liver cancer, which is rare.
Some previous studies have linked diets high in calcium with prostate cancer but the current study found no such risk.
Adults who ate the most calcium also tended to be healthier overall than the others.
Northwestern University preventive medicine instructor Patricia Sheean called the results impressive. But she noted that all those in the study, AARP members, may have been healthier and wealthier than the general U.S. population so it's not clear if the results would apply to the wider population.
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On the Net:
Archives of Internal Medicine: http://archinternmed.com
© 2009 The Associated Press.
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Posted in Uncategorized at 1:00 am by Luis
WASHINGTON (AP) -- Popping a pill can cut your cholesterol. But did the doctor also prescribe cutting the stress that's eroding your immune system? Or teach you how to exercise without worsening painful joints?
Think 3 Ps: Good health care is preventive, predictive and personalized, a rarity today in a crisis-oriented care system far better at treating disease than keeping it at bay. To help change that, one of the nation's top medical groups starts a major push this week for what patients might call whole-body wellness care.
"Health is more than the absence of disease," says Dr. Ralph Snyderman, who heads a three-day meeting of the prestigious Institute of Medicine to get onto Congress' radar this health-promotion approach, what jargon-loving doctors call "integrative medicine."
What does that mean? Basically, it's going beyond standard disease-of-the-day care to involve a range of extra factors - physical, lifestyle habits, mind-body interaction - that play a role in preventing illness, and helping people stick with recommended changes long enough to see a benefit.
"Not enough attention is paid to wellness," says AARP chief Bill Novelli, who worries that's lost in the coming health care reform movement.
"The doctor says, 'Lose weight, exercise, see you in a year.' We know that doesn't work," adds Dr. Tracy Gaudet, an obstetrician/gynecologist who heads integrative medicine at Duke University Medical Center.
But how to pay for keeping people well is a barrier. Even though preventing disease is cheaper overall than treating it, it's not clear where the upfront investment would come from, a big part of the Institute's debate.
Still, a growing number of respected academic medical centers are adopting integrative medicine in different ways. At Duke, specially trained health coaches help patients implement a personalized care plan that complements treatment prescribed by their regular physicians, extra care that patients often pay for out-of-pocket.
"If I didn't have coaching, I would have given up," says Roberta Cutbill, 68, of Cary, N.C., whose cardiologist referred her to the program in hopes that better nutrition and exercise could lower her cholesterol enough to avoid medication.
But these centers must straddle a line between adopting some non-mainstream therapies that seem to at least help a patient's quality of life, while avoiding unproven "alternative therapies," even outright quackery.
"We're extremely wasteful in health care in America because we don't respect what the patient can bring to the table, the healing properties of the body itself, the use of lower-technology routes to healing," says Dr. Donald Berwick, a Harvard health-quality expert who heads the nonprofit Institute for Health care Improvement.
Yet Berwick will issue the IOM meeting a strong warning: "Evidence matters."
There is some evidence. Medicare funded a Duke study of 154 middle-aged people at high risk of heart disease. In 10 months, people who received health coaching were exercising 3.7 days a week - two days a week more than when they started - and had an average 10-point drop in cholesterol. That equaled a small but significant drop in their overall heart risk, while people who got standard checkups barely budged.
Another example: A chronically stressed brain orders release of hormones and other chemicals that tamp down the immune system so it can't fight off disease or speed healing, says Dr. Esther Sternberg of the National Institute of Mental Health. Too much stress even ages us faster. But regular exercise, a healthy diet and stress-relieving techniques such as meditation or yoga have been shown in scientific studies to help battle stress' bad effects.
That doesn't mean replacing medication or other treatment, Sternberg cautions.
"We're saying do it together with the space-age advances in medicine," she says. "That will allow your body to receive that treatment and respond optimally to that treatment, which otherwise it might not."
That's Cutbill's hope. A rare autoimmune disease had ravaged her joints, hindering her ability to exercise. She also suffered a drug side effect - hearing loss - while treating it, a reaction that made her balk at anti-cholesterol pills.
With the coach's help, Cutbill started gentle yoga and weight training, building up to heart-healthier exercises. When her joints hurt, she heads for acupuncture. Cutbill has switched to heart-healthy olive oil; takes omega-3 fatty acids and some other heart-targeting nutrients that her cardiologist agreed couldn't hurt; sneaks fiber into meals; and learned that protein snacks level her blood sugar so she doesn't crave high-fat sweets.
She's not there yet - a January blood test showed her cholesterol nudging up a bit. Tests can fluctuate so doctors said to give the lifestyle another six weeks. If she ultimately needs medication, Cutbill says her effort at least will give her the lowest possible dose.
"You need people who can keep the whole picture in mind of all of your conditions and be able to guide you," she says.
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EDITOR's NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
© 2009 The Associated Press.
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Posted in Uncategorized at 1:00 am by Luis
NEW YORK (AP) -- The California fertility doctor who implanted the octuplet mom with lots of embryos was no lone wolf: Fewer than 20 percent of U.S. clinics follow professional guidelines on how many embryos should be used for younger women. "Clearly, most programs are not adhering to the guidelines," said Dr. Bradley Van Voorhis, director of the fertility clinic at the University of Iowa.
The furor over Nadya Suleman and her octuplets has brought scrutiny to U.S. fertility clinics and how well they observe the guidelines, which are purely voluntary. The controversy had led to talk of passing laws to regulate clinics, something that has already been done in Western Europe.
"There are enough clinics that quite openly flout professional guidelines that we really do need to start thinking about public policy in this area," said Marcy Darnovsky of the Oakland, Calif.-based Center for Genetics and Society, a public interest group. "I think it's way overdue."
The 20 percent figure is contained in reports filed by clinics with the Centers for Disease Control and Prevention.
Fertility doctors say there are many reasons clinics skirt the guidelines: pressure from patients who want to use more embryos to improve their chances of getting pregnant; financial concerns from those who are paying for their treatment out of their own pockets; and the competition among clinics to post good success rates.
And the only penalty for violating the guidelines is expulsion from some of the industry's professional organizations, though that can affect whether insurance companies will cover a clinic's treatments.
"You have patients who are desperate and you have doctors who are driven by success rates. It's not a good combination," said Pamela Madsen, founder and former head of the American Fertility Association.
When the guidelines were issued in 1996 by the American Society of Reproductive Medicine, the intent was to cut down the number of multiple births, particularly triplets and higher, that can result when many embryos are implanted and more than one takes. Big multiple births can lead to disastrous, life-threatening complications, lifelong disabilities such as cerebral palsy, and crushing medical costs.
The guidelines suggest how many embryos doctors should use, with the number varying by age and other factors. They also allow for some flexibility for more if previous attempts have failed or the embryo quality is poor.
"These decisions are complex and need to be individualized, which is why we strongly believe that guidelines are better than hard rules," said Dr. David Adamson, a former president of the reproductive medicine society.
The group credits the guidelines with reducing triplets and higher multiple pregnancies from 7 percent of attempts to 2 percent in 2006. Nearly two-thirds of the procedures involved four or more embryos in 1996; that has fallen to 16 percent.
But for women under 35, government records show that just 83 of 426 clinics followed the guidance calling for one and no more than two embryos. The average for fresh embryos (as opposed to frozen) implanted in women in that age group ranged from a 1.4 to 4.8. The vast majority of the clinics averaged between two and three embryos.
Dr. Mousa Shamonki, director of the IVF program at the University of California, Los Angeles, said his patients frequently ask for more embryos to boost their chances of getting pregnant. He tells patients that it's not OK to end up with triplets or even twins.
"The only thing that happens when you add additional embryos is you're increasing the multiple pregnancy rate," he said. "You're rarely increasing the overall pregnancy rate significantly."
The UCLA program had one of the highest transfer rates in 2006 for younger women. That rate - 3.5 embryos per cycle - matched that of the West Coast IVF Clinic in Beverly Hills, Calif., where Suleman was treated. Shamonki said changes he implemented after he took over drove down UCLA's rate to 2.1 embryos the next year.
Fertility specialists have attacked Suleman's doctor, Michael Kamrava, for using so many embryos. Suleman, 33, has said she had six embryos implanted; two presumably split. She said she refused selective abortion to reduce the number, which is a common option in such cases. Kamrava has declined requests for interviews.
The reproductive medicine society and the Medical Board of California are looking into the case.
Europe has brought down transfer rates and multiple births through laws and voluntary agreements. England and Sweden have laws barring more than two embryo transfers for younger women.
In Sweden, "we have a slogan: One at a time," said Dr. Karl Nygren, former head of an IVF monitoring committee for the European Society of Human Reproduction and Embryology.
Seventy percent of in vitro fertilization procedures in Sweden involved only a single embryo in 2005, according to Nygren. For Europe, the average was 20 percent. By contrast, only 11 percent in the U.S. involved one embryo in 2006.
A key difference, though, is that health programs in Europe cover the cost, so that if one attempt fails, women can try again without having to worry about the expense.
In the U.S., most patients have to foot the bill for IVF, which costs about $12,400 per attempt. Only 14 states make insurers cover some infertility treatments.
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On the Net:
CDC fertility clinic reports: http://www.cdc.gov/ART/
© 2009 The Associated Press.
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