Sister to Sister

WEDNESDAY, Sept. 1 (HealthDay News) -- A new study is linking the popular weight loss drug Meridia to an increased risk of non-fatal heart attacks and stroke, although taking the drug did not seem to up the risk of death in patients with a history of heart problems.

The finding is stirring mixed reactions from experts.

According to the authors of the trial, which was funded by Meridia's maker, Abbott, the findings are generally in line with what has been known about the drug and shouldn't change how it is used.

"The only time you've got an increase in heart attacks or strokes were in those patients who had had previous heart disease or strokes, in other words, the people who . . . should never have received the drug in the first place," said Dr. Philip T. James, a professor at the London School of Hygiene and Tropical Medicine in England, and first author on the paper, which appears in the Sept. 2 issue of the New England Journal of Medicine.

Since January, Meridia (sibutramine), has carried a label warning that it should not be used by people with preexisting heart disease, so "the current prescription is entirely appropriate," James said.

However, not everyone agrees. The U.S. Food and Drug Administration is slated to meet in September to decide if more regulatory action -- perhaps a tougher "black-box" warning or even removing Meridia from the market -- should be taken.

According to Dr. Greg Curfman, executive editor of the NEJM and co-author of an accompanying editorial, the FDA's January warning was based on preliminary information only. The new study results represent the first hard data, "the first outcomes trial," he said.

Based on the findings, he and others wonder if the drug is worth keeping around.

The drug did not seem to make people healthier, Curfman said. "Some people were actually made worse," he said. "All this taken together results in an unfavorable risk-benefit profile and, based on that, we don't see a rationale for keeping this on the market."

Also, he said, "the efficacy of producing weight loss with the drug is very unimpressive. In this trial, patients lost on average less than 4 kilograms [about 9 pounds] and we know that that's not going to translate into a real health benefit over time. It's not enough weight loss. The FDA has a benchmark of about 5 percent loss of baseline body weight to consider a weight loss drug [effective]."

A University of Rochester expert concurs.

"I have never really found that people taking Meridia had obtained a real substantive weight loss," said Dr. J. Chad Teeters, assistant professor of clinical medicine, cardiology division at the University of Rochester Medical Center. "It seems that a lot of these 'quick fix' weight loss drugs don't really live up to the hype and they come with risks. I think there's probably going to be a significant downturn in the use of the drug given the low efficacy and increased risk of side effects."

This trial involved almost 11,000 older overweight or obese adults with type 2 diabetes or heart disease or both who were randomized either to take Meridia or a placebo and followed for about 3.4 years.

In the group taking Meridia, 11.4 percent had a heart attack, stroke or died as the result of a heart problem, versus 10 percent in the control group, a 16 percent increase.

People taking Meridia also had a 28 percent higher risk for nonfatal heart attack and a 36 percent raised risk for nonfatal stroke, compared to those taking placebo, the authors found.

All trial participants were also engaged in a diet-and-exercise program to lose weight, whether they were taking the drug or not, said study author James. "Meridia is not a wonder drug that guarantees people lose weight but it is a major additional help for people who change their diet and increase their physical activity," he said.

But Teeters narrowed the prescription. "Good old-fashioned diet and exercise is the only substantive sustained therapy that's shown to be helpful," he said. "There's no quick-fix pill."

More information

There's more on Meridia at the U.S. National Library of Medicine.

SOURCES: Philip T. James, M.D., D.Sc., professor, London School of Hygiene and Tropical Medicine, U.K.; Chad Teeters, M.D., assistant professor, clinical medicine, cardiology division, University of Rochester Medical Center; Greg Curfman, M.D., executive editor, Sept. 2, 2010, New England Journal of Medicine

Last Updated: Sept. 01, 2010

Today, September 1, 2010, is a very special day – it's the start of the fourth annual National Atrial Fibrillation Awareness Month. In celebration, StopAfib.org is kicking off a new initiative asking you to "Take a Stand against Atrial Fibrillation and Stroke."

We are launching the new Take a Stand videothat shares important statistics about the impact of atrial fibrillation (afib). For instance, did you know that of those who have afib, over a third will have a stroke? You'll find many more surprising facts in the video.

Please help us spread this message far and wide by sharing this video with family, friends, co-workers, and anyone that needs to know about this. Then ask them to educate themselves about atrial fibrillation and strokes by visiting the Get Started Learning About Atrial Fibrillation Guide.

Please share this information by clicking on the buttons below the story to Tweet on Twitter, "Like" on Facebook, or share via a variety of social media sites and e-mail.

Or use the toolbar at the bottom of the blog to do these things and more, such as to access the videos at the StopAfib YouTube Channel for Atrial Fibrillation Patients.

By spreading the word, you can help get individuals diagnosed with atrial fibrillation before they have a stroke, or two, and help them learn how to protect themselves from afib and strokes.

Thanks so much for sharing this during National Atrial Fibrillation Awareness Month.

• See the video: Take a Stand video
• Visit the guide: Get Started Learning About Atrial Fibrillation Guide
• Read the press release: New Video Helps StopAfib.org Celebrate National Atrial Fibrillation Awareness Month in September 2010

Also, what do you think of the new look and features of the Atrial Fibrillation Blog, which we have launched for afib month? We hope you like them.

Image:  Image Caption:  Photo: Getty Images

I love the research that goes into writing for EmpowHER almost as much as I love the writing itself. I get to read so many interesting studies about our heart health and almost always learn some little tidbit of information that hopefully will make me (and you as well, Gentle Readers) heart healthier in the long run. But, sometimes, I come across an article that simply makes me laugh and shake my head in disbelief because someone just spent millions of dollars on a study for which the answer is so obvious!

The name of the no-brainer article that caught my eye this week was “Antagonistic People May Increase Heart Attack, Stroke Risk.” My immediate reaction to the title was - “Duh! Like someone really needed to spend millions of dollars and conduct a study to call the pot black!” Perhaps for me, this was obvious because I worked for one of those “antagonistic” people once-upon-a-lifetime-ago. (Then, I discovered life is too short to waste on such unpleasantness but that’s a whole different story in and of itself.) This person (a woman at that, I might add) would rampage about the office when vexed - yelling and screaming (and sometimes crying, complete with the Biblical weeping, and wailing, and gnashing of teeth), kicking desks, throwing papers and files across the room, etc. etc. etc. (You get the picture, don’t you? And yes, she was one of the “bosses” at the firm so the behavior was tolerated.) Her color would begin to flush and turn to a beautiful shade of fuchsia as she became more out of control until finally the veins in her temples and neck would begin to literally bulge out. (She would have done a Marine drill sergeant proud!) Young and aggressive, she was trying to compete and “make it” in a male-dominated industry. Needless to say, her methods of handling the stress often created stress for the rest of us. (For obvious reasons, I no longer work at that firm!)

It didn’t take a rocket-scientist - or a research study - for all of us who worked with this young woman to know that in addition to being generally unpleasant to be around, her behavior was unhealthy and that one day, if the behavior continued unchecked, there would be a cost to her health. The U.S. National Institute on Aging, or NIA for short (NIA is a division of the National Institutes of Health or NIH), recently completed a study which appears to confirm what we knew all along: persons who are antagonistic, aggressive, manipulative, and overly competitive, may be at a greater risk for a heart attack or stroke. (See the report in Hypertension: Journal of the American Heart Association).

Conducted in Italy (what a sweet gig!) as a part of the SardiNIA Study of Aging, researchers administered standard personality tests to more than 5,600 individuals (mostly from villages in the Sardinia area of Italy, hence the name SardiNIA Study) which measured participant responses in six main areas: trust, straightforwardness, altruism, compliance, modesty and tender mindedness. The SardiNIA Study participants were a mix of male (42 percent) and female (58 percent) with an average participant age of 42 years (the oldest participant was 94 years and the youngest 14).

The thickness of the carotid arteries in the necks of the participants was also documented. Researchers found that the participants who topped the personality test as being an in-your-face or my-way-or-the-highway kind of gal or guy also had much thicker neck arteries than their sweeter, nicer, kinder, and (as the article called them) generally just more agreeable counterparts. Yes, you guessed it - those thick bulging veins in the neck are risk factors for both stroke and heart attack.

In addition, researchers also found that as time went by (participants were rechecked at three years), those with the nastiest dispositions continued to down the road to heart attack and stroke as their neck arteries thickened, and thickened, and thickened. These antagonistic overachievers were found to have a 40 percent increase in their risk of heart attack or stroke over the “nice” participants (you know, the participants who were kind, trusting, straightforward, etc. versus manipulative, self-centered, or arrogant). Age and sex didn’t appear to be a factor. Women with a bad case of a nasty disposition also tended to have thicker neck arteries as did younger participants who were identified as “antagonistic.”

Granted, the study took place in Italy and we already know that sometimes such things as ethnicity or race, diet, or even regions of the world, may have an impact on heart disease. But the study should give all of us something to think about. Maybe addressing cholesterol, weight, blood pressure, etc. are not enough to prevent heart disease. Just maybe we should consider treating the whole person and investing in some anger or stress management classes to give these super-charged antagonistic kings and queens of the “bad mood” a few coping tools to help them chill out a little. It’s a thought--and it certainly couldn’t hurt the work environment either!

Mary Kyle is a freelance writer, editor, and project manager. She has a Master of Arts in Legal Studies, a Bachelor of Music, and multiple professional certifications in project management. In addition to health advocacy, she is passionate about literacy and volunteers in local schools teaching writing seminars and reading.

Source:
American Heart Association (2010, August 18). Antagonistic people may increase heart attack, stroke risk. ScienceDaily. Retrieved August 30, 2010, from http://sciencedaily.com¬ /releases/2010/08/100816162633.htm

Journal Reference:
1. Angelina R. Sutin, Angelo Scuteri, Edward G. Lakatta, Kirill V. Tarasov, Luigi Ferrucci, Paul T. Costa Jr, David Schlessinger, Manuela Uda, and Antonio Terracciano. Trait Antagonism and the Progression of Arterial Thickening. Women With Antagonistic Traits Have Similar Carotid Arterial Thickness as Men. Hypertension, 2010; DOI: 10.1161/HYPERTENSIONAHA.110.155317

Image:  Image Caption:  Photos: Getty Images

TUESDAY, Aug. 31 (HealthDay News) -- Eating a diet rich in fruits and vegetables and low in saturated fats can significantly lower the risk of heart attack for people with mildly elevated blood pressure, Johns Hopkins University researchers say.

The diet they examined -- called the DASH diet (Dietary Approaches to Stop Hypertension) -- was designed to lower blood pressure and cholesterol. In this new study, it reduced the risk of heart attack by almost 20 percent, the researchers said.

"Heart disease is an important cause of mortality and morbidity in the United States," said lead researcher Dr. Nisa M. Maruthur, an assistant professor of medicine at Hopkins' School of Medicine. "Thus, adoption of the DASH diet should have important benefits on a public health scale."

The diet also calls for reducing fats, red meat, sweets and sugary beverages, and replacing them with whole grains, poultry, low-fat dairy products, fish and nuts. The eating plan is recommended by the U.S. Dietary Guidelines for Americans and the American Heart Association.

For the study, published online Aug. 31 in Circulation: Cardiovascular Quality and Outcomes, Maruthur's team studied 436 people with high blood pressure or borderline hypertension who were not taking blood pressure medication. The participants were assigned to either the DASH diet; a typical American diet, which is low in important minerals and high in saturated fat, total fat and cholesterol; or an American diet plus more fruits and vegetables.

High blood pressure, or hypertension, is a major risk factor for heart disease, stroke, heart failure and kidney disease.

To determine their risk of having a heart attack over 10 years, the researchers used the Framingham Heart Study risk equation.

After eight weeks, the DASH dieters, who were eating nine to 11 servings of fruits and vegetables a day, had reduced their risk of heart attack 18 percent compared with those eating the American diet. They also saw their low-density lipoprotein ("bad") cholesterol levels reduced by about 7 percent and their systolic blood pressure lowered by 7 mm Hg.

While both whites and blacks benefited from the DASH diet, black participants had the greatest benefit, the researchers noted. Blacks on the DASH diet saw their heart risk decline by 22 percent over those on a typical diet, versus 8 percent for whites.

Those who ate the American diet plus fruits and vegetables reduced their risk of heart attack by 11 percent compared with those chowing down the usual American fare.

"The problem with hypertension is that it really is a silent killer because you do not feel it," said Samantha Heller, clinical nutrition coordinator at the Center for Cancer Care at Griffin Hospital in Derby, Conn. Millions of people have no idea their blood pressure is high and are walking around like "ticking time bombs," she said.

Those who know they are hypertensive do not always know what to do about it aside from taking medication, Heller added.

"The good news is that with a few dietary tweaks, the risk of these diseases and their co-morbidities can drop considerably. For example, add a salad or side of vegetables with lunch. Have fruit for dessert. Make your mashed potatoes with olive oil and low-fat milk. Top your pizza with part-skim mozzarella, broccoli, spinach and mushrooms," she said.

"The DASH eating plan is a good way to go for people looking to lower their blood pressure and improve heart health," she said.

Another expert, Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said although the DASH diet has been shown to lower systolic blood pressure and total cholesterol levels, changing risk factors does not always translate to a reduction in actual heart disease.

"It is therefore essential to hold dietary modification and other forms of lifestyle modification to the same gold standard that statins and antihypertensive medical therapies have been held to," he said. What's needed are prospective randomized trials that demonstrate actual reduction in coronary heart disease events, Fonarow said.

More information

For more information on the DASH diet, visit the American Heart Association.

SOURCES: Nisa M. Maruthur, M.D., M.H.S., assistant professor of medicine, Johns Hopkins Medical Institutions, Baltimore; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Samantha Heller, M.S., R.D., dietitian, nutritionist, exercise physiologist, clinical nutrition coordinator, Center for Cancer Care, Griffin Hospital, Derby, Conn.; Aug. 31, 2010, Circulation: Cardiovascular Quality and Outcomes, online

Last Updated: Aug. 31, 2010

MONDAY, Aug. 30 (HealthDay News) -- A number of factors put patients with abnormal fatty deposits in an artery at high risk for heart attack, stroke and cardiovascular death, a new study shows.

Patients in various stages of this condition -- atherothrombosis -- are at increased risk for heart attack and stroke stemming from reduced blood flow from the artery blockage, but some are at greater risk than others. In an analysis of more than 45,000 patients, the researchers found that patients with abnormal fatty deposits in an artery were at highest risk if they had a prior history of heart attack or other emergencies linked to an artery blockage.

Narrowing of the arteries in various locations also substantially increased the risk for patients with atherothrombosis, as did diabetes for all the patients -- even those with only the risk factors for atherothrombosis.

Knowing that these factors boost the risk can help physicians take preventive action, according to the researchers, who are from the VA Boston Healthcare System, Brigham and Women's Hospital and Harvard Medical School in Boston.

The researchers analyzed data from 45,227 patients enrolled in an international study known as Reduction of Atherothrombosis for Continued Health (REACH) between 2003 and 2004. They collected detailed information from the patients when they enrolled and conducted follow-ups one, two, three and four years later.

They found that 81.3 percent of the patients had hypertension, 70.4 percent had high cholesterol levels in the blood, and 15.9 percent had polyvascular disease (narrowing of the arteries in numerous locations). In addition, 48.4 percent of the patients had "ischemic events" -- prior heart attacks, unstable angina or other problems related to the artery blockage, with 28.1 percent of those patients having had such an event within the previous year.

During the follow-up period, 2,315 patients suffered cardiovascular death, 1,228 had a heart attack, 1,898 had a stroke, and 40 had a heart attack and a stroke on the same day.

The researchers found that patients with atherothrombosis with a prior history of heart attacks and other events related to a blood vessel blockage had the highest rate of subsequent cardiac emergencies linked to blood flow problems. Patients with stable heart, cerebrovascular or peripheral artery disease had a lower risk, while the risk was lowest among those with risk factors for atherothrombosis but without established disease.

"Among all categories of patients, diabetes substantially increase the risk of future ischemic events," the study authors wrote. "In those with established atherothrombosis, polyvascular disease was a particularly strong independent risk factor, even stronger than diabetes."

The findings show that "there is a whole spectrum of [emergencies relating to artery blockage and blood flow] in patients with risk factors or with established cardiovascular disease -- easily ascertainable clinical characteristics are the prominent factors associated with a high risk of future ischemic events," they concluded.

The study appears online and in the Sept. 22 issue of the Journal of the American Medical Association and is slated to be presented Monday at the European Society of Cardiology meeting in Sweden.

More information

The U.S. National Heart, Lung, and Blood Institute has more about heart and vascular diseases.

-- Robert Preidt

SOURCE: Journal of the American Medical Association, Aug. 30, 2010, news release.

Last Updated: Aug. 30, 2010

Whether you're an atrial fibrillation (afib) patient or caregiver, or are just interested in learning more about afib, check out the new Get Started Learning About Atrial Fibrillation Guide at StopAfib.org. You'll find a wealth of information, including:

• what afib is and the problems it causes, including stroke and congestive heart failure
• information about an afib risk prediction tool
• an array of atrial fibrillation treatments
• how to know if you need to be on Coumadin or Warfarin, including what are the newest stroke risk factors
• how to communicate with your doctor
• what caregivers need to know
• a list of valuable patient and caregiver resources
• where to find doctors, hospitals, and afib or arrhythmia centers
• the latest afib news and events
• video interviews with top afib doctors
• an atrial fibrillation news feed
• articles about whether factors such as stress, alcohol, coffee, or air pollution can cause afib
• StopAfib discussion forum and event calendar
• how to follow StopAfib on various social media sites

Please check it all out at:
Get Started Learning About Atrial Fibrillation Guide

Mellanie True Hills Bio

SUNDAY, Aug. 29 (HealthDay News) -- Most heart patients who take low-dose omega-3 fatty acid supplements don't appear to gain any additional protection against further cardiac trouble, new Dutch research cautions.

In fact, neither low doses of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are found in fish oil, nor of alpha-linolenic acid (ALA), derived from nuts and several vegetable oils, provided any benefit to the vast majority of heart patients, the study showed.

The scientists focused on patients who were already taking medications to control blood pressure, cholesterol and potential clotting. So, the researchers theorized that the poor performance of the supplements may simply reflect the overwhelming power of the medications.

Study author Daan Kromhout, from the division of human nutrition at Wageningen University in the Netherlands, is to present the findings Sunday at the European Society of Cardiology Congress in Stockholm; the study will appear online in the New England Journal of Medicine simultaneously.

In the study, researchers focused on a group of more than 4,800 Dutch heart attack patients between the ages of 60 and 80, slightly more than three-quarters of whom were men.

All had experienced a heart attack at some point in the decade leading up to the study, and all were taking blood pressure medications, anti-clotting drugs and statins.

At the study's start, the patients were instructed to consume (over a period lasting a little over three years) one of four different types of margarines: one supplemented with omega-3 fatty acids; one supplemented with the plant-derived ALA; one supplemented with both omega-3 fatty acids and ALA; and one with no supplements.

The amount of supplementation added to the various margarines was deemed to be "low-dose." During the study, the patients consumed an average of 18.8 grams of margarine per day, which meant ingestion of an average of 226 milligrams of EPA combined with 150 milligrams of DHA omega-3 fatty acids and/or 1.9 grams of ALA.

By the study's end, almost 14 percent of the heart attack patients had experienced another "major cardiovascular event," with some cases ending in death.

None of the low-dose supplements seemed to stave off such events in most of the patients. One exception appeared to be among women ingesting ALA; researchers saw a 27 percent reduction in the risk for further cardiac complications, although that reduction did not quite reach statistical significance.

"The bottom-line finding of the Alpha Omega Trial is that [omega]-3 fatty acids did not reduce the primary endpoint major cardiovascular events," Kromhout said, noting that the ALA finding needs further confirmation.

Dr. Murray A. Mittleman, director of the cardiovascular epidemiology research unit at Beth Israel Deaconess Medical Center at Harvard Medical School in Boston, said he was "not that surprised by these results."

"Other studies have shown no benefit from omega-3, other than specifically protecting against cardiac death linked to arrhythmia among patients who have just survived a heart attack," Mittleman noted. It is during this acute post-attack period, he explained, when patients are most vulnerable to a subsequent event.

"But here, in some cases the patients they looked at are years following their first heart attack when they start taking these supplements," he stressed. "So, that's a big difference in what kind of patient they're examining. And they're also not just looking at preventable fatalities but all heart-related events that follow. And on top of that, the supplement doses they use here are very low, much lower than those used in prior studies."

"So it might be big differences in study design that account for this new finding," Mittleman cautioned. "In any case, I would say this is absolutely worth further investigation."

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, agreed.

"It is possible that improvements in other treatments for heart attack patients have made fish oil supplementation less important for reducing cardiovascular risk," he acknowledged. "But it's also possible that the different dosing used in this study relative to previous work made a difference in the outcome. The dosing here may have been just too low, whereas higher doses given immediately following an initial heart attack might have been protective."

"So I would say," Fonarow added, "that this is by no means the final word regarding omega-3s and cardiovascular health."

Image: 

FRIDAY, Aug. 27 (HealthDay News) -- The quality of care a patient receives immediately after orthopedic surgery has a major impact on long-term heart health, a new study shows.

A team of French researchers checked troponin levels in 378 patients for three days after they had orthopedic surgery, which includes procedures such as joint replacement. Troponin is a protein that's measured to determine whether physiologic stress related to surgery has caused damage to the heart.

Dr. Sylvain Ausset, of Percy Military Hospital in Clamart, France, and colleagues focused on troponin levels to detect myocardial ischemia (commonly called angina), which correlated with worse long-term cardiac outcomes. The researchers then modified postoperative care to reduce events believed to lead to increased episodes of angina based on elevated troponin levels. Doing so lowered the incidence of cardiac problems months, and even years, later, they found.

The methods used to improve quality of care included tighter control of oxygen and glucose levels in patients' blood, along with consistency and continuity of care as hospital staff monitored and cared for patients, according to the report published in the October issue of Anesthesiology.

"An improvement of quality of postoperative care results in a twofold decrease of postoperative myocardial ischemia and a fourfold decrease of major cardiac events later on," Ausset said in a news release from the American Society of Anesthesiologists.

The findings could lead to new or improved clinical guidelines, according to an accompanying editorial written by Dr. Don Poldermans, of Erasmus Medical Center in Rotterdam, the Netherlands.

More information

The U.S. National Institute of Arthritis and Musculoskeletal Diseases explains joint replacement surgery.

-- Robert Preidt

SOURCE: American Society of Anesthesiologists, news release, Aug. 24, 2010

Last Updated: Aug. 27, 2010

For those people suffering from cardiomyopathy, or any form of moderate heart failure, there may soon be a device able to take over some of the hard work their hearts are put through.

Cardiologists believe the new C-Pulse will benefit patients with class III heart failure – classified by limitations of physical activity. Patients with this type of heart failure experience extreme tiredness, shortness of breath, low blood pressure and dizziness and have few options other than open-heart surgery, or a heart transplant.

Device makers Australian Sunshine Heart Company and Ohio State University are currently conducting a 20 patient, U.S. Food and Drug Administration-approved clinical trial in the United States.

Over 1.4 million people in the United States a year suffer from class III moderate heart failure.

Cardiomyopathy is a disease of the heart muscle in which the heart isn't able to function efficiently and pump blood adequately throughout the body. The implanted C-Pulse device is able to increase cardiac output and generate a greater blood flow, thereby reducing the strain on the heart to pump. The C-pulse is able to increase the flow of blood to the heart muscle by 65 percent.

The device comes in three parts: a cuff, consisting of a wrap and balloon, a sensor lead and a base unit worn outside of the body on a belt.

The surgery to implant the C-Pulse is done under general anesthetic and would normally take about two hours. The cuff is wrapped around the aorta in the chest, above the heart. The sensor lead is inserted into the heart through a vein. The lead and cuff is attached to a wire and comes out under the skin and exists in the abdomen, attached to a controller. The entire device is powered by rechargeable batteries and can be turned on and off, when required, by the patient themselves.

As the heart fills with blood a small balloon, located inside the cuff, inflates forcing blood through the aorta to the rest of the body, distributing blood more efficiently.

The device functions without any contact to blood, lessening any complications or infections for the patient.

“C-Pulse is highly innovative and implanted with a simple, low-risk, minimally invasive procedure. The device has the potential to offer a new therapy option for the treatment of moderate heart failure,” said Dr. Benjamin Sun, chief of the Division of Cardiothoracic Surgery and director of the Cardiac Transplant and Medical Support.

“The start of our clinical trial brings us one step closer toward out goal to address the large and growing unmet clinical need for an alternative heart failure treatment to improve and sustain a patient's quality of life,” said Don Rohrbaugh, CEO of Sunshine Heart Company.

Source: http://www.sunshineheart.com/pdfs/Sunshine_Heart_First.pdf

There I was - sitting in a rather boring meeting, minding my own business (thank you very much) when a bolt of lightening split my skull with such force that I reached up looking for blood (surely if I hurt this badly there must be blood involved, right?). The florescent lights in the room began to shimmer and dance about like a mirage rising from the desert. I managed to make it outside the meeting room before becoming violently ill. I was hit (and I use the word literally) by a migraine, specifically a migraine with aura.

Migraines have to be the mother of all headaches. Not only is the pain debilitating, but migraines are often accompanied by nausea and vomiting as well as light sensitivity. A migraine with aura adds a whole new layer of misery to an already unbearable situation with additional symptoms such as the shimmering and dancing lights, vision loss, stars, zigzag lines in vision, confusion, numbness (especially in the face or in your hands or feet), difficulty speaking, and extreme skin sensitivity. If you’ve never had a migraine, then try to imagine the worst headache you’ve ever had times, oh say, a thousand (just to be on the conservative side) and you might come close to imagining what migraine is like for those who have them. If you’ve ever had a migraine, then you know what I’m talking about and you have my deepest sympathy.

As if migraines aren’t bad enough, they bring with them an increased risk of stroke and heart disease. According to the Mayo Clinic, migraine sufferers are more likely to suffer a stroke than are their non-migraine counterparts. This risk of stroke increases if you have high blood pressure, smoke, or take birth control pills. Now, researchers in Iceland indicate that those who have migraines with aura are at a greater risk not only of stroke but for dying of heart disease as well.

The Reykjavik Study was a long-term, large population study which was led by Larus Gudmundsson from the University of Iceland. Sponsored by the Icelandic Heart Association, the Reykjavik Study began in 1967. Researchers examined more than 18,700 participants who were migraine sufferers to determine the impact, if any, of the migraines on mortality and heart disease. In all, researchers were able to examine data from more than 470,000 study participants. As mentioned, this was a long-term study and data was collected for 26 years.

Researchers found that participants who suffered migraines with aura were at a higher risk for not only stroke but death by heart disease as well. In addition to a higher risk of death from stroke or heart disease, researchers also found that those who had migraines with aura were at a greater risk of dying from any cause. (The risks were greater for women than men.) Interestingly, these findings only extended to those who have migraines with aura. No increased risk was found for those who had just plain old “normal” migraines without the associated aura.

Researchers were not able to say why women were at a greater risk than men or why the migraines with aura appear to put you at a greater risk for stroke or cardiac event. The study authors are calling for additional studies to explore the link between migraines and heart disease. Also recommended are studies to determine if preventing migraines with aura from occurring might lessen or even eliminate the increased risk.

Sources:
Migraine With Aura, The Mayo Clinic, 03 Mar 2009, http://www.mayoclinic.com/health/migraine-with-aura/DS00908

BMJ-British Medical Journal (2010, August 24). Migraine sufferers have higher risk of dying from heart disease and stroke, research finds. ScienceDaily, Retrieved August 25, 2010, from http://www.sciencedaily.com/releases/2010/08/100824231218.htm

I had not been to Indiana for 42 years. But last week I found myself on a commuter train in Michigan City, Indiana taking my family on the South Shore Line to Chicago for the day. We were vacationing not far away on the shores of Lake Michigan.

The train was crowded so my group of six spread out where there were vacant seats. I found myself sitting with two men, father and grown son, on the way to a day at Wrigley Field and a Chicago Cubs baseball game. Before long the chit-chat turned to my work, and my explanation of patientpower.info sparked the telling of an incredible medical story from the older of the two men, a story of good luck and great medical care that has given him a second life.

Ed Dunifin, now 54, is a production manager at a packaging company in Portage, Indiana. Six years ago he was playing softball with friends when he didn’t feel well. He sat down and continued to watch the game. He ate, he drank. But he still didn’t feel well. The early signs of a heart attack? A nurse at the game checked for a pulse. She couldn’t find one. Dunifin was turning gray. As my seatmate explained, it was surreal to him. As the game ended – and yes, he waited! – he was driven to the emergency room. They checked him over. Nothing. They checked some more. Nothing. Finally after hours they found the root of the problem deep in his chest. His aorta, the body’s major artery, was starting to dissect. If it blew open he could be dead in a flash. Very, very few people survive. And those are the ones where usually the dissection or an aneurysm that is about to burst are spotted coincidentally when doctors are looking for something else.

Dunifin was rushed by ambulance to a bigger hospital in Kalamazoo, Michigan where heart surgeon Dr. Alphonse DeLucia was prepped and ready to try to save his life. During a nine hour surgery he wrapped Dacron mesh around the artery to prevent a break. DeLucia told Dunifin it was only the second time he’d performed the surgery because most all other patients had not survived long enough to make it to him.

The computer train rumbled on and Dunifin kept talking. He told me of his second life, how grateful he has been that his aorta held up until he could have surgery to correct the problem., he told me of the medicine he takes now to keep his blood thin and the Zoloft he takes to keep himself calm. No more softball. He misses it. But there have been other joys: Dunifin saw his son get married, his granddaughter turn 2, and he’s celebrated his 48th birthday, and his 49th.

It’s been six years. Five years since Dunifin recovered and felt back to his old self. He says he can feel the patch. And he can feel something else: an aneurysm growing and now bulging on the arch of his aorta. His new doctor is a super specialist heart surgeon, Dr. Himanshu Patel, at the University of Michigan. Dunifin carries his card in his wallet. He’s laminated it to protect it. Another surgery may be coming before long and he is hoping Patel can give him yet another lease on life. He knows it’s a gamble and that he’s been very, very lucky so far.

I told him I was grateful to him that he shared his story and I mentioned the programs we have produced on this topic. Dunifin said he’d be sure to check them out. His son, sitting across from us, smiled. You could tell the day with Dad at the ball park would be special. In Chicago I bid them farewell. But that was not the end of the story.

The next day I received the following email:

“Andrew, I am the aortic dissection survivor. Yesterday was my most interesting ride on the South Shore Train that I have ever had. I am sending this email to let you know what happens to me at the U of M. I will be going there 8/26….” He went on to include the letter of gratitude he wrote to DeLucia, the Kalamazoo surgeon for saving his life. And there was this final sentence that meant more to me than anything: “I have visited your website. Very nice.”

Here’s wishing the very best for Ed Dunifin. It’s making a difference for the Dunifins of the world and also telling their stories that makes it all worthwhile for me. It just goes to show that chatting with the person sitting next to you on a train can make for an unforgettable experience for you both.

Patient Power: Online Video & Audio Interviews for Patients
Andrew's Blog: Leukemia Survivor

Wouldn’t it be wonderful if we could talk about heart disease in a vacuum - isolated from all other factors or influences? It would be wonderful, but the hard reality is that nothing about our health is isolated. Our bodies are a magnificent mesh of interconnecting systems, neurons, muscles, bone, organs, and so very much more.

Often what affects one part of the body - or more specifically, the “cure” for what affects one part of the body - has the potential to have very unhealthy (and generally unwelcome) side effect on another part. One only has to watch television to verify this truth. The airways are full of advertisements for pharmaceutical cures - try product X (the newest, latest, greatest on the market, guaranteed to help and endorsed by patients and physicians alike) but side effects include nausea, vomiting, diarrhea, sterility, mood swings, depression, muscle cramps, changes in vision, hair loss, and so on ad infinitum! I’ve yet to see a single drug where known side effects were listed as “none.” (Maybe they do exist, but I’ve never personally come across such a novelty.)

If you are concerned about heart disease, then you also need to be aware that some drugs, or combination of drugs, just may take a toll on your heart health. While they may cure the ailment they’re designed to target, you may be left with new health concerns. One such new red-treatment-flag was just raised by the U.S. Food and Drug Administration (FDA) on August 20, 2010 regarding the use of Stalevo (entacapone or C/LE).

Stalevo is a drug that is commonly used to treat Parkinson’s disease (PD). As a part of the Stalevo Reduction in Dyskinesia Evaluation–Parkinson's Disease (STRIDE-PD) clinical trials, researchers have been evaluating the effectiveness of taking combined carbidopa/levodopa and Stalevo for the treatment of PD. While carbidopa/levodopa are used to treat PD, the real improvement for those suffering from PD comes when Stalevo is added to the cocktail. Stalevo is currently available as a stand-alone drug but is generally prescribed for use in combination with carbibopa/levodopa.

The STRIDE-PD study findings appeared to indicate that the addition of Stalevo leads to an increased risk of all types of “cardiovascular events” such as stroke and heart attack. In this study, the control group taking cardibopa/levodopa and Stalevo combination suffered a total of seven heart attacks and one death (heart related) compared no heart events or deaths in the group which took only cardibopa/levodopa. The STRIDE-PD study lasted for almost three years.

The disparity in the cardiovascular events between the two groups was significant enough for the FDA to examine the results from 15 other similar clinical trials. When the STRIDE-PD data was combined with date from the other studies, the results were similarly lopsided against Stalevo. A total of 27 “cardiovascular events” (stroke, heart attack or death from heart attack) were reported in groups taking Stalevo compared to only 10 such events in groups taking only cardibopa/levodopa. The FDA noted that most of the participants who had a cardiovascular event, already had some risk factors for heart disease. While the FDA is not yet saying conclusive that adding Stalevo increases your risk of heart disease, it does bear watching particularly if you are already at risk for heart disease.

Most of us know someone whose life has been touched by PD in some way. I myself have a family member and a friend living with PD. It’s a horrible, terrible debilitating disease I’d be hard pressed to tell someone who may be considerably better because they’re taking Stalevo to stop. Despite this, as with any drug, it’s prudent to know what the side effects are and what else may be in store as a result - health care is all about empowerment and making informed decisions. If you or someone you know has PD and as taking Stalevo, then discuss with your doctor if this is the right choice for you given your personal full health (including your personal risk factors for heart disease) picture.

Source:
Robert Lowes, Parkinson’s Drug Under FDA Review: Stalevo Suspected of Upping Cardiovascular Risk, 20 Aug 2010, Medscape, http://www.medscape.com/viewarticle/727266

I’m 28yo, 5ft 1in, and weigh 130lbs. I’m not on any type of medications and I’m very active, at least in my opinion. I work out 5 days/week for at least an hour each time. On Monday’s and Wednesday’s I run anywhere from 2-4 miles, in addition to calisthenics. On Tuesday’s and Thursday’s I attend spin classes which last about 45-50 min, and I combine that with strength training. My main problem/concern is when I run. I always get so tired so fast, about 5 min into the run. I always feel like I’m suffocating, or just can’t breathe and I feel like someone has drained all of my energy. I purchased a heart rate monitor, and I've noticed that I start to get tired when my heart rate gets around 170. Once it reaches the 190’s-200, it’s very uncomfortable and sometimes hurt, and I have to stop to catch my breath. I run at a very slow pace but it doesn’t matter, b/c I still can’t complete 1 mile without having to stop 2 or 3 times. If I increase my pace, I just get exhausted even faster.
I have tried different things like doing 2-A-days to build my endurance, taking daily multivitamins, eating a banana or cereal bar about an hour b/f I run, not eating b/f I run, and even 5-hr energy. I make sure I’m hydrated b/f I run and the only thing I drink is water and sometimes low calorie Gatorade or crystal light. I’ve tried the breathing technique of breathing in through the nose and out through the mouth, and even chewing gum, but it doesn’t help, I still have to stop for a break when I run. I’m not on any medications and as far as I know, I don’t have asthma. I do have sickle cell trait though, which may not be important. I’ve been in to see a doctor about the issue. They did an EKG which came out normal; he listened to my heart and said it sounds fine. He told me it was normal for my heart rate to get high b/c I’m young. But several co-workers & friends tell me that a heart rate that high is not normal. I’m so frustrated b/c I’ve been working out for years now and still can’t run. I understand that I’m supposed to feel some degree of exhaustion while running, but it seems like I should at least be able to do 1 mile without stopping. Or could it be that I’m just not a good runner and will never be? Sorry this is so long but I wanted to give as much info as I could.

It was 14 years ago that I was diagnosed with leukemia. At that time I had a wife and two children: a boy, 7, and a girl, 3. Later, with a “green light” from my doctor, we chose to have a third child.

I have previously written about how to tell your spouse, children, and co-workers about your diagnosis. But this time I wanted to share not my perspective, but rather, one of theirs.

I was very much touched this past weekend when I received a solicitation letter from my eldest child, Ari. He’s the 7-year-old who is now 20 and a sophomore at the University of Michigan in Ann Arbor. He is very devoted to the American Cancer Society’s “Relay for Life,” and he will be participating at college this Spring.

Here’s an excerpt from the letter he sent out far and wide to raise funds for the ACS:

“…why exactly am I involved in Relay? Well, it is much more than just wanting to have a huge sleepover with hundreds of my peers. I really feel strongly about being involved in this event because I have known many people close to me who have been touched by cancer. The foremost person in my father, Andrew Schorr. When I was just elementary school age I was faced with the reality that my dad had Leukemia. At the time I really did not know what to think, but the idea of not having my dad for the rest of my life scared the crap out of me. Thankfully, by the blessing of God, my dad has reached 'molecular remission' due to an amazing clinical trial. Today, with the biggest heart of anyone I know, my father has gone about trying to bring the best information to patients just like himself. I hope to contribute, even if in a small way, to help people afflicted with cancer just like my dad.”

Wow! This brought home to me the loved one’s perspective on our journey as patients. It is especially satisfying when a negative diagnosis can be turned into a positive.

I know this happens time and again but I had to share my pride in my son. I sent him a significant contribution and hope I can for many, many years to come!

Patient Power: Online Video & Audio Interviews for Patients
Andrew's Blog: Leukemia Survivor

I’m all for self-empowerment when it comes to heath care. I also really believe in taking preventative measures, when and if, they’re appropriate. After all, wouldn’t it be better to avoid getting sick in the first place versus treating yourself after you’re ill? So, when it comes to caring for your heart, when is it too early to begin screening for heart disease? The answer to this question just might surprise you. According to the American Academy of Pediatrics (AAP) guidelines, screening for high cholesterol should begin at age 2, with statin therapy starting as early as age 8 for some groups of children.

The new AAP recommendations were based on the results of the Universal Versus Targeted Blood Cholesterol Screening Among Youth: The CARDIAC Project. The CARDIAC Project was no small undertaking. Researchers took the family cardiac history, along with the lipid profiles, of 20,000 fifth graders in the state of West Virginia. This study differed from other studies in that all of the fifth grade students were tested for cholesterol levels regardless of whether or not they fit the risk “profile” for heart disease. Profile factors included a familial history of early heart disease or dyslipidemia. About 71 percent of the students tested fit the profile while the remaining students tested (5,798) had no risk factors. Of the group which had no risk factors for heart disease, researchers found 268 students with cholesterol high enough to recommend medical intervention (i.e. treatment with statin drugs). As a result of the study, researchers recommend testing all children regardless of risk factors for heart disease.

Other recommendations regarding children and cholesterol include:
• Cholesterol screening for children beginning at age 2 (but no later than age 10), if there is a familial history of smoking, hypertension, diabetes, obesity, dyslipidemia, or premature heart attack.
• Treatment with statins for children beginning at age 8 who have LDL cholesterol of more than 190 mg/dL. (If there is a family history of heart disease or if at least two other risk factors are present, this figure goes to 160 mg/dL. Some recommend that levels be 110 mg/dL depending on the risk factors.)

Unhealthy cholesterol levels, particular low-density lipoprotein (LDL or “bad”) cholesterol levels have been linked to the development of heart disease. Unhealthy cholesterol levels can be treated in a number of ways, ranging from lifestyles changes (such as diet, nutrition and exercise) to intervention with drugs - primarily statins. Statin usage is not without controversy. Statins have been linked to numerous side effects including: nausea, chronic fatigue, reduction in CoQ10 levels (which may lead to congestive heart failure later), muscle pain or damage (which may be permanent), cardiomyopathy, and liver damage. It was unclear in the research for this article how much research had been done with respect to treating children with statin therapy and the side effects that it may cause.

Heart disease is still very treatable with diet, nutrition and exercise. Just as you would with yourself, if you are concerned about your child’s heart health, ensure that they are eating a healthy diet which includes fish and limits grains and sugars. Also, consider limiting the amount of time glued to the television, iPod, telephone or other electronic texting device in favor of an activity that gets them off the couch and moving (bike riding, swimming, even normal running and playing - the point is to get them to move!). If you have questions about heart disease as it relates to your child, be certain to talk it over with your pediatrician at your next well child check.

Sources:
Dr. Al Sears, Stain Candy for Children?? What’s up with that?, 13 Aug 2010, http://www.alsearsmd.com/statin-candy-anyone/

Study Supports Universal Cholesterol Screening of Children, 12 July 2010, American Academy of Pediatrics, http://www.aap.org/advocacy/releases/july1210studies.htm

Stephen Daniels, MD, PhD, and Frank Greer, MD, Lipid Screening and Cardiovascular Health in Childhood, www.pediatrics.org/cgi/doi/10.1542/, peds.2008-1349, doi:10.1542/peds.2008-1349,

Image:  Image Caption:  Photos: Getty Images

WEDNESDAY, Aug. 18 (HealthDay News) -- The Mountain states region of the United States had the lowest average rate of potentially avoidable hospitalization for heart failure in 2006, according to a U.S. government report released Wednesday.

The rate in this region, which includes Montana, Wyoming, Idaho, Utah, Nevada, Colorado, Arizona and New Mexico, was 266 admissions per 100,000 people.

Potentially avoidable hospitalizations are admissions for care of chronic illnesses that could be prevented if patients had good quality outpatient care. Patients who receive poor quality outpatient care are at increased risk for complications that require hospitalization, explained the authors of the latest News and Numbers from the Agency for Healthcare Research and Quality.

The next lowest rate of potentially avoidable hospital admissions for heart failure was in the Pacific states (California, Oregon, Washington and Alaska), at 316.5 admissions per 100,000, according to the report. The other lowest rates were:

* West North Central (North Dakota, South Dakota, Nebraska, Iowa, Missouri, Minnesota, Kansas) at 362 per 100,000.
* New England (Connecticut, Rhode Island, Massachusetts, New Hampshire, Vermont, Maine) at 364 per 100,000.

The report said the highest rates were in:

* East South Central region (Alabama, Mississippi, Tennessee, Kentucky) at 583 per 100,000.
* East North Central region (Wisconsin, Michigan, Illinois, Indiana, and Ohio) at 502 per 100,000.
* West South Central (Texas, Oklahoma, Arkansas, Louisiana) at 496 per 100,000.
* Southeast (Florida, Georgia, North Carolina, South Carolina, Virginia, West Virginia, Maryland, Delaware) at 460 per 100,000.
* Mid-Atlantic (New Jersey, New York, Pennsylvania) at 430 per 100,000.

The report is based on data in the AHRQ State Snapshots, which provides state-specific health care quality information.

More information

The American Heart Association has more about heart failure.

-- Robert Preidt

SOURCE: U.S. Agency for Healthcare Research and Quality, news release, Aug. 18, 2010

Last Updated: Aug. 18, 2010

TUESDAY, Aug. 17 (HealthDay News) -- Deaths from a severe type of heart attack rise by about 10 percent for every hour of delay between the time the patient calls for an ambulance and the time that patient is treated in the hospital, a new European study finds.

Researchers in Denmark analyzed data from Danish medical registries on 6,209 patients taken by ambulance to three major hospitals for an ST-segment elevation myocardial infarction (STEMI), a particularly serious type of heart attack caused by a blocked artery, between January 2002 and December 2008.

In patients with such heart attacks, the longer the artery is blocked, the more heart muscle that is damaged and the greater the chances of death, explained study author Dr. Christian Juhl Terkelsen, a cardiologist at Aarhus University Hospital in Denmark.

During a median follow-up period of 3.5 years, about 15.4 percent of patients died in the group that waited less than an hour from the time they called for an ambulance to the time they were being treated at the hospital, compared to 23.3 percent of those treated in up to two hours; 28.1 percent of those treated within just over two to three hours; and 30.8 percent of those treated within three to four hours.

Previous research has focused on delays in such care (called door-to-balloon delay, since the preferred treatment is known informally as balloon angioplasty), the researchers noted. But this study is the first to document that delays from the moment the patient calls for an ambulance increases the risk of death, Terkelsen said.

"Our message is we should focus on all health-care system delays, which often starts with the call for the ambulance," Terkelsen said.

The study is published in the Aug. 18 issue of the Journal of the American Medical Association.

The three hospitals included in the study were high-volume centers that offer primary percutaneous coronary intervention (PCI), also known as balloon angioplasty, in which a catheter is threaded into the artery and a balloon at the end is inflated to help widen it. Usually, when the tube is removed, a stent, or wire mesh structure, is left behind to prevent the artery from narrowing again.

All the patients were treated within 12 hours by PCI, and 2 percent of them were pretreated with clot-busting drugs to restore blood flow.

In Denmark, PCI became the recommended treatment for STEMI heart attacks in 2003, according to the study. Research shows that PCI is more effective than older treatments, such as clot-dissolving medications, Terkelsen said.

But in the United States, not every hospital is equipped to do PCI, said Dr. Christopher Granger, director of the cardiac care unit at Duke University Medical Center.

Even hospitals that do offer PCI don't necessarily have the medical staff on hand 24-7 to get it done quickly, Granger said.

That makes it critical to get to the right sort of hospital -- one that has a "catheterization lab" in which staff can be activated quickly when a STEMI patient is on route, Granger said.

A key step in activating the "cath lab" is making sure that paramedics can diagnosis the heart attack en route, Granger said. To do this, ambulances need to be equipped with 12-lead electrocardiogram (ECG) machines, which can diagnosis the telltale signs of STEMI.

While all ambulances in Denmark have 12-lead electrocardiogram, the same can't be said of all U.S. ambulances, Granger said.

Even when STEMI is diagnosed by first responders, it is not ideal to rush a patient to a hospital that doesn't offer PCI.

"The time from the 911 call until the artery is opened is a very powerful, independent predictor of long-term survival," Granger said. "The faster you get to a hospital that has the ability to PCI, the better your chances of living."

About 400,000 people in the United States have a STEMI heart attack annually, according to the American Heart Association, which is working with hospitals and emergency medical services to develop more coordinated, regional systems of care for heart attacks. Called Mission:Lifeline, the program calls for a new approach to improve outcomes, including training first responders to use 12-lead electrocardiograms and protocols that instruct responders to consider bypassing hospitals that don't offer PCI for those able to perform PCI quickly, even if the hospital is further away.

"What's clear is you should do pre-hospital diagnosis. You should reroute patients to hospitals that can provide PCI quickly, within 30 minutes," Juhl said. "And when patients arrive, they should not go to emergency room, the intensive care unit or the coronary care area. They should go directly to the cath lab."

Patients also need to be aware they should call 911 if they are experiencing the signs of a heart attack, which can include squeezing chest pain, shortness of breath and fatigue, Granger said.

More information

The American Heart Association has more on heart attacks.

SOURCES: Christian Juhl Terkelsen, M.D., Ph.D., cardiologist, Aarhus University Hospital, Aarhus, Denmark; Christopher Granger, M.D., director, cardiac care unit, Duke University Medical Center, Durham, N.C.; Aug. 18, 2010, JAMA

Last Updated: Aug. 17, 2010

Prior to 2002, hormone replacement therapy (HRT) was routinely given by doctors to millions of women across America who was going about their daily lives feeling out of sorts.

One woman, Paula, recalls when she began taking a combination of estrogen and progestin, a man-made version of progesterone, to ease her natural menopausal symptoms. “I just felt flat, irritable, and like I just couldn’t get enthused about doing anything. Honestly, I felt like I hadn’t had a good night sleep for years and the life force was just being sucked right out of me.”

When Paula started HRT, besides quelling her hot flashes and easing vaginal symptoms, it was thought to have positive long-term benefits such as preventing heart disease and osteoporosis, and lowering the risk for colorectal cancer. For millions of women like Paula, it seemed like a Godsend. But attitudes changed abruptly when the landmark Women’s Health Initiative study found that the treatment actually posed more health risks that benefits for postmenopausal women.

As more and more studies began linking HRT to an increase in breast cancer, ovarian cancer, and lung cancer, among other health hazards, doctors became less likely to prescribe it and most women already taking HRT discontinued use, often without telling their physicians.

Now a new analysis of the California Teachers Study which looked at HRT use among 2,857 women for almost a decade confirms what an 2009 analysis by Harvard Medical School professor Joann Manson found: in the initial two years of HRT there was no increase in the number of breast cancer cases in patients receiving combination hormone therapy. However, over five to six years of HRT, those odds significantly increase.

“This is evidence that the story is complicated," said Tanmai Saxena, an M.D. and Ph.D. student at the University of Southern California Keck School of Medicine, who authored the new study report published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research. “The benefits of hormone therapy for relief of postmenopausal symptoms among women are clear, but the risks are more complicated than we had previously thought."

Saxena and colleagues found when women who had never used hormone therapy were compared with women who used estrogen therapy for more than 15 years, they had a 19 percent greater risk of developing breast cancer. Women who used combined therapy with estrogen plus progestin for 15 or more years had an 83 percent greater risk. Breast cancer risk was highest among women who used the combination regimen.

Breast cancer risk seemed dependent on a woman’s body mass index (BMI). Those with a BMI less than 30 appeared to have an increased risk of breast cancer with combined hormone therapy; the risk was strongest among women with BMI less than 25. In contrast, obese women (those with a BMI of 30 or more) had no further increase in risk associated with using combined hormone therapy.

Finally, the risk of breast cancer was confined to tumors that were positive for both estrogen and progestin receptors. The risk was somewhat weaker for HER2 negative tumors.

Harvard Medical School professor of medicine Susan Hankinson, Sc.D., who’s also a Cancer Epidemiology, Biomarkers & Prevention senior editor, said in a written statement that the findings underscore the reality that even following the Women's Health Initiative trial and large prospective studies including the California Teachers Study, there are still questions that remain. All women should have a personalized risk-benefit discussion before beginning any hormone replacement therapy.

“These results add new evidence that risk does vary by other personal characteristics. However, for now, the public health message remains essentially the same. There is an increased risk of breast cancer from hormone use, and further studies will address the question of how specific that risk is,” said Hankinson.

Lynette Summerill is an award-winning writer who lives in Scottsdale, Arizona. In addition to writing about cancer-related issues, she writes a blog, Nonsmoking Nation, which follows global tobacco news and events.

Source: American Association for Cancer Research (2010, August 12). “New findings further clarify breast cancer risk with hormone therapy.”

Image: 

Close your eyes for a moment and imagine this scenario.

Image: 

read more

MONDAY, Aug.

read more