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The findings, published in the journal Nature, double the number of genes already linked with lung adenocarcinoma, a type of non-small cell lung cancer that accounts for 40 percent of the more than 1 million lung cancer deaths each year.
"We think that our study may achieve a real impact on the cure of lung cancer patients," Dr. Matthew Meyerson of the Broad Institute of Massachusetts Institute of Technology and Harvard University said in a telephone briefing.
Meyerson was part of an international team that decoded 623 genes from tumors in 188 lung cancer patients and compared these to genes from normal tissues from the same people.
They found 26 genes that were most commonly altered in the tumors, most of which had never been linked with lung cancer. Some had been found in other types of tumors.
The new genes included mutations in neurofibromatosis 1, a gene known to cause a rare neurological disorder and raise the risk of nerve and brain tumors; ataxia telengiectasia mutated or ATM, which has ties with leukemia and lymphoma; retinoblastoma 1, which is linked with a rare childhood cancer of the eye; and adenomatosis polyposis coli or APC, which is common in colon cancer.
Many of the mutated genes also share common biological pathways or gene networks.
"Looking at the pathways helps simplify the picture," said Richard Wilson of Washington University in St. Louis, who helped lead the project.
PROMISING DRUGS
One of the most promising of these pathways is the mitogen-activated protein kinase or MAPK pathway, altered in more than 70 percent of the tumors. Drug compounds called MEK inhibitors that affect this pathway have already shown promise in mice with lung cancer.
About half of the tumors had defects in the p53 pathway, which is critical for suppressing tumor growth. Companies such as Introgen Therapeutics Inc (INGN.O: Quote, Profile, Research, Stock Buzz) are working on drugs that affect this pathway.
Some 30 percent of the tumors had mutations in the mTOR pathway, raising hope that drugs that inhibit the mTOR protein might help some lung cancer patients. Swiss drugmaker Novartis' (NOVN.VX: Quote, Profile, Research, Stock Buzz) mTOR inhibitor for kidney cancer, Afinitor, is currently under review by U.S. regulators.
The researchers also saw that a familiar class of genes known as tyrosine kinases, which trigger cell growth, played a key role in lung tumors. Gene families in this group include EGFR and VEGF.
Genentech (DNA.N: Quote, Profile, Research, Stock Buzz) and Roche Holding AG's (ROG.VX: Quote, Profile, Research, Stock Buzz) drug Avastin targets VEGF, while their pill for advanced lung cancer called Tarceva interferes with EGFR. A recent study found combining the two did little to help lung cancer patients live any longer.
Meyerson said genetic testing may help determine which patients might benefit from current drugs, but he said many new drugs will likely come from the findings as well.
"Probably, we will need a lot more drugs. What's great is we've identified many new drug targets," he said.
Some analysts predict the market for non-small cell lung cancer could exceed $4 billion between 2010 and 2015.
Food Allergy in Kids Up 18%
Four out of every 100 U.S. kids under age 18 now suffer food allergies, which doubles their risk of asthma and triples their risk of skin or respiratory allergies.
"It is a significant trend -- food allergies do appear to be continuously increasing over the decade," CDC health statistician Amy Barnum, MSPH , tells WebMD. "And if you look at hospital discharges with any diagnosis related to food allergy, there has been a significant increase."
The new CDC data confirms what pediatricians and allergists have been suspecting, says Hugh Sampson, MD, director of the Jaffe Food Allergy Institute at Mount Sinai Hospital, New York.
"There was the impression food allergy is increasing in children, but we only had data on peanut allergy," Sampson tells WebMD. "This report shows it is food allergy in general. That goes along with what a lot of pediatric allergists and pediatricians have been thinking."
Eight types of food account for 90% of food allergies, the CDC finds:
Why are our more and more American kids allergic to foods? Nobody knows for sure, Sampson says. But one clue comes from the fact that peanut allergies are up not just in the U.S., but in other nations that eat the same way we do.
"This seems to be primarily a phenomenon of Westernized countries, among people who have our kind of lifestyle and our kind of diet. You don't see similar things in countries in Asia or in Africa," he notes.
For example, Sampson says, children in China eat just as much peanut-based food as U.S. children do. But peanut allergy is almost unheard of in China.
"We eat peanuts dry roasted, and they eat them boiled or fried," Sampson notes. "The high temperature of dry roasting does make peanuts accrue changes that make them more allergenic."
Most food allergies develop in the first years of life. Milk and egg allergies tend to occur before a child's first birthday. Sampson suggests that the CDC numbers -- based on food allergies in the last year in kids up to 18 years old -- may actually underestimate the prevalence of food allergies in very young children.
"There was a study suggesting that 6% to 8% of kids up to age 3 years had some form of food allergy. Then by age 10 it drops down to about 4%, which corresponds with the number the CDC has come up with," Sampson notes.
Food allergy is different from food intolerance. An allergic reaction is a haywire immune response to what should be a harmless substance. Food intolerance is the inability to digest or to metabolize food.
Sampson says kids who develop food allergies usually get a skin rash or hives. With more severe cases, there may be vomiting or difficulty breathing. A child with food intolerance usually has a stomachache, bloating, and/or diarrhea.
Food allergies can be very serious.
"I would never ignore a rash. At a minimum, contact a pediatrician," Sampson says. "And we know that children who develop a milk allergy are at risk of another allergy. We see that kids with milk allergy get other allergic symptoms, like asthma, much more often than kids without food allergies."
Indeed, the CDC finds:
The CDC data come from two sources: the National Health Interview Survey, which sampled some 9,500 children in 2007; and the National Hospital Discharge Survey, which includes 270,000 inpatient records from about 500 hospitals.
The CDC report, "Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations," was released on Oct. 22.
Daniel J. DeNoon
Patients with heart disease should be screened and treated for depression because it can adversely affect their health outlook and quality of life, according to a new report by the American Heart Association.
The recommendation could potentially affect millions of people - heart disease is the top cause of death in the
"The important message is to identify people and offer them treatment," said Erika Froelicher, a professor at the UCSF School of Nursing and Medicine and a leader in writing the scientific statement.
In the report released Monday, researchers reviewed dozens of studies and found that depression is three times more common among people who have had a heart attack compared with the general population. Moreover, young women appeared to have an even higher risk of depression after a heart attack.
Additionally, the American Heart Association said that people who were hospitalized for such conditions as unstable angina, angioplasty, bypass surgery or valve surgery suffered from depression at rates similar to those who'd had an outright heart attack.
Froelicher said that cardiac patients should be asked two key questions: "Have you recently felt little interest or pleasure in doing things?" and "Are you feeling down, depressed or hopeless?"
If patients answer yes, they should be evaluated further.
The screening should be routinely done in such medical settings as hospitals, rehabilitation centers and doctors' offices. Treatment could range from medication to exercise to cognitive behavioral therapy.
Depression can also lead to heart attacks in the first place, Froelicher noted. "People with depression might not exercise or eat well, or they might smoke," she said.
"But everything I touched turned to garbage," said Lacey, now 70, a retired machinist living in
As coordinator of a Mended Hearts Inc. chapter, which offers support to heart patients, Lacey visits patients weekly at several hospitals. If he senses that they might be experiencing depression, he alerts their doctor or spouse.
"I try my best to take the negativity out of what is going on," he said. "The reality is we get a reprieve every single day."
Treatment for neck pain consists of reducing the pain with ice and medication, improving neck movement and flexibility with exercises or physical therapy, and avoiding further neck injury by changing activities and body mechanics, such as how you sit or sleep. The specific treatment may depend on whether your neck pain is caused by activities, an injury, or another medical condition. Home treatment is often all that is needed for neck pain.
Because most neck pain is caused by repeated or prolonged movements to the neck's muscles, ligaments, tendons, bones, or joints, nonsurgical treatment is usually effective. Most cases of neck pain caused by activities resolve within 4 to 6 weeks.1
Acute neck pain
For sudden (acute) neck pain:
· Place an ice pack or cold pack over painful muscles for 24 to 48 hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If you prefer, try ice massage. Massage the painful area with ice for 2 to 7 minutes, long enough to numb the pain. Ice frozen in a Styrofoam cup works well. Be sure not to damage your skin (frostbite).
· Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first 48 hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments.
· Return to your normal daily activities as soon as possible. Research suggests that continuing normal activities after a neck-strain injury helps resolve some symptoms faster than taking time off from work and using neck immobilization.2
· Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
· Take pain relievers. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome. Acetaminophen (such as Tylenol) can help relieve pain.
For severe pain or muscle spasm, your doctor also may prescribe:
· Muscle relaxants, which treat severe pain spasms when neck pain begins. They include diazepam (Valium), cyclobenzaprine (Flexeril), and carisoprodol (Soma).
· Narcotic pain relievers, which are used short-term for severe neck pain. They include codeine, acetaminophen and hydrocodone (Vicodin, Lortab), aspirin and oxycodone (Percodan), and acetaminophen and oxycodone (Percocet).
The treatment that is right for you may be different from the treatment for someone else with neck pain. Some treatments have been studied more than others. Many treatments for neck pain haven't been very well researched, even if they are used a lot. A review of multiple studies shows that exercise and manual therapy, used either separately or together, are likely to be beneficial in the treatment of uncomplicated neck pain.2
Your health professional may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should be used only for a day or two. See an illustration of a cervical collar.
Chronic neck pain
For long-lasting (chronic) neck pain, you can use the same treatment used for acute pain, although you do not have to worry about swelling. Your health professional may prescribe other medications, such as antidepressants. These include doxepin (Sinequan) and amitriptyline (Elavil, Endep).
You can aid healing and prevent further injury by:
· Having physical therapy. For home treatment, you can use heat and massage. A physical therapist can teach you exercises to do at home. These can keep your neck flexible and strong and prevent stiffness.
· Changing or avoiding any activities that may be causing your neck pain, such as prolonged computer work or overhead work.
· Maintaining good health habits. If possible, reduce stress and tension at work and home. Stop smoking; smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Tobacco Use, and Fitness.
· Trying manual therapy. A trained practitioner may use slow twisting, pulling, or pushing movements. When slow, measured movements are used, it is known as "mobilization." Avoid rapid, forceful movements, which are known as "manipulation." Talk to your doctor before trying manual therapy.
Surgery
Surgery is rarely required for neck pain. It may be considered to treat neck pain caused by pressure on the nerve roots or spinal cord, a severe injury that has broken a neck bone (vertebra), a tumor, infection, or a spinal condition such as narrowing of the spinal canal (cervical spinal stenosis) or arthritis of the neck (cervical spondylosis). Surgical options include:
· Discectomy (with or without fusion). For more information on discectomy, see the Surgery section of the topic Herniated Disc.
· Cervical spinal fusion, in which selected bones in the neck are joined (fused) together.
· Spinal decompression, in which pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.
What To Think About
A review of studies reports that:2
· Exercise reduced pain better than medication for muscle pain or spasm, stress management, or no exercise.
· There is not enough evidence to determine whether medications, transcutaneous electrical nerve stimulation (TENS), ice and heat, soft cervical collars, or special pillows are helpful for neck pain.
In one small study, women with chronic neck pain were taught and used neck endurance and strengthening exercises for 1 year. Compared with people who had chronic neck pain and were not using the exercises, the exercise group had less pain and disability.3
Keeping your neck moving improves its function and helps it heal. In general, cervical collars are only used after a surgery or for a day or two after a neck sprain.
People who have chronic pain syndrome and its associated problems, such as depression or drug dependence, may respond to treatment more slowly. Counseling in addition to medical treatment may help in recovery.
What Happens
Abnormal Pap test results can be caused by infection, which leads to cell changes in the transformation zone of the cervix. Pap test results often return to normal when the cells have returned to healthy growth or after an infection has been treated or has resolved on its own.
In some cases, untreated cervical cell changes that cause abnormal Pap tests may progress to precancerous or cancerous stages. Certain high-risk types of the human papillomavirus (HPV) have been linked to the development of cervical cancer. However, changes in cervical cells usually progress slowly and take many years to become cancer cells. Treatment can remove or destroy these cells before they become cancerous.
The American Cancer Society has reported the following statistics.1
· In women ages 13 to 21, minor cervical cell changes go away on their own about 90% of the time.
· In women older than 21, minor cervical cell changes go away on their own about 50% to 80% of the time.
Regular Pap test screening can detect cervical cell changes early.
· Minor cell changes often go away without treatment.
· Early detection of precancerous cell changes or cervical cancer usually makes a complete cure possible.
· If a high-risk type of HPV is diagnosed, more frequent Pap tests or other testing (such as colposcopy or cervical biopsy) may be needed for further evaluation.
Cervical polyps are unrelated to cervical cancer, but may be found and removed at the time of a pelvic examination and Pap test.
A virus that causes a universal childhood infection is often passed from parent to child at birth, not in the blood but in the DNA,
They found that most babies infected with the HHV-6 virus, which causes roseola, had the virus integrated into their chromosomes. Not only that, but either the father or mother also had the virus in the chromosomes, suggesting it was a so-called germline transmission -- passed on in egg or sperm.
"This is really a unique mechanism for congenital infections," said Dr. Caroline Breese Hall, a pediatrician at the University of Rochester Medical Center in
Her team is now investigating what this means for the children.
"If you have a chromosome that has got a virus integrated into it, what does it mean? What does it do? Can it activate again? Can it start spewing out virus and cause problems? Can you get an immune response to it?" she said in a telephone interview.
The questions are critical because nearly everybody is infected with HHV-6. It is a herpes virus that causes roseola -- an infection marked by high fever and the usual vague virus symptoms that may include respiratory or stomach problems.
About 20 percent of children also have a characteristic sudden rash that appears just as the fever breaks.
Hall's team studied 250 infants, 85 with HHV-6. Of them, 43 were born with the virus and 42 were infected later.
Most of the babies born with the virus -- a congenital infection -- had the virus in the chromosome. Hall said the assumption had been that the virus somehow crossed the placenta from mother to child, but in 86 percent of cases, it was inherited directly in the genetic material.
Just 14 percent were infected across the placenta.
Tests showed either the mother or the father -- but not both -- also had HHV-6 in the chromosomes.
"Because we know a parent already had the virus in the chromosome, we know that it didn't spontaneously wiggle its way in once the baby got it," Hall said.
There were several spots where the virus integrated into the DNA, but usually right at the end of the chromosome, where a key structure called the telomere is found. Telomeres protect the chromosome and are involved in aging and immune response.
The virus is everywhere in people who inherit it, Hall said. "In your hair, your nails, your skin, your blood, and at very high titers (levels)," she said.
The babies infected this way did not appear ill but Hall wants to follow them as they grow up to see if they develop normally. They all had antibodies to HHV-6, which is evidence of an immune reaction of some sort.
There is no drug licensed to treat HHV-6 infection.
Other viruses are known to integrate into the DNA and pass on from parent to child, but these so-called human endogenous retroviruses have never been known to cause symptoms or activate an immune response.
Young men who die suddenly after being arrested by the police may be victims of a new syndrome similar to one that kills some wild animals when they are captured, Spanish researchers said on Tuesday.
Manuel Martinez Selles of Madrid's Hospital Gregorio Maranon reached the conclusion after investigating 60 cases of sudden unexplained deaths in
In one third of the cases, death occurred at the point of arrest, while in the remainder death was within 24 hours, Selles told the annual meeting of the European Society of Cardiology.
All but one of the casualties were male and their average age was just 33 years, with no previous history of cardiovascular disease.
"Something unusual is going on," Sells said.
Just why they died remains a mystery but he believes young men, in particular, may experience surges in blood levels of chemicals known as catecholamines when under severe stress.
Adrenaline is one of the most abundant catecholamines.
"We know that when a wild animal is captured, sometimes the animal dies suddenly," he said.
"Probably when these young males are captured it is very stressful and their level of catecholamines goes very high and that can finish their life by ventricular fibrillation (cardiac arrest)."
Selles compiled his study -- the first of its kind in any country -- by scouring Spanish newspapers for cases of unexplained death after police detention over the past 10 years.
Only sudden deaths with no clear causes were included and autopsy reports were checked to exclude the possibility of mistreatment or past serious medical conditions.
Twelve of the victims were drug users but Selles said this was not thought to have contributed to their deaths.
Jonathan Halperin of the
"We all know stress is bad for you and this may be stress in the extreme," he said.
Women who experience migraine with aura appear to be at an increased risk of heart disease and stroke if they have a certain gene, according to a study published in the July 30, 2008, online issue of Neurology®, the medical journal of the
For the study, researchers followed 25,001 Caucasian women for the occurrence of cardiovascular disease, including heart attacks and ischemic stroke. About 18 percent of the women in the study had a history of migraine while 40 percent of those with active migraine reported migraine with aura. Migraine with aura can be described as neurological symptoms that usually last for about 30 minutes and most often lead to visual disturbances. The women were also tested for a certain gene variant in the methyleneterahydrofolate reductase gene.
During a 12-year follow-up period, 625 cardiovascular disease events occurred.
The study found that women who had both the gene variant and migraine with aura had more than three times the risk of cardiovascular disease, which was driven by four times the risk for stroke compared with women who did not have the gene variant and no history of migraine. An estimated 11 percent of the study population carries the gene variant.
"This gene by itself does not appear to increase the risk for overall and for specific cardiovascular disease, but rather this research suggests a possible connection between the gene variant and migraine with aura. While it is too early to start testing young women with migraine with aura for this gene variant, more focused research will help us to understand these complex links and will help us to potentially develop preventative strategies," said study author Tobias Kurth, MD, ScD, with Brigham and Women's Hospital and
Since the study only looked at women, investigators say it is not known whether the results would be the same in men.
"Doctors should try to reduce heart disease risk factors and advise young women who experience migraine with aura not to smoke and to consider birth control pill alternatives as these increase the risk of ischemic vascular problems," said Kurth.
Heart disease is the leading cause of death and stroke is the third leading cause of death in the
Gastrointestinal bleeding after stroke may increase risk of death
People who have gastrointestinal (GI) bleeding after a stroke are more likely to die or become severely disabled than stroke sufferers with no GI bleeding, according to a study published in the August 6, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"This is an important finding since there are effective medications to reduce gastric acid that can lead to upper gastrointestinal bleeding," said study author Martin O'Donnell, MB, of
The study involved 6,853 people who had ischemic strokes. The most common type of stroke, ischemic strokes occur when blood flow to the brain is reduced or blocked. Of those, 829 people died during their hospital stay and 1,374 had died within six months after the stroke.
A total of 100 people, or 1.5 percent, had gastrointestinal bleeding, or bleeding in the stomach or intestines, while they were in the hospital from the stroke. In more than half of the cases, the GI bleeding occurred in people who had mild to moderate strokes.
The people with GI bleeding were more than three times more likely to die during their hospital stay or be severely dependent on others for their care at the time they left the hospital than people who did not have GI bleeding. A total of 81 percent of those with GI bleeding died in the hospital or were severely dependent, compared to 41 percent of those without GI bleeding.
Those with GI bleeding were also 1.5 times more likely to have died within six months after the stroke than those without GI bleeding. Of those with GI bleeding, 46 percent had died within six months, compared to 20 percent of those without GI bleeding. This relationship remained even after researchers adjusted for other factors, including other conditions such as pneumonia and heart attack. >>>>
Antipsychotic Drugs Increase Risk of Stroke
A new study in the British Medical Journal suggests all drugs used to treat psychosis are linked to an increased risk of stroke, with dementia sufferers having double the risk.
Previous research has shown that second generation (atypical) antipsychotic drugs can increase the chances of patients having a stroke. But the risk of stroke associated with first generation (typical) antipsychotics, and whether the risk differs in people with and without dementia, is not known.
Concerns about an increased risk of stroke among people taking atypical antipsychotic drugs were first raised in 2002, particularly in people with dementia. In 2004, the
A team of researchers from the London School of Hygiene and Tropical Medicine, examined data from the General Practice Research Database (GPRD), which contains the clinical information of more than six million patients registered at over 400 general practices in the
They assessed the effect of exposure to antipsychotic medication on the incidence of stroke in 6 790 patients with a recorded incident of stroke and at least one prescription of any antipsychotic between January 1988 and the end of 2002.
The authors found that during periods when patients were receiving an antispychotic drug they were 1.7 times more likely to have a stroke, whereas people with dementia were 3.5 times more likely to have a stroke whilst taking any antipsychotic.
The likelihood of having a stroke was slightly higher for people taking atypical antipsychotics than people taking typical antipsychotics.
The study did not look at the specific mechanisms linking antipsychotics and stroke or why the risk is greater with atypical antipsycotics.
Previously, the risk of stroke associated with typical antipsychotics was unclear, say the researchers, but “we have established that all types of antipsychotics carry an increased risk, although the risk might be somewhat higher with the atypical drugs.”
They conclude: “We reaffirm that the risks associated with antipsychotic use in patients with dementia generally outweigh the potential benefits, and in this patient group, use of antipsychotic drugs should be avoided wherever possible.” >>>>
All types of antipsychotic drugs increase the risk of stroke
All drugs used to treat psychosis are linked to an increased risk of stroke, and dementia sufferers are at double the risk, according to a study published on bmj.com today.
Previous research has shown that second generation (atypical) antipsychotic drugs can increase the chances of patients having a stroke. But the risk of stroke associated with first generation (typical) antipsychotics, and whether the risk differs in people with and without dementia, is not known.
Concerns about an increased risk of stroke among people taking atypical antipsychotic drugs were first raised in 2002, particularly in people with dementia. In 2004, the
A team of researchers from the London School of Hygiene and Tropical Medicine, examined data from the General Practice Research Database (GPRD), which contains the clinical information of more than six million patients registered at over 400 general practices in the
They assessed the effect of exposure to antipsychotic medication on the incidence of stroke in 6 790 patients with a recorded incident of stroke and at least one prescription of any antipsychotic between January 1988 and the end of 2002.
The authors found that during periods when patients were receiving an antispychotic drug they were 1.7 times more likely to have a stroke, whereas people with dementia were 3.5 times more likely to have a stroke whilst taking any antipsychotic.
The likelihood of having a stroke was slightly higher for people taking atypical antipsychotics than people taking typical antipsychotics.
The study did not look at the specific mechanisms linking antipsychotics and stroke or why the risk is greater with atypical antipsycotics.
Previously, the risk of stroke associated with typical antipsychotics was unclear, say the researchers, but "we have established that all types of antipsychotics carry an increased risk, although the risk might be somewhat higher with the atypical drugs."
They conclude: "We reaffirm that the risks associated with antipsychotic use in patients with dementia generally outweigh the potential benefits, and in this patient group, use of antipsychotic drugs should be avoided wherever possible." >>>>
Post-Withdrawl Study Confirms Vioxx, Bextra Link To Stroke Risk
Arthritis painkiller, Vioxx was pulled from the market in 2004 after it was linked to an increase in heart attack and stroke.
Drug maker, Merck will soon begin issuing checks from the $4.85 billion settlement it's set aside for thousands of victims of Vioxx.
Now a new study is adding to the evidence that Vioxx (rofecoxib) and withdrawn drug, Bextra (valdecoxib), both so-called "Cox-2" inhibitors, should never have been approved by the FDA.
Dr. Christianne Roumie of
The drugs considered were the most common NSAIDS, including Vioxx, Celebrex, Bextra, ibuprofen, naproxen, indomethacin, and diclofenac. Among participants more than 78,000 were current users of one of the seven.
Also included were more than 16,000 patients taking other NSAIDS or NSAID combinations. They were compared to a control group not taking drugs of more than 242,000 participants.
The risk of stroke for the Vioxx users was 28 percent higher compared to the control group. The risk of stroke was 41 percent higher among Bextra users when compared to the control group.
Among those taking Celebrex or with other NSAIDs there was no significant increase in the risk of stroke.
Dr. Roumie tells Reuters Health in an interview, that the withdrawl of Vioxx and Bextra from the market was appropriate and that they should not be reintroduced.
"Since all NSAIDs, including coxibs, can raise blood pressure and increase the risk of gastrointestinal bleeding, we believe that caution is warranted, especially with long-term use of these medicines."
A study published in the New England Journal of Medicine last year by
"It would appear...that patients do not need to take rofecoxib (Vioxx) for 18 months to be at increased risk of a cardiovascular thrombotic event," the authors wrote.
Global study shows telmisartan reduces outcome of cardiovascular death, heart attack or stroke
An international study led by Canadian researchers has found that telmisartan, a medication used to lower blood pressure, reduced the outcome of cardiovascular death, heart attack or stroke in people who are unable to tolerate a widely available and effective standard treatment.
Dr. Salim Yusuf and Dr. Koon Teo, professors in the Michael G. DeGroote School of Medicine at
ACE inhibitors, or angiotensin-converting-enzyme inhibitors, are widely used and effective medications used to lower blood pressure. They work by helping to widen blood vessels to improve blood flow. Approximately 20 per cent of patients who could benefit from an ACE inhibitor stop taking it because of cough, kidney problems, swelling or symptomatic low blood pressure.
Telmisartan is a type of angiotensin-receptor blocker, or ARB. Like ACE inhibitors, telmisartan also lowers blood pressure, but works in a different manner. ARBs block the receptor sites in the body for angiotensin II, a naturally occurring hormone that constricts blood vessels and increases blood pressure.
The TRANSCEND (Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease) study enrolled nearly 6,000 people worldwide who are intolerant to ACE inhibitors, and evaluated whether telmisartan — compared to placebo — would reduce the risk of major cardiovascular events. A high proportion of patients received proven therapies, such as statins, anti-platelet agents and beta-blockers. Physicians were also free to use other medications that could lower blood pressure.
The researchers found that the outcome of cardiovascular death, heart attack or stroke was modestly reduced when patients took telmisartan. In addition, fewer patients receiving telmisartan were hospitalized for any cardiovascular reason compared to placebo. Telmisartan was also remarkably well tolerated, and fewer patients on telmisartan discontinued the medication compared to placebo.
Telmisartan reduced the outcome of cardiovascular death, heart attack, stroke or hospitalization for heart failure by a relative eight per cent (17 per cent in the placebo experienced those cardiac events compared to 15.8 per cent in the telmisartan group). This difference was not statistically significant.
However, when the outcome included cardiovascular death, heart attack or stroke (and not hospitalization for heart failure), telmisartan reduced that outcome by a significant 13 per cent (14.8 per cent in the placebo group experienced those cardiac events compared to 13 per cent with telmisartan).
"The TRANSCEND study demonstrates the value of telmisartan in people who are unable to tolerate angiotensin converting enzyme inhibitors," said principal investigator Dr. Yusuf, director of the Population Health Research Institute at
"Although the benefit is of moderate size, there is an impact on a range of outcomes including the composite of cardiovascular death, myocardial infarction and strokes, as well as cardiovascular hospitalizations. Given the large proportion of people who are unable to tolerate an ACE inhibitor, the use of telmisartan would be clinically important."
"The remarkable tolerability of telmisartan is emphasized by the fact that fewer individuals stop medication if they were receiving telmisartan compared to placebo," said Dr. Teo, the project director. "This is particularly noteworthy, as all the individuals enrolled in the study were unable to tolerate an ACE inhibitor, which is a closely related class of agents." >>>>
Vegan Diet Reduces Risk of Arthritis, Heart Attack and Stroke
Researchers from the Karolinska Institute in
Rheumatoid arthritis is considered a significant risk factor for cardiovascular disease.
The researchers studied 66 adults with rheumatoid arthritis, averaging 50 years in age. Thirty-eight of the adults were placed on a vegan, gluten-free diet in which carbohydrates provided 60 percent of daily calories, fat provided 30 percent and protein provided 10 percent.
A vegan diet is one free of any animal products, including flesh, dairy and eggs. In addition to omitting animal products, the study participants also eschewed gluten, a protein found in wheat, barley, oats and rye.
Instead, participants in the vegan, gluten-free group began with a one-day, low-energy diet of berry juice and broth. Starting on the second day, they were fed grains such as buckwheat, corn, millet and rice, as well as ample quantities of nuts, sunflower seeds, vegetables and fruits. Calcium was provided with a daily serving of sesame milk.
The 28 participants in the control group were fed a diet including both animal products and gluten with a similar carbohydrate-fat-protein breakdown to the vegan diet. They were encouraged to eat five or more servings of fruits and vegetables per day and to eat complex carbohydrates, such as whole grains and potatoes, over simpler sources.
In both diets, saturated fat was kept to a maximum of 10 percent of daily energy intake.
After three and 12 months, the researchers measured several biomarkers in all the participants. Only 58 percent of the people in the vegan, gluten-free group completed the study.
The researchers found that participants in the vegan group experienced a drop in their body mass index, total cholesterol and LDL ("bad") cholesterol. Triglyceride and HDL ("good") cholesterol levels did not change. There was also an increase in the levels of antiPC antibodies, which are believed to help protect the body against cardiovascular disease.
None of these markers changed in the control group.
"These findings are compatible with previous results of vegetarian/vegan dietary regimens in non-rheumatoid arthritis subjects, which have shown lower blood pressure, lower body mass index and lower incidence of cardiovascular disease," the researchers said.
High LDL and total cholesterol, as well as higher body mass index, are all risk factors for heart attack and stroke.
In addition, the researchers found that levels of the inflammation marker CRP and the number of swollen joints decreased in those on the vegan, gluten-free diet. There was no change in those on the control diet.
In contrast to the more common osteoarthritis, which is caused by damage to the cartilage and lubricating fluid in the joints, rheumatoid arthritis is an autoimmune disorder caused when the body's immune system attacks its own tissue. In addition to the pain and restricted movement caused by the destruction of joints, the inflammation caused by the immune system's attacks increases patients' risk of heart attacks and strokes.
Approximately 20 million people around the world suffer from rheumatoid arthritis, which affects women more than men. Early diagnosis can slow the progress of the disease, but there is no cure.
The
Still, Sir Muir Gray, the agency's chief knowledge officer said that anyone interested in preserving their health should try to eat a more vegan diet.
"The evidence is mounting; if you want to stay healthy and save the planet, eat less, eat more plants and eat only food that your great grandmother would recognize if she were alive today," Gray said. >>>>
Diabetics who tightly control their blood sugar — even if only for the first decade after they are diagnosed — have lower risks of heart attack, death and other complications 10 or more years later, a large follow-up study has found.
The discovery of this "legacy effect" may put new emphasis on rigorous treatment when people first learn they have Type 2 diabetes, the most common form and the type linked to obesity.
Doctors warn that people should not let their blood sugar spin out of control — that could have serious health consequences.
"What you don't want is for people to think that they had a period of good glucose control and then they allow their blood glucose to go high — that would be disadvantageous," said Dr. Stephen Davis, head of
Results were published online Wednesday by the New England Journal of Medicine and were being presented at the European Association for the Study of Diabetes meeting in
Diabetes affects more than 18 million Americans. Most have Type 2, which occurs when the body makes too little insulin or cannot use what it does produce. Being overweight raises this risk.
Researchers led by Dr. Rury Holman at the
That study showed intensive blood sugar control lowered the risks of eye disease and kidney damage, but did not find any significant difference in heart attack risk except in the overweight group taking metformin. Those results led to guidelines recommending tight blood sugar control still in wide use today.
The follow-up study was on 3,277 participants who were tracked for an average of 10 more years — first in clinics, where blood sugar could be measured, and through questionnaires in the later years.
Within one year of the original study ending, differences in blood sugar control between the groups disappeared.
Despite that, the sulfonylurea group had a 15 percent lower risk of heart attack and a 13 percent lower risk of death compared with the diet group.
The benefits were even greater among overweight diabetics on metformin, who had a 33 percent lower risk of heart attack and a 27 percent reduced risk of death.
"It really stresses the importance of taking the long term-view of a chronic disease," said Dr. Judith Fradkin, who heads the diabetes division at the National Institute of Diabetes and Digestive and Kidney Diseases.
"This really gives information on steps that people can take that's going to improve their health," said Fradkin, who had no role in the latest research.
In a related study,
Both studies were funded by various British government health organizations and advocacy groups. Six major drug companies, including the makers of diabetes drugs, also supported the research.
Dr. Alvin C. Powers, director of Vanderbilt's diabetes center, said the studies underscore the need to treat diabetes in a holistic manner — managing blood sugar, blood pressure and cholesterol levels.
"The important message is that it re-emphasizes that glucose control is important," said Powers, who is not connected with the research.
Recent attention on the impact of tight blood sugar rose after the
Statement Highlights:
• This is the first guidance on stroke in children from the American Heart Association/American Stroke Association.
• Stroke risk, symptoms and treatment in children are different from those in adults.
• The clot-busting drug t-PA is not generally recommended for treating children, especially newborns.
Stroke in children is not as rare as once thought and the symptoms do not mirror stroke in adults. In its first scientific statement on the topic, the American Heart Association/American Stroke Association addresses treatment, symptoms and risk for stroke in infants and children.
View the study here
The “Management of Stroke in Children” statement published in Stroke: Journal of the American Heart Association provides healthcare professionals with evidence-based guidelines for prevention, evaluation and treatment.
“Children and adolescents with stroke have remarkable differences in presentation compared with adults,” said E. Steve Roach, M.D., chair of the statement writing group and professor of pediatric neurology at the Ohio State University College of Medicine. “In newborns, the first symptoms of stroke are often seizures that involve only one arm or one leg. That symptom is so common that stroke is thought to account for about 10 percent of seizures in full-term newborns. Seizure is a much less common stroke symptom in adults.”
Roach emphasized, however, that while stroke symptoms may differ between children and adults, speedy diagnosis and treatment are still very important to minimize the risk for brain damage, disability and death. In addition to prompt treatment, age-appropriate rehabilitation and therapy is indicated for children after a stroke.
A major treatment difference between adult and child stroke is the use of the drug tissue plasminogen activator (t-PA). The clot-busting agent is the cornerstone of treating adult ischemic stroke but, in the new statement it’s not generally recommended for treating young children, especially newborns, outside of a clinical trial until additional safety and efficacy data are published. In general, the statement recommends that if any treatable risk factor is discovered in a child who has had a stroke, the condition should be treated.
“Stroke in children is uncommon but not as rare as we used to think,” said Roach, who is also chief of neurology at Nationwide Children’s Hospital in
He added that improvements in diagnostic techniques such as magnetic resonance imaging (MRI) and vascular ultrasound have made it possible to confirm that a stroke has occurred when it was only suspected before. Research has also helped to better define treatment protocols. Because of these advances, experts now believe that a significant number of cerebral palsy cases may be due to strokes before or right after birth.
The most common underlying risk factors for childhood stroke are sickle cell disease and congenital or acquired heart disease. However, the list of associated conditions include:
• head and neck infections;
• systemic conditions such as inflammatory bowel disease and autoimmune disorders;
• head trauma; and
• dehydration.
Suspected maternal risk factors for infant stroke include a history of infertility, chorioamnionitis (infection in the fluid surrounding an unborn baby), premature rupture of membranes, and preeclampsia (pregnancy-related high blood pressure).
According to the statement, more than half of children who have a stroke have a known risk factor, and one or more risk factors are often discovered in others after a thorough evaluation. The risk of stroke in children is greatest in the first year of life, particularly in the first two months. It decreases after that. Data from the statement shows that stroke in the first month of life (neonatal stroke) occurs in about one of every 4,000 live births. Stroke also can occur before birth.
In adults, stroke risk factors are much different, and include high blood pressure, cigarette smoking, age (over 55), artery disease, diabetes, and atrial fibrillation. Sickle cell disease is a risk factor common to both children and adults.
Prevention efforts are different for children as well. For adults, prevention often means adopting behaviors or medication to prevent a first stroke. Prevention in children is focused on reducing the likelihood of second or additional strokes.
“Primary prevention – stopping the first stroke from occurring – is sometimes possible in children when we know of an underlying risk factor such as a heart problem or sickle cell disease. Aside from those conditions, an initial stroke is difficult to prevent because the stroke is often the first sign of a problem,” Roach said. “That’s why it’s critical to promptly recognize and diagnose a stroke, because treating the cause reduces the likelihood of additional strokes.”
Recommendations for preventing a second or subsequent stroke in children include:
• Children with ischemic stroke who also have migraines may be evaluated for other stroke risks. Common migraine isn’t likely linked to stroke, but migraine with aura seems to increase risk.
• It is reasonable to counsel children with stroke and their families about the benefits of a healthy diet, exercise and avoiding tobacco products.
• It is reasonable to suggest an alternative to oral contraceptives after a stroke or cerebral venous sinus thrombosis (CVST).
• Children with brain hemorrhage not caused by trauma should undergo a thorough risk factor evaluation, including standard cerebral angiography when noninvasive tests have failed to establish a cause to identify treatable risk factors before another hemorrhage occurs.
The incidence of the two main types of stroke (ischemic and hemorrhagic) is different in adults and children. According to the statement, 80–85 percent of adult strokes in Western countries are ischemic (caused by a blood clot). In contrast, in children about 55 percent of strokes are ischemic and the other 45 percent are hemorrhagic (bleeding in the brain).
The writing committee said the new guidelines will need to be updated as new information and technology becomes available. It urged continued research to better understand the unique diagnosis and treatment of stroke in children. >>>>
Stroke in babies? No. that can’t be. When we think of stroke, we know the risk factors involved: excess weight, bad nutrition, excessive alcohol consumption, lack of exercise, and cigarette smoking. So how can babies suffer from stroke?
Apparently, stroke in children is not that common but not that rare, either. The risk of stroke from birth till the18th year of life is 10.7 per 100,000 children per year.
Last month, the American Heart Association issued a scientific statement on the management of stroke in infants and children.
What are the differences between adult stroke and children stroke?
Type and incidence: In adults in western countries, 80 to 85% of stroke cases are ischemic where it is about 55% in children. The rest are hemorrhagic.
Symptoms: In children, seizure is a common symptom of stroke not observed in adults. About 10% of seizures in full-term babies are due to stroke.
Treatment: It is highly recommended that adults suffering from ischemic stroke be treated with the medication tissue plasminogen activator (t-PA). t-PA is a clot-busting agent that should be administered within 3 hours of the onset of symptoms. This medication is not yet ready for pediatric use and still needs to be tested.
Risk factors: Risk factors for adult stroke are listed above. The most common risk factors for childhood stroke are sickle cell disease, congenital or acquired heart disease, and chronic anemia. Associated conditions include:
Sickle cell disease is a risk factor common to both adults and children.
There are also maternal factors that can influence an infant’s risk for stroke and these include a history of maternal infertility, infection in the fluid surrounding the fetus (chorioamnionitis), premature rupture of membranes, and pregnancy-related hypertension (preeclampsia).
Prevention: Primary prevention is highly feasible in adults. Lifestyle change is the main preventive strategy in adult stroke, followed by medication therapy. In children, prevention is to reduce the likelihood of subsequent strokes after the first one has been correctly diagnosed. Primary prevention is only possible when the underlying condition such as sickle cell disease or congenital heart disease is already known. Children with sickle cell disease 221 times more likely to suffer stroke, according to AHA.
The AHA recommendations for the prevention of subsequent stroke in children are as follows:
Parents can get more information about childhood stroke by downloading this AHA brochure Let’s Talk About Children and Stroke. >>>>
In a previous post, I’ve discussed about how lack of sleep can adversely affect women’s hearts much more than men’s.
In another study on sleep, too much or too little sleep seems to increase the risk of ischemic stroke among postmenopausal women.
The researchers conducted this prospective study involving 93,175 postmenopausal women aged 50 to 79 years in order to examine link between risk of ischemic stroke and self-reported sleep duration. Ischemic stroke is the most common type of stroke and it occurs when an artery supplying blood to the brain is blocked. The participants were followed up for an average time of 7.5 years, during which 1,166 cases of ischemic stroke were reported among the study participants. 8.3% of the women reported getting less than 6 hours of sleep per night while 4.6% get more than 9 hours of nightly sleep.
Analysis of the data showed that women who slept seven hours a night had lowest risk for stroke. In comparison,
The health risks of lack of sleep are quite well-known but very little is known about the effects of getting too much sleep. This study showed surprising results wherein too much sleep in linked to higher risk of stroke than too little sleep. However, more women reported getting too little sleep than getting too much sleep (8.3 vs. 4.6%). Therefore, the health risks of lack of sleep should not be underestimated.
It is not clear why longer sleep duration increases the risk for stroke and this should be addressed by in future studies. For example, such link should also be investigated among younger women and men.
In another study, midlife stroke has been found to be more common among women aged 45 to 54 years old than men of the same age group. High blood pressure, high cholesterol levels, and weight problems were all identified as possible risk factors. Sleeping pattern would probably be added to this list.
Poor sleep among women seems to be very common and has been linked to physiological and psychological causes. Recent studies have shown that sleeping problems especially increase during the menopausal transition. The American Academy of Sleep Medicine (AASM) is a good source of information about sleep. >>>>
The most exciting news is that Wyeth/Elan's Bapineumezab (AAB001) data showed some positive benefit. The overall data was negative but an analysis of those that completed the trial (completers analysis) was positive and those without the ApoE4 genotype had a positive result. This is good news not just for Elan-Wyeth but for all companies developing immunotherapies including Lilly, Pfizer, Novartis, Baxter, Roche, Genetech, and others. Baxter's immunoglobulin therapy IVIG continues to report positive results in a small cohort of individuals now followed for over 18 months
Tarenflurbil (aka Flurizan), a gamma secretase modulator was decidedly negative in its phase III clinical trial. This trial included over 1600 individuals with mild Alzheimer's disease (AD) randomized to Flurizan or placebo. After 18 months, there we no demonstrable differences between the groups. Investigation of this product has essentially stopped.
The Alzheimer Disease Neuroimaging Initiative (ADNI) reported a lot of CSF and imaging biomarker data. With these data, researchers are now better able to predict conversion and progression from MCI (mild cognitive impairment or pre AD) to AD. The search for reliable biomarkers continues. Validation studies of CSF (cerebrospinal fluid) demonstrate that the changes identified as typical for AD can show up even before symptoms are fully manifested.
Other companies are reporting encouraging positive results of safety and/or efficacy from clinical trials. These include Prana, Medivation, Pfizer, GSK, and Ebewe. Drug development is quite active with many novel compounds with new and intriguing mechanisms of action being developed. The ADAPT prevention study did show some reduction in conversion in the group taking Naproxen.
Molecular mechanisms for pathways related to ApoE, APP, Presenillin, beta-amyloid and tau continue to be elucidated. It is becoming clearer that the production of beta-amyloid through unknown triggers is a seminal event that is more dynamic than previously believed that eventually, with time and accumulation, causes downstream effects including excitotoxicity, inflammation, and reactive tangle formation. Additionally the mitochondria stop working and glucose traficking is impaired. All these lead to cell death, loss of neurotransmitters and the eventual phenotype of dementia. These have been known for a period of time but how these events occur and interact with one another is becoming better understood. Marwan Sabbagh >>>>
Reducing levels of uric acid in blood lowered blood pressure to normal in most teens in a study designed to investigate a possible link between blood pressure and the chemical, a waste product of the body's normal metabolism, said researchers at Baylor College of Medicine in a report that appears in the current issue of the Journal of the American Medical Association.
"If you reduce uric acid, at least in some patients, you may be able to reduce blood pressure," said Dr. Daniel Feig, associate professor of pediatrics-renal at BCM and chief of the pediatric hypertension clinics at Texas Children's Hospital. "This could be one way people develop hypertension and may allow us to develop new therapies."
Understanding how people develop high blood pressure gives scientists new tools for understanding the disorder and developing drugs to prevent and treat it.
Uric acid builds up when the body makes too much of it or fails to excrete it. It is a waste product resulting from the metabolism of food. Too much uric acid can cause gout, which occurs when uric acid crystals accumulate in the joints. In this study, researchers used allopurinol to reduce high uric acid levels. Allopurinol is usually used to treat gout, but Feig said its potential side effects rule it out as a treatment for high blood pressure.
In the JAMA study, Feig and his colleagues treated teens with newly diagnosed high blood pressure and elevated levels of uric acid in their blood with allopurinol. In the study, half of the 30 teen-agers with newly diagnosed high blood pressure and higher than normal levels of uric acid in their blood underwent treatment with allopurinol twice a day for four weeks. The other half received a placebo (an inactive drug) on the same schedule. They then went without either drug for two weeks before receiving the opposite treatment for another four weeks.
The treatment not only reduced uric acid levels, it also reduced blood pressure in most of the teens, said Feig. In fact, he said, blood pressures decreased to normal in 20 of the 30 teens when they were on allopurinol. By contrast, only 1 of the 30 teens had normal blood pressure when receiving placebo.
"This is far from being a reasonable therapeutic intervention for high blood pressure, but these findings indicate a first step in understanding the pathway of the disease," said Feig. "You cannot prevent a disease until you know the cause. This study is way of finding that out."
Studies in rats had indicated previously that high levels of uric acid could be associated with the development of high blood pressure through a proven pathway, said Feig. However, he and his colleagues needed to determine if this was true for humans as well.
"The antihypertensive therapies available to patients are well proven and safe," said Feig. "Currently available antihyperuricemic therapies (treatments that lower uric acid) are not safe enough to be used as first line therapy for most people with high blood pressure."
Side effects could include nausea, diarrhea, vomiting, liver problems and even a very rare, potentially life-threatening reaction known as Steven-Johnson syndrome. While only 1 in 3,000 people develop this problem, the risk is too great to prescribe the drug on a routine basis to people with high blood pressure, a problem that affects 30 to 35 percent of adults.
Currently available therapies are effective but are not solving the problem in everyone. Optimal blood pressures are achieved in only 40 percent of people who are treated for the problem. Understanding the cause of high blood pressure could lead to better treatments and even methods of prevention.
Animal studies indicate that early in the disease, the extra uric acid activates the renin angiotensin system of the body, shrinking key blood vessels and causing high blood pressure. Eventually, however, the small vessels in the kidney are permanently affected, making the blood pressure sensitive to salt or sodium. Too much salt causes the pressure to rise. >>>>
A new study investigates how the body regulates blood pressure in response to daily stress.
“Research shows that two-thirds of patients’ high blood pressure is not controlled despite the best efforts of their doctors. That is terrible,” says Dr. Gregory Harshfield, director of the Georgia Prevention Institute at the Medical College of Georgia.
“We are trying to identify the mechanisms through which blood pressure is regulated under normal everyday conditions – which is what stress is – and take that information back to the clinic to better determine what sort of therapy is going to be most effective at treating your blood pressure or your grandfather’s.”
More than a dozen researchers have teamed up to do parallel studies in animal models and young adults to learn more about what factors like genes, stress and obesity contribute, their synergy and novel ways to control them.
“This research will give us information that allows us to identify what treatment is going to be effective in what individual by genotype, by obesity and other factors. What kind of treatment is going to be effective at keeping an individual’s blood pressure down or maybe preventing it from ever getting high,” says Dr. Harshfield, principal investigator on the $10.6 million Program Project grant renewal from the National Institutes of Health’s National Heart, Lung and Blood Institute. 72 million Americans – 1 in 3 – are hypertensive, according to the NHLBI.
Studies will explore fundamentals such as why about 30 percent of young healthy blacks and 15 percent of whites can’t effectively excrete sodium, a problem that raises blood pressure by increasing the body’s fluid volume.
“We think there is a defect in their kidneys, in the normal mechanisms that allow them to excrete salt,” said Dr. David Pollock, renal physiologist at MCG’s
Dr. Harshfield’s studies identified this impaired stress-induced sodium natriuresis. He believes it’s also a primary reason blood pressure remains elevated at night in some blacks, rather than dipping as it should, which keeps stressing the cardiovascular system.
Using a rat bred to be salt-sensitive, the researchers are working to identify more about the genetics of impaired sodium-handling.
“We have animal model data that says the endothelin system normally functions to help your kidneys get rid of salt,” says Dr. Pollock. His studies have shown the kidney’s endothelin B receptor plays a critical role in promoting excretion of acute and chronic salt loads by activating the precursor to nitric oxide, a powerful dilator of blood vessels.
In the new studies, he’ll control the rats’ diet and see whether stress slows down sodium excretion. Preliminary evidence suggests it does. He’ll also give the rats an endothelin antagonist, which blocks this hormone, and see if sodium excretion improves. He’ll also see how a high-fat diet and obesity alter the equation.
Meanwhile, for about a week, young study participants with impaired sodium excretion will take a drug to block the powerful blood vessel constrictor, angiotensin.
“From our point of view, angiotensin promotes sodium retention directly and it also increases aldosterone, another hormone which promotes sodium retention,” Dr. Harshfield says. The researchers chose to study endothelin and angiotensin because they believe they work together.
To explore the genetics, they’ll also look at young adults with a different version of the angiotensin receptor gene that they believe exacerbates sodium-handling problems. MCG researchers identified this genetic variation in people who retain sodium; blocking the receptor gene will provide more evidence about the importance of angiotensin, says Dr. Harshfield.
They’ll mimic the way many people work – an hour of stress, a few minutes of relief, then back to stress – by getting the young people to play competitive video games, then measuring how gene blockers affect sodium excretion.
“Ultimately, you want to know how to treat people with this variation,” Dr. Harshfield says. “There is still a need to figure out why some people respond to some therapies and other don’t,” adds Dr. Pollock. “That is not our specific question but these studies will help address that. We have to identify what is it about different individuals that make them react more to stress, makes them retain more salt.”
Obesity, which is associated with increased blood pressure reactivity, is probably a differentiator, Dr. Pollock says. Fat cells actually secrete angiotensin, which gets into the bloodstream.
“We are arguing in our study that you might want to treat patients differently depending on whether or not they are obese. The angiotensin receptor blocker may be more effective in obese individuals who have angiotensin falling out into their bloodstream,” says Dr. Harshfield. Consequently they’ll also compare the effectiveness of the blocker in obese and normal-weight individuals with impaired sodium excretion.
Another project is exploring the role of oxidative stress, or reactive oxygen species, in raising blood pressure. In an animal model genetically predisposed to salt-sensitive hypertension, Dr. Jennifer Pollock, biochemist in MCG’s Vascular Biology Center and a program project leader, has shown a prolonged recovery to normal blood pressure following stress.
She’s also found oxidative stress levels go up with stress. Oxidative stress, or reactive oxygen species, helps make normal chemical reactions in the body but, in excess, can cause havoc. In fact, when she gives the rats an antioxidant before a stressor, blood pressure doesn’t rise as high and recovery is more normal.
“We also found out that endothelin actually is the stimulus for increasing reactive oxygen species,” Dr. Jennifer Pollock says. “When we gave the rats a specific type of endothelin blocker, that also blocked the increase in oxidative stress, blocked the blood pressure increase and improved recovery.”
Another animal model is providing insight into the impact of early life stressors or low socioeconomic status on cardiovascular disease. Research again found that, as with people, these animals have normal blood pressure as pups. But as stressed adult rats, they have higher pressure increases and a delayed recovery unless they are missing an endothelin receptor gene.
“It cures it,” says Dr. Jennifer Pollock. “This early life stressor is being mediated through the endothelin pathway.” Her postdoctoral fellow, Dr. Analia Loria, found these early life stressor models also have more constrictive blood vessels because they are more sensitive to angiotensin. New studies will further test the endothelin connection and see if a high-fat diet makes things worse by increasing oxidative stress.
Wildlife biologists have found naturally occurring models. Rat pups whose mother builds a nest far from a food source and so must be gone foraging several hours each day, are more anxious. Neurobiologists have shown animals separated from their moms for long periods can’t run through mazes well and tend to back off in competition for food, Dr. Jennifer Pollock says. “We took that to mean their blood pressure could also be hyper reactive. Sure enough, that is what we found.”
“This has a lot of implications for earlier detection of risk-increasing environmental exposures and what you can do about it,” says Dr. Treiber, a clinical child psychologist and program project leader. “If you can’t alter the environment that quickly in life, you know now where they are headed and maybe you can preempt it pharmacogenetically.”
In the diverse group of some 600 young people he’s been following for 17 years, Dr. Treiber has found that, as with the general population, some already are obese and/or hypertensive at the average age of 25. He’ll continue to follow and annually assess them over the next five years in an effort to better understand how stress contributes to hypertension.
“What we are doing is looking at chronic environmental stress in combination with some bad candidate genes that are stress activated,” says Dr. Treiber. He’s thinking that, as with rats, genetic predisposition and stress can doom people with normal pressures to hypertension. They’ll look at blood pressure reactivity, recovery, sodium secretion, measure the footprints left by oxidative stress and the levels of the stress hormone cortisol. They’ll look at early indicators of cardiovascular disease, such as enlargement of the pumping chamber of the heart and signs of carotid artery disease.
“If you have a tendency to have high blood pressure or if you are obese, we can see the inner layer of the carotid getting thicker than normal people your age,” says Dr. Gaston Kapuku, cardiologist and cardiovascular researcher at the Georgia Prevention Institute and a project core leader.
America’s current obesity and type 2 diabetes epidemic also has them looking at insulin, glucose and cholesterol levels and whether fat exacerbates all the factors they are following, which they believe it does.
One reason the Georgia Prevention Institute was founded was to identify risk factors for cardiovascular disease, says Dr. Harshfield. In his 10 years at the institute, the agenda has shifted from looking at precursor development of adult hypertension to identifying mechanisms causing pediatric hypertension, a disease that didn’t exist when most hypertension textbooks were written, he says.
“Our ultimate goal, of course, is prevention,” he says. “But when we can’t do that, we want to give physicians ways to determine precisely the cause or causes of your hypertension and optimal ways to target your disease.” >>>>
Young women who experience more than one stressful life event are at greater risk of developing breast cancer, but a general feeling of happiness and optimism may help guard against the disease, Israeli researchers report.
The findings shouldn't be interpreted to mean that optimism is all you need to prevent breast cancer, Dr. Ronit Peled of
Peled and her team investigated the role of severe life events, such as losing a parent before age 20, in breast cancer risk. The breast cancer incidence in Israeli women is among the highest in the world, while stress is also a fact of life for people living in the country, Peled noted.
She and her colleagues recruited 255 women between 25 and 45 years old who had been diagnosed with breast cancer and 367 women of the same age who were free from the disease. They asked the women whether they had experienced any severe life events, such as loss of a spouse or a close relative, as well as events considered to be mild or moderately stressful, such as severe illness, job loss, or separation from a spouse. Women also completed a 15-item questionnaire to evaluate their levels of anxiety, depression and happiness and optimism.
Women who had experienced two or more severe or mild-to-moderate life event were 62 percent more likely to have breast cancer, the researchers found. "This suggests that stressful events do not protect us from the effect of additional events, and even 'moderate or mild events' seem to have a cumulative effect," Peled and her team write in the medical journal BMC Cancer.
Women with breast cancer were statistically more likely to have higher scores for depression and lower score for happiness and optimism.
However, they also found that women with a "general feeling of happiness and optimism" had a 25 percent lower risk of having been diagnosed with breast cancer.
The fact that women with breast cancer were asked about their mood pre-diagnosis but surveyed after they had been diagnosed is one limitation to the study, Peled conceded. However, she added, the number of life events a person experiences can be measured objectively.
Based on these findings, she concludes that "women who suffer severe losses in their young age should be considered as a (breast cancer) risk group and be treated accordingly."
Contrary to popular belief and common medical advice, eating seeds, nuts, corn and popcorn does not cause the bowel disease diverticulosis or its painful complications, researchers said on Tuesday.
In fact, nuts and popcorn may even provide some protection from the complications and those who avoid nuts may be depriving themselves of valuable nutrients, said Dr. Lisa Strate and colleagues at the University of Washington School of Medicine in
Their findings came from a look at more than 47,000 male
Diverticulosis is the development of small pouches in the colon that bulge outward through weak spots.
In the
Many have no symptoms but 10 to 25 percent of those with diverticulosis can have attacks of diverticulitis caused by inflammation in the pouches.
The
But they noted a recent survey of colorectal surgeons found that nearly half felt their patients should avoid those foods.
The researchers said they found 801 new cases of diverticulitis and 383 new cases of diverticular bleeding among the men over the course of the study.
Men who ate nuts twice a week or more had a 20 percent lower risk of diverticulitis than those who ate them less than once a month, and men who ate the most popcorn had a 28 percent lower risk of diverticulitis, they found.
The findings show "nut, corn and popcorn consumption did not increase the risk of diverticulosis or (its) complications," the report concluded.
The NIDDK, one of the National Institutes of Health, advises that eating a high-fiber diet is the key to colon health, and that nuts and such seeds as tomato, zucchini, strawberry, raspberry and poppy are considered harmless.
A new analysis of government data is the first to link low-level arsenic exposure, possibly from drinking water, with Type 2 diabetes, researchers say. The study's limitations make more research necessary. And public water systems were on their way to meeting tougher
Still, the analysis of 788 adults' medical tests found a nearly fourfold increase in the risk of diabetes in people with low arsenic concentrations in their urine compared to people with even lower levels.
Previous research outside the
"The good news is, this is preventable," said lead author Dr. Ana Navas-Acien of Johns Hopkins Bloomberg School of Public Health in
New safe drinking water standards may be needed if the findings are duplicated in future studies, Navas-Acien said. She said they've begun a new study of 4,000 people.
Arsenic can get into drinking water naturally when minerals dissolve. It is also an industrial pollutant from coal burning and copper smelting. Utilities use filtration systems to get it out of drinking water.
Seafood also contains nontoxic organic arsenic. The researchers adjusted their analysis for signs of seafood intake and found that people with Type 2 diabetes had 26 percent higher inorganic arsenic levels than people without Type 2 diabetes.
How arsenic could contribute to diabetes is unknown, but prior studies have found impaired insulin secretion in pancreas cells treated with an arsenic compound.
The policy implications of the new findings are unclear, said Molly Kile, an environmental health research scientist at the Harvard School of Public Health. Kile wrote an accompanying editorial in the journal.
"Urinary arsenic reflects exposures from all routes — air, water and food — which makes it difficult to track the actual source of arsenic exposure let alone use the results from this study to establish drinking water standards," Kile said.
Also, the findings raise a chicken-and-egg problem, she said, since it's unknown whether diabetes changes the way people metabolize arsenic. It's possible that people with diabetes excrete more arsenic.
The
Scientists say they've found an efficient way to make red blood cells from human embryonic stem cells, a possible step toward making transfusion supplies in the laboratory. The promise of a virtually limitless supply is tantalizing because of blood donor shortages and disappointments in creating blood substitutes.
Red blood cells are a key component of blood because they carry oxygen throughout the body.
Experts called the new work an advance, but cautioned that major questions had yet to be answered.
The research, published online Tuesday by the journal Blood, was reported by scientists at Advanced Cell Technology in
The researchers said the cells they made behaved like natural red blood cells in lab tests, and that their process could be used in large-scale production. The results suggest that embryonic stem cells could someday supply type O-negative "universal donor" red cells for transfusion, they wrote.
Mohandas Narla, director of the Lindsley F. Kimball Research Institute at the
Now it will be important to show that the complex lab process really can pump out red cells on a large scale, and that the cells will survive long enough in the human body to be useful, he said. Natural red cells circulate for an average of 120 days.
Study Shows Most Patients With Disease Return to
West Nile virus is sneaky and can be stealth-like. It's hard to even know you have it. Most infected people do not have symptoms. Some think they have the flu or a cold.
But for those who do get
The study's lead author, Mark Loeb, MD, with
In this new study, he says, "We found that both physical and mental functions, as well as mood and fatigue, seemed to return to normal in about one year."
The study tracked 156 Canadian patients during four years (from 2003 to 2007) who were infected with
The participants were given several tests to measure their physical and mental health, as well as levels of depression, anxiety, and fatigue.
They were checked at 10, 20, and 30 days after study enrollment to achieve a baseline. After that they were tested once a month for a year.
Recovery From
Researchers found that within about a year, infected people returned to a normal level of fatigue and physical, mental, and emotional function.
Having other medical conditions played a big role.
Researchers found that those who didn't have other medical problems (such as heart disease and diabetes) before getting infected snapped back into physical shape more quickly than those who had other health conditions at the time of infection.
Men healed more quickly than women when it came to regaining their mental health.
Researchers acknowledge that the results may be "overly optimistic." For instance, only people who survived
Seven infected participants died before being able to enroll in the study.
Researchers hope the study may help doctors and their patients better gauge how to proceed with a plan when it comes to recovering from
As I scanned my E-mails this morning, several were from readers asking for my take on the latest breast cancer news showing that the risk of relapse after five years is much lower than a patient might expect. The study, published yesterday in the Journal of the National Cancer Institute, found that once patients make it to the five-year mark without a relapse, about 89 percent are disease free five years later at the 10-year mark and 80 percent at the 15-year mark. That's certainly reassuring news for those patients paralyzed by a fear of relapse long after they finish their treatments.
Still, the statistics quoted in the news reports are meaningless for the individual woman diagnosed with breast cancer. Certainly, cancer can recur 15 years after treatment—or even 20 or 30 years out. One survivor wrote me: "All my doctors informed me that the two-year mark is important and then the six-year mark, but with breast cancer, you are never out of the woods." Today's conflicting news reports could only have added to her confusion. "Risk of Breast Cancer Relapse Can Linger" blares one headline. "Risk of Breast Cancer Relapse Is Low After Surviving 5 Years" declares another.
The real story lies in a complicated table that accompanied the study, which shows the various factors that predict recurrence. They include: whether cancer spread to the lymph nodes; tumor size; and whether the cancer is fueled by the hormone estrogen. A doctor needs to factor in these and other characteristics of the tumor before determining a particular patient's risk of relapse and when she's most likely to experience a recurrence.
For example, women whose tumors grow in the presence of estrogen (the most common type of breast cancer) tend to have fewer recurrences within the first five years but are more likely to relapse a decade later. What's more, breast cancer expert Susan Love previously told me that the protective effects of antiestrogen drugs like tamoxifen can persist for 15 years after women stop taking them. So, it could be that recurrences in these women occur beyond the 15-year mark, which the study didn't examine. The study also didn't measure whether taking aromatase inhibitors (another class of antiestrogen drug now routinely given instead of or after tamoxifen) protects a woman even longer. That's something a woman should also discuss with her doctor if she's thinking about taking an aromatase inhibitor after finishing tamoxifen. For more details on this, click here. And if you've previously had breast cancer, you can employ these lifestyle measures to help lower your recurrence risk. >>>>
Countries around the world may be preparing for a possible H5N1 bird flu pandemic, but another strain called H9N2 also poses a threat to humanity, researchers reported on Tuesday.
Tests on the H9N2 strain of the virus show it is capable of infecting and spreading with very few changes, a team from the University of Maryland, St. Jude's Children's Research Hospital in Memphis, and elsewhere reported.
"Our results suggest that the establishment and prevalence of H9N2 viruses in poultry pose a significant threat for humans," the researchers wrote in the Public Library of Science journal PLoS ONE.
Most influenza experts agree that a pandemic -- a deadly global epidemic -- of some kind of flu is inevitable.
No one can predict what kind but the chief suspect is the H5N1 bird flu virus, which has infected 385 people and killed 243 of them since 2003. It is entrenched in birds now in some areas and has killed or forced the slaughter of 300 million.
Just a few mutations could turn it into a virus that people catch and transmit easily. But flu experts caution H5N1 is not the only virus with this potential.
H9N2, a virus seen mostly in birds, has infected at least four children in Hong Kong, causing mild illness, and is found in birds, pigs and other animals in Europe and
A single mutation made H9N2 more virulent and pathogenic, and also helped it transmit more easily from one ferret to another, they reported in their study, available on the Internet at http://dx.plos.org/10.1371/journal.pone.0002923.
They also mixed H9N2 with an H3N2 virus, a type of influenza virus that causes seasonal flu in people. Scientists believe that if a human or animal is infected with two strains of flu at the same time, this "reassortment" can happen in nature.
The reassorted virus was easier for the ferrets to catch and transmit.
One reassuring finding -- neither of the lab-engineered viruses could be transmitted in the air, via aerosol. This might make them somewhat less transmissible, although people pick up flu from surfaces touched by an infected person.
"Although no aerosol transmission was observed, the virus replicated in multiple respiratory tissues and induced clinical signs similar to those observed with the ... human H3N2 virus," the researchers wrote.
There are hundreds of strains of avian influenza viruses, but only four -- H5N1, H7N3, H7N7, and H9N2 -- are known to have caused human infections, according to the World Health Organization.
It’s been rough times for the development of Alzheimer’s drugs.
Last month, Myriad Genetics said its late-stage trial of its experimental drug Flurizan failed to show any benefit for Alzheimer’s patients. Another late-stage study, of Alzhemed from
The results of the Flurizan study will be unpacked this week at a big annual Alzheimer’s conference, as researchers look at what’s next in the field, the Los Angeles Times reports this morning.
Available Alzheimer’s drugs may help a bit with symptoms, but none of them change the course of the disease. The industry is pouring resources into coming up with better drugs, but the basic biology of the disease remains mysterious, and it’s likely to be years before any breakthrough drugs come to market.
Eli Lilly is running a late-stage trial of its drug LY450139, which is supposed to block the production of gamma secretase, an enzyme believed to play an important role in the disease. The study is scheduled to finish in 2012.
And Elan and Wyeth are in the midst of late-stage study of bapineuzumab, an antibody-based drug that’s supposed to clear plaques from the brain. Results from the big test are expected in 2010. But the drug has generated some excitement among investors, even though preliminary results of a mid-stage study didn’t shoot the lights out. More details on those results are scheduled to be released tomorrow. Jacob Goldstein
A
Dr. John Milner of Loyola University Chicago Stritch School of Medicine, in
"For many people, iced tea is potentially one of the worst things they can drink," Milner says in a statement. "For people who have a tendency to form kidney stones, it's definitely one of the worst things you can drink."
Kidney stones are crystals that form in the kidneys or ureters, the small tubes that drain the urine from the kidney to the bladder, Milner explains. The most common cause of kidney stones is the failure to drink enough fluids. Dehydration combined with increased iced tea consumption raises the risk of kidney stones in people prone to develop them.
"People are told that in the summertime they should drink more fluids," Milner says. "A lot of people choose to drink more iced tea, thinking it's a tastier alternative. However, in terms of kidney stones, they're getting it going and coming. They're actually doing themselves a disservice."
To remain hydrated there is no better alternative than water, Milner said. >>>>
Scientists in
In the latest issue of Nature, the researchers described how they zeroed in on an enzyme that flu viruses need to replicate, and managed to capture a snapshot of the enzyme.
Enzymes in influenza viruses are made up of three proteins bound tightly together.
"Scientists have been trying to study its (enzyme's) structure and no one has yet got a detailed picture of the whole thing," said
But the team managed to crystallize the proteins and get a peek at part of the structure, which involves the tip of one of the proteins coming into contact with another protein.
"This gives us some hope that we can interrupt this interface (contact point)," Tame said.
Such an interruption would "kill the virus, or slow it down sufficiently," he added.
All influenza A viruses, including the H5N1 bird flu virus, are believed to have similar structures. Theoretically, one drug could fight all of them.
"We would like to start work. We're hopeful that will lead to efforts to work on completely novel drugs," Tame said.
Scientists in
In the latest issue of Nature, the researchers described how they zeroed in on an enzyme that flu viruses need to replicate, and managed to capture a snapshot of the enzyme.
Enzymes in influenza viruses are made up of three proteins bound tightly together.
"Scientists have been trying to study its (enzyme's) structure and no one has yet got a detailed picture of the whole thing," said
But the team managed to crystallize the proteins and get a peek at part of the structure, which involves the tip of one of the proteins coming into contact with another protein.
"This gives us some hope that we can interrupt this interface (contact point)," Tame said.
Such an interruption would "kill the virus, or slow it down sufficiently," he added.
All influenza A viruses, including the H5N1 bird flu virus, are believed to have similar structures. Theoretically, one drug could fight all of them.
"We would like to start work. We're hopeful that will lead to efforts to work on completely novel drugs," Tame said.
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