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Quitting Smoking Leads to Significant Reduction in Mortality Risks After 5 Years

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Women smokers who quit reduce the risk of death from heart disease within 5 years, and their risk of any other smoking-related death by 20%, according to a recent study.

"Tobacco use remains the leading preventable cause of death in the United States. Globally, approximately 5 million premature deaths were attributable to smoking in 2000. The World Health Organization projects by 2030 that tobacco-attributable deaths will annually account for 3 million deaths in industrialized countries and 7 million in developing countries," the authors write. They add that the rate of mortality risk reduction after quitting compared with continuing to smoke is uncertain.

By analyzing data from the Nurses’ Health Study, an observational study of 104,519 female participants, with follow-up from 1980 to 2004, Stacey A. Kenfield, Sc.D., of the Harvard School of Public Health, Boston and his colleagues measured the relationship between cigarette smoking and quitting smoking on mortality in women. 12,483 deaths were recorded in this group, of which 4,485 (35.9%) had never smoked, 3,602 (28.9%) were current smokers, and 4,396 (35.2%) were among past smokers.

A 13% risk reduction in mortality from any cause within the first 5 years of stopping smoking (compared with continuing to smoke), with the excess risk falling to the level of someone who had never smoked 20 years after quitting.

According to the study, "Significant trends were observed with increasing years since quitting for all major cause-specific outcomes. A more rapid decline in risk after quitting smoking compared with continuing to smoke was observed in the first 5 years for vascular diseases compared with other causes."

In regard to coronary heart disease, 61% of the full benefit of quitting was realized within the first 5 years; similarly for cerebrovascular mortality where 42% of the potential benefit was realized within the first 5 years after quitting. Death due to respiratory disease showed an 18% reduction in risk within 5 to 10 years of quitting.

Lung cancer mortality showed a 21% risk reduction during the first 5 years compared with people who did not quit, but the excess risk remained for 30 years. Past smokers with 20 to less than 30 years of not smoking showed an 87% reduction in risk of lung cancer mortality compared with continuing smokers. The researchers also found that approximately 64 percent of deaths among current smokers and 28 percent of deaths among former smokers were attributable to cigarette smoking.

"Early age at initiation is associated with an increased mortality risk so implementing and maintaining school tobacco prevention programs, in addition to enforcing youth access laws, are key preventive strategies. Effectively communicating risks to smokers and helping them quit successfully should be an integral part of public health programs," the authors conclude.

Source: Journal of the American Medical Association (JAMA), April 7, 2008 – 2008;299[17]:2037-2047

Study Shows Obesity Is a Major Risk for Heart Failure

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The results of the Multiethnic Study of Atherosclerosis (MESA) identifies "the biological effects of obesity on the heart" as a serious reason for 72 million overweight Americans to worry about their health.

Senior study investigator Joao Lima, M.D., says "Even if obese people feel otherwise healthy, there are measurable and early chemical signs of damage to their heart, beyond the well-known implications for diabetes and high blood pressure. Now there is even more reason for them to lose weight, increase their physical activity and improve their eating habits."

The development of heart failure of some 7,000 mean and women, aged 45 to 84 was followed by researchers conducting the MESA study, which started in 2000. To date, of the 79 participants who developed congestive heart failure 44% were obese with a body mass index (BMI) of 30 or more. They were also found to have higher blood levels of interleukin 6, C-reactive protein and fibrinogen, key immune system proteins involved in inflammation, than non-obese adults. An 84% greater risk of developing heart failure was accounted for by a near doubling of average interleukin 6 levels.

The links between inflammation and the combination of risk factors known as the metabolic syndrome alarmed the researchers from 5 U.S. universities.

The researchers from five universities across the United States also found alarming links between inflammation and the dangerous mix of heart disease risk factors known as the metabolic syndrome. Its combined risk factors for heart disease and diabetes—high blood pressure, elevated blood glucose levels, excess abdominal fat and abnormal cholesterol levels, and particularly obesity—double a person’s chances of developing heart failure.

"More practically, physicians need to monitor their obese patients for early signs of inflammation in the heart and to use this information in determining how aggressively to treat the condition," says Lima, a professor of medicine and radiology at the Johns Hopkins University School of Medicine and its Heart Institute. "Our results showed that when the effects of other known disease risk factors—including race, age, sex, diabetes, high blood pressure, smoking, family history and blood cholesterol levels—were statistically removed from the analysis, inflammatory chemicals in the blood of obese participants stood out as key predictors of who got heart failure," says Lima.

The study found that higher levels of interleukin 6 and a tripling of average levels of C-reactive protein in study subjects increased the possibility of heart failure by 36%.

What this tells us is that both obesity and the inflammatory markers are closely tied to each other and to heart failure," says lead researcher Hossein Bahrami, M.D., M.P.H. Bahrami, a senior cardiology research fellow at Hopkins, says "the basic evidence is building the case that inflammation may be the chemical route by which obesity targets the heart, and that inflammation may play an important role in the increased risk of heart failure in obese people, especially those with the metabolic syndrome."

Each year, nearly 300,000 Americans die from heart failure.

Source: Journal of the American College of Cardiology, May 6, 2008

Children Still At Risk from Lead Poisoning, Despite Programs Promoting Cleaning and Home Repair

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A review of studies shows that children are still at risk of lead poisoning, despite attempts to encourage home cleaning and repairs, and parental awareness.

Lead author Dr. Berlinda Yeoh, a pediatrician at Sydney Childrens’ Hospital in New south Wales, Australia, says of these attempts that "none that have been tried so far have been proven to be effective." The most common cause of lead poisoning in children is ingestion of dust from old lead paint, and Dr. Yeoh cited lead poisoning as an important health issue for children. It can, she said, contribute to behavior and growth problems, anemia, kidney damage, and other physical, cognitive and behavioral impairment.

Although the sale of lead paint in the United States was prohibited as long ago as 1978 children today can still ingest paint from peeling walls, broken plaster or old painted window sills. 12 U.S. studies, encompassing 2239 children, were examined, and analyzed 2 types of parental interventions—educational and environmental. Educational intervention taught awareness of lead poisoning and methods of preventing dust and lead exposure in the home; environmental intervention suggested making repairs, cleaning and painting.

The Cochrane Library carried the review, and the reviewers’ findings that educational programs for parents had no effect on children’s blood lead levels, which was also the case for environmental programs. Soil abatement, or the replacement of lead-contaminated soil around the home, was also analyzed and 2 studies showed that this significantly reduced childrens’ blood lead levels, although insufficient data prevented recommending these practices as effective. Even studies that combined both educational and environmental interventions failed to reduce children’s blood lead levels.

Dr. Yeoh pointed to other sources of lead exposure—at day care or relatives’ home, for example—which might make home dust removal programs ineffective.

A further reason might be lack of time to be cleaning thoroughly, said Dr. Yeoh. Based on these results, "it is difficult to support the use of the interventions examined in this review as a general population health measure, given their cost and the lack of data showing positive reductions in blood lead levels," the authors said.

Susan Buchanan, M.D., a clinical assistant professor at the University of Illinois at Chicago School of Public Health, called the review "a very thorough evaluation of current literature. It takes so little lead dust to poison a child that it doesn’t matter how clean your house is, your child is still going to have exposure to lead dust," she said.

"As adults, our neurological systems are somewhat immune to the dramatic effects of lead," Buchanan said. However, very young children often put objects in their mouths—increasing their ingestion of house dust and dirt—that in turn affects their developing neurological systems, she said.

"We have to use the knowledge we have—there is lead in dust, so as much dust removal as possible should still be recommended," she said. However, to "continue screening is critical because if high blood lead levels are caught, then health department inspectors can be used to point out obvious sources of lead in the home," Buchanan said.

The review noted that a coauthor, Bruce Lanphear, was an investigator in two of the studies included in this review.

Source: Health Behavior News Service

Sports and Exercise Reduces Breast Cancer Rates

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Women who actively participate in sports are 25% less likely to get breast cancer, though the benefits are not seen in obese women, and lean women see the lowest breast cancer rates.

The type of activity undertaken, at what time in life and the woman’s body mass index (BMI) will determine how protective the activity is against the disease.

The researchers reviewed the literature and analysed 62 studies looking at the impact of physical activity on breast cancer risk. They then examined the findings to find out how breast cancer risk appeared to be affected by type of activity, intensity of activity, when in life the activity was performed and other factors.

They found the most physically active women were least likely to get breast cancer. All types of activity reduced breast cancer risk but recreational activity reduced the risk more than physical activity undertaken as part of a job or looking after the house. Moderate and vigorous activity had equal benefits.

Women who had undertaken a lot of physical activity throughout their life had the lowest risk of breast cancer, and activity performed after the menopause had a greater effect than that performed earlier in life.

Physical activity reduced breast cancer risk in all women except the obese and had the greatest impact in lean women (BMI < 22kg/m2)

Women who were mothers, had no family history of breast cancer, were not white and had oestrogen receptor negative tumours also had a reduced risk of breast cancer.

The authors said the way in which physical activity protected against breast cancer was likely to be complex and may involve effects on sex hormones, insulin-related factors, the immune system and other hormone and cellular pathways.

Source: British Journal of Sports Medicine 2008; doi:10.1136/bjsm.2006.029132

FDA Approves NovoSeven RT Coagulation Therapy

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A new formulation of a genetically engineered version of Factor VIIa, a plasma protein essential for the clotting of blood—has been approved by the FDA. The new formulation allows the product to be stored at room temperature (up to 77 degrees Fahrenheit) for up to two years.

"Approval of this product for room temperature storage creates greater flexibility in disease management for both patients and physicians," said Jesse L. Goodman, M.D., M.P.H., director of the FDA’s Center for Biologics Evaluation and Research. "As with all FDA-approved products, the agency will monitor NovoSeven RT throughout its life cycle."

NovoSeven RT—the new formulation of NovoSeven Coagulation Factor VIIa (Recombinant)—contains sucrose and L-Methionine, which allow for storage at room temperature. This is helpful for health-care facilities with limited refrigerated space. The original formula could be stored for three years at temperatures between 36 and 46 degrees Fahrenheit.

NovoSeven RT shares the same uses as the earlier NovoSeven product. These uses include the treatment of bleeding and the prevention of surgical bleeding in patients with hemophilia A or B, who have antibodies that neutralize the action of clotting Factors VIII or IX; the treatment of bleeding and the prevention of surgical bleeding in patients with congenital Factor VII deficiency; and the prevention of surgical bleeding in patients with acquired hemophilia.

Coagulation factors are proteins found in plasma, which help blood clot. When one or more of these proteins are missing or inactive, bleeding can occur.

The most commonly observed adverse reactions with NovoSeven RT are fever, bleeding, injection site reaction, joint discomfort, headache, elevations or falls in blood pressure, nausea, vomiting, pain, swelling, and rash. Some elderly patients experienced an increased risk of arterial clotting when they were treated with NovoSeven RT outside of its approved indications.

NovoSeven RT and NovoSeven Coagulation Factor VIIa (Recombinant) are manufactured by Novo Nordisk A/S, located in Denmark.

Source: FDA, May 9, 2008

Treatments for Excessive Sweating of Underarms, Feet or Hands

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A sweaty handshake can be an uncomfortable situation for many, particularly in business settings. Called focal hyperhidrosis, the condition is characterized by excessive sweating of the palms, underarms and the soles of the feet. Focal hyperhidrosis usually starts by the end of the teenage years, and is often hereditary.

Treatment options for focal hyperhidrosis include:

  • Non-prescription antipirspirants: Includes products such as Certain Dri, Secret Clinical Strength, Degree Clinical Protection and 5 Day. These products often work well to inhibit mild to moderate sweating.
  • Prescription antipirspirants: These containing aluminum chloride (Drysol, Xerac) and may be more effective than non-prescription antipirspirants.
  • Lontophoresis: This treatment can be done at home and involves placing hands or feet in a pan of water while a battery-powered device delivers a low-voltage current through the water. Treatments last 15 to 30 minutes and are typically done daily for a couple of weeks and then less frequently for maintenance. Iontophoresis is believed to temporarily block the sweat glands, but results may not be any better than using an antiperspirant.
  • Oral medications: Drugs in the anticholinergic class can help. This approach isn’t used often because of side effects that include dry eyes and mouth and difficulty urinating. Anti-anxiety medications may be helpful if stress-induced anxiety contributes to excessive sweating.
  • Botulinum (Botox) injections: Injections of Botox into the palms, soles or underarms can block the nerves that trigger sweat glands. This approach is effective for even severe hyperhidrosis, but the injections are painful. The effect from the Botox wears off after four to 12 months, and the treatment needs to be repeated.
  • Surgery: Two surgical approaches are options when other treatments haven’t worked. They entail surgically removing sweat glands from the underarms or severing the nerve in the chest that carries messages to the sweat glands. Surgery is seldom used because it is a major procedure. If needed, it’s effective.

As with any health concerns, it is essential to consult your healthcare provider before following any course of action.

Alzheimer’s Disease Risk Different for Men and Women

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Recent research suggests that the chances of developing Alzheimer’s Disease are different for men and women, with stroke in men and depression in women being key elements.

The research was conducted in France, among 7,000 people aged 65 and over, drawn from the general population. While none of the participants had dementia, some 40% had mild cognitive impairment. Four years later 6.5% of those displaying mild cognitive impairment had developed dementia, while no change was noted in just over half. About one third returned to normal cognitive ability.

The move from cognitive impairment to dementia however, was marked among subjects taking anticholinergic drugs for depression. A variation in the ApoE gene, a known risk factor for dementia, was also more common among those whose mild cognitive impairment progressed.

The results demonstrated that men with mild cognitive impairment were probably overweight and diabetic, and to have suffered a stroke. In fact, male stroke victims were three times as likely to progress from cognitive impairment to dementia.

Women with mild cognitive impairment had poorer general health, were disabled, and suffered from insomnia, besides having an inadequate support group. They were also unable to perform the daily tasks that would enable them to live alone without assistance. It was judged they were 3.5 times as likely to develop dementia, while those suffering from depression were twice as likely to do so. Stroke was not a risk factor for women, although there was similar rate of occurrence in men and women.

Source: Journal of Neurology, Neurosurgery, and Psychology, 2008; doi 10.1136/jnnp.2007.136903

Gene Linked to Severe Diabetic Retinopathy and Renal Disease

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Researchers have identified a gene called erythropoietin (EPO) that is linked to higher risk of severe retinopathy and nephropathy, eye and kidney diseases that often affect diabetic patients.

Diabetic retinopathy (PDR) is the most common cause of legal blindness in working-aged adults in the United States, accounting for 10% of new cases of blindness. Diabetes is also the leading cause of kidney disease, called end-stage renal disease (ESRD), in the U.S. and the Western world.

While researchers have known that these conditions in diabetic patients can be hereditary, the actual genese involved have been relatively unknown until now.

Researchers discovered the involvement of the EPO gene in a study of 1,618 people with diabetic retinopathy and end-stage renal disease, and 954 diabetes patients without any eye or kidney disease in three separate populations. Their studies demonstrate that if a person has a copy of the mutant EPO gene, they have an increased risk of developing PDR and ESRD during their lifetime.

According to Dr. Dean Li from the Program in Human Molecular Biology and Genetics at the University of Utah, while there is no proven pharmacologic treatment for diabetic vascular eye diseases, "inhibiting the growth of unwanted blood vessel growth using antibodies directed against vascular endothelial growth factor (anti-VEGF therapy) has been advocated. This genetic study suggests that future therapeutic strategies need to consider blunting the effects of erythropoietin in addition or as an alternative to an anti-VEGF strategy."

The study was led by Kang Zhang M.D., Ph.D., Director of the Division of Ophthalmic Genetics at the Moran Eye Center and Associate Professor of Ophthalmology and Visual Sciences at the University of Utah, and was published in the journal Proceedings of National Academy of Sciences.

New Crohn’s Disease Treatment Approved by FDA

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The U.S. Food and Drug Administration (FDA) has approved a new medicine called Cimzia for the treatment of Chron’s disease. The drug is manufactured by UCB, Inc., and is known as a tumor necrosis factor (TNF) blocker. It is used to reduce the signs and symptoms of moderately to severely active Crohn’s disease in adult patients who have not been helped enough by usual treatments.

Crohn’s disease is a condition that causes inflammation of the gastrointestinal tract, and most commonly occurs at the lower end of the small intestine. Typical symptoms include diarrhea, fever, rectal bleeding, malnutrition, narrowing of the intestinal tract, obstructions, abscesses, cramping, and abdominal pain. It also can lead to abnormal connections (fistulas) leading from the intestine to the skin or internal organs. The disease affects more than 1 million men and women worldwide. It has no cure and its cause is unknown.

"Crohn’s is a debilitating disease that disrupts the quality of life for its sufferers," said Julie Beitz, M.D., director of the Office of Drug Evaluation III for the FDA’s Center for Drug Evaluation and Research. "This drug works to reduce the signs and symptoms of Crohn’s, but it also carries risks that will require patients on it to be closely monitored by their physicians or other health care professionals."

Patients treated with Cimzia will receive an injection every two weeks for the first three injections. Once benefit has been established, Cimzia should be given once every four weeks.

The most common side effects of Cimzia are headache, upper respiratory infections, abdominal pain, injection site reactions and nausea.

Patients taking Cimzia are at increased risk for serious adverse effects, including serious infections that can lead to hospitalization or death. Because Cimzia affects the immune system, it can lower the body’s ability to fight infections, such as tuberculosis and other opportunistic infections. Cimzia is a blocker of TNF (tumor necrosis factor) and may cause lymphomas (a form of cancer) and other malignancies. Although an increased risk of tumors was not seen in studies of Cimzia, the modest size and relatively short duration of the controlled studies prevents any firm conclusion. Post-marketing studies and clinical trials will be required to obtain long-term safety data.

Patients taking Cimzia should be educated about how to identify an infection and be instructed to contact their health care professional at the first sign of infection while on Cimzia. In cases of serious infections, the drug should be discontinued immediately.

New Study Begins for Kids with High Risk Cancer, Neuroblastoma

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Molecular Insight Pharmaceuticals has announced the initiation of a clinical trial of Azedra in pediatric neuroblastoma patients. Neuroblastoma is a type of neuroendocrine cancer that primarily affects children and is the most common solid tumor in children outside of the brain.

The drug Azedra is a small, targeted radiotherapeutic molecule that binds to the norepinephrine transporter, a protein highly expressed on neuroendocrine tumors such as neuroblastoma. Because of this preferential binding, Azedra can deliver a greater amount of radiation to the tumor cell, thus increase tumor killing while reducing side effects.

“Neuroblastoma is an aggressive and difficult to treat form of neuroendocrine cancer that usually affects children under five years of age,” said Katherine Matthay, M.D., Chief of Pediatric Hematology and Oncology at the University of California San Francisco Children’s Medical Center. “Unfortunately, the prognosis for many of these children is quite poor. There currently are no FDA-approved treatments available for patients who have progressive, recurrent or refractory disease, and our current treatment options are extremely limited.”